3
138 ABSTRACT OBJECTIVE: To evaluate the frequency of benign and malignant breast diseases in females at Pathology Department, Al-Nafees Medical College & Hospital (ANMCH) Islamabad STUDY DESIGN: A Cross sectional study th th PLACE AND DURATION: From 10 January, 2015 to 20 October, 2015 at Department of Pathology, Al-Nafees Medical College & Hospital (ANMCH) Islamabad. METHODOLOGY: 120 breast specimens collected in a period of 9 months at pathology laboratory, Al-Nafees Medical College & Hospital (ANMCH) Islamabad were fixed in formalin, processed by automated tissue processor. Slides were stained with H&E stain and examined by consultant histopathologist under light microscope. All slides were divided into benign and malignant cases. Malignant cases were further graded according to Modified Bloom and Richardson system. RESULTS: Among total 120 breast specimens, commonest lesion is fibroadenoma (51%) followed by infiltrating duct carcinoma (12.5 %), breast abscess (11.6 %), fibrocystic change (10.8%), mastitis (3.3%) and medullary carcinoma (3.3%). CONCLUSION: Benign breast lesions were more common than malignant lesions in our study. Fibroadenoma was the commonest breast pathology. KEYWORDS: Frequency, Breast, Fibroadenoma, Infiltrating Ductal Carcinoma ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 8 - Issue 3 | July - Sep 2016 INTRODUCTION 1 The frequency of breast lesions are increasing worldwide. The presentation of breast lesions depends upon socio-economic conditions, the level of health awareness and knowledge about 2 breast diseases in general population. Breast carcinoma ranks first among all malignancies affecting females in most regions of 3,4 the world. The impact of breast disease in the Western society assumes even greater importance as the incidence of breast cancer continues to increase steadily. There is vast difference in the range of breast lesions and .5-9 epidemiology of breast carcinomas in different countries Both benign and malignant diseases occur in men and women of all ages but benign lesion tend to occur more commonly at younger age than cancer. Benign breast diseases are common with estimate of over half of the female population at some 10 time in life seeking medical advice for breast problem. In Pakistan, various researches on breast conditions are mostly 11-12 related to malignancies. Incidence of breast cancer varies being highest in North America and Western Europe, while it is 13 lowest in Asia and Africa. The incidence of carcinoma of breast in Pakistan is high thus making it the most common malignancy 14 among Pakistani females. To evaluate the spectrum of breast diseases , we are analyzing the biopsy findings of various breast diseases in females. METHODOLOGY It is a cross sectional study conducted at Department of Pathology, Al-Nafees Medical College & Hospital (ANMCH) th Islamabad over a period of nine months i.e, from 10 January, th 2015 to 20 October, 2015. All breast specimens of mastectomy, lumpectomy, needle biopsy and others were included in the study. Breast specimens from male patients were excluded from the study. A total of 120 specimens were analyzed. All specimens were collected in formalin and processed in automated tissue processor. Paraffin embedded sections were stained with the hematoxylin and eosin stain. Slides were examined by consultant pathologist under light microscope. Benign and malignant cases were separated. Grading of breast carcinoma was done according to the Modified Bloom and Richardson 15 system. Frequencies of various breast lesions were calculated by SPSS version 20 and is represented in tables and graphs. RESULTS During the period of nine months, 120 breast specimens were received. The nature of breast lesions in order of decreasing frequency is presented in table-I. Among the various breast lesions, fibroadenoma was the most common disease. It was found in 51%(n=61) of patients. Next common disease is infiltrating ductal carcinoma found in 12.5 %(n=15) of patients. Grading was done for all 15 cases of infiltrating ductal FREQUENCY OF BENIGN AND MALIGNANT BREAST LESIONS: A HISTOPATHOLOGICAL ANALYSIS 1 1 2 3 ANUM USMAN , AYESHA ALI , NOOR KHAN LAKHANNA , HUMAIRA ZAFAR 1. Post Graduate Resident- MPhil Histopathology, Al Nafees Medical College & Hospital, Isra University Islamabad Campus, Pakistan 2. P rofessor of Pathology Department 3. Assistant Professor of Microbiology, Al Nafees Medical College & Hospital, Isra University Islamabad Campus, Pakistan Correspondence to: Anum Usman Post Graduate Resident- MPhil Histopathology, Al Nafees Medical College & Hospital, Isra University Islamabad Campus, Pakistan Email: [email protected] Received for Publication: 28-01-16 Accepted for Publication: 02-08-16

FREQUENCY OF BENIGN AND MALIGNANT BREAST LESIONS: A …€¦ · FREQUENCY OF BENIGN AND MALIGNANT BREAST LESIONS: A HISTOPATHOLOGICAL ANALYSIS ANUM USMAN, AYESHA ALI, NOOR KHAN LAKHANNA,

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Page 1: FREQUENCY OF BENIGN AND MALIGNANT BREAST LESIONS: A …€¦ · FREQUENCY OF BENIGN AND MALIGNANT BREAST LESIONS: A HISTOPATHOLOGICAL ANALYSIS ANUM USMAN, AYESHA ALI, NOOR KHAN LAKHANNA,

138

ABSTRACT

OBJECTIVE: To evaluate the frequency of benign and malignant breast diseases in females at Pathology Department, Al-Nafees Medical College & Hospital (ANMCH) IslamabadSTUDY DESIGN: A Cross sectional study

th thPLACE AND DURATION: From 10 January, 2015 to 20 October, 2015 at Department of Pathology, Al-Nafees Medical College & Hospital (ANMCH) Islamabad. METHODOLOGY: 120 breast specimens collected in a period of 9 months at pathology laboratory, Al-Nafees Medical College & Hospital (ANMCH) Islamabad were fixed in formalin, processed by automated tissue processor. Slides were stained with H&E stain and examined by consultant histopathologist under light microscope. All slides were divided into benign and malignant cases. Malignant cases were further graded according to Modified Bloom and Richardson system.RESULTS: Among total 120 breast specimens, commonest lesion is fibroadenoma (51%) followed by infiltrating duct carcinoma (12.5 %), breast abscess (11.6 %), fibrocystic change (10.8%), mastitis (3.3%) and medullary carcinoma (3.3%).CONCLUSION: Benign breast lesions were more common than malignant lesions in our study. Fibroadenoma was the commonest breast pathology. KEYWORDS: Frequency, Breast, Fibroadenoma, Infiltrating Ductal Carcinoma

ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 8 - Issue 3 | July - Sep 2016

INTRODUCTION

1The frequency of breast lesions are increasing worldwide. The presentation of breast lesions depends upon socio-economic conditions, the level of health awareness and knowledge about

2 breast diseases in general population. Breast carcinoma ranks first among all malignancies affecting females in most regions of

3,4 the world. The impact of breast disease in the Western society assumes even greater importance as the incidence of breast

cancer continues to increase steadily.There is vast difference in the range of breast lesions and

.5-9epidemiology of breast carcinomas in different countries Both benign and malignant diseases occur in men and women of all ages but benign lesion tend to occur more commonly at younger age than cancer. Benign breast diseases are common with estimate of over half of the female population at some

10time in life seeking medical advice for breast problem. In Pakistan, various researches on breast conditions are mostly

11-12related to malignancies. Incidence of breast cancer varies

being highest in North America and Western Europe, while it is 13lowest in Asia and Africa. The incidence of carcinoma of breast

in Pakistan is high thus making it the most common malignancy 14among Pakistani females. To evaluate the spectrum of breast

diseases , we are analyzing the biopsy findings of various breast diseases in females.

METHODOLOGY

It is a cross sectional study conducted at Department of Pathology, Al-Nafees Medical College & Hospital (ANMCH)

thIslamabad over a period of nine months i.e, from 10 January, th2015 to 20 October, 2015. All breast specimens of mastectomy,

lumpectomy, needle biopsy and others were included in the study. Breast specimens from male patients were excluded from the study. A total of 120 specimens were analyzed. All specimens were collected in formalin and processed in automated tissue processor. Paraffin embedded sections were stained with the hematoxylin and eosin stain. Slides were examined by consultant pathologist under light microscope. Benign and malignant cases were separated. Grading of breast carcinoma was done according to the Modified Bloom and Richardson

15system. Frequencies of various breast lesions were calculated by SPSS version 20 and is represented in tables and graphs.

RESULTS

During the period of nine months, 120 breast specimens were received. The nature of breast lesions in order of decreasing frequency is presented in table-I. Among the various breast lesions, fibroadenoma was the most common disease. It was found in 51%(n=61) of patients. Next common disease is infiltrating ductal carcinoma found in 12.5 %(n=15) of patients. Grading was done for all 15 cases of infiltrating ductal

FREQUENCY OF BENIGN AND MALIGNANT BREAST LESIONS:A HISTOPATHOLOGICAL ANALYSIS

1 1 2 3ANUM USMAN , AYESHA ALI , NOOR KHAN LAKHANNA , HUMAIRA ZAFAR

1. �Post Graduate Resident- MPhil Histopathology, Al Nafees Medical College & Hospital, Isra University Islamabad Campus, Pakistan2. P� rofessor of Pathology Department 3. �Assistant Professor of Microbiology, Al Nafees Medical College & Hospital, Isra University Islamabad Campus, Pakistan

Correspondence to:Anum UsmanPost Graduate Resident- MPhil Histopathology,Al Nafees Medical College & Hospital, Isra University Islamabad Campus, PakistanEmail: [email protected]

Received for Publication: 28-01-16Accepted for Publication: 02-08-16

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ISRA MEDICAL JOURNAL | Volume 8 - Issue 3 | July - Sep 2016Anum Usman et al.

139

phyllodes tumor 1.6%(n=2), tubular adenoma 1.6%(n=2 ), lipoma 1.6 %(n=2), infiltrating lobular carcinoma , mucinous carcinoma and metastatic carcinoma 0.83%(n=1).

3,25abcess. It is easily managed by the use of medication so there is less chances of high rate of these lesions. Medullary carcinoma comprises also 3.3 %. Lipoma, phyllodes tumor and tubular adenoma comprises 1.6%. Infiltrating lobular carcinoma and mucinous carcinoma comprise 0.83 % in our study. In this study 2 cases were of benign breast hypertrophy and ectopic breast in axilla.In order to alleviate anxiety of patients, an early diagnosis of breast disease is very important. So for early diagnosis of breast lesions, education of females about self assessment of breasts, need for mammography and early seek for medical help should be done.

CONCLUSION

Fibroadenoma is the commonest diagnosis. Infiltrating ductal carcinoma (Not otherwise specified) is the commonest malignant type of breast carcinoma.

Contribution of authors: Anum Usman: Corresponding author, provoking the idea of manuscript, introduction and methodology writing.Ayesha Ali: Collection of References for introduction and discussionNoor Khan Lakhnana: Histopathological diagnosis of all breast specimensHumaira Zafar: Final formatting of entire manuscript, Result and discussion writing

REFERENCES

1. Farkhanda J, Sharif A, Ahsan A, Noor M, Imtiaz S, Zulfiqar I. An early diagnosis of benign breast diseases. J of Surg Pak. 2010;15(4):186-89.

carcinoma. Among them grade 1 includes 2 patients while grade 2 and 3 includes 7 and 6 patients respectively. Followed by breast abscess 11.6 %(n=14 ), fibrocystic disease 10.8 %(n=13), breast mastitis 3.3%(n=4) , medullary carcinoma 3.3 %(n=3),

DISCUSSION

In Pakistan, the data regarding frequency of various breast lesions is limited. The studies mostly done have focused on breast cancer statistics. We have conducted this study in order to gain awareness about the distribution of breast diseases at our institute. The most common disease in our study was fibroadenoma

16-17which is in concordance with other studies in Pakistan. In our study fibroadenoma is 51% which is higher than the documented frequency in England (7.7%) and USA (8.5%), but

18lower in Saudia Arabia and Jordan. The high frequency of fibroadenoma was also reported in black American, African and India as compared to low frequency in the Western white

19-21females. The causes of increased frequency can be related to the awareness of the patient to visit the doctor for a palpable lesion.Ductal carcinoma of the breast has been reported as the second common among all breast diseases in our study. There are various studies in Pakistan which revealed that breast carcinoma is the most common breast disease among females

22and accounts for 25% of all tumors. In one study conducted at Karachi, breast carcinoma marked as the third commonest

23 lesion in females. So, infiltrating ductal carcinoma is the common entity and its early diagnosis is very necessary for the benefit of patients.Breast abcess is the third most common lesion in our study comprising 11.6%. Fibrocystic disease marks as fourth common lesion in our study comprising 10.8% of the total lesions. It is very common breast disease in England (37%) and America

24,25(33.9%). According to one study in Saudia Arabia, it comprises the second common lesion because of increased biopsy and mammographic application. As it ranks at different levels at different areas, to detect it as early as possible regular mammography has to be done.Mastitis comprised 3.3% and has low frequency than the documented cases in other studies because presentation of mastitis in patients is delayed till it is symptomatic and forms an

GRAPH 1: SHOWS DECREASING ORDER OFFREQUENCY OF BREAST DISEASES . (n=120)

TABLE -I: BENIGN AND MALIGNANT BREAST LESIONS. (n=120)

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