Prevalence of breast fibroadenoma in healthy physical examination population in Guangdong province of China: a cross-sectional study

OBJECTIVE

To provide an accurate assessment of the prevalence of breast fibroadenoma in a large population and to confirm the diagnostic accuracy of ultrasound for fibroadenoma.

DESIGN

This was a cross-sectional survey.

SETTING

This research was conducted at Nanfang Hospital, Guangzhou, Guangdong, China.

PARTICIPANTS

A total of 11 898 women aged 18-40 years who underwent breast screening between 1 January 2019 and 31 December 2019 were included in the fibroadenoma prevalence study. From 1 June 2019 to 31 December 2019, 342 breast lesions with pathology reports and preoperative ultrasound images were collected for diagnostic fibroadenoma testing (vs histological diagnostic testing).

PRIMARY OUTCOME MEASURES

Pearson's χ² test was performed to compare the prevalence of different lesions between age groups, and descriptive statistics were used to report the clinical characteristics of fibroadenoma. For ultrasound diagnosis, fibroadenoma was defined as a well-circumscribed lesion with round or oval shape, consisting of a homogeneously hypoechoic or isoechoic solid mass, located parallel to the chest wall with a smooth margin and no posterior shadowing. Diagnostic test results for breast fibroadenoma were stratified by diagnostic type (histological vs ultrasound).

RESULTS

Of the women aged 18-40 years, 27.6% (3285/11 898) had an ultrasound diagnosis offibroadenoma. Of these, the prevalence of fibroadenoma was stable across age groups (p=0.14) and did not differ between the left and right sides of the breast. Almost two-thirds of women presented with a single fibroadenoma, and most fibroadenomas did not exceed 1 cm in size. The sensitivity and specificity for fibroadenoma were 97.0% (95% CI for sensitivity: 93.7% to 98.8%) and 91.4% (95% CI for specificity: 85.4% to 95.5%) for ultrasonography, respectively.

CONCLUSIONS

The prevalence of fibroadenoma in South China is as high as 27.6%, and ultrasound could be used as a tool to diagnose fibroadenoma.

Breast diseases histologically diagnosed at a tertiary facility in Uganda (2005-2014)

BACKGROUND

The prevalence and distribution of histologically diagnosed breast disease are not well documented in low income countries, Uganda inclusive. Although the greater majority of breast lesions globally are benign, breast cancer is the most frequently diagnosed cancer all over the world. We aimed at documenting the prevalence of different breast diseases histologically diagnosed at the histopathology laboratory of the Department of Pathology of the Makerere University College of Health Sciences (MakCHS Lab) over a decade (2005-2014). We also describe the demographic characteristics of the patients in Uganda diagnosed with breast disease at the MakCHS Lab during the same period.

METHODS

This was a 10 year retrospective study of histologically diagnosed breast disease between 2005 and 2014 inclusive at the MakCHS Lab. We extracted information from hard copies of all 2510 histopathology reports retrieved from archives of the Department of Pathology at the MakCHS Lab. 640 records that were either damaged beyond recognition of key details, were duplicated, were implausible or had no conclusive diagnosis made were excluded. Information to be analyzed was then entered into Epidata (version 3.1) on a password protected laptop. Data analysis was done using SPSS software (v16 for Windows × 64).

RESULTS

From the 1870 patients' records eventually analyzed, breast disease was most diagnosed in female patients (97.1%). The overall mean age for breast disease diagnosis was 33 years (S.D ± 16.46) and median age 26 years (IQR: 20-43). Fibroadenoma (40.1%) was the most diagnosed breast disease overall. We noticed steadily increasing frequency of diagnosis of cancerous breast diseases over the last half of the study period. Invasive ductal carcinoma was the most diagnosed breast cancer (326 cases, 55.6%). A high female to male breast cancer ratio of 48:1 was observed. The highest regional breast cancer proportion was from the Western region of the Country.

CONCLUSIONS

There is need for more research into the picture of breast disease in the country, covering various demographic characteristics of the country's population for all regions and informing about its incidence rates and prevalence and also the breast cancer risk estimate for benign breast disease.

Surgery for giant tumours of the breast: a 15 year review

BACKGROUND

Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes.

METHODS

Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement.

RESULTS

Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12-49 years (y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10-45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21 patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%.

CONCLUSION

Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction.

Breast fibroadenomas are not associated with increased breast cancer risk in an African American contemporary cohort of women with benign breast disease

BACKGROUND

Fibroadenomas are common benign breast lesions, and studies of European American women indicate a persistent, increased risk of breast cancer after diagnosing a fibroadenoma on biopsy. This association has not been independently assessed in African American women, despite reports that these women are more likely to present with fibroadenomas.

METHODS

The study cohort included 3853 African American women with a breast biopsy completed between 1997 and 2010 in metropolitan Detroit. Biopsies were microscopically reviewed for benign breast lesions, including fibroadenoma, proliferative disease, and atypia. Risk of breast cancer within the cohort was estimated using relative risk ratios and 95% CIs calculated using multivariable log-binomial regression. Relative risk of breast cancer in this cohort compared with African American women in the broader metropolitan Detroit population was estimated using standardized incidence ratios (SIRs).

RESULTS

Fibroadenomas occurred more frequently in biopsies of younger women, and other types of benign breast lesions were less likely to occur when a fibroadenoma was present (p = 0.008 for lobular hyperplasia; all other p values < 0.01). Unlike women with other benign lesions (SIR, 1.41; 95% CI, 1.20, 1.66), women with fibroadenomas did not have an increased risk of developing breast cancer compared with the general population (SIR, 0.94; 95% CI, 0.75, 1.18). Biopsies that indicated a fibroadenoma were associated with a reduced risk of breast cancer after adjusting for age at biopsy, proliferation, and atypia (relative risk, 0.67; 95% CI, 0.48, 0.93) compared with biopsies without a fibroadenoma.

CONCLUSIONS

These findings have important implications for breast cancer risk models and clinical assessment, particularly among African American women, in whom fibroadenomas are common.

Multicentric study on ¹⁸F-FDG-PET/CT breast incidental uptake in patients studied for non-breast malignant purposes

AIM

Our study has aimed to establish the prevalence and pathological nature of fluorine-18-fluorodeoxyglucose ((18)F-FDG) breast incidental uptake (BIU) in patients studied for non-malignant breast tumours and then to compare our data obtained in three Italian nuclear medicine centres with those available in literature.

MATERIAL AND METHODS

We retrospectively evaluated 42,927 (18)F-FDG-PET/CT scans performed on patients studied in three Italian Nuclear Medicine Centres. All patients underwent (18)F-FDG-PET/CT for oncologic purposes not related to breast disease.

RESULTS

Among 42,927 scans, a BIU was identified in 79 (0.18%) patients, 75 (95%) female and 4 (5%) male with an average age of 62 ± 17 years. Twenty-five out of 35 (71.5%) BIUs were malignant and 10/35 (28.5%) benign. Among the 25/35 incidentalomas that were malignant, 12/25 (48%) were infiltrating ductal carcinoma, 5/25 (20%) ductal carcinoma (infiltrating and in situ), 4/25 (16%) lobular carcinoma, 2/25 (8%) ductal carcinoma in situ and 2/25 (8%) were metastases from the primary tumour under investigation. Of the 10 BIUs that were benign in the histological examination, after further investigations it was found that 9/10 (90%) were fibroadenomas and 1/10 (10%) was a benign lesion not better specified. The lesion to liver or to blood-pool SUVmax ratio in malignant lesions is significantly higher than in benign ones.

CONCLUSIONS

Our multicenter study demonstrates that, although they are uncommon, BIUs show a high percentage of malignancy and therefore requires further research.

Selenium levels in neoplastic breast lesions

AIMS AND OBJECTIVES

The aim of this prospective case controlled study was to evaluate the tissue levels of selenium in patients with cases of fibroadenoma, cancer of the breast and in the controls in order to relate them to the occurrence of breast diseases.

SUBJECTS AND METHODS

Consecutive consenting patients who had histologically confirmed breast cancer and fibroadenoma attending the General surgical outpatients departments of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, were recruited for the study. One gram of core disease breast tissues was taken for Selenium level estimation.

RESULTS

There were 127 female subjects;. 95 (74.8%) cases of fibroadenoma and 32 (25.2%) of breast cancer. While breast cancer was common on the left, fibroadenoma was more common on the right breast (? = 8.994; p=0.011). The median tissue level of selenium in patients with fibroadenoma was 0.0272 mg/g with a range of 0.0124 to 0.0576 mg/g and that of the cancer patients was 0.0178 mg/g with a range 0.0072 to 0.0436 mg/g. These were statistically significantly different ( p=0.001). Factors affecting tissue selenium level include age (p<0.001), overall stage of breast cancer (p<0.001), maximum length of breast mass (p=0.023), previous delivery (p=0.004), age at last confinement (p=0.007), parity (p<0.001), oestrogen receptor (ER) status (p<0.001) and progesterone receptor (PR) status (p=0.021).

CONCLUSION

Tissue selenium was lower in breast cancer than in fibroadenoma; Tissue selenium inhibits carcinogenesis; low tissue level of selenium therefore may be a factor in the development of breast cancer.

Breast diseases in adolescents

Fibroadenomas and breast growth disorders are the most common breast diseases in adolescent women. Assessment of breast disorders in this age group generally involves clinical evaluation through history and physical examination and when is needed ultrasonography. Due to the absence of breast cancer in adolescent women, it is easy to reassure women at the first consultation. Breast growth disorders can lead great psychological and physical embarrassment. Treatment consists of surgical procedures when the cosmetic defect is severe. According to the ANDI classification, small fibroadenomas are normal, clinical fibroadenomas are a mild aberration of the normal processes, and giant or multiple fibroadenomas are placed to the disease end of the spectrum. Fibroadenomas can be treated conservatively provided diagnosis is confident. Giant fibroadenomas are treated by surgical enucleation. Breast abscess is mainly due to the duct ectasia. In adolescence, ectasia has been described as an exaggeration of sinus duct development and can be considered as a variant of normality. Diseases of the adolescent breast are usually benign and their management are simple using medical strategy and more rarely surgical therapy.

Histomorphological spetrum of breast lesions

BACKGROUND

Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon.

METHODS

This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010.

RESULTS

114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male.

CONCLUSIONS

Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal.

Role of exogenous and endogenous sources of estrogen on the incidence of breast fibroadenoma: case-control study in Iran

Breast fibroadenoma (FAD) is the most common benign mammary condition among women but the environmental risk factors have not identified yet. As the role of long term estrogen exposure in the incidence of FAD has been remained controversial; we have decided to investigate the possible role of endogenous and exogenous sources of estrogens in present study. Women less than 45 years old who underwent surgery from June 2009 to June 2010 were matched with controls by age and hospital. From reproductive factors, lack of breast feeding (p< 0.001, 8.76 CI95% 3.79-20.24), Nulliparity (p=0.001, OR=8.09, CI95% 3.505-18.67), Lack of parity (p=0.001, OR=6.64, CI 95% 2.56-16.31) and Hormonal dysfunction (p=0.016, OR=4.66, CI 95% 1.26- 17.28) were considered as the most important ones. Adiposity and abnormal weight gain after 18 years were considered as major background factor which induce FAD and may be contributed to the level of endogenous estrogen. Out of evaluated exogenous sources of estrogen, lower age at first OCP consumption (20.76_+3.87 vs. 22.85_+3.88, p=0.046) and living near Polycyclic aromatic hydrocarbons (PAHs) producing factories (p< 0.001, OR=3.7, CI95%1.61-7.94), were considered as the main sources of exposure to xenestrogens in FAD patients but FAD showed inverse association with cigarette smoking because of antiestrogenic activities of cigarette smoking . This study concludes that the incidence and development of FAD could be associated with the reproductive history of women, activity of ovarian hormones as well as environmental factors.

Influence of age on PPV of sonographic BI-RADS categories 3, 4, and 5

PURPOSE

The purpose of this retrospective study was to calculate the positive predictive value (PPV) of sonographic Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4, and 5 in different age groups to investigate whether age influences the PPV of the BI-RADS category in breast ultrasound.

MATERIALS AND METHODS

From our sonography-guided core biopsy database of breasts between 2006 and 2008, we identified 2817 BI-RADS category 3, 4, and 5 lesions with known pathological diagnosis in 2587 women, all of whom underwent the earlier breast assessment via ultrasound with a sonographic BI-RADS lexicon and later sonography-guided core biopsy. All lesions were classified into three age groups (< 45, 45 - 59, and > 59 years). The age-related PPVs of each BI-RADS category among three age groups were calculated on the basis of pathological diagnoses and were compared using a χ(2)-test.

RESULTS

The overall PPV of each BI-RADS category was 2.2 % in category 3, 6.5 % in category 4a, 35.2 % in category 4b, 79.6 % in category 4c, and 99.6 % in category 5. The age-related PPVs of category 3 varied significantly among the three age groups (0.9 % versus 3.9 % versus 2.0 % p = 0.048), and notably, the age-related PPV in group 2 was higher than the others. Additionally, there was a significant positive association between the age-related PPVs and increasing age in categories 4a and 4b (4a, p < 0.0001 and 4b, p = 0.0139), but not in categories 4c and 5 (4c, p = 0.1853 and 5, p = 0.2871).

CONCLUSION

The incidence of female breast cancer differs not only in different sonographic BI-RADS categories, but also in different age groups. Therefore, more attention should be paid to the special age group that we found for sonographic BI-RADS categories 3, 4a, and 4b.

Breast diseases in Southern Yemen

OBJECTIVE

To investigate the magnitude of breast diseases, and its frequency distribution in different age groups in Hadramout, Yemen.

METHODS

This is a prospective study conducted at the Central Laboratory of Ibn-Sinna Hospital, Hadramout, Yemen from January 2006 to December 2009. Patients attending surgical units for breast problems were eligible. Patients were assessed clinically and referred to the laboratory center to confirm the diagnosis by histopathology. The data were collected from the patients and referral sheets.

RESULTS

A total of 635 cases of breast disease were diagnosed. This includes 604 female and 31 male patients. Benign breast diseases (BBD) was the most common lesion found in this study comprising 493 cases (77.6%), and 142 (22.4%) comprised malignant cases. Among BBD, the most common lesion was fibroadenoma (40.5%) followed by fibrocystic changes (16%), other benign breast lesions (10%), and inflammatory lesion (8%). The age groups affected by BBD were: 20-29 years for fibroadenoma; 30-39 years for fibrocystic change; 20-29 years for other benign breast lesions; and 30-39 for inflammatory lesions, and carcinoma of the breast was common in the 40-49 age group. The left breast was affected in 331 (52%) cases, the right in 283 (45%), while in 3%, both breasts were affected.

CONCLUSION

Fibroadenoma was the most frequently diagnosed benign breast lesion in Hadramout. An educational program is needed to alert patients of the significance of breast masses.

Role of hormonal and environmental factors on early incidence of breast cancer in Iran

Although the probability of having breast cancer increases with the age in general, this malignancy affects Iranian women at least one decade younger than their counterparts in other countries. However the underlying risk factors for the discrepancy have not been identified. The aryl hydrocarbon receptor (AhR) mediates the effects of many environmental endocrine disruptors and contributes to the loss of normal ovarian function in polluted environments. This study was aimed to compare the interactions between AhR and other fundamental genes (p53, K-Ras, ER, PgR) in a clinical setting. To conduct the immunohistochemical studies using appropriate monoclonal antibodies, 25 premenopausal invasive ductal carcinoma, 29 postmenopausal invasive ductal carcinoma and 30 breast fibroadenoma were selected retrospectively from 2004 to 2007 in the pathology department of Imam Khomeini hospital complex of Tehran University of Medical Sciences . Higher levels of AhR in epithelial cells of premenopausal patients and breast fibroadenoma emphasized the susceptibility of these cells to environmental-induced tumors. AhR overexpression contributed to ER-/PgR-immunophenotype in young/premenopausal patients but the same pattern was not observed in benign and postmenopausal malignant tumors. It seems that early incidence of breast cancer in Iran is the result of interactions between hormonal and environmental factors.

A clinicopathologic study of breast lumps in Bhairahwa, Nepal

BACKGROUND

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. 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. Analysis of pattern and prevalence will be a valuable guideline for clinicians of this location to compare with that of others.

METHODS

In the retrospective clinical study during 9 years period, the cases of breast lesions and lumps underwent fine needle aspiration cytology. Pap staining was done in alcohol fixed smears. The doubtful cases 65 were diagnosed through histopathological examinations by conventional method of fixation, processing and staining with routine hematoxylin and eosin. The cases with undetermined and inconclusive material were excluded from the study.

RESULTS

In the study of total 243 cases, inflammatory conditions 22.6%, fibrocystic change 41.2%, fibroadenoma 21.8%, other benign breast disease 4.5%, gynaecomastia 2.5% and carcinoma 7.4% were detected.

CONCLUSION

Fibrocystic change was the commonest lesion in this study with 33 years as the average age of presentation. However, malignancy was detected above 40 years of age.

Risk of Developing Fibroadenoma with the Use of Cyclosporine A in Renal Transplant Recipients

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.

Clinicopathologic features of breast disease in Jamaica: findings of the Jamaican Breast Disease Study, 2000-2002

OBJECTIVE

To describe the clinicopathologic profile of breast disease in Jamaica.

METHODS

The Jamaican Breast Disease Study is an ongoing prospective, multidisciplinary investigation of breast disease at the University Hospital of the West Indies (UHWI). The initial phase was a prevalence survey comprising all consenting patients referred to the Surgical Outpatient Department (SOPD) UHWI, for breast disease. Demographic, clinical, radiologic and pathologic information were recorded for each patient and the data for the first three years (2000-2002) were analyzed.

RESULTS

A total of 1189 patients was enrolled for the study period (28.8% of all new SOPD patients). The age range was 10 to 93 years (mean/SD = 36.5 +/- 16.4 years) with a female : male ratio of 14:1. Most patients (67.8%) presented with a palpable lump and the clinical diagnosis was benign in the majority (70.4%) of patients. Fibroadenoma was the most common benign histologic result (39.4% of all biopsies) followed by non-proliferative (fibrocystic) disease (19.3% of all biopsies). Proliferative disease without atypia, complex fibroadenoma and atypical ductal hyperplasia accounted for 6.9%, 2.6% and 0.4% of biopsies respectively. Overall, 23.4% of biopsies showed malignant histology (10.8% patients); invasive ductal carcinoma accounted for the majority of these cases (69.5%).

CONCLUSIONS

The majority of patients with breast disease in Jamaica are young women with clinically benign disease. There was a low prevalence of clinically significant premalignant disease. This is the first study to prospectively describe the clinicopathologic features of breast disease in Jamaica and supports the need for advocating breast cancer screening to facilitate detection of significant premalignant disease and early stages of breast cancer.

Benign breast lesions in Eastern Nigeria

OBJECTIVE

To characterize benign breast diseases in Eastern Nigeria and to highlight the age variations of these lesions as base line data.

METHODS

The Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Enugu caters for over 30 million African blacks and receives 2000 surgical pathology specimens yearly. Seven hundred and twenty-two benign breast specimens were analyzed over 5 years from 1st January 2000 to 31st December 2004, out of 1050 breast samples received.

RESULTS

Of 1050 breast specimens received, 722 (68.8%) were benign. Fibroadenoma was the most common lesion with 318 cases (44%), occurring at a mean age of 16-32 years. Next was fibrocystic changes with 165 cases (22.9%) at a mean age of 23-45 years. Normal breast in the axillary tail region was seen in 32 cases (4.4%), represented as no pathology, with a mean presentation age of 20-46 years. Low grade Phyllodes tumor had 28 cases (3.9%), presenting at an average mean age of 17-32 years. Lactating adenoma had 19 (2.6%) cases. Other lesions made up less than 3% each. Benign breast lesions peaked at the 20-24 age range and then declined. Most were females.

CONCLUSION

Benign breast lesions occur more frequently than malignant breast lesions with a ratio of 2.3:1 and were presented 20 years earlier than their malignant counterparts. Fibroadenoma was the most common benign lesion followed by fibrocystic disease, similar to the findings in Western Nigeria. In Northern Nigeria, fibrocystic breast disease was more common.

FNA of breast fibroadenoma: observer variability and review of cytomorphology with cytohistological correlation

OBJECTIVE

To determine the observer variability in reporting fibroadenoma of the breast by fine needle aspiration (FNA) and to review the cytomorphological features of the lesion with cytohistological correlation.

METHODS

Retrospective analysis of FNA smears from 110 cases diagnosed as fibroadenoma of which surgical pathology follow-up was available in 33. Two pathologists were asked to categorize smears from 67 cases of breast lesions while blinded to the clinical finding as fibroadenoma, epithelial hyperplasia (usual and atypical) and malignant. All fibroadenoma (33) and cancer (15) cases were biopsy-proven. The same set of slides was re-circulated to one of the pathologists, and his first and second round results were compared.

RESULTS

Pre-review cytohistological correlation was attained in 32 of 33 cases of fibroadenoma (97%). The overall agreement between the two observers was 87% [Kappa = 0.74, 95% confidence interval (CI) 0.72-0.76]. Cytohistological correlation was achieved in 26 of 33 (79%) cases. Intra-observer agreement was 91% (Kappa = 0.82, 95% CI 0.89-0.93) with cytohistological correlation in 29 of 33 (87%) cases. Causes of diagnostic errors included marked dissociation, pleomorphism, poorly cellular smears from hyalinized fibrodenoma, lacational changes and apocrine metaplasia with cystic changes. Multinucleated giant cells were frequently encountered in FNA smears from fibroadenoma (31.8%), but in none of the lumpectomy specimens. Their histiocytic nature was suggested by immunohistochemistry.

CONCLUSION

FNA was a highly sensitive method for the diagnosis of fibroadenoma. Current cytological criteria were reliable and gave high inter- and intra-observer reproducibility.

Profile of breast lesions among women with positive biopsy findings in Yemen

This study described the profile of breast pathology based on records from a reference histopathology laboratory in Yemen of 773 women with positive biopsy or mastectomy findings. Cancers were classified according to the International classification of diseases for oncology. Benign lesions were found in 79.9% of cases. Fibroadenoma was the most prevalent lesion (30.0%) with a mean age at presentation of 22.2 years, followed by fibrocystic disease (27.4%) and breast inflammation (13.1%). Invasive carcinoma was found in 155 cases (20.1%), at a mean age of 44.7 years.

The role of major duct excision and microdochectomy in the detection of breast carcinoma

BACKGROUND

The association of nipple discharge with breast carcinoma has resulted in numerous women undergoing exploratory surgery to exclude malignancy. The aim of this study was to determine whether pre-operative factors can identify those patients that are most at risk of carcinoma.

METHODS

All patients over a 14-year period (1991-2005) who had a microdochectomy or subareolar exploration for the evaluation of nipple discharge were assessed. Patient characteristics, pre-operative imaging and pathological findings were analysed.

RESULTS

Of the 211 patients included in this study, 116 patients had pathological (unilateral, uniductal serous or bloody) discharge. On excision, 6% (n = 7) of patients with pathological discharge and 2.4% (n = 2) of patients with non-pathological discharge were diagnosed with carcinoma. Overall, major duct excision resulted in the diagnosis of carcinoma in 4.3% (n = 9), ADH/LCIS in 4% (n = 8), papilloma in 39% (n = 83), and duct ectasia or non-specific benign disease in 53% (n = 111) of patients. In the patients determined to have malignancy, 44% (n = 4) were premenopausal. No patient with a non-bloody discharge in the total population analysed (28%; n = 59/211), or in the population with a pathological discharge (21%; n = 24/116) was found to have carcinoma upon excision.

CONCLUSION

Microdochectomy or major duct excision performed for nipple discharge resulted in a low rate of malignancy on excision. Conservative management of non-bloody nipple discharge can be considered in patients with no other clinical or radiological signs of malignancy.

Breast pathology and reduction mammaplasty

Breast cancer is the tumor with the highest prevalence and incidence in women. Reduction mammaplasty is one of the most common procedures performed in Brazil by the plastic surgeon, and it is not uncommon for the surgeon to find a breast tumor during the operation or afterward, when the histopathological report is received. In this study, 2488 patient files were reviewed retrospectively. All patients had undergone reduction mammaplasty at the senior author's private clinic (the Ivo Pitanguy Clinic) between January of 1957 and December of 2002. Resected breast tissue was examined histopathologically. The objective of this study was to verify the occurrence of breast carcinoma found accidentally postoperatively. The senior author's team performed all of the operations and the same pathologist performed every histopathological examination. The histopathological test results were divided into two groups: benign lesions and tumors. The highest frequency of breast pathology was benign lesions, and of them, 80.8 percent involved fibrocystic changes and fibroadiposity. The tumor group was subdivided into benign tumors and malignant tumors. Among the benign tumors, fibroadenoma was the one most common, in 2.2 percent. The frequency of malignant tumors was 0.5 percent of all patients. Most of the histopathological lesions were found in patients between 30 and 50 years of age. A reduced number of patients had no lesions (3.7 percent). Lack of a pathological investigation or a cursory or hurried examination of any mammary tissue by the pathologist may overlook important lesions. In the analysis of these statistics, the concept of normal breast tissue was questioned.

Three discrete areas within the chromosomal 8p21.3-23 region are associated with the development of breast carcinoma of Indian patients

Deletion in the 22.9 -Mb chromosomal (chr.) 8p21.3-23 region has been shown to be necessary for the development of breast carcinoma (CaBr). In this study, we have attempted to detect the minimal deleted region(s) in the chr.8p21.3-23 region in 62 primary breast lesions having 56 CaBr tumors and six other breast lesions of Indian patients using 15 microsatellite markers. The loss of heterozygosity (LOH) was observed for at least one marker in 96.4% (54/56) of the CaBr samples. Three discrete minimal deleted regions with high frequencies of LOH (39-65%) were identified in the chromosomal 8p23.1-23.2 (D1), 8p23.1 (D2) and 8p 21.3-22 (D3) regions within 2.03, 0.41, 2.47 Mb, respectively. No significant correlation was observed with the high deleted regions and the different clinicopathological parameters. Interestingly, 51.8% (29/56) CaBr samples showed either loss of chr.8p or interstitial deletions in this arm, indicating the importance of chr.8p in the development of CaBr. The pattern of allelic loss in the bilateral lesions had indicated that the lesions were clonal in origin and probably the deletion in the D3 region was the early event among the D1-D3 regions. Thus, our data have indicated that the D1-D3 regions could harbor candidate tumor suppressor gene(s) (TSGs) associated with the development of CaBr.

Prise en charge des tumeurs phyllodes du sein à l'Institut national d'oncologie de Rabat, Maroc

OBJECTIVES

Phyllodes tumors of the breast (PTB) are rare fibro epithelial tumors. Their terminology, histological classification and their treatment are exposed to controversy. The aim of our work is to underline the epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours through a retrospective study and a review of the literature.

PATIENTS AND METHODS

We reviewed at the National Institute of Oncology of Rabat, Morocco, between 1985 and 1998, all the files of patients with histological certainty of PTB, doubtful PTB were excluded. We collected epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours.

STATISTICS

quantitative parameters were represented by mean +/- S.D. and qualitative parameters by percentage or effective.

RESULTS

We studied nine cases of PTB, which represented 0.09% of all primitive tumors of the breast treated at our institution during the study period. All our patients were female. Mean age was 37.3 +/- 10.07 years. Two of our patients (22.2%) had a history of fibroadenoma and 44.4% were nulliparous. Mean delay before consulting was 60.7 +/- 17.56 months and the median tumour size was 13 +/- 7.47 cm. Pathological findings were six benign or borderline phyllodes tumours (66.7%) and three cystosarcomas phyllodes (33.3%). The treatment consisted in simple mastectomy in seven cases (77.8%) and tumorectomy in two cases (22.2%). All the surgical margins were clear. Two of the three cystosarcomas phyllodes received adjuvant external bean radiation therapy 50 Gy on the thoracic chest wall. After a median outcome of 3 +/- 2 years ranging from 3 to 74 months, we did not note any relapse or metastasis.

DISCUSSION AND CONCLUSION

In our series, PTB happened exclusively in females. History of fibroadenoma within 22.2% of the patients suggests the hypothesis of a filiation between these two entities. Their distinctive features were young age in diagnosis, long delay before consulting, important tumor size, predominant benign and borderline histological types, treatment mainly surgical and good local and distant control.

Breast fibroadenoma in teenage females

Over a period of 30 years, the author received surgical specimens of fibroadenoma from doctors who had operated on 530 teenage females of the Igbo ethnic group, who inhabit southeastern Nigeria, West Africa. The peak age was 18 years. The right breast (51.3%) was involved more often than the left (48.7%). There were 58 bilateral cases, i.e., 10.9% of the entire series. Seven teenagers had undergone previous operations for fibroadenoma and five growths were infarcted. The teenagers showed awareness of breast disease as manifested by (a) rising incidence trend during the 1970s, 1980s, and 1990s, (b) little delay in presenting for treatment and (c) smallness of the excised tumors.

Systematic review of fibroadenoma as a risk factor for breast cancer

Fibroadenoma (FA) is a common breast lesion occurring in 25% of asymptomatic women. Several studies considered FA as a risk factor for breast cancer, prompting a systematic review of the literature. We selected cohort and case-control studies. Seven studies satisfied the selection criteria. Dupont et al. (1994) and McDivitt et al. (1992) were considered to provide the strongest evidence, showing the relative risk for excised FA without hyperplasia in the range 1.48-1.7, with hyperplasia 3.47-3.7, and with hyperplasia and atypia 6.9-7.29, persisting for more than 20 years. Five studies by Levi et al. (1994), Ciatto et al. (1997), Moskowitz et al. (1980), Carter et al. (1988), and Levshin et al. (1998), were considered to provide weaker evidence, although they showed similar results. None of the results could be used to quantify the risks of excised, non-excised, and asymptomatic FA. More care should be taken in managing patients with complex FAs and FAs with hyperplasia with or without atypia. Core biopsy may be a better option in diagnosis of FAs. Regular screening may be advisable in patients with FAs and a family history of breast cancer in a first-degree relative. More rigorous research is needed in this area.

Urinary phytoestrogen excretion and breast cancer risk: evaluating potential effect modifiers endogenous estrogens and anthropometrics

Steroid sex hormones play a central role in breast carcinogenesis. Evidence from in vitro and animal studies suggests that phytoestrogens may inhibit the development of mammary tumors through their role in regulating the synthesis, metabolism, and signal transduction of steroid hormones. In a study of 117 case-control pairs of postmenopausal women in Shanghai, we investigated whether the association between urinary phytoestrogen excretion and breast cancer risk may differ by levels of endogenous steroid sex hormones, sex hormone binding globulin (SHBG), body mass index (BMI), and waist:hip ratio (WHR). Fasting morning blood and urine samples were collected for the analysis of urinary isoflavonoids and mammalian lignans, as well as blood levels of SHBG and selected steroid hormones. For cancer patients, samples were collected before any cancer therapy. Conditional logistic regression models were used to estimate odds ratios and 95% confidence intervals after adjusting for potential confounding factors. The inverse associations between urinary phytoestrogens and breast cancer risk were found to be more evident among women with a high BMI or WHR than those with a low level of these anthropometric measurements. Although a reduced risk of breast cancer was observed among women with a high excretion rate of urinary isoflavonoids in all of the strata defined by blood SHBG and steroid hormones, the inverse association was more pronounced among women with a high blood concentration of estradiol, a low level of estrone sulfate, or a low level of SHBG. The risks of breast cancer were also reduced with increasing excretion rate of mammalian lignans, although no test for a linear association was statistically significant in stratified analyses. Findings from this study suggest that the potential protective association of phytoestrogens may be modified by BMI, WHR, and blood levels of SHBG, and steroid hormones.

Spontaneous mammary tumors in aging Noble rats

Noble (Nb) rat strain has been used for the study of hormonal carcinogenesis of mammary and prostate glands, for its susceptibility to develop premalignant lesions as well as carcinomas in these organs by sex hormones. However, background information on the spontaneously developed mammary tumors in this rat strain is scarce. We report on the incidence rate, latency period and histopathology of mammary tumors spontaneously developed in the senile intact and untreated Nb rats compared with those induced by either combined treatments with sex steroids or 7,12-dimethylbenz[a]anthracene (DMBA) in the same rat strain. We observed that the incidence rate of spontaneous mammary tumors was 45% in female Nb rats and 3% in the males. The average age of the female Nb rats to develop palpable tumors was 14 months and rarely detected in animals less than 12 months old. It was also noted that the incidence rate of the spontaneous mammary tumors was similar to those induced by combined treatments with sex steroids for 8-10 months (46.7% for T+E2 and 55.6% for T+DES) but less than those by DMBA treatment in 8 months (over 80%). Histologically, majority of the spontaneous mammary tumors were fibroadenomas, which comprised 70% of all collected tumors and about 20% were carcinomas whereas tumors induced by steroid hormones and DMBA were all carcinomas. Distant metastases of spontaneous mammary carcinomas to lung, liver and lymph nodes were also noted, but rarely.

Comparison of full-field digital mammography to screen-film mammography with respect to diagnostic accuracy of lesion characterization in breast tissue biopsy specimens

RATIONALE AND OBJECTIVES

This study was performed to investigate whether full-field digital mammography (FFDM) is at least as accurate as screen-film mammography with respect to breast lesion characterization.

MATERIALS AND METHODS

Seventy-nine breast surgical specimens were obtained by means of preoperative needle localization with surgical excision from 79 patients. The specimens were imaged with both screen-film mammography and FFDM. Six radiologists specialized in breast imaging analyzed both sets of images and characterized the visualized lesions on a five-point scale: 1, definitely not malignant; 2, probably not malignant; 3, possibly malignant; 4, probably malignant; and 5, definitely malignant. Receiver operating characteristic curve analysis of the data was then performed to assess for differences between modalities in the radiologists' ability to predict breast malignancy.

RESULTS

The areas under the receiver operating characteristic curves for the prediction of breast malignancy in surgical biopsy specimens were not statistically significantly different for FFDM and screen-film mammography.

CONCLUSION

The results demonstrate that with breast surgical specimens, FFDM is similar in diagnostic accuracy to screen-film mammography.

Risk factors for fibroadenoma in a cohort of female textile workers in Shanghai, China

Risk factors for fibroadenoma were investigated in a cohort of 265,402 female textile workers in Shanghai, China, who were interviewed at enrollment into a randomized trial of breast self-examination between October 1989 and October 1991 and followed until July 2000. Based on 1,507 women who developed fibroadenoma, relative risks and trends in risk were estimated using Cox regression. The risk of fibroadenoma was highest in women under 35 years of age, and it decreased with age after 35 and dropped markedly at the time of menopause. The risk decreased with increasing number of livebirths and with duration of oral contraceptive use. The risk increased with number of prior benign breast lesions and with decreasing age at the first benign lesion. The risk of a diagnosis of fibroadenoma was elevated in women who received instruction in breast self-examination. The development and persistence of fibroadenomas are dependent on the presence of ovarian hormones, and full-term pregnancies and exposure to exogenous estrogen-progesterone combinations before menopause may reduce risk by enhancing differentiation or reducing estrogen-induced proliferation in the mammary epithelium. The practice of breast self-examination detects some fibroadenomas that would otherwise not be detected.

Giant fibroadenoma of the breast in an Arab population

In a retrospective study of giant breast masses over a period of 20 years (1980-2000), we encountered 18 patients with fibroadenomas. Most of them were adolescents and young adults. The bimodal age incidence seen in Caucasians was not observed. The masses ranged from 6 to 15 cm in size and in the youngest patient, they were bilateral. All 18 patients were examined by mammography and 10 of them by ultrasonography (US) as well. The right breast was involved in 12 patients and the left in six. The diagnosis was confirmed pathologically in all patients, by excision biopsy in 17 patients and by fine needle aspiration cytology and excision biopsy in one patient. The radiological findings were the same as those previously described. All patients were treated by simple enuculation. There was only one recurrence over a follow-up period from 2 months to 3 years.

Trends in benign breast tumors in Japanese women, 1973-1995: experience of Hiroshima Tumor Tissue Registry

Although some benign breast lesions such as multiple intraductal papilloma have been pointed out as a risk factor for breast cancer, there is little documentation about trends in the incidence of benign tumors of the breast in Japanese women. The author conducted an epidemiological study using data abstracted from the Hiroshima Tumor Tissue Registry file, which includes cases of malignant and benign neoplasms in Hiroshima prefecture between 1973 and 1995. A total of 17064 cases of female breast tumor were registered in the file between 1973 and 1995. The registration rate for fibroadenoma of the female breast was 19.5 among females and peaked during the 5-year period 1983 - 1987, while the fibroadenoma registration rate in Hiroshima gradually decreased between 1988 and 1995. The registration rate for intraductal papilloma has risen substantially in Hiroshima, with about a 5-fold increase among females between 1973 and 1995. The mean proportion of fibroadenoma cases accompanied by malignant tumors of the breast was 1.85%, and there was no significant change in the mean proportion between 1973 and 1995 (P = 0.17). On the other hand, the mean proportion of intraductal papilloma cases accompanied by malignant tumors of the breast gradually rose with about a 14-fold increase among females between 1973 and 1995. The significance of intraductal papilloma as a risk factor for breast cancer may have increased.

Benign breast lesions in prepubertal female children--a study of 20 years

A clinicopathological study of benign breast lesions in prepubertal female children was done retrospectively for 20 years. Thirty-seven cases of benign breast lesions like fibroadenoma in 22 (59.5%) cases, juvenile fibroadenoma in 9 (24.2%) cases, virginal hypertrophy in 3 (8.1 %) cases, cystosarcoma phylloides, duct papilloma and tuberculosis of the breast in one (2.7%) case each were seen. The majority of the cases of breast lesions were from urban area ie, 34 (91 .9%) cases. The commonest age of occurrence of benign breast lesion was observed between 7.5 and 11.5 years. In 2 (5.4%) cases bilateral virginal hypertrophy was seen. The aim of presenting this paper is to study the occurrence of breast lesions in prepubertal age especially before menarche. In rare case even the possibility of malignancy has to be ruled out.

Benign breast diseases in an Afro-Caribbean population

BACKGROUND

The diagnosis and effective treatment of benign breast disease still remains a clinical challenge and the need for surgical intervention has not been clearly defined.

OBJECTIVES

To determine the patterns of benign breast disease in an Afro-Caribbean population in order to define the patterns of disease encountered and to review the approach to diagnosis and treatment.

METHODS

A review of all breast biopsy operations performed for benign disease at the Kingston Public Hospital, Jamaica was made by examining a total of 333 patient records over a two year period.

RESULTS

Of the cases reviewed this study clearly showed that the majority of benign breast lesions were due to fibrocystic disease (41%) and fibroadenomas (33%). Intraduct papillomatosis which accounted for 6.7% was the next in frequency. Other diseases found included fat necrosis 12 (4.4%) with breast abscess and mammary duct ectasia in eight patients (3%) each. Fourteen patients (5%) had no diagnostic abnormality. The mean age of patients with fibroadenoma was 20 years whereas the mean age of patients with fibrocystic disease was 40 years. The co-existence of fibrocystic disease with malignancy was reported in 15 cases.

CONCLUSION

Benign breast disease in this population occurs mainly in young women less than 30 years of age. Eighty per cent of breast biopsies done in patients with palpable lumps are for benign disease. The data support a more conservative approach to diagnosis and management of these patients.

The significance of malignancies incidental to microcalcifications in breast spot localization biopsy specimens

BACKGROUND

Incidental breast cancer is occasionally found in spot localization biopsy specimens adjacent to mirocalcifications in benign breast disease. Because this phenomenon could prove problematic for percutaneous sampling of microcalcifications without excisional biopsy, we studied surgical specimens from patients with cancers incidental to microcalcifications and compared them with specimens with microcalcifications within the malignancy.

METHODS

The pathology database at the Mount Sinai Medical Center from January 1993 to July 1998 was reviewed to identify breast cancer patients who underwent spot localization biopsy for microcalcifications. Patients presenting with microcalcifications within malignancy (determinate) were compared with patients with mirocalcifications in benign breast tissue adjacent to malignancy (incidental).

RESULTS

Thirty-two (13%) of the 241 specimens had microcalcifications in benign tissue adjacent to malignancy and 209 (87%) had microcalcifications within the malignancy. Fifty-six percent of the incidental cases and 65% of the controls had ductal carcinoma in situ. Infiltrating lobular carcinoma accounted for 25% of the incidental cancers and 2% of the determinate cancers (P <0.001). Fifty-seven percent of the infiltrating carcinomas incidental to mammographic findings were infiltrating lobular carcinoma compared with 7% of the nonincidental infiltrating carcinomas. None of the incidental invasive carcinomas were poorly differentiated (P = 0.002). There were no significant differences with regard to age, tumor size, stage, differentiation, estrogen and progesterone receptors, type of surgery and final margin status. In none of the patients with incidental malignancies did local or distant recurrences develop.

CONCLUSIONS

Incidental carcinomas were found in 13% of spot localization biopsy specimens obtained for suspicious mammographic microcalcifications and have a favorable prognosis. Infiltrating lobular carcinomas are more commonly found with incidental microcalcifications than with determinate microcalcifications, and incidental invasive carcinomas are less likely to be poorly differentiated. The majority of malignancies, both determinate and incidental to microcalcifications, are due to ductal carcinoma in situ. Incidental malignancies commonly occur adjacent to fibrocystic changes and their other pathologic characteristics are not significantly different from nonincidental carcinomas. Despite the absence of radiographic findings, these patients can be successfully treated with breast conservation.

Benign breast disease at Wesley Guild Hospital, Ilesha, Nigeria

A prospective survey of 225 patients carried out over a period of 7years (1992 - 1999) to determine the pattern and outcome of benign breast diseases. Two hundred and seventeen (96.4%) were females and 8 males, with the age ranging from 14-63 years, mean 28.7 SD+10.6 years. The mean age for patients with fibroadenoma was 24 years and 31.6 years for fibrocystic disease of the breast. One hundred and ninety six patients (87.2%) presented with breast lumps or mass, non-menstrual cycle and menstrual cycle related pain in 39(17.3%) and 32(13%) patients respectively and nipple discharge in 60 patients (26.7%). Mean duration of symptoms was 0.91+0.64 years, 2 + 1.2 weeks for inflammatory lesions and 0.86 + 0.56 yers for benign tumours and also menstrual cycle related breast pain. Right side was involved in 162 patients (72%), 85(38%) left side and 77(34.2%) bilateral. Clinical diagnosis was fibrocystic disease 96(42.7%). Fibroadenoma 89 (39.5%), inflammatory conditions 35(15.7%), galactocele in 9(40%) and gynaecomastia in 7(3%) of the patients. Excisional or incisional biopsy was carried out in 197 patients (87.5%), antibiotic and analgestic administration in 35(15.6%) and 29(13%), respectively. Histopathologic analysis showed fibroadenoma in 91 (46.2%), fibrocystic disease 83 (42.2%), and others in 23 (11.6%) cases. The mean follow-up period was 10 months for tumours and I month for others. Postoperative complications were infrequent, there were recurrence either on the ipsilateral or contralateral breast in 10(4.4%) patients of which 3(1.3%) cases were malignant.

CONCLUSION

Fibroadenoma was the most common benign breast disease, followed by fibrocystic disease of the breast. Postoperative complications were uncommon.

Breast tumors during adolescence

A variety of benign tumors may involve the breast of the adolescent female. Neoplasms and cysts originating from the breast tissue itself, as well as from anatomically related tissues such as lymph nodes may occur. Imaging of the adolescent with a breast mass varies from that of the mature women because of the extremely uncommon occurrence of breast malignancy is this younger population. During a 22-year period (1978-99), 684 young females (14-20 years) were referred to the Breast Unit of the 1st Department of Obstetrics and Gynecology in the major University-appointed hospital of the University of Athens, because of breast masses. The clinical and imaging evaluation of the masses confirmed their presence in the majority of cases. Most cases (442-64.6%) were managed conservatively and carefully followed-up. In 242 cases (35.4%) ablation of the masses was performed. Biopsy showed 236 (97.5%) benign and 6 (2.5%) malignant tumors. The malignant tumors were 2 cases of hemangiosarcoma, 1 case of rhabdomyosarcoma, 1 case of ductual carcinoma, 1 case of cystosarcoma phylloides and 1 case of metastatic rhabdomyosarcoma from the eye. In three cases patients died as a consequence of the disease, two survived and one was lost due to the family's wishes to be transfered to another oncology department abroad.

Pattern of breast diseases in a teaching hospital in Jeddah, Saudi Arabia

OBJECTIVE

The aim of this case series study is to evaluate the outline and pattern of male and female breast diseases in Saudi Arabia. Also to compare 8 studies of literature discussing the profile of malignant and benign female breast diseases in the Kingdom. We hope that this study will assist us to appreciate the prototype breast diseases in our region.

METHODS

Our study consisted of 1084 consecutive male and female breast lesions. Data on these specimens, received in the time frame of 15 years between January 1984 and March 2000, was retrieved from the records of the laboratory. The outline of breast lesions were tabulated and classified into inflammatory, benign and malignant lesions.

RESULTS

In female breasts, benign lesions comprised 57% of all lesions (mean age 28.5), most commonly reported being fibroadenoma 47%, fibrocystic disease 22% and fibroadenosis 14%. Malignant lesions comprised 32.5% of all lesions (mean age 48.49), most commonly reported being ductal carcinoma 88% and lobular carcinoma 4.5%. Inflammatory lesions comprised 11% of all lesions (mean age 35.0), most commonly reported lesion being chronic mastitis 31% and ductectasia 19%. Male benign lesions comprised 55 cases (87%). Eight cases (13%) of malignant lesions, 6 ductal carcinomas and 2 metastatic adenocarcinomas, were also identified.

CONCLUSION

The rates for female breast lesions varied in different studies but benign fibroadenoma constituted the most common breast lesion and secondly ductal carcinoma. The mean age for malignant lesion in 7 different studies came to be 44.05. In the male breast, carcinomas constituted 3% of all breast carcinomas. Gynecomastia being the most common male breast lesion constituting 54%.

An incidental case of breast cysticercosis associated with fibroadenoma

It is unusual for cysticercosis to occur in the substance of the breast. Only a few cases have been described in the literature. We report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 35 year old Nepali woman. The patient had no discernible evidence of cysticercosis in the other organs.

Computer-aided diagnosis for surgical office-based breast ultrasound

HYPOTHESIS

The computer-aided diagnostic system is an intelligent system with great potential for categorizing solid breast nodules. It can be used conveniently for surgical office-based digital ultrasonography (US) of the breast.

DESIGN

Retrospective, nonrandomized study.

SETTING

University teaching hospital.

PATIENTS

We retrospectively reviewed 243 medical records of digital US images of the breast of pathologically proved, benign breast tumors from 161 patients (ie, 136 fibroadenomas and 25 fibrocystic nodules), and carcinomas from 82 patients (ie, 73 invasive duct carcinomas, 5 invasive lobular carcinomas, and 4 intraductal carcinomas). The digital US images were consecutively recorded from January 1, 1997, to December 31, 1998.

INTERVENTION

The physician selected the region of interest on the digital US image. Then a learning vector quantization model with 24 autocorrelation texture features is used to classify the tumor as benign or malignant. In the experiment, 153 cases were arbitrarily selected to be the training set of the learning vector quantization model and 90 cases were selected to evaluate the performance. One experienced radiologist who was completely blind to these cases was asked to classify these tumors in the test set.

MAIN OUTCOME MEASURE

Contribution of breast US to diagnosis.

RESULTS

The performance comparison results illustrated the following: accuracy, 90%; sensitivity, 96.67%; specificity, 86.67%; positive predictive value, 78.38%; and negative predictive value, 98.11% for the computer-aided diagnostic (CAD) system and accuracy, 86.67%; sensitivity, 86.67%; specificity, 86.67%; positive predictive value, 76.47%; and negative predictive value, 92.86% for the radiologist.

CONCLUSION

The proposed CAD system provides an immediate second opinion. An accurate preoperative diagnosis can be routinely established for surgical office-based digital US of the breast. The diagnostic rate was even better than the results of an experienced radiologist. The high negative predictive rate by the CAD system can avert benign biopsies. It can be easily implemented on existing commercial diagnostic digital US machines. For most available diagnostic digital US machines, all that would be required for the CAD system is only a personal computer loaded with CAD software.

Fibroadenoma of the supernumerary breast of the axilla

Supernumerary breast or polymastia is a well documented anomaly of the breast, and commonly presents along the embryonic milk line extending between the axilla and groin. However, cases of polymastia have been recorded in the face, vulva and perineum. The clinical significances of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems. The present article reports a case of fibroadenoma developing in the supernumerary breast of the right axilla in a 28 year old woman. Clinical and mammography examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue. The article also outlines the common congenital anomalies of the breast, and emphasizes on their proper clinical assessment for any other associated anomaly together with adequate surgical excision and regular follow up of the treated patients.

Population-based, case-control study of HER2 genetic polymorphism and breast cancer risk

BACKGROUND

Alterations of the HER2 (also known as erbB-2 or neu) proto-oncogene have been implicated in the carcinogenesis and prognosis of breast cancer. A polymorphism at codon 655 (GTC/valine to ATC /isoleucine [Val(655)Ile]) in the transmembrane domain-coding region of this gene has been identified and may be associated with the risk of breast cancer. We evaluated this hypothesis in a subgroup of women who participated in a large-scale, population-based, case-control study of breast cancer in Shanghai, China.

METHODS

Genomic DNA from 339 patients with breast cancer and 361 healthy control subjects was examined for the Val(655)Ile polymorphism with a polymerase chain reaction-restriction fragment-length polymorphism-based assay. All study subjects completed a structured questionnaire during an in-person interview. All P values are from two-sided tests.

RESULTS

We found that 25.1% of the case patients and 21.7% of the control subjects were heterozygous for the Val allele and 3.2% of the case patients and 0. 3% of the control subjects were homozygous for this allele (P =.005). Compared with women with the Ile/Ile genotype, women who had the Ile/Val or Val/Val genotype had an elevated risk of breast cancer (odds ratio [OR] = 1.4; 95% confidence interval [CI] = 1.0-2.0; P =. 05) after adjustment for age, educational level, study period, history of breast fibroadenoma, leisure physical activity, and age at first live birth. The risk was elevated even more among women who were homozygous for the Val allele (OR = 14.1; 95% CI = 1.8-113.4). The association was more pronounced among younger women (</=45 years) than among older women (>45 years). The adjusted OR associated with the Val allele was 1.7 (95% CI = 1.1-2.6) for younger women and 1.0 (95% CI = 0.5-1.9) for older women.

CONCLUSIONS

Results of this study suggest that polymorphisms of the HER2 gene may be important susceptibility biomarkers for breast cancer risk, particularly among younger women.

Breast cancer in Iran: a review of 903 case records

A retrospective study was carried out in five main General District and Teaching Hospitals in Tehran (18 general surgical wards) to investigate breast cancer in Tehran, Iran. All patients who have had breast pathology during 1985-95 were reviewed. For each patient the following data were extracted from case records sex, age, type of disease (based on ICD-10 and ICD-O), breast cancer pathology, tumor size, lymph node involvement, pathological staging (based on TNM system), type of surgery, mass location and the affected side of breast. In all 3085 records were reviewed. Of these, in 903 cases the final diagnosis was breast cancer. The mean age of breast cancer patients was 47.1 (SD=12.3) y and the age-adjusted analysis showed that the observed number of breast cancer cases in the age group 40-49 was higher than expected (P<0.001). The majority of patients (71%) were patients with infiltrating ductal carcinoma, 70% had advanced disease (Stage III), and in 51% of cases the tumour was more than 5 cm in size. Finally it was found that two-third of patients (76%) underwent modified radical mastectomy. Although this study does not address true incidence, but rather frequency, the findings suggest that the Iranian breast cancer patients are relatively younger than their western counterparts and mostly have locally advanced disease. In terms of breast cancer screening programs, these findings have some implications for public health professionals in Iran.

Benign and malignant mammary tumors induced by DMBA in female Wistar rats

This study pretends to characterize 7, 12-dimetylbenz[a]anthracene-induced benign and malignant tumors. One hundred and twenty female Wistar rats were randomly allocated to two groups: Control Group and Induction Group; IG animals were given a single dose of DMBA and killed 24 weeks after. Other tumors besides breast tumors were diagnosed, mainly tumors of the salivary glands and ovarian benign epithelial tumors. Incidence of breast disorders was about 60%. Macroscopic mammary tumors varied in dimension from 2 mm to 55 mm. Malignant breast tumors (n = 56) were essentially invasive ductal carcinomas (91.1%), G1 (92.2%), presenting histologic characteristics of good prognosis. Predominant benign breast disorders consisted of glandular (68.6%) and atypical (20%) hyperplasias reproducing histologic types of human breast diseases. Different individual susceptibility to DMBA apparently occurs; while some rats never developed neoplasias, others exhibited several tumors.

Breast masses in African American teenage girls

PURPOSE

The aim of this study was to evaluate the incidence of malignancy in breast lumps excised from African American teenagers.

METHODS

The authors reviewed the pathology records at King's County Hospital Center between January 1982 and December 1992. The pathology reports and charts of all patients who had breast masses excised during this period were reviewed. Data for this study were derived from the group of African American and black Caribbean American teenage patients who underwent breast biopsies and whose pathology reports and medical records were available. The age of patients, size of the lesion, and diagnosis were recorded.

RESULTS

Medical records from 155 African American and black Caribbean American girls between the ages of 13 and 19 years (inclusive) who underwent breast biopsies between January 1982 and December 1992 were reviewed. Fibroadenoma was the most common diagnosis (127 of 155; 82%). This was followed in frequency by fibrocystic mastopathy (18 of 155; 11.6%) and breast abscess (3 of 155; 2%). None of the patients had a malignancy. Review of tumor registry data from the same time period at Kings County Hospital Center and the University Hospital of Brooklyn showed that the youngest African American or black Caribbean American patient diagnosed with breast cancer was 21 years of age.

CONCLUSIONS

The incidence of malignant breast lumps in African American and black Caribbean American teenagers is distinctly low. Conservative treatment in this population is warranted, and diagnosis can be made easily in most cases with either needle aspiration for cytology or core biopsy of any lesions discovered.

A cohort study of cigarette smoking and risk of fibroadenoma

BACKGROUND

This cohort study examines the association between cigarette smoking and risk of fibroadenoma.

METHODS

The study was conducted among the 56,537 women in the Canadian National Breast Screening Study (NBSS) who completed self-administered lifestyle and dietary questionnaires. (The NBSS is a randomised, controlled trial of screening for breast cancer in women aged 40-59 at recruitment.) Cases were the 222 women who were diagnosed with biopsy-confirmed incident fibroadenoma. For comparative purposes, a subcohort, consisting of a random sample of 5,681 women was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 222 cases and 5,488 non-cases. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using Poisson regression.

RESULTS

Cigarette smoking was associated with reduced risk of fibroadenoma, the IRR (95% CI) for more than 550 cigarette-years of exposure being 0.66 (0.40-1.10). Although the reduction in risk was evident for all smokers combined (ex-smokers and current smokers), it was indicative largely of an inverse association in current smokers, in whom the IRR (95% CI) for > 300 cigarette-years of exposure was 0.49 (0.24-0.98). The results were mostly the same when examined in strata defined by method of detection of fibroadenoma, menopausal status and history of previous breast disease. There was no evidence for a reduction in risk with time since last use of cigarettes.

CONCLUSIONS

The results of this study suggest that cigarette smoking is associated with reduced risk of fibroadenoma, especially in current smokers.

Chronic toxicity, oncogenicity, and mutagenicity studies with chlorotetrafluoroethane (HCFC-124)

The chronic toxicity, oncogenicity, and mutagenicity of chlorotetrafluoroethane (HCFC-124) were evaluated. In the chronic toxicity/oncogenicity study, male and female rats were exposed to 0, 2000, 10,000, or 50,000 ppm HCFC-124 for 6 hr/day, 5 days/week, for 2 years. Body weights were obtained weekly during the first three months of the study and every other week for the remainder of the study. Food consumption was determined weekly. Clinical signs of toxicity were monitored throughout the study. An ophthalmological examination was performed on all animals prior to study start, and all surviving rats were examined at approximately 3, 12, and 24 months after study start. Clinical pathology was evaluated at 3, 6, 12, 18, and 24 months. An interim termination was conducted at 12 months. All surviving rats were necropsied at 24 months. A complete set of tissues was collected for microscopic examination, and selected tissues were weighed. There were no compound-related, adverse effects on body weight, food consumption, survival, clinical signs of toxicity, ophthalmoscopically observable ocular lesions, serum hormone concentrations, or clinical pathology parameters at any exposure concentration in either male or female rats. Compared to controls, urine fluoride was increased in males and females at all exposure concentrations, and plasma fluoride was increased in females at all exposure concentrations. Excretion of fluoride represents conversion of the parent molecule, and as such is not considered to be an adverse effect. There were no toxicologically significant, compound-related organ weight changes or gross or microscopic findings in male or female rats at any of the exposure concentrations tested. HCFC-124 was not toxic or carcinogenic in rats of either sex after inhalation exposure at concentrations of up to 50,000 ppm in this two-year chronic toxicity/oncogenicity study. After exposure to HCFC-124 for six hours per day, five days per week, for 24 months, the no-observed-adverse-effect level for male and female rats was 50,000 ppm. HCFC-124 was not mutagenic in Salmonella typhimurium strains TA1535, TA97, TA98, and TA100 with and without activation when evaluated at concentrations up to 60% HCFC-124 for 48 hours. No evidence of clastogenic activity was observed in cultured human lymphocytes at atmospheric concentrations up to 100% HCFC-124 for 3 hours, with and without metabolic activation. In vivo, no micronuclei were induced in mouse bone marrow cells following exposure of mice to concentrations of 99,000 ppm HCFC-124 6 hours/day for 2 days.

Spectrum of breast disease in young females: a retrospective study of 1315 patients

A total of 1315 breast lesions seen in women up to 40 years of age were registered in the files of Pathology Department. Out of these 807 were benign and 508 malignant lesions. Breast carcinoma was very rare up to second decade of life but its incidence progressively increased with age. Among benign tumours fibroadenomas were the commonest tumours. This study shows a higher incidence of inflammatory diseases and malignant tumours in young females as compared to the reports from the West.

Implementation of image-guided large-core needle biopsy of the breast on a limited budget

Image-guided large-core needle biopsy (LCNB) of the breast is becoming widely accepted as an accurate, minimally invasive and economical way to obtain a tissue diagnosis of breast lesions. However, much of this work has been done with expensive dedicated equipment, often favouring stereotaxic guidance. Image-guided LCNB was introduced to Middlemore Hospital based around existing inexpensive equipment, and stereotaxic or ultrasound guidance was chosen depending on which showed the lesion best. Multidisciplinary clinical, radiological and pathological assessment of each case was performed. The results of 213 biopsies (112 stereotaxic and 101 ultrasound guidance) are reported here. Malignancy was shown or suspected in 85 biopsies (40%). The absolute sensitivity for malignancy was 97% with complete sensitivity of 100%. The absolute specificity was 100% and the complete specificity 98.5%. Large-core needle biopsy can be successfully implemented in a large institution without investment in expensive equipment while maintaining high ratios of malignant/benign biopsies. Attention to technique and careful multidisciplinary review are important to the success of such a programme.

Short-term outcome of chronic immunosuppression on the development of breast lesions in premenopausal heart and lung transplant patients

The risk of development of breast lesions in patients on chronic immunosuppression is unknown. In order to assess this risk, a retrospective review was performed of the records of 87 women between the ages of 12 and 47 years who received thoracic organ transplant from 1987 to 1996 at our institution. Inclusion criteria consisted of patients who were premenopausal, had no previous history of breast disease, and survived for at least 1 year posttransplantation. All patients were on a triple immunosuppressive regimen consisting of cyclosporine, steroids, and azathioprine. Mean follow-up was 4 +/- 1.2 years with a range of 1-6 years. During this period, 21 patients (24%) with a mean age of 38 +/- 10 years had screening or diagnostic mammography. The remainder of patients with a mean age of 24 +/- 9 years were followed clinically. Overall, 10 patients (11%) developed a total of 17 palpable, solid lesions at 33 to 72 months posttransplantation. Fifteen of these lesions were surgically excised. Five of the patients had multiple lesions. Pathological examination of the specimens revealed fibroadenoma in nine, fibrocystic disease in four, low grade phylloides tumor in one, and T-cell lymphoma in one case. None of the patients have developed primary breast cancer during follow-up. In conclusion, short-term immunosuppression does not increase the risk of the development of benign breast lesions in young women after thoracic organ transplantation, but rather the distribution of benign lesions is similar in an age-matched population. There were several cases of multiple fibroadenomas in the transplant population, but mammography revealed no malignant disease in this age group and does not need to be utilized in this population beyond what is considered standard for immunocompetent patients. The long-term effect ofimmunosuppressive therapy on the developmentof breast cancer in this group remains to be defined.

[Risk factors and correlations with some tumor markers in the incidence of breast cancer in pre- and post-menopausal patients]

Between January and November 1992, forty eight women with benign disorders of the breast were studied and compared with one hundred fifty two patients with malignant disease of the breast. The content of alkaline phosphatase (ALP) levels was measured in the serum of premenopausal and postmenopausal patients. In all of them clinical history was taken, weight size and corporal mass index (CMI) (weight/size2). When the patients were grouped according to type of breast lesions, it appeared that plasmatic ALP levels, were higher in the groups with infiltrating carcinoma than in the women with benign disorders of the breast. The physiological status of the enzyme in this study, relate probably the activity of the tissue in either benign or malignant tissue, through fibroadenoma had less activity than adenocarcinoma. Status ALP (> or = 90 UI/L), CMI, menstrual state and histological type were compared. We found a significant correlation between these parameters.