A study of diagnostic accuracy in benign breast disease with special reference to recent diagnostic tools

Chandramohan, V (2006) A study of diagnostic accuracy in benign breast disease with special reference to recent diagnostic tools. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION: Benign breast disease is a common disorder. It is atleast 10 times more common than breast cancer in hospital clinics. The histological changes of benign breast disease are in reality part of the spectrum of changes that occur in the life time of breast tissue. These histological charges do not proceed as a smooth continuum; the individual elements often occur simultaneously and can give rise to anatomical (palpable) abnormalities such as nodularity (or) cystic change, which may initiate referral to hospital, but are not disease in the true sense of word. However an increasing interest in histology of the normal human breast with studies of autopsy and biopsy material, is providing a background which allowed a better understanding of what is normal and what is abnormal, thus helping to correct the tendency to overrate the malignant potential of benign Breast disease. The term benign breast disease encompasses a wide range of clinical and pathological entities. Up to 30% of women may suffer from a benign breast disorder requiring treatment at sometime in their life. In general population on examination of breast grossly evident cystic changes were found in 20% but histological evidence of cystic changes were found in 59% of women(2). In patients attending breast clinic for various breast problems, 40% of patients were found to be having fibrocystic changes and about 7% having fibroadenoma. Hence benign breast disease requires imaging studies for evaluations. Mammography and ultrasound are the most useful tools for this purpose. Mammography is used as a primary tool in benign breast disease and also as a screening tool to detect early breast cancer. Ultrasound is used to differentiate cystic lesions from solid lesions and particularly useful in dense breast seen in young women. Both of these tools are also useful in localizing to lesion and in guiding biopsy. Hence both ultrasound and Mammography are the pillars on which the edifice of this study is built. AIM OF THE STUDY 1. To compare the utility of mammography and sonography in the diagnosis of benign breast diseases. 2. To study the utility of 3D Ultrasound in the evaluation of Benign Breast lesions. MATERIALS AND METHODS: Female patients in the pre, peri and post menopausal age groups with benign breast disorders who underwent breast ultrasound and mammography from September 2003 were included in this study. Patients with features of malignancy were excluded from the study. Standard nomenclature for characterization of the lesions on mammography and ultrasound were used. Subsequently all the patients underwent histopathological examinations of lesions in the form of excision biopsy or true cut biopsy. Patients in whom histopathology could not be done due to practical reasons Fine Needle Aspiration Cytology was done. In correlation with the clinical diagnosis and FNAC final diagnosis was arrived and patients were treated accordingly. RESULTS: Sixty nine patients were included in this study. All patients underwent ultrasound of the breast and mammography. All the 69 patients underwent FNAC. Histopathological examinations were done for 49 patients. In Our study out of 69 patients histopathological confirmation was possible in 49 patients. Of the remaining patients, 10 patients were not willing for surgery because of the small size of the lesions and for cosmetic objections and another 10 patients did not require biopsy and were conservatively treated. Out of the 49 patients in whom histopathological confirmation and FNAC were done, result of the FNAC did not correlate with the HPE in 5 patients. Because of difficulty in finding out location of the lesion in 3 patients FNAC was negative. In 2 cases of phylloids tumour FNAC was unable to diagnose correctly. All other cases FNAC was consistent with histopathological examination. Out of the 49 patients Ultrasound showed positive diagnosis for 46 patients with a sensitivity of 93.9%. Whereas mammography was positive was only in 33 patients with a sensitivity of 67.3%. Statistical test of proportion showed that Z value is 3.3 with the corresponding p value less than 0.001. Hence it is concluded that ultrasound produces statistically significant higher sensitivity compared to mammography. We compared sensitivity of ultrasound and mammography keeping gold standard as histopathological examination. It is found that ultrasound in general shows the sensitivity of 92.8% (positive results for 64 patients out of 69 examined), whereas mammography showed the sensitivity of 66.7% (Positive results for 46 out of 69 patients examined). This difference is statistically significant because the z value is 3.8. Hence the corresponding p value is less than 0.001. CONCLUSION: Mammography is superior to ultrasound in the detection of Microcalcification. Sonography is complementary to mammography in patients with palpable abnormalities of the breast. Sonography’s superiority over mammography is in its ability to show the presence and extent of lesions that are obscured by Dense breast tissue and in characterising palpable lesions that are mammographically not visible or occult. Ultrasonogram is most helpful in characterising cystic Lesions and studying the internal component of these lesions. Three dimensional ultrasound is helpful in additionally Characterising most of the lesions that cause greater degrees Of architectural distortion. Compression pattern proves to be more specific for benign Lesions. Three dimensional ultrasound is not very specific for Lesions causing lesser degrees of architectural distortion.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diagnostic Accuracy ; Benign Breast Disease ; Special Reference ; Recent Diagnostic Tools.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 08 Jun 2018 15:56
Last Modified: 23 Mar 2020 08:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/8290

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