DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150238

Clinico-pathologic profile of women with palpable breast lumps in Chitwan Medical College, Nepal

Ranabhat S, Subedi M, Bhandari A, Tiwari M, Maharjan S, Kshetri J, Osti BP

Abstract


Background: Spectrum of female breast diseases is manifold and includes various non-neoplastic and neoplastic conditions. This study focused on the clinico-pathological profile of several breast diseases, including fibrocystic change, fibroadenoma and breast carcinoma.

Methods: This cross sectional analytic observational study included Fine Needle Aspiration Cytology cases of female breast diseases diagnosed over three years from 2011 to 2014 in Chitwan Medical College Teaching hospital in Central Nepal. Univariate analysis was carried out to find out age group-wise proportion of the diseases in relation to five cytologic categories and various cytomorphologic diagnoses. Independent samples t-test was used to find out the significance of difference between mean age of benign and malignant breast diseases.

Results: The proportion of benign, suspicious for malignancy and malignant breast diseases was 90.4 %, 0.8% and 8.8 % respectively. The mean age of patients at diagnosis for benign diseases and malignant disease was 31.7± 10.4 years and 49.2 ± 12.0 years respectively. t-test showed difference in mean age between benign and malignant diseases to be statistically significant (t=8.79, p= <0.001). Fibrocystic change and fibroadenoma were the most common breast disease overall and the most common neoplasm respectively. 58.1 %, 25.9 % and 6.5 % of all carcinoma cases in this study were found below 50, below 40 and below 30 years of age respectively.

Conclusions: Fibrocystic change and fibroadenoma are most common disease of breast and most common neoplasm of breast respectively. Breast cancer occurs in younger women in Nepal in comparison to women in developed countries. Therefore, breast cancer prevention programs in Nepal should target young women also.

 


Keywords


Breast lump, Fibrocystic disease, Fibroadenoma, Breast cancer, Prevention, Nepal

Full Text:

PDF

References


Lester SC. Clinical presentations of breast disease. In: Kumar V, Abbas AK, Aster JC eds. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, Pa: Elsevier Inc; 2015: 1044-71.

Guray M, Sahin AA. Benign Breast Diseases: Classification, Diagnosis and Management. The Oncologist. 2006;11:435-49. doi:10.1634.

Talei A, Akrami M, Mokhtari M, Tahmasebi S. Surgical and clinical pathology of breast diseases In: Poblet E ed. Histopathology - Reviews and Recent Advances. InTech. 2012;33-64. doi: 10.5772/52105.

Pradhananga KK, Baral M, Shrestha BM. Multi-institution hospital-based cancer incidence data for Nepal: an initial report. Asian Pac J Cancer Prev. 2009;10:259-62.

Pradhan M, Dhakal H. Study of breast lump of 2246 cases by fine needle aspiration. J Nepal Med Assoc. 2008;47:205-9.

Ariga R, Bloom K, Reddy VB, Kluskens L, Francescatti D, Dowlat K et al. Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation. Am J Surg. 2002;184:410-3.

Klein S. Evaluation of palpable breast masses. Am Fam Physician. 2005;71(9):1731-8.

Shabot M, Goldberg I, Schick P, Nieberge R, Pilch YH. Aspiration cytology is superior to Tru-cut needle biopsy in establishing the diagnosis of clinically suspicious breast masses. Ann Surg. 1982;196:122.

Sayami P, Singh BM, Singh Y, Timila R, Shrestha U, Sayami G. Retrospective analysis of breast cancer cases and surgical treatment in a period of ten years. J Nepal Med Assoc. 2001;40:112-9.

NHS. Non-operative Diagnosis Subgroup of the National Coordinating Group for Breast Screening Pathology. Guidelines for non-operative diagnostic procedures and reporting in breast cancer screening. United kingdom: NHS Cancer Screening Programmes 2001. NHSBSP Publication No 50. Available at http://www.cancerscreening.nhs.uk/ breastscreen/publications/nhsbsp50.pdf. Accessed 2 March 2015.

Directorate General of Health Services. Ministry of Health and Family Welfare. Government of India. Manuals for Training in Cancer Control: Manual of cytology; November 2005. Available at http://screening.iarc.fr/doc/Cancer_resource_Manual_3_Cytology_New.pdf. Accessed 4 March 2015.

Perry N, Broeders M, de Wolf C, Tornberg S, Holland R, von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. 4th ed. Luxembourg: Office for Official Publications of the European Communities 2006. Available at http://ec.europa.eu/health/ph_projects/ 2002/cancer/fp_cancer_2002_ext_guid_01.pdf. Accessed 5 March 2015.

Pandey J S, Sayami G, Dali S, Shrestha H G, Shrestha B, Adhikari R C, et al. Fine needle aspiration cytology of breast lump in T.U. Teaching hospital. J Nepal Med Assoc. 2002;41:388-91.

Shrestha A, Chalise S, Karki S, Shakya G. Fine needle aspiration cytology in a palpable breast lesion. JPN. 2011;1:131-5.

Tiwari M. Role of fine needle aspiration cytology in diagnosis of breast lumps. Kathmandu Univ Med J. 2007;5(2):215-7.

Bajwa R, Zulfiqar T. Association of fine needle aspiration cytology with tumor size in palpable breast lesions. Biomedica. 2010; 26:124-9.

Mahajan NA, Bhale CP, Mulay SS. Fine needle aspiration cytology of breast lesions and correlation with histopathology- a 2 year study. IJHSR. 2013;3(2):55-65.

Deshpande KA, Bharambe BM, Ajmera AP. Diagnostic utility of aspiration biopsy of the breast lesions. Cibtech J Bio-Protocols. 2012; 1(2):14-21.

Shah SA, Pervez SN, Javed K. Diagnostic performance of fine needle aspiration cytology in the diagnosis of breast lumps. J Ayub Med Coll. 2013;25(1-2):46–8.

Siddiqui MS, Kayani N, Gill MS, Pervez S, Muzaffar S, Azizz SA, et al. Breast diseases: a histopathological analysis of 3279 cases at a tertiary care centre in Pakistan. J Pak Med Assoc. 2003; 53:94–7.

Rosai J. Chapter 20. Breast. In: Rosai J, ed. Rosai and Ackerman’s Surgical Pathology. 9th ed. Philadelphia, USA: Mosby Year Book Inc; 2004: 1763–876.

Santen RJ, Mansel R. Benign breast disorders. N Engl J Med. 2005;353:275–85.

Kumar R. A clinicopathologic study of breast lumps in Bhairahwa, Nepal. Asian Pacific J Cancer Prev. 2010;11:855-58.

Kelsey JL, Gammon MD. Epidemiology of breast cancer. Epidemiol Rev. 1990;12:228–40.

Cole P, Mark JE, Kaplan SD. Incidence rates and risk factors of benign breast neoplasms. Am J Epidemiol. 1978;108:112–20.

Sarnelli R, Squartini F. Fibrocystic condition and “at risk” lesions in asymptomatic breasts: a morphologic study of postmenopausal women. Clin Exp Obstet Gynecol. 1991;18:271–9.

Talei A, Akrami M, Mokhtari M, Tahmasebi S. Surgical and Clinical Pathology of Breast Diseases. In: Poblet E, ed. Histopathology - Reviews and Recent Advances, 2012; ISBN: 978-953-51-0866-5, InTech, doi: 10.5772/52105.

Pass HA. Chapter 53. Diseases of breast. In: Norton JA, Bollinger RR, Chang AE, Lowry SF, Mulvihill SJ, Pass HI et al eds. Essential practice of surgery: basic science and clinical evidence. New York, NY: Springer-Verlag Inc; 2003: 655-670.

Singh Y, Sayami P, Sayami G, et al. Nepalese breast cancer in relation to reproductive factors: comparison between Nepalese and Japanese cases. Anticancer Res. 2002;22:319-23.

Rahman MZ, Islam S. Fine needle aspiration cytology of palpable breast lump: a study of 1778 cases. Surgery S12:00 2013. doi:10.4172/2161-1076.S12-001.

Khokar A. Breast cancer in India: where do we stand and where do we go? Asian Pacific J Cancer Prev. 2012;13(10),4861-6.

M Rabia. Surviving breast cancer in Pakistan. Available at http://tribune.com.pk/story/457197/ surviving-breast-cancer-in-pakistan. Accessed 14 March 2015.

Australian Institute of Health and Welfare 2014. Cancer in Australia: an overview 2014. Cancer series no 90. Cat. No. CAN 88. Canberra: AIHW. Available at http://www.bcna.org.au/media/2089/ current-statisitcs bcna_brief_summary_of_breast_ cancer_statistics_jan-15.pdf. Accessed 14 March 2015.

Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Semin Oncol. 2009;36(3):237–49.doi:10.1053/j.seminoncol.2009. 03.001.

Singh YP, Sayami P. Management of Breast Cancer in Nepal. J Nepal Med Assoc. 2009;48(175):252-7.

Bhattacharya S, Adhikari S. Evaluation of risk factors, diagnosis and treatment in carcinoma breast-a retrospective study. Kathmandu Univ Med J. 2006;4:54-60.

del Carmen MG, Halpern EF, Kopans DB, Moy B, Moore RH, Goss PE, Hughes KS. Mammographic breast density and race. Am J Roentgenol. 2007;188(4):1147-50.