BREAST DISEASES: COMPARING THE INITIAL CLINICAL DIAGNOSIS WITH THE DEFINITIVE HISTOLOGICAL REPORT.
Orient Journal of Surgical Sciences
Vol. 1[1] March, 2020

original article

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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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