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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 66-69

A clinico-pathological study of benign breast disease in tertiary centre of Bihar


1 Additional Professor, IGIMS, India
2 Associate Professor, IGIMS, India
3 Senior resident, Dept. of General Surgery, IGIMS, India
4 Associate Professor, Dept. of Pathology, IGIMS, India
5 Assistant Professor, Dept. of General Surgery, IGIMS, India

Date of Submission09-Dec-2019
Date of Acceptance21-Feb-2020
Date of Web Publication16-Nov-2020

Correspondence Address:
Mukesh Kumar
Associate Professor, Dept. of General Surgery, IGIMS, Patna
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background: Benign breast disease is most common problem in female of our society. The aim of study to know the patterns of clinically benign breast disease in females and to co-relate them with the pathological condition.
Material and method: This study was conducted on outdoor patients of department of general surgery in Indira Gandhi institute of medical science, Patna Bihar from April 2018 to march 2019. The first 100 one hundred female patients who were treated for benign breast disease were included in this study. Diagnosis was made by a combination of clinical assessment, radiological imaging and tissue biopsy so called triple assessment.
Results: In all benign breast disease, the most common presentation was breast lump which comprised 84 cases, of which fibro adenoma is most common with mainly in the age group of 21-30 years. Median age at presentation was 29.5 years. Excision is most commonly used and most satisfactory method of treatment.
Conclusions: Benign breast disease present mainly in 21-30 year age group. The clinical diagnosis of the benign breast disease was accurate in 92% cases. The actual factors responsible for this change need further research and study.

Keywords: Breast, Benign breast diseases, Triple assessment.


How to cite this article:
Gopal K, Kumar M, Prasad S, Singh SK, Roy VK. A clinico-pathological study of benign breast disease in tertiary centre of Bihar. J Indira Gandhi Inst Med Sci 2020;6:66-9

How to cite this URL:
Gopal K, Kumar M, Prasad S, Singh SK, Roy VK. A clinico-pathological study of benign breast disease in tertiary centre of Bihar. J Indira Gandhi Inst Med Sci [serial online] 2020 [cited 2020 Nov 24];6:66-9. Available from: http://www.jigims.co.in/text.asp?2020/6/1/66/300744




  Introduction Top


Benign breast disease is most common problem in females of our society. Benign breast disease is a group of breast disease which is not a cancer.[1] Up to 30% of women who suffer from benign breast disease will require treatment at some time in their lives.[2] A triple assessment which include clinical examination, imaging (mammography or USG of breast) and pathological examination ( FNAC or core needle biopsy) during initial consultation and found majority of the patients with discrete Benign breast disease and to be given immediate reassurance. Majority of benign lesion are not associated with increased risk of breast cancer and unnecessary surgical procedure can be avoided. Making an early diagnosis and planning the treatment within 72 hours of the first consultation, helps in alleviating unnecessary anxiety about breast cancer[3]. The popular classification of benign breast disease according to the aberration of the normal development and involution(ANDI) causes confusion due to lack of clarity in distinguishing between the normal physiological changes and pathological ones. One of the more satisfying classification so called Nashville classification,[4] benign breast disease is classified by two systems. Pathologically, benign breast disease is divided into (a) non profilaratı‘ve lesions, (b) profilaratı‘ve lesions without atypia and (c) atypical profilarative lesions. Clinically benign breast disease is classified as (a) physiological swelling and tenderness, (b) nodularity, (c) breast pain, (d) palpable lumps, (e) nipple discharge and (f) infection or inflammation.


  Pathophysiology of Benign Breast Disease Top


The exact mechanism of the condition is not fully understood, through it is known to be tied to hormone levels, as the conditions usually subsides after menopause and is also related to the menstrual cycle. Post-menopausal women[5] placed on hormone replacement therapy, have also reported symptoms of fibrocystic breast change indicating hormones may play a role.

Fibrocystic breast[6] changes is a cumulative process, caused partly by the most hormonal variation during a woman’s monthly cycle. The most important of these hormones are estrogen, progesterone and prolactin.

The hormones directly affect the breast tissue by causing cells to grow and multiply many other hormones such as TSH, Insulin ,Growth hormone and Growth factors such as TGF-Beta exact direct and indirect effects amplifying or regulating cell growth. Years of such fluctuation eventually produce small cysts and /or areas of dense or fibrotic breast pain commonly develop when a women hit her 30s. Larger cyst usually do not occur until after the age of 35. Overtime presurvey driven by aberrant growth signals such as lesions may accumulate epigenetics , genetic and receptors and loss of heterozygosity[7]. Several variants of fibrocystic breast changes may be distinguished and these may have different causes and genetic predisposition and Adenosis involves abnormal count and density lobular units , while other lesions to be stem mainly from ductal epithelial origins .

There is preliminary evidence that iodine deficiency contributes to fibrocystic breast changes by enhancing the sensitivity of breast tissue to estrogen.


  Material and Method Top


This descriptive study was conducted on outdoor patients of department of general surgery in Indira Gandhi institute of medical science, Patna Bihar from April 2018 to march 2019. The first 100 one hundred female patients who were treated for benign breast disease were included in this study. The patients were required to give written informed consents were taken prior to their enrolment in this study. After taking Clearance from institutional ethical committees have taken and study was registered in clinical trial registry of India (CTRI /2018/11/016341). Detailed clinical data were noted as per the Performa with emphasis on history, physical examination and relevant investigations.


  Inclusion Criteria: Top


Females patients with any benign breast disease of breast for example, a breast lump, breast pain, or a nipple discharge in the age group of 11 year to 60 year.


  Exclusion Criteria: Top


Females patients with obvious malignant disease or those who had treated for malignancy earlier or operated. The detailed history was taken and the patients were subjected to triple assessment. Triple assessment include clinical examination, imaging (USG of breast or mammography of breast) and biopsy include FNAC or core needle biopsy of lumps. USG of breast were done younger the age of 30yrs due to dense breast. Patient with lump breast underwent FNAC or core needle biopsy and operated for excision biopsy. Excised specimen sent for Histo- pathological examination. The clinical diagnosis, particularly in the case of benign breast lumps was compared with the cytological or the histological finding and the accuracy of the clinical diagnosis was evaluated. Follow up of the patients were done every 1 month for 3 months and final follow up at 6 months.


  Aim and Objectives: Top


  1. Different modes of presentation of breast lump.
  2. Their etiological factors study in relation to age, socioeconomic status, and family history of breast disease, use of ocp, menstrual status, and marital status.
  3. To diagnose clinically with different available, investigation parameter like FNAC, USG, Mammography and Histopathology.
  4. Management protocol -conservative and surgical.
  5. Comparative studies of different breast lump.



  Results Top


This study included a total of one hundred cases that were studied prospectively in department of general surgery, IGIMS, Patna. The patients were broadly grouped on their symptoms or presentation such as breast lump, breast pain and nipple discharge.

The commonest presentation was breast lump which comprised 84 cases, out of which 24 cases had associated symptoms like breast pain and nipple discharge. More than one symptom has present for same patients. Among 36 patients with breast pain 15 patients complained of mastalgia only, who were treated by conservative or reassurance. The rest had associated complaints like a breast lump and nipple discharge. The pain was cyclical in 22 patients and non cyclical in 14 cases. Among 8 cases with nipple discharge only one case presented with nipple discharge only. Serosanguinous nipple discharge was in 4 cases and reddish and black color in 2 cases each. The cause for 2 cases was intraductal papilloma and for rest were mammary ductal ectasia.
Table 1: Different types of presentation and their incidence

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The age of the patients with benign breast disease ranged from 12 years to 58 years. The majority of the patients are in the age group 21 years to 40 years. The median age at presentation was 29.5 years
Table 2: Age wise distribution of benign breast disease

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Fibro adenoma are the commonest benign breast disease constitutes 53% of the total and fibroadenosis form the next common lesion comprising 16% of benign breast disease. Breast pain (mastalgia) is also a common problem in breast (15%).
Table 3: incidence of different types of benign breast disease.

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Among the 100 patients the right breast affected is 46 (46%) patients, while the left breast was affected in 42(42%) patients. In 12 (12%) patients both the breast was affected.
Table 4: side wise distribution of benign breast disease.

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The diagnosis of benign breast disease was also confirmed either cytological or radiological or both ways. FNAC was done in 81 cases. FNAC and biopsy was done in 58 cases. The accuracy of the clinical diagnosis of fibro adenoma was 92% (53 out of 58 cases). Among the 58 cases of excised biopsy, 4 cases were reported as proliferative lesion with atypia and one was diagnosed as florid hyperplasia.


  Discussion Top


Female presenting with breast problem, especially breast lump is a common finding and a cause of significant anxiety and trouble in view of major public awareness. The incidence of benign breast disease varies in different geographical area and benign breast diseases are common in developing countries due to lack of education in women and low socioeconomic status of family .Due to illiteracy , social taboo and unawaraness results in delay diagnosis in both benign and malignant lesions. Such delay in diagnosis of malignant lesions is associated with poor prognosis. It therefore becomes necessary for a surgeon to distinguish benign from malignant condition. Benign breast disease is a heterogeneous group of condition which range from normal, to aberrations in the physiology, to frank disease. Most of the patients of benign breast disease have one or more symptoms such as breast lump, breast pain or nipple discharge. It has been recommended that all the patients with lump in breast should undergo a triple assessment to make an early diagnosis. By this technique we diagnose of most of the benign breast condition within 72 hours and ease the anxiety and fear of malignancy.

Foncrot LM[1] et al says 87.4% of the women who visited in Wesley breast clinic had presented with breast lump while in study of Ratana chaikanont[3] T a breast lump was the presenting symptom in 72.35% of the 331 benign breast patients. In our study shows 81% of benign breast lump of which 53% were fibroadenoma. Choudhary[8] et al in benign breast disease noted lump in 39% cases, pain in 27.39% cases and nipple discharge in 2.49% cases with predominant involvement of left breast. The peak incidence of fibroadenoma ranged from the 2nd to 3rd decade of life which was consistent with finding of other studies.

The fibroadenosis were the next common lesion (16%) in our study and most of the patients were in 3rd to 4th decade. Adesunkani AR[2] and Agbakwuru EA[2] found that incidence of fibrocystic changes ranged from 29.5-42.2% for the benign breast lump. Kumar et al stated that fibrocystic disease is commonly seen in 21-30 years of the age group.

Mastalgia is also significant problem and in my study shown 36% of benign breast disease which is similarly accounted 41% in study of Karki et al[9].

Hand huma[10] et al reported in their series of 360 fine needle aspirations as a diagnostic tool with efficiency of 98.3%. In our study accuracy of the FNAC diagnosis of fibro adenoma was 92% (53 out of 58 cases). Among the 58 cases of excised biopsy, 4 cases were reported as proliferative lesion with atypia and one was diagnosed as florid hyperplasia. According to selvakumran S[11] et al FNAC were the most useful and costeffective investigation with sensitivity 89.6%, specificity 87.8% and accuracy 94.2%. USG and mammography were additional tools to FNAC and clinical examination.


  Conclusion Top


Benign breast disease is a common problem in female society. The commonest age group which is affected is the 21-30 years age group. Breast lump is commonest presentation and other symptoms are breast pain and nipple discharge. Among the breast lump fibro adenoma is more common followed by fibroadenosis and breast abscesses. The clinical diagnosis of the benign breast disease were accurate in 92% cases. The risk factors for developing invasive carcinoma in the patients with proliferative lesion were also identified and the patients were advised follow-up. The actual factors responsible for this change needs further research and study. Breast self examination and health education to females is very important in cases of benign breast disease.



 
  References Top

1.
Foncroft LM, Evans EB, Hirst C, Hicks BJ. Presentation and diagnosis of adolescent breast disease. Breast ,2001;10(5):399-404.  Back to cited text no. 1
    
2.
Adesunkami AR, Agbakwuru EA. Benign breast disease at Wesley Guild Hospital, Llesha, Nigeria. West Afr J Med. 2001;20(2):146-51.  Back to cited text no. 2
    
3.
Ratanachaikamount T . Clinical breast examination , palpable breast lesion.J Med Assoc Thai.2005;88(4)P:505-7.  Back to cited text no. 3
    
4.
Navneetkaur, Nitin Agarwal, Pankaj Pawar. Clinicopathological profile of benign breast conditions in Indian Women. Prospective study based on aberration of normal development and involution classification. World J Surgery.2012;36:2252_58.  Back to cited text no. 4
    
5.
Disorders of breast (N60-N64) IN icd-10.  Back to cited text no. 5
    
6.
Atlantic womens speclialist “fibrocystic Breast Changes”, Retrieved 21june 2012.  Back to cited text no. 6
    
7.
Gadducci A, Guerrrieri ME , Genazzani AR. Benign breast disease, contraception and hormone replacement therapy. MinervaGinecologica. February 2012; 64(1):67-74.  Back to cited text no. 7
    
8.
Chaudhuri M, Sen S, Sengupta J. Breast lump: a study of 10 years. J Indian Med Assoc.1995; 93:455-7.  Back to cited text no. 8
    
9.
Karki OB, Kunwar D, De A. De Benign breast disease: Profile at a teaching hospital. Amer J Pub Health Res .2015:3(4A):83-6.  Back to cited text no. 9
    
10.
Hand Uma, Mohan Harsh. “Fine needle aspiration as a diagnostic Tool in Breast lesions” Indian journal of surgery. May 2000;62(2):125-128.  Back to cited text no. 10
    
11.
Selvakumaran S et al .Study of various benign breast diseases. Int Surg . J.2017 Jan ;4(1): 339-343.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Pathophysiology ...
Material and Method
Inclusion Criteria:
Exclusion Criteria:
Aim and Objectives:
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Conclusion
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