A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the
degree of Master of Medicine in Diagnostic Radiology
Johannesburg, 2013 / Palpable solid breast masses that are circumscribed and not calcified on
mammogram or ultrasound are probably benign. There is controversy therefore,
whether these deserve tissue diagnosis. More data is required to determine
whether short term follow up can replace the need for biopsy.
Benign appearing lesions greater than 3cm in diameter on ultrasound continue to
undergo biopsy due to fear that a malignancy or phyllodes tumour might be
missed. Published research reflects patients from Europe and North America, and
no relevant data from Africa exists.
AIM: This study aims to determine the histological spectrum of sonographically
benign lesions greater than 3cm, which were biopsied, in our local population
(majority of black patients) and to determine whether biopsy is indicated based on
the local cancer risk. The study also aims to characterise the results by age and
population group as well as correlate the histological result with the size of the
lesion on ultrasound, the HIV status, family history and the seniority of the
examining radiologists.
MATERIALS AND METHODS: A retrospective descriptive study of biopsy results
of sonographically benign breast masses was undertaken using biopsy procedural
recording sheets. .
The size of the lesions (continuous variables) mean with standard deviations was
determined. The prevalence of lesions was expressed as a percentage. Other
categorical variables were summarized as frequency and percentage. The
vi
histological spectrum of the lesions was determined. The HIV status and family
history of the patients as well as the seniority of the reviewing radiologist was
assessed. A Krusskal Wallis test and separate logistic regression analysis was
used.
RESULTS: A total of 68 patients (below 40 years of age) were included from a
total of 13112 patients (of all ages) seen between 2007 and the end of 2010. 73
lesions were identified (65 benign and 8 malignant). The prevalence of benign
lesions was 89.7%. .The prevalence of malignant lesions was 10.29%.There was
little evidence to support lesion size for predicting histology (p value = 0.22) or
benignity. There was little evidence that the family history and HIV status were
significant.
CONCLUSION: There was a high prevalence (10.29%) of malignancies in lesions
classified by ultrasound as benign. The size of the lesion did not correlate with
histological subtype or whether the lesion was benign or malignant.
Training of sonographers, standardization of technique for established users and
double reading, may produce a different result, as both junior and senior
radiologists mistook malignant lesions for benign ones on ultrasound. Repeating
this research using double reading after training may demonstrate whether there is
a true higher prevalence of malignancy in ultrasonically benign breast lesions in
our community. Until then, routine biopsy of these lesions is recommended.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13904 |
| Date | January 2013 |
| Creators | Kemp, Marnie Laura |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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