Ultrasound-Guided Core Biopsy of Breast Lesions in a Resource Limited Setting: Initial Experience of a Multidisciplinary Team.

OBJECTIVE: There is increasing tendency to multidisciplinary care of patients with of breast lesions. This study sought to evaluate the initial experience of the diagnostic arm of a new breast program in a resource limited setting. MATERIALS AND METHODS: In 2015, we commenced the pilot phase of an IRB-approved breast care protocol. As part of the protocol's diagnostic arm, an ultrasound-guided breast core biopsy training was implemented. Eligible patients were clinically evaluated and underwent CNB using 16G needle under US guidance. The procedure was rated by the participants and histopathological results compared with surgical specimens. RESULTS: Eighty six participants (18.22%) with 113 palpable breast lesions completed the study. The diagnostic accuracy, sensitivity, and specificity were 94.44%, 92.86%, and 95.83% respectively. Unweighted kappa-coefficient (k) agreement between histopathology of core biopsy and surgically excised specimens, were 0.798 (95% CI of 0.69 - 0.90) and 0.801 (95% CI of 0.71-0.92) for benign and malignant breast lumps respectively. The procedure was well accepted and all the patients were willing to accept a repeat CNB and would recommend it. CONCLUSION: Despite the prevailing challenges, co-ordinated team diagnosis is feasible and may result in the modest improvement in the diagnostic accuracy of breast lesions and patient satisfaction.

Changing pattern of perforated PUD: Are NSAIDs to be blamed?

OBJECTIVES: This study aimed to determine if there is association between gastric perforation and non-steroidal anti-inflammatory drugs (NSAIDs) abuse in patients presenting with perforated peptic ulcer disease (PPUD). MATERIAL AND METHODS: The data were collected retrospectively from May 2011 to May 2015 and then prospectively until December 2017. Sixty patients diagnosed with PPUD on exploratory laparotomy were evaluated. Data were analyzed using SPSS (version 21.0). P value ≤ 0.05 was considered significant. RESULTS: A total of 60 patients were operated on for PPUD during the study period. Forty-five (75.0%) patients gave significant history of NSAIDs use, of which nine (20.0%) had medical prescription, while others were over the counter medications. None of the patients was on ulcer prophylaxis including those who were on long term use and with prior dyspeptic symptoms. Five patients (11.1%) were on the recommended dose of the NSAIDs, thus patients in this series showed irrational use of NSAIDs. Forty-two (93.3%) patients had gastric perforation, while only three of the patients had duodenal perforation. The association between significant NSAIDs use and gastric perforation was found to be significant (p= 0.002). There was no difference in the site of perforation when patients who were on long term NSAIDs were compared with short term NSAIDs use (10.0 vs. 35.0) (p= 0.061). In addition, long term NSAIDs use (p= 0.041), ignorance of proper dose of the medication (p= 0.003), and gastric ulcer perforations (p= 0.011) were independent causes of mortality in the studied patients when age and duration of the presentations were matched. CONCLUSION: NSAIDs use, including both long- and short-term use, was significant among patients with gastric perforation.

Breast Pain: Clinical Pattern and Aetiology in a Breast Clinic in Eastern Nigeria.

BACKGROUND: Patients with breast pain are likely to be very worried because some consider pain in the breast as an indication of malignancy. OBJECTIVE: To highlight the causes of pain in the patients are presenting to our breast clinic. MATERIALS AND METHODS: A prospective study of all consenting patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008. RESULTS: A total of 664 patients presented to the breast clinic during the study period. Of this number, 127 presented with breast pain either as the sole symptom or in association with other symptoms. The presenting complaints were a pain, pain with lump, and pain with nipple discharge in 63 (49.6%), 59 (46.4%), and 5 (4.0%) patients, respectively. The pain was noncyclical in 96 (75.6%) patients. The site of the pain was whole breast in 87 (68.5%) patients and a lump in 40 (31.5%). The clinical diagnosis in 31 (24.4%) cases was fibrocystic disease, 28 (22.0%) cancer, 23 (18.1%) unknown, 10 (7.9%) fibroadenoma, 8 (6.3%) duct ectasia, 6 (4.7%) normal breast, and others 21 (16.5%) cases benign diseases were diagnosed. The histological diagnosis was fibrocystic changes, carcinoma, and fibroadenoma in 15 (42.9%), 10 (28.6%), and 5 (14.3%) patients, respectively. Others were benign phyllodes, abscess, duct ectasia, chronic mastitis, and lipoma, each constituting 1 (2.9%) case. CONCLUSION: Breast pain constitutes a small proportion of complaints to our breast clinic. Fibrocystic changes were the most common cause of breast pain both clinically and histologically.

Efficacy of neoadjuvant chemotherapy in down staging locally advanced pre-menopausal breast cancer in Eastern Nigeria: is four courses adequate?

CONTEXT: Breast cancer is the most frequent cancer among women in most part of the world and in Nigeria. Neoadjuvant chemotherapy (NAC) has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer (LABC). AIMS: To determine if the use of four courses of doxorubicin based neoadjuvant chemotherapeutic regimen will result in significant primary tumor down-staging. SETTINGS AND DESIGN: One year prospective study of premenopausal breast cancer patients presenting to the specialty breast clinic. METHODS: The patients were recommended for four courses of doxorubicin based NAC and response assessed using response evaluation criteria in solid tumors (RECIST) methodology. STATISTICAL ANALYSIS USED: Simple frequency and descriptive statistics were used to analyze data using SPSS statistical software. RESULTS: One hundred and fourteen patients presented with breast cancer. Their ages ranged from 26 to 51 years with a mean age of 42.1 years ± 7.7 years. Thirty-one patients completed the four courses of NAC. At the end of NAC, 23 (74.2%) patients had more than 30% reduction in primary tumor size and 8 (25.8%) had no response (NR). The response according to the modified RECIST methodology was 12.9% for a complete clinical response, 61.3% for partial response, and 25.8% for NR. Significant clinical response was seen in 74.2% of patients (P < 0.0001) (one sample t-test). CONCLUSIONS: Four courses of antracycline based NAC is effective in premenopausal patients with LABC in our environment.

Acceptance and adherence to treatment among breast cancer patients in Eastern Nigeria.

This study reports on the acceptance and adherence behaviors of patients presenting with a clinical suspicion of breast cancer at a breast clinic in Nigeria during a 5-year period (2004-2008). Of the 275 study patients, 28.7% (79 patients) refused a biopsy needed for a definitive diagnosis. Of those who agreed to a biopsy, 10.2% (28 patients) did not return for a follow-up visit. Mastectomy was offered to 140 patients, 47.9% (67 patients) refused the surgery. Of the 53 patients diagnosed with locally advanced lesions offered neo-adjuvant chemotherapy, 28.3% (15 patients) completed the recommended therapy. Of the 44 patients offered adjuvant chemotherapy, 38.6% (17 patients) completed the recommended therapy. Only 23 of the patients advised to go for radiotherapy complied. Barriers to patient adherence to diagnostic and treatment recommendations included both patient barriers and system barriers.