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PubMed2002

[Benign breast diseases: clinical, radiological and pathological correlation].

INTRODUCTION: Benign lesions of the breast are common; however, benign pathological states have always been neglected in comparison to cancer even though they account for as much as 90 percent of the clinical presentations related to breast. A useful classification system for benign breast disease has been described by Love and colleagues and is based on symptoms and physical findings, six general categories have been identified, which include physiological swelling and tenderness, nodularity, mastalgia, dominant lumps, nipple discharge, and inflammation. Another classification system developed by Page and coworkers separates the various types of benign breast lesions into three clinically relevant groups: non-proliferative lesions, proliferative lesions without atypia, and proliferative the histopathological evaluation of the biopsy specimen in order to determine the subsequent risk of developing carcinoma if the lesions represents atypia of lobules or ductal epithelium. OBJECTIVE: The study was made to evaluate the clinical, radiological and pathological correlation of the benign breast lesions. METHODS: We studied women aged 40 years or less that went to the Foundation Rodolfo Padilla Padilla by mastalgia or the presence of a mass. We determined the Kappa coefficient in order to identify the agreement between the three observers according to different pathologies: fibroadenoma, abscess, cyst, mastitis, fibrosis, and cancer. RESULTS: We made 698 breast Ultrasounds in women younger 40 years, we found 52% ultrasound normal and 48% were reported with benign breast pathology: fibroadenomas 38%, cyst 27%, dilated ducts 24%, benign nodule 4%, mastitis 3%, ectasia 2%, and abscess 2%. The correlation was made to 58 patients, finding the following coefficients kappa. Fibroadenoma: when evaluating the clinical examination versus ultrasound: K = 50%. Cysts: when evaluating clinical examination versus ultrasound: K = 17%, when evaluating ultrasound versus pathology: K = 3%. Fibrosis: when evaluating clinical examination versus ultrasound: K = 56%, when evaluating ultrasound versus pathology: K = 50%, when evaluating ultrasound versus pathology: K = 50%. CONCLUSION: The benign breast pathology must be studied carefully because the clinical and ultrasonic evaluation is not conclusive, and the histopathological evaluation of the biopsy specimens sometimes is necessary to discard malignancy.

Adult↗

PubMed1971

Ethnic and constitutional differences and their relation to breast diseases in Israel: educational and socio-economic status.

An Israeli Jewish population group consisting of 1298 cases of breast cancer and 1816 cases of benign mastopathy hospitalized in 1960-64 and 10,604 properly selected control women was studied with respect to the relationship of breast diseases to ethnic origin, educational background and socio-economic status. It was found that the percentage of Israeli-born and Orientals was higher in the benign mastopathy group than in the cancer group. For the Westerners the opposite was true. Educational level and socio-economic status were considerably higher in patients than in controls, regardless of ethnic origin. They were also higher in Westerners than in Orientals and among the Orientals higher in Iraqis than in Yemenites. The population groups with high breast cancer incidence rate appear to be on a higher educational and socio-economic level than those with a low incidence rate.

Adolescent↗

PubMed1998

[The triple diagnosis of breast diseases].

The aim of the study is to assess the data of clinical, mammographic, cytological and triple diagnosis of breast diseases. 188 patients are included in the study. The hystological findings are as follow: 58 patients with carcinoma and 130 with benign diseases. The coincidence of the exams are: 1. clinical examination--109 benign and 46 with carcinoma 2. mammography--114 for the benign group and 51 with carcinoma 3. cytology of FNB--104 to 40 4. triple diagnosis--118 to 40 The best method of diagnosis, according to our study, is the triple method.

Biopsy, Needle↗

PubMed1984

The use of immunohistochemical probes in the study of benign and malignant breast disease.

A review is presented of the use of immunohistochemical probes in the study of the cellular pathology of the breast. Using a combination of monoclonal and polyclonal antisera it has been possible to investigate the relationship between myoepithelial cells and basement membrane components in benign breast disease and the disturbance of this relationship in early invasive and infiltrating ductal carcinomas. The use of immunohistochemical techniques at the ultrastructural level provides the methodology for future detailed analyses. The heterogeneous expression of antigenic determinants characteristic of epithelial cells in the normal breast is considered in conjunction with its relevance to the heterogeneity seen in the invasive tumours.

Animals↗

PubMed1983

Cytochemical and competitive protein binding assays for estrogen receptor in breast disease. A comparative study of 62 cases.

Estrogen receptor content of breast lesions was estimated using a fluorescent cytochemical technique and a competitive protein binding assay. Of 48 cancers examined, an equal proportion contained significant quantities of receptor by either method (62.5%). The concordance between methods for individual patients was also 62.5%. A greater proportion (26%) of patients younger than 45 years of age had receptor-positive cancers using the cytochemical method than were found by the biochemical method (10%). Benign breast disease was also studied using the fluorescent cytochemical method. A greater proportion of lesions containing estrogen receptors was found compared with that cited in the literature for the competitive protein-binding assay. Because of the methodologic simplicity of the fluorescent cytochemical method, further study for routine use is indicated.

Adenofibroma↗

PubMed1990

[Reproductive variables and risk of benign breast diseases. A case-control study].

The purpose of the study was the identification of risk factors for benign breast diseases (BBD); 257 women with BBD diagnosed through pathological anatomy or cytology and a matched control for each were studied. Subjects were selected at The State University of Campinas Hospital and at a private clinic. To enter the study cases had to have a first diagnosis of BBD between October 1979 and August 1984. The following BBD were considered: dysplasia, fibroadenoma, cystic disease, papilloma and ductal ectasia. Reproductive variables were studied as risk factors, including menstrual ovulatory cycles. The date on which the BBD was diagnosed was defined as the index date. For controls, data were considered up to when they had reached the same age as the matched case on the occasion of her diagnosis. Nulliparity was a risk factor for BBD. First birth at or above age 30 was a protective factor. Women who had used contraceptive pills for two or more years had a significantly lower risk than those who had never used them. The number of menstrual ovulatory cycles was not found to be associated with the risk of BBD. The results obtained from the study of Brazilian women confirm some of the conclusions found in the literature, mainly those that associate some reproductive variables with the risk of BBD. A few of these variables are also confirmed as risk factors for breast cancer.

Brazil↗

PubMed1983

Oral contraceptive use and fibrocystic breast disease with special reference to its histopathology.

The relationship between use of oral contraceptives and fibrocystic breast disease was examined in a hospital-based case-control study undertaken in New Haven, Connecticut, from 1977 to 1979. Particular emphasis was placed on the extent of epithelial atypia and other histopathologic characteristics found in the biopsy specimens from the cases. Women who had ever used oral contraceptives were at a somewhat decreased risk for fibrocystic disease as a whole. Cases with high atypia and controls had similar patterns of oral contraceptive use, whereas cases with low and intermediate atypia had less oral contraceptive use than controls. Cases with intermediate atypia reported the lowest oral contraceptive use. Subjects with biopsy specimens exhibiting gross cysts, microscopic cysts, or papillomatosis were about 50% less likely to have used oral contraceptives than controls.

Adult↗

PubMed1991

The patron saints of breast disease.

Throughout the Christian era, saints have been adopted as patrons of countries and towns, trades and professions, and also for protection against disease. Although patronage is usually related to the saint's most spectacular cure or mode of death, sometimes it derives from a play on words, an unusual physiognomy or mistaken identity. Historical research has identified 295 patrons of specific diseases. Thirteen of these saints are patrons of breast disease. St Agatha, who was martyred by mastectomy, being the most famous. The lives, legends, cults and pictorial representations of these saints are described.

Breast Diseases↗

PubMed2000

Breast reconstruction by tissue expansion. A retrospective technical review of 197 two-stage delayed reconstructions following mastectomy for malignant breast disease in 189 patients.

Despite the advent of free tissue transfer, breast reconstruction by tissue expansion is an important technique in the armamentarium of the reconstructive breast surgeon. The concept is deceptively simple and yet in reality can produce difficult complications and poor results. A database was compiled of all the patients receiving tissue expanders and/or implants for cosmetic, congenital and reconstructive purposes between 1986 and 1998. 189 patients had 197 delayed two-stage tissue expansion breast reconstructions following mastectomies for malignant breast disease between 1986 and 1997. 103 breasts (52%) had two uncomplicated stages. The remainder had one or more complications, revisional procedures for complications or alterations to the reconstruction for size, position or shape. Overall each breast reconstruction required 2.9 procedures (range 2-9). The complications and additional procedures are discussed. In particular, capsular contracture of the definitive implant (12%) was related to implant type and not to the speed of tissue expansion or the degree or duration of over-expansion. Although 17% of patients received radiotherapy, none of those who developed contracture around the definitive implant had this adjuvant therapy, P< 0.05. Twelve reconstructions (6%) totally failed due to complications of which six underwent secondary flap reconstruction. Twenty-one patients have subsequently developed metastatic disease of which 15 have died to date. Breast reconstruction by tissue expansion is still an important technique. It should be used carefully and thoughtfully by surgeons trained to deal with any complications. Patients need to be carefully selected and counselled prior to undertaking this process.

Adult↗

PubMed1993

Activity of type IV collagenases in benign and malignant breast disease.

Using zymography and computer assisted image analysis, we have measured the levels of type IV collagenases in biopsies from normal breast, and benign and malignant breast disease. The 92 kDa form was present in three of 11 cases of normal/benign disease, three of nine grade I tumours, four of 12 grade II tumours, but 11 of 11 grade III tumours. Mean levels were higher in grade III tumours (P < 0.0001). When the levels of 72 kDa collagenase and its active 62 kDa form were considered together, there was no difference between the benign and malignant cases (P = 0.55), but the amount of active enzyme, considered as a proportion of the 62 + 72 kDa forms, was significantly higher in malignant disease (P = 0.003). There was also a trend towards a higher proportion of active enzyme with increasing tumour grade (P < 0.0001). In situ hybridisation and immunohistochemistry studies showed that that mRNA and protein for the 92 kDa enzyme was primarily found in the tumour stroma. mRNA for the 72 kDa enzyme was also found in stromal areas. This study demonstrates a clear relationship between production of Type IV collagenases and malignant breast disease. Inhibitors of these enzymes may be of value in preventing metastatic disease.

Breast↗

PubMed1989

Diabetic fibrous breast disease.

Women with long-standing insulin-dependent diabetes mellitus (IDDM) and radiographically dense mammary glandular tissue can have benign breast masses clinically resembling cancer. The authors have identified 36 patients, aged 20-54 years, with this little-known condition, which the authors call diabetic fibrous breast disease (DFBD). For a diagnosis of DFBD, the patient must fulfill certain stringent requirements: a long-term history of IDDM; radiographically dense glandular tissue; and one or more hard, irregular, easily movable, discrete, painless, palpable breast masses with strong ultrasonographic acoustical shadowing and firm resistance to the back-and-forth motion of the needle used for fine-needle aspiration cytology (FNAC). Patients meeting all criteria can be monitored with serial FNAC procedures to prevent them from undergoing multiple surgical biopsies. During an average of 6 years of monitoring these 36 women, breast cancer did not develop in any mass fulfilling all requirements for DFBD.

Adult↗

PubMed1988

Immunohistochemical study of D5 antigen (an oestrogen receptor related protein) in normal breast, benign breast disease, and mammary carcinoma in situ.

Patterns of staining with a monoclonal antibody which recognises D5 antigen (a 29,000 kD oestrogen receptor-related protein) were studied in seven normal and 76 benign breast biopsy specimens as well as in 12 cases of pure in situ mammary carcinoma. Staining in benign breast lesions was weak and heterogeneous when compared with that seen in most infiltrating carcinomas. In situ carcinomas showed an intermediate pattern of staining. The finding of only small foci of weak positivity for D5 antigen in normal and benign breast disease indicated that there are similarities between the expression of D5 antigen and the presence of oestrogen receptor protein in these tissues. A further similarity was seen with in situ carcinomas, which have been shown to have lower oestrogen receptor content than infiltrating carcinomas and a more heterogeneous staining pattern with D5 than is seen in infiltrating tumours. The importance of these findings remains to be evaluated because the precise nature of D5 antigen and its association with the oestrogen receptor molecule is not fully understood.

Adolescent↗

PubMed1988

Development of current concepts for the treatment of breast diseases as documented by the Transactions of the Southern Surgical Association.

The development of current concepts in the treatment of breast diseases during the last 100 years is well documented in the Transactions of the Southern Surgical Association. Fellows of the SSA have been on the cutting edge of these developments and chose the SSA as the forum to describe and debate their new observations.

Breast Diseases↗

PubMed1991

Oral contraceptives and breast disease.

Epidemiologic data support the hypothesis that the types of OCs used before the mid-1970s protected against most forms of benign breast disease. It is unclear whether current low-dose progestogen OCs will confer the same protection. Further studies are necessary to clarify this. For breast cancer, the relationship is more complex. It is possible that prolonged use of high-dose OCs exert a small increased risk for breast cancer development in women before age 45. Furthermore, prolonged use before a first term pregnancy may result in a small increase in risk for breast cancer before age 45. Studies evaluating the effect of current low-dose OCs are necessary to elucidate what, if any, effect they may have on breast cancer development. Furthermore, as our population ages, studies will be able to determine what effect, if any, may be present in women over age 60, those women with the highest underlying risk of breast cancer. And finally, more research of basic breast tissue physiology and the effect of endogenous and exogenous hormones on this complex organ is needed.

Breast↗

PubMed1989

Histologic and mammographic specificity of risk factors for benign breast disease.

This study evaluates the effects of potential risk factors for benign breast disease (BBD) with special attention to the histologic and mammographic specificity of the effects. Cases were 172 women with BBD that underwent biopsy; controls were 134 women free of breast signs or symptoms. All cases and controls had undergone mammography. For all types of BBD combined, parity, use of oral contraceptives, and use of exogenous estrogen after menopause were strongly protective, whereas obesity and early menarche were weakly protective. Family history of breast cancer was virtually unrelated to BBD. The protective effect of parity was stronger for BBD with intralobular or extralobular fibrosis, and with mammographic homogeneous density or large nodular densities, than it was for BBD without these characteristics. Similar relations with the histologic and mammographic features were observed for obesity. These findings suggest that some risk factors for BBD have effects that are related to specific features of its morphology.

Breast Diseases↗

PubMed2006

Value of scoring system in classification of proliferative breast disease on fine needle aspiration cytology.

Fine-needle aspiration (FNA) cytology is successful in identification of benign and malignant breast lesions, but its role in proliferative breast lesions which increase cancer risk is poorly defined. We have analyzed the cytomorphologic features of proliferative breast lesions in conjunction with cytologic scoring system proposed by Masood et al and with histopathology. Sixty two patients (14 cases of fibroadenoma, 15 cases of fibroadenoma with atypia, 11 cases of proliferative breast disease (PBD), 8 cases of PBD with atypia and 14 cases of carcinoma) diagnosed on routine FNA were subjected to scoring following Masood's criteria. All cases with the cytologic diagnosis of fibroadenoma were confirmed on histology. Of 11 cases of PBD on FNA, 10 were PBD without atypia on histology. One case, which showed atypical hyperplasia on histology, was missed by both the scoring system and cytomorphology and one case was over-diagnosed as PBD with atypia by the scoring system. FNA cytology correctly identified all the carcinoma cases, while the scoring system under-diagnosed 2 cases as PBD with atypia. Hence, in cases not suspected to be atypical or confirmed to be cancer on routine cytology, scoring added no information over and above cytomorphology and was not useful. All fourteen cases of fibroadenoma with atypia suspected on routine cytology were fibroadenoma on histology. Scoring system correctly placed 11/14 of these cases as PBD without atypia. Similarly 3/8 cases thought to be PBD with atypia were correctly placed as PBD without atypia by scoring. Only 2/8 cases thought to be PBD with atypia on cytology were confirmed to have atypical hyperplasia on histology. Scoring improved the diagnostic yield to 2/5. Hence, in cases of fibroadenoma or PBD, suspected on FNAC to have cytological atypia, Masood scoring gives additional information by eliminating benign cases and improving diagnostic yield. Application of scoring in a step-wise manner, on atypical aspirates, can help in selection of cases suitable for biopsy.

Adolescent↗

PubMed1996

A matrix attachment region (MAR)-binding activity due to a p114 kilodalton protein is found only in human breast carcinomas and not in normal and benign breast disease tissues.

A M(r) 114,000 protein (p114) that specifically binds to nuclear matrix attachment DNA (matrix attachment region, MAR) from a breast carcinoma cell line SK-BR-3 was purified to near homogeneity. p114 strongly binds to a wild-type A+T-rich MAR probe with high unwinding propensity with a dissociation constant (Kd) of 10(-9), while it exhibits substantially reduced binding to a mutated A+T-rich non-MAR probe, which lacks unwinding propensity. This binding specificity and affinity is similar to the previously cloned thymocyte-associated MAR-binding protein SATB1. By Southwestern blot analysis, the MAR-binding activity of p114 is detectable in human breast carcinomas but is undetectable in normal breast tissues, benign breast diseases, and immortalized epithelial MCF-10A cells. Thus, the MAR-binding activity of p114 is not merely reflecting cell proliferation, but it strongly associates with breast carcinomas. The p114 MAR-binding activity was found in all 43 human breast carcinoma specimens tested, without exception. Much stronger p114 MAR-binding activity was detected in poorly differentiated than well-differentiated carcinomas. p114 may be a reliable diagnostic and possibly prognostic marker for breast cancer.

Base Sequence↗

PubMed1992

Risk of breast cancer after benign breast diseases. Variation by histologic type, degree of atypia, age at biopsy, and length of follow-up.

The issue of risk of breast cancer subsequent to benign breast diseases (BBD) remains controversial. To determine whether this risk varies by histologic type of BBD, degree of atypia (as measured by the Black-Chabon method), age at BBD biopsy, or length of follow-up, the authors followed 2,731 women in the San Francisco Bay Area for an average of 16 years after their first occurrence of biopsy-proven BBD between 1948 and 1973. The cohort's age-adjusted rate of breast cancer was 1.8 times that of the general population (95% confidence interval (CI) 1.6-2.2). Among the different histologic types of BBD, rates were greatest for intraductal papilloma (rate ratio (RR) = 3.9, 95% CI 2.0-7.4) and adenosis (RR = 2.5, 95% CI 1.2-4.9). Rates were also significantly elevated for fibrocystic BBD (RR = 1.5, 95% CI 1.1-1.9). Risk increased directly with degree of atypia, rising from a rate ratio of 1.8 among women with Black-Chabon scores of 1 and 2 (95% CI 1.5-2.2) to 7.2 among women with a Black-Chabon score of 5 (95% CI 1.8-28.9). Among women with the higher-risk types of BBD, rate ratios increased with age at BBD biopsy and decreased with increasing length of cancer-free follow-up. These findings are interpreted in the light of possible biases affecting this and other studies and recent advances in knowledge regarding neoplastic lesions and breast cell kinetics.

Adult↗