Publication:

A study on the usefulness of triple assessment in lumpy breasts in peri-menopausal women

Background As opposed to discrete lumps, diagnosing malignancy in ladies with lumpiness or lumpy breasts is a challenge. Often the clinician is in a dilemma whether to ignore, keep on follow up or evaluate the vague lumps that are palpable.

Methods A prospective, observational study was conducted at Department of General Surgery, Pushpagiri Institute of Medical science & Research centre, Tiruvalla, from December 2012 to September 2014 in women of age group 35-45 years, complaining of lumpy breasts. All patients who had palpable but ill-defined lumps were included in the study. Patients who had discrete lumps or any definite clinical features of malignancy were excluded. Our objective was to correlate the clinical features, radiological, and cytology of lumpy breast perimenopausal women with the histopathological diagnosis. Hence all patients in the study underwent excision biopsy. After clinical examination, radiological assessment was done using ultrasound scan and/or mammography examination based on if patients were more or less than 40 years old. FNAC of the lump was also done using ultrasound guidance wherever feasible. Then the patients underwent excision of suspected area and specimen was subjected to histopathological examination.

Results 63 patients were included in the study. Mean age of the study group was 40.29 (+/- 3.62). 42.8% of the patients presented with associated pain along with lumpiness. 25.4% of patient had bilateral lumpiness. There were 4 cases of malignancies and 33 cases were fibrocystic changes. Through kappa analysis, inter agreement statistics of radiological diagnosis and FNAC with histopathological diagnosis of malignancy was good but that of clinical diagnosis and histopathological diagnosis was poor.

Conclusions These findings show that lumpy breasts should be evaluated by both radiological and cytological method before coming to a final decision in diagnosis.