BREAST DISEASES: COMPARING THE INITIAL CLINICAL DIAGNOSIS
WITH THE DEFINITIVE HISTOLOGICAL REPORT.
Madubogwu, CI (MB.BS,
MSc, FWACS, FICS).
Department
of Surgery, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka,
Anambra State, Nigeria.
Correspondence to:
Dr. Madubogwu CI.
E-mail: chymezo@yahoo.com
Citation: Madubogwu
CI. Breast Diseases: Comparing The Initial Clinical Diagnosis With The
Definitive Histological Report.
The Orient Journal of Surgical Sciences, March 2020; 1 (1); 14 -19
Background:
Breast lump is a common clinical presentation of breast
lesions. The physical characteristics associated with breast lumps are
very vital in making a clinical diagnosis of breast disease.
Objective:
To evaluate the accuracy of the initial clinical diagnosis
(as obtained from the physical characteristics of the breast lump) with
the definitive histopathological report of the various breast lesions.
Methodology:
A one-year prospective study of all consecutive patients
with palpable breast lumps presenting at the general surgery out-patient
clinic of a tertiary health institution. Patients were evaluated clinically and
then followed up until the histology reports were obtained following open
surgical biopsy. The data were entered into a database and statistical analyses
carried out using the Statistical Package for Social Sciences (SPSS) version
17.0.
Results:
Of the 110 patients evaluated, 47.3% had malignant breast
lesions while 52.7% others had benign lumps. Fifty-four individuals had masses
greater than 5cm in their widest diameter, 13 of which were benign and 41
malignant. Thirty-five subjects had axillary lymphadenopathy, 30 were malignant
while five were histopathologically benign. Forty-seven tumours were hard:
3(6.4%) benign and 44(93.6%) malignant. Of the 37 patients with attached
growths, 3(8.1%) had benign disease while 34(91.9%) were malignant. Out of 52
cases with malignancy, 23(44.2%) had no cutaneous involvement while 29(55.8%)
manifested at least one skin change. Only 4(6.9%) people out of 58 with benign
diagnosis had skin changes.
Conclusion: The
physical characteristics of breast masses still accurately reflect the
histopathological diagnosis.
Key words: Breast
masses, Physical features, Histological diagnosis.
INTRODUCTION
Breast
disease ranges from benign to malignant. Benign breast tumours are more common
than the malignant ones.1 Breast cancer however, is the most common
malignancy affecting women in many parts of the world with an estimated 2.1
million new cancer cases diagnosed in 2018 worldwide.2 This disease
is the leading cause of cancer death followed by colorectal and lung cancers
for incidence and vice versa for mortality.2
Breast cancer in Nigeria and other developing countries is
characterized by late presentation and poor outcome due to ignorance,
superstition, self-denial, the fear of mastectomy and unavailability of
treatment facilities.3-5 Breast cancer presents a decade earlier in
Nigerian women and indeed other black women, with worse biological behavior and
poor prognosis.6-11 Black women encounter a lower incidence of
breast cancers than their
Caucasian counterpart but the hospital incidence is rising.7,12
The diagnosis of
breast diseases can be achieved, like for other clinical conditions, using
clinical history, physical | examination
and investigations which include cytological or histological studies for
confirmation. Breast lump, which is one of the commonest presentations of
breast lesions, is commonly detected by means of self-breast examination,
clinical breast examination and radiological investigations using
mammography/ultrasonography.
Physical characteristics associated with breast
tumours are very vital in making a clinical diagnosis of either a benign or
malignant breast lesion. Some of these features include the size of the growth,
consistency, attachment, pain, nipple retraction and discharge. Others are skin
changes
and regional lymph nodal status. The combined evaluation of these
physical characteristics of a breast lump is the main ingredient in making
specific clinical diagnosis of a breast disease.
This
study aims to compare the accuracy of the initial clinical diagnosis with the
definitive histopathological report of the various breast conditions.
MATERIALS AND
METHODS
This is a one-year
prospective study of all the consecutive patients with palpable breast lesions
presenting at the
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