Hallazgos mastográficos benignos que simulan malignidad: un dilema diagnóstico / Benign mammographic findings that simulate malignancy: a diagnostic dilemma

Resumen OBJETIVO: Identificar los principales hallazgos histopatológicos benignos y determinar la tasa de falsos positivos que suelen causar conflicto al categorizar las mastografías en el sistema BI-RADS por su aspecto, que puede simular un proceso maligno. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en pacientes atendidas en la Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) con reporte mastográfico alterado o sospecha clínica de malignidad. Para el análisis estadístico se utilizó el programa JASP 2.0 y χ2 para la diferencia de proporciones entre grupos. RESULTADOS: De un grupo de 11,481 pacientes, se reportaron 1643 mastografías alteradas: 444 con reportes falsos positivos, 23 pacientes con sospecha clínica y exclusión de 16 que no cumplieron con los criterios de inclusión establecidos. La muestra poblacional estudiada fue de 451 pacientes. La mayoría permaneció asintomática al momento del estudio (42.1%). El hallazgo histopatológico benigno con mayor prevalencia fue el fibroadenoma y su síntoma más relevante el nódulo palpable. La tasa de falsos positivos fue de 4.3%. CONCLUSIONES: En la actualidad, gracias a la implementación de programas de tamizaje es posible establecer diagnósticos de cáncer de mama en etapas tempranas, aunque con la desventaja que el reporte puede resultar falso positivo y ello dar lugar a incremento de la morbilidad y sobretratamiento. Los estándares internacionales indican que estos no deben sobrepasar el 10%.

Abstract OBJECTIVE: To identify the main benign histopathological findings that often cause conflict when categorizing mastographies in the BI-RADS system due to their appearance, which may simulate a malignant process and false positive rate. MATERIALS AND METHODS: Retrospective cohort study carried out in patients attended at the Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) with an altered mastographic report or clinical suspicion of malignancy. For statistical analysis we used the JASP 2.0 programme and χ2 for the difference in proportions between groups. RESULTS: From a group of 11,481 patients, 1,643 altered mastograms were reported: 444 with false positive reports, 23 patients with clinical suspicion and exclusion of 16 who did not meet the established inclusion criteria. The population sample studied was 451 patients. The majority remained asymptomatic at the time of the study (42.1%). The most prevalent benign histopathological finding was fibroadenoma and the most relevant symptom was a palpable nodule. The false positive rate was 4.3%. CONCLUSIONS: Currently, thanks to the implementation of screening programmes it is possible to establish breast cancer diagnoses in early stages, although with the disadvantage that the report may be false positive and this may lead to increased morbidity and overtreatment. International standards indicate that these should not exceed 10%.

Fibroadenoma gigante juvenil de mama: presentación de un caso clínico / Juvenile giant fibroadenoma of the breast: presentation of a clinical case

RESUMEN El fibroadenoma gigante juvenil es un tumor de mama benigno y una variante rara de los fibroadenomas. La presentación clínica suele ser una masa tumoral unilateral, de crecimiento rápido e indolora. En este artículo presentamos el caso de un fibroadenoma gigante juvenil de 12 cm de diámetro en la mama de una niña de 13 años. Se realiza estudio radiológico e histológico de la lesión siendo categorizada como un fibroadenoma gigante juvenil por lo que se realiza tumorectomía completa con remodelación mamaria posterior. A los dos meses de seguimiento, la paciente se encuentra sin signos de recidiva, con buena situación general y a la espera de cirugía de remodelación mamaria.

ABSTRACT Juvenile giant fibroadenoma is a benign breast tumor and a rare variant of fibroadenomas. The clinical presentation is usually a painless, fast growing, unilateral tumor mass. In this article we present the case of a giant juvenile fibroadenoma of 12 cm in diameter in the breast of a 13-year-old girl. A radiological and histological study of the lesion was carried out and it was categorized as a juvenile giant fibroadenoma, so a complete lumpectomy with posterior breast remodeling was performed. After two months of follow-up, the patient is without signs of recurrence, in good general condition and waiting for the breast remodeling surgery.

Usefulness and Complications of Ultrasonography-Guided Vacuum Assisted Biopsy for the Removal of Benign Breast Lesions

PURPOSE: To evaluate the usefulness and complications of ultrasonography (US)-guided vacuum assisted biopsy (VAB) for the removal of benign breast lesions, and the short- and long-term changes after VAB as shown on follow-up US. MATERIALS AND METHODS: From January 2007 to May 2008, 110 sonographically benign lesions in 62 patients were sampled via US-guided VAB. We prospectively evaluated the sonographic findings 1 week and 6 months after VAB in all patients to determine the presence of residual tumors, hematomas and scarring. We evaluated the prevalence of hematoma, pain, skin dimpling, fibrotic scarring and residual tumors after US-guided VAB, and determined if correlation existed between complications, size of the lesions and lesion pathology. RESULTS: The age of the patients was 15-65 years, with a mean age of 36.5 years. The pathologic diagnoses were fibroadenomas (41.8%, n = 46), fibrocystic changes (30.9%, n = 34), fibroadenomatoid hyperplasias (13.6%, n = 15), fibroadenomatoid mastopathies (6.3%, n = 7), adenoses (3.6%, n = 4), hamartomas (1.8%, n = 2) and phyllodes tumors (1.8%, n = 2). Complications 1 week after the US-guided VAB included hematomas (n = 39, 35.4%), pain (n = 23, 20.9%), fibrotic scars (n = 26, 23.68%), residual tumors (n = 4, 3.6%) and skin dimplings (n = 4, 3.6%). Complications 6 months after the US-guided VAB included hematomas (n = 12, 10.9%), pain (n = 3 2.7%), fibrotic scars (n = 14, 12.7%), and residual tumors (n = 17, 15.4%). Residual tumor after US-guided VAB existed in association with 15.2% of fibroadenomas (7/46), 14.7% of fibrocystic changes (5/34), 13.3% of fibroadenomatoid hyperplasias (2/15), 25% of adenoses (1/4), and 100% of phyllodes tumors (2/2). CONCLUSION: US-guided VAB is an effective procedure for removal of benign breast lesion. Periodic follow up studies at 1week and 6months after the VAB are useful to assess Post-VAB complications.

Ultrasound-guided mammotome excision biopsy for benign breast lesions

OBJECTIVE: A 15-month review of all mammotome excision breast biopsies in the Medical City to evaluate our experience in excising benign breast lesions using this technique by taking into consideration the complications encountered and patient satisfaction regarding the procedure and the postoperative result.METHODS: The study included all patients seen by two breast surgeons of the Medical City Breast Clinic from May 2007 to July 2008 with both palpable breast masses visible on ultrasound with a Breast Imaging Reporting a Data System (BIRADS) classification of 2-4. Women with lesions at high risk for malignancy were excluded from the study. Patient demographics were noted, lesions were classified according to BIRADS classification and data regarding the procedure, compilations incurred and patient satisfaction ratings were obtained.RESULTS: One hundred nineteen patients with ages ranging from 17 to 72 years old underwent ultrasound guided mammotome excision at the TMC-Breast Clinic removing a total of 167 lesions. Majority (82%) of patients were premenopausal whereas 22 (18%) were postmenopausal. Ecchymosis (73%) was the most frequent complication during the procedure due to hematoma formation, pain and a skin nick that require suturing. Of the 25 patients who had a previous open biopsy, 23 (92%) preferred mammotome excision over open breast biopsy.CONCLUSION: Ultrasound-guided mammotome excision is a safe and well-tolerated alternative to open excision biopsy for benign lesions of the breast.

Excision of Benign Breast Lesion by an Ultrasound-Guided Mammotome Biopsy Device

PURPOSE: Percutaneous vacuum-assisted breast biopsy (Mammotome, Fa. Ethicon Endo-Surgery Breast Care) is now commonly performed as the initial approach to diagnose and treat benign breast lesions. It can obviate the need for surgery in women with benign lesions and often lead to a one-stage surgical procedure when malignant lesions are diagnosed. The purpose of this study was to report the outcome of the Mammotome biopsy.. METHODS: We performed 902 cases of Mammotome biopsy (total 474 patients) to confirm the diagnosis and to excise the lesion between January 2003 and December 2006. Among all these cases, 888 cases with radiographically suspected benign lesions, below BI-RADS category 4, were followed up for more than 6 months and we analyzed clinical and pathologic results of these cases, retrospectively. Ultrasonographic follow-up examinations were performed and no malignant tumor or atypical ductal hyperplasia was included. RESULTS: The mean patient age was 42 (range: 17~76) years. The average size of lesion was 1.12 (range: 0.20~5.0) cm. In BI-RADS category, there were 450 (49.8%) C2 lesions, 158 (17.8%) C3 lesions and 251 (27.8%) C4 lesions. Histology revealed 506 cases (56.0%) of fibrocystic disease, 295 (32.7%) fibroadenomas, 11 (1.1%) intraductal papillomas, 16 cases (1.7%) of sclerosing adenosis, 21 cases (2.5%) of ductal epithelial hyperplasia, 18 cases (2.1%) of fat necrosis, 3 cases (0.3%) of gynecomastia, 18 cases (1.9%) of chronic inflammation. 824 lesions (92.8%) were completely removed, 39 cases (4.4%) of residual lesion and 25 cases (2.8%) of postoperative scar were reported. CONCLUSION: Mammotome biopsy is an effective diagnostic and therapeutic management of benign breast lesions with minimal-invasiveness and minimizes postoperative complications.

Descarga papilar: relação com o câncer de mama e estratégias para a sua abordagem / Nipple discharge: relation with breast cancer and its approach

A descarga papilar está presente em 5% das mulheres e ocorre em razão de causas fisiológicas, doenças benignas da mama e câncer de mama. Algumas das lesões benignas da mama estão relacionadas a um maior risco de desenvolvimento de patologia maligna mamária. A papilar para a avaliação desse sintoma mamário e sua relação com as lesões benignas importância da descarga papilar está na possibilidade de essa condição associar-se a câncer de mama. Uma avaliação clínica detalhada é fundamental para a determinação da abordagem terapêutica da paciente com descarga papilar. Foram avaliadas 23 pacientes do Serviço de Mastologia do Instituto Fernandes Figueira/Fiocruz submetidas à exérese de árvore ductal em virtude de descarga e com o câncer de mama. Das 23 pacientes analisadas, o resultado histopatológico foi de lesão benigna não proliferativa em 26,1%, lesão proliferativa sem atipias em 60,8%, hiperplasia ductal com atipias em 8,7% e câncer em 4,4%. Os resultados demonstraram que em 69,5% dos casos a histopatologia foi de lesão proliferativa de mama, que, apesar de benigna, apresenta maior risco de desenvolvimento do câncer de mama. Apesar de a descarga papilar estar na maioria dos casos relacionada à doença mamária benigna, em alguns casos esta se associa a um risco aumentado de câncer de mama. É fundamental ressaltar que pode haver uma relação entre a descarga papilar e o câncer de mama, embora este não seja a correspondência histopatológica mais freqüente da descarga papilar.

Nipple discharge is present in 5% of women and occurs due to physiological causes, benign breast disease and breast cancer. Some of benign breast lesions are associated with a higher risk of malignant breast diseases development. The importance of nipple discharge is the possibility of this condition to be associate with breast cancer. A detailed clinical evaluation is fundamental to determinate the therapeutic approach of a patient with nipple discharge. Twenthy-three patients from the Mastology Department of Fernandes Figueira Institute/Fiocruz were submitted to removal of central mammary ducts due to nipple discharge for evaluation of this symptom and its relationship with benign breast lesions and breast cancer. The histopathological results from 23 patients that have been analysed were not proliferative benign breast lesions in 26.1%, proliferative lesions without atypias in 60.8%, atypical ductal hyperplasia in 8.7% and 4 cancer in 4,4%. The results proved 69.5% of proliferative breast lesions thats presents a higher risk of breast cancer development. Although nipple discharge is associated in most of the cases with benign breast diseases sometime it is related to a higher risk of breast cancer. It is important to emphasize that it could be a relation between nipple discharge and breast cancer even if it is not the most frequent, histopathological correspondence of nipple discharge.

Stereotactic excision of benign breast lesions using the Mammotome system / 中国微创外科杂志

Objective To discuss the clinical value of u ltrasound-guided stereotactic biopsy and excision using the Mammotome system in the treatment of benign breast lesions. Methods A retrospecti ve analysis was made on the efficacy of ultrasound-guided Mammotome biopsy and e xcision in the management of 61 patients clinically diagnosed as having benign b reast lesions between October 2001 and October 2002. Results T he lesions were histologically confirmed as fibroadenoma in 51 patients and mast opathia in 10 patients. The operative time was 20.6?4.1 min. All procedures w ere performed smoothly. Of the 61 patients, no infection or breast deformity occ urred on short-term follow-up examinations (1 month) except for mild subcutaneou s hemorrhage in 3 patients, and no obvious scarring was seen on long-term follow -up (2 years). Recurrence was found in only 2 patients. Conclusions Treatment of benign breast diseases by the Mammotome system can offer comp lete excision of the lesion, minimal invasion, a low recurrence rate, and good c osmetic outcomes.

Minimally Invasive Excision of Benign Breast Tumor Using Ultrasound Guided Vacuum-Assisted Mammotome

PURPOSE: Current epidemiologic study indicates that the incidence of breast cancer has increased in Korea. However, significantly more women will develop benign breast disease during their adult lives. Even though benign breast disease is not life threatening, it can cause patient discomfort, anxiety, and fear. This study evaluates the safety, efficacy, and patient acceptance of an ultrasound guided vacuum-assisted mammotome (UVAM) in percutaneous total removal of benign breast lesions. METHODS: From Aug. 2002 to Feb. 2003, 106 sonographically benign breast lesions (up to 2.5 cm in size) of 86 patients underwent total removal under local anesthesia using 11-guage or 8-guage UVAM needles. Ultrasonographic follow-up evaluation was performed at 14 days post operation to assess the residual lesions and complications. RESULTS: UVAM allows total removal of benign breast lesions that are up to 2.5 cm in size and no residual lesions were found in follow-up breast sonogram for any of the patients. Forty-one patients (47.7%) were younger than 40. The pathologists classified the majority of removed lesions as fibroadenoma (52.9%) or fibrocystic changes (34.9%). Most complications were mild or moderate. Among the complications such as hematoma, pain, and skin dimpling, hematoma was most common and resolved spontaneously without additional intervention. All of the patients were satisfied with this procedure. CONCLUSION: Percutaneous excision of benign breast lesions using UVAM is feasible, safe, and yields high patient satisfaction. Long-term efficacy is being evaluated in an ongoing study.