Modified triple assessment in the diagnosis of breast lump in Saurashtra region of Gujarat

Background: Breast lump is a common complaint of women presenting to surgeons. Most of them are benign, careful evaluation, exact diagnosis and definitive treatment is mandatory to rule out cancer. The diagnosis of breast cancer is suggested on clinical examination. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. Together they give sensitivity of 100%. The triple assessment is taken as positive if any of the three components, two are positive or positive report of FNAC and negative only if all of its components are negative for malignancy.Methods: This study was conducted in the Department of Surgery, P.D.U Medical College, Rajkot, Gujarat over a period of 2 years. A total of 100 patients with a breast lump were selected more than 15 years of age. A detailed history, focused clinical examination, radiological imaging and FNAC were used as diagnostic tools for screening of the patients. The aim of this study was to evaluate accuracy of modified triple assessment in the preoperative diagnosis of patients with breast carcinoma.Results: Results shows sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 99.3%, respectively. Positive predictive value was 93.3%, negative predictive value was 100%, p-value was highly significant (p<0.0001). We conclude that modified triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and an overall accuracy of 98%.Conclusions: Thus, triple assessment is an easily available, cost effective, least invasive, rapid and patient compliant diagnostic tool for diagnosis of breast lump.

A Study to Evaluate the Relevance and Validity of Triple Assessment in Diagnosing Carcinoma Breast.

Breast cancer is the second leading cause of cancer related deaths. Breast cancer survival is strongly determined based on the stage of the cancer after diagnosis. This demonstrates the benefits of early detection of breast cancer in keeping survival rates of patients higher. Triple Test that comprises clinical examination, radiological assessment (USG/Mammography) and FNAC is considered as the gold standard in diagnosing carcinoma breast. This study aimed at diagnosing carcinoma breast in patients with the help of triple assessment and studying its relevance and validity.METHODSWomen who presented with a lump in breast to surgery OPD in the department of general surgery, NMCH, Patna were included in the study. This is a prospective study undertaken from December 2017 to November 2019. After taking informed consent from the study participants, they were thoroughly examined, and detailed history was taken. Subsequently, they were subjected to other components of triple test, so that a definitive diagnosis could be formed. Cases of breast abscess and those with fungating or ulcerative mass were excluded from the study.RESULTSClinical examination had a sensitivity of 90% and specificity of 86.66%. FNAC had a sensitivity of 95% and specificity of 96.66%. Radiological assessment when used alone, yielded a sensitivity of 90% and specificity of 96.66%. The sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 96.66% respectively. The positive predictive value was 95.23% and negative predictive value was 100%. The p value was highly significant (<0.0001).CONCLUSIONSTriple assessment is an important diagnostic tool in the assessment of carcinoma breast and is better than either of the modalities used alone.

Diagnosis of breast lumps based on breast imaging reporting and data system score and histopathological examination: a comparative study

Background: Breast cancer incidence in India is increasing and has now become the most common cancer among women. Preoperative pathology diagnosis and mammography (using breast imaging reporting and data system      (BI-RADS) scoring system) constitute an essential part of the workup of breast lesions. The present study was aimed to compare the diagnostic accuracy of BI-RADS score with histopathological finding in diagnosis of benign and malignant lesions of breast.Methods: This is a cross-sectional study. The present study was conducted on 100 randomly selected newly diagnosed cases of breast lump attending the General Surgery Department (OPD).Results: Considering histopathological examination as gold standard, the sensitivity and specificity of BI-RADS score is 93.9% and 82.3% respectively. The positive predictive value, negative predictive value and diagnostic accuracy of BI-RADS score is 91.1%, 87.5% and 90.0% respectively.Conclusions: Author conclude from the present study that BI-RADS score being non-invasive, it may become a very useful test for evaluating Breast lump lesions. However, BI-RADS score cannot be considered as gold standard and thus cannot be used as an alternative to histopathology in diagnosis of breast lumps.

​Fine-Needle Aspiration Cytology In Palpable As Well As In Non-Palpable Breast Lesions: A Study Of 430 Cases

Background: Fine-needle aspiration cytology (FNAC) is an established, highly accurate, and cost-effective method for diagnosinglesions in different organs including the breast. The method is minimally invasive without unwanted side effects. At present,accurate diagnosis of breast lesions depends on a triple assessment approach that is combined clinical, radiological, andpathological diagnosis. FNAC is widely adopted for pathological diagnosis of different types of the breast lesions. In developingcountries, like India, malignant causes as well as non-malignant causes are the most common causes of breast lump. FNACproves to be a valuable tool in diagnosing these cases.Aims: This study intended to look the frequencies and various cytomorphological presentations of different lesions on FNACof breast lump.Materials and Methods: In a study period of January 2015–December 2017, in the Pathology Department, GMERS MedicalCollege, Ahmedabad, 430 patients of breast lesions for FNAC came. Those were subjected to cytological evaluation withhematoxylin and eosin, Giemsa, Papanicolaou, and Ziehl–Neelsen stained smears. We assessed the age of the patients, lesionsize, site, type of lesion, and axillary lymph node metastasis in case of malignancies. In addition, the ultrasonography/mammographyof these patients with the clinical presentation was also studied.Results: Age ranges from 13 to 100 years with a mean age of 38 years. Among the lesions, 31.86% fibroadenoma, 23.02%malignant lesions, 11.81% fibrocystic changes, and 20.23% inflammatory lesions were identified. Mean lesion size was3.37 ± 2.08 cm. 12 (12.12%) of malignant lesion cases showed metastasis in axillary lymph nodes.Conclusion: FNAC serves as a safe, rapid, economical, requiring minimal instrumentation, and highly sensitive tool forthe diagnosis of different kind of the breast lesions and ductal carcinoma. The cytomorphological examination of theselesions before operation or treatment serves as an important diagnostic modality. The sensitivity can be further increased bycomplementing with radiological and clinical findings.

Correlative cytohistologic study of breast carcinoma with special reference to oestrogen and progesterone receptor status

Breast carcinoma is the second major killer next to lung carcinoma in female population, and the incidence is on rise. The current study is undertaken to underscore the importance of a low-cost and easy technique like fine-needle aspiration to identify and to grade carcinoma cytologically using Robinson's grading system and Fisher's modification of Black's nuclear grading system and compare with standard Scarff-Bloom-Richardson (SBR) histologic grading system and hormonal receptor status, as these are an important prognostic factor determining the therapy and outcome. The study found that Robinson's cytological grading system is superior to Fischer's modification of Black's nuclear grading, and the former system lined in congruence with the SBR histologic grade of tumour.

A study of accuracy of triple assessment as a clinical tool for the diagnosis of a palpable breast lump.

Background: Diseases related to breast are the highest in this country as well as in the world. Various types of lesion from inflammation to carcinoma can affect breast. Some lesions are common in young females while others in elderly age group. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. In this study many cases related to breast lesions from the region are reported in the surgery clinics of this institute and various breast diseases are being managed in the clinical departments. For disease confirmation, many diagnostic procedures are recommended with aims to help in decision for surgical treatment. To study prevalence of various breast disease condition coming to our hospital and their management. Analysis of pattern and prevalence will be a valuable guideline for clinicians of this location to compare with that of others. This study was to evaluate the accuracy of Triple assessment (physical examination, mammography and fine needle aspiration cytology) as a clinical tool for the diagnosis of a palpable breast lump. Aims & Objective: (1) To study incidence for breast disease; (2) To study etiopathogenesis of it; (3) To study patient presentation and manifestation; (4) To study management of various breast diseases; and (5) To study various modalities of treatment. Material and Methods: This prospective study was carried out in the department of surgery during period from 1st march 2011 to 28th February 2012 in indoor and outdoor patients. Each patient was study in detail with relevant clinical history, examination, mammography and histological findings and management. The study comprised of total 100 patients of breast disease treated with various modalities. Results: In the study of total 100 cases, inflammatory conditions were present in 15%, fibrocystic lesion 35%, fibroadenoma 20%, gynaecomastia 2% and carcinoma 10%. This comparative study reported data by clinical analyses, mammography and histological findings in 100 women with ages from 18 to 60. Malignant carcinoma found in 10% of cases while benign breast disease and other condition found in 90% of cases. Conclusion: Fibrocystic disease was the commonest lesion in this study with 30 years as the average age of presentation. Malignancy was detected above 47 years of age. Ninety patients with breast lumps interpreted by Triple Assessment as benign correlated with the histopathological findings whereas of 10 malignant lumps. This gives Triple Assessment an overall accuracy of 100% in our study.

Benign breast diseases: experience at a teaching hospital in rural India.

Background: Though benign breast diseases are very common with nearly 1/3 of women suffering some time during their life time, not many studies have focused on this entity, especially in rural areas. Our teaching hospital situated amongst the villages in rural part of India provided the right background for the study. Objective: To determine the frequency of benign breast diseases in a teaching hospital situated in the rural setting and to analyze the role of triple assessment in assessing benign breast diseases. Study design: Prospective, descriptive study. Setting: MVJ Medical College and Research Hospital, Hoskote, Bangalore Rural district, Karnataka, India. Method of study: Data including age, complaints, clinical examination, radiological investigations and histopathological diagnosis was collected from patients presenting to the department of surgery with breast complaints. Patients with carcinoma of the breast were excluded from the study. Results: A total of 110 patients were studied between November 2009 to March 2011. Mean age of patients was 28.6 years. Fibroadenoma was the most common diagnosis in 56.4% followed by fibroadenosis in 20.9%. There was one case each of lipoma, tuberculosis and duct ectasia and two cases of atypical ductal hyperplasia. The sensitivity of clinical diagnosis in our study was 91.1% and FNAC was 100% accurate in all patients with fibroadenoma but had a sensitivity of only 78% in the diagnosis of fibroadenosis. Only 3.3% of cases of fibroadenoma were treated conservatively.