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FREQUENCY OF FIBROADENOMA IN PATIENTS PRESENTING WITH BREAST LUMP.

Byline: Muhammad Kalim, Hamdullah, Siddique Ahmad, Farrukh Ozair Shah and Muhammad Yosaf

Abstract

Objective: To determine the frequency of fibroadenoma in patients presenting with breast lumps.

Methodology: This descriptive cross sectional study was conducted in the Department of Surgery, Hayatabad Medical Complex, Peshawar (from 1st March 2016 to 30th May 2017) recruiting a total of 165 patients who presented with breast lump. These patients were subjected to ultrasonography, fine needle aspiration cytology and tru-cut biopsy to detect fibroadenoma. Data was analyzed with SPSS 17 and presented as tables.

Results: The mean age was 23.2 +-4.6 years. Maximum patients were between 15 to 25 years of age (66.7%). Left side was involved in 58.8% while right side breast lumps were present in 41.2% of patients. Breast lumps in the superior-medial quadrant were in 26.7% of patients, superolateral quadrant 32.7%, inferomedial quadrant 13.3% and inferolateral quadrant 27.3% patients. Fibroadenoma was detected in 33.3% of women.

Conclusion: Fibroadenoma was a common benign breast disorder among women who presented with breast lump.

Key Words: Breast lumps, Fibroadenoma, Benign breast disorders, Fine needle aspiration cytology

INTRODUCTION

A breast lump is any discrete mass noticed by the patient or by their physicians that prompts them to seek medical advice and treatment1. The presence of a lump in the breast is a great cause of anxiety and apprehension in females. Public awareness has contributed largely to this and the consequence is a steady flow of frightened females attending outpatient clinics. Many of them have cyclical mastalgia, nodularity, or asymmetry but a small proportion will indeed present with breast lump2. Fibroadenoma is a common benign breast lesion that typically occurs in young patients between ages of 20 and 35 years3. The palpable lump is the first most common presentation and pain being the second symptom4. About 5-10% of these lumps are ultimately diagnosed as tumors in young adolescents5. Among these invasive ductal cell carcinoma is more common6,7.

Benign breast disorders include benign tumors, trauma, breast abscess, granulomatous mastitis, mastitis, cysts, duct papilloma etc.8,9. The evaluation of breast disease is very important as early as possible and triple assessment is very important tool for evaluation because certain benign breast diseases have increased risk of malignancy in the long run10,11.

Fibroadenoma are usually small and can be managed conservatively; 0.5-2% of these lesions will grow rapidly3. Giant fibroadenoma, greater than 5cm or 500gm can be associated with significant deformity, raising suspicion for malignancy and requiring surgical excision12. There are reports of in situ ductal carcinoma and neoplasm in a Fibroadenoma4. Distinction between fibroadenoma and phyllodes tumour is challenging on core needle biopsy13,14.

Benign tumors in breast have been reported in up to 85.69% cases. Among these benign tumors, fibroadenoma is reported as the commonest breast lesion (85%) followed by fibrocystic disease (10.36%)15. In a study done in Pakistan, benign tumors were reported in up to 82.2% cases and malignant tumors in up to 17.3% cases. Among benign tumors, 62.1% were fibroadenoma, 22.6% were fibrocystic change while 6.5% were inflammatory lesions and 5.6% were pyogenic abscesses16.

The rationale of our study was to determine the exact statistics of benign breast disorders especially fibroadenoma in our region as patients presenting with breast lumps are very anxious and "assume the worst" as it has been reported that every 9th Pakistani woman is suffering from carcinoma presenting with breast disorder17. Counseling such patients with fresh statistics of our local setup will help greatly in relieving their anxiety. Breast is simply modified sweat gland in female18,19. The hormonal variations during menarche, menstruation, lactation and menopause influence the complex structure of breast and make many changes.

METHODOLOGY

This cross sectional descriptive study of 15 months duration from 1st March 2016 to 30th May 2017 was conducted at Department of Surgery, Hayatabad Medical Complex, Peshawar. Sample size was calculated by WHO software to be 165 patients, using 19% fibroadenoma in breast lump1, 5% margin of error and 95 % confidence interval. These patients were recruited by non-probability consecutive sampling technique. All females having clinically palpable breast lump of age between 15 and 35 years were included in this study. Patients having breast lump associated with menstrual cycle or ulcerated breast lump or recurrent breast lump or lump formed due to breast trauma were excluded from the study. All patients meeting the inclusion criteria were admitted through OPD of general surgery department.

The purpose and benefits of the study were explained to all patients and written informed consent was taken. A detailed history was taken from all patients included in the study followed by routine physical examination and baseline investigations. Initial diagnosis of lump was based on triple assessment. Definitive diagnosis was based on true cut biopsy and histopathology of specimen.

The tru-cut biopsy procedures was conducted by single expert general surgeon under local anaesthesia in operation theatre with full aseptic measures in the presence of a female charge nurse and specimen was sent to histopathology laboratory. All histopathological studies of incisional biopsy of breast lump were done by a single histopathological laboratory. All the above mentioned information including name, age, site of breast, quadrant of breast, date of admission and hospital admission number and address were recorded in a pre-designed proforma. Strictly exclusion criteria were followed to control confounder variables and bias in the study.

All data were entered in SPSS version 17. Mean and standard were calculated for age. Frequencies and percentages were calculated for categorical variables like fibroadenoma, breast site and quadrant of breast. Fibroadenoma was stratified among age, breast site and quadrant of breast to see the effect modification. Post stratification was done through chi-square test keeping p <0.05 as significant. All the results were presented in tables.

Table 1: Side and quadrant involvement in breast lump

###Quadrant of Breast

Side Of Breast###Superomedial###Superolateral###Inferomedial###Inferolateral###Total

Right###18 (10.9%)###30 (18.2%)###10 (6.0%)###10 (6.0%)###68 (41.2%)

Left###26 (15.8%)###24 (14.5%)###12 (7.3%)###35 (21.3%)###97 (58.8%)

Total###44 (26.7%)###54 (32.7%)###22 (13.3%)###45 (27.3%)###165 (100%)

Table 2: Age wise stratification of fibroadenoma (n =55)

###Fibroadenoma

Age Groups###P value

###Yes###No

15-20###20 (12.1%)###22 (13.3%)

21-25###24 (14.5%)###44 (26.7%)

###0.001

26-30###11 (6.7%)###21 (12.7%)

31-35###0 (0.0%)###23 (13.9%)

Table 3: Side wise stratification of fibroadenoma (n =55)

###Fibroadenoma

###Side of Breast###P value

###Yes###No

Right###12 (7.3%)###56 (32.7%)

###0.000

Left###43 (26.1%)###54 (32.7%)

Table 4: Quadrant wise stratification of fibroadenoma (n =55)

###Fibroadenoma

###Qaudrant Involved###P value

###Yes###No

Superomedial###31 (18.8%)###13 (7.9%)

Superolateral###0 (0.0%)###54 (32.7%)

###0.0000

Inferomedial###12 (7.3%)###10 (6.1%)

Inferolateral###12 (7.3%)###33 (20.0%)

RESULTS

The mean age of the women was 23.2 +-4.6 years with a range of 15.5-31 years. We divided the age in 4 different groups. In age group up to 20 years we had 42 (25.5%) of women, in 20.01 to 25 years we had 68 (41.2%) women, in 25.01 to 30 years we had 32 (19.4%) women and in the age group 30.01 to 35 years we had 23 (13.9%) of women.

Looking at the side of the breast involved in our group of patients, we recorded that left side was involved in 97 (58.8%) of patients and 54 (32.7%) of patients had breast lump in the superolateral quadrant (Table 1).

On tru-cut biopsy, fibroadenoma was confirmed in 55 (33.3%) of women. Others were fibrocystic disease in 50 (30.30%), tubular adenoma in 23 (13.94%), acute mastitis in 20 (12.12%) and invasive ductal carcinoma in 17 (10.30%) patients. Frequency of fibroadenoma was high in age group of 21 to 25 years i.e. 24 (14.5%) while no patient was having fibroadenoma in the age group of 31 to 35 years (Table 2). Fibroadenoma was most common on left side i.e. 43 (26.1%) patients (Table 3) and most common quadrants were inferolateral in 35 (21.3%) and superolateral in 30 (18.2%) patients (Table 4).

DISCUSSION

Fibroadenomas are benign and well demarcated tumors from the surrounding tissue20 composed of of combined proliferation of epithelial and connective tissue elements with a good histologic evidence of lobular origin21. The mean age of patients in our study was 23.2 +- 4.6 years with the age range of 15.5 to 31 years which is in contrast with reports of Isaac and colleagues elsewhere in Pakistan22,23. It may be due to the fact that we studied patients aged 35 years or less. The mean age in our study remains consistent with other reports like Cheung et al24. Literature has reported that fibroadenoma being the most common benign breast disorder with peak incidence in 2nd and 3rd decade of life7-10. The left breast was involved in the majority of patientsi.e. 58.8%. This finding wasalso noted by Isaac and colleagues23. Talpur et al25 has also reported left side involvement more than the right side i.e. 53.33%.

In our study, 26.7% of patients had breast lump in the superiomedial quadrant and 32.7% had in superolateral quadrant. This finding has been supported by other studies22,26.

The frequency of fibro-adenoma in our study was found to be 33.3%. In Karachi, Talpur and colleagues25 also reported that fibroadenoma was the most common benign breast lump among their patients i.e. 30.66%. Rashid et al27 showed that 42.1% patients had fibrodenoma breast in their study which was conducted at PIMS in 2005. Internationally, Jamal28 has reported that fibroadenoma was the most common breast lesion (47%) in the population in Jeddah, Saudia Arabia. On the other hand, in Nepal, fibroadenoma was the least common lesion, present in 21.6% of the female patients29. However, this is higher than reported frequency from USA (8.5%). No significant difference has been noted in recent literature regarding the age group of fibroadenoma which was twice (16.8%) as reported by Rashid et al27, however it was almost similar to the results shown by Ali et al30 (36%) and Choudhary et al31.

It was a pilot study and we recommend further research on breast lumps in incorporating other variables in the study to detect a range of breast disorders in women who are presenting with breast lumps.

CONCLUSION

Fibroadenoma was a common benign breast disorder among women who presented with breast lump.

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Publication:Journal of Postgraduate Medical Institute
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2018
Words:2868
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