Breast Cancer


SUMMARY AND CONCLUSION


Breast cancer is an ancient and elusive disease. It is the most common malignancy among females .It is the leading cause of death in their midlife and a horribly destructive malignancy both organically and psychologically. Benign breast disease have great incidence among female patients and these benign disease may be confused with malignancy.


Ultrasound is now well established as an important non-invasive technique for the investigation of breast problems. The aim of this work is to evaluate the ultrasonography in proper diagnosis of breast lesions and making early rapid detection of malignant breast lesions before its dissemination. Thus helps the surgeon to deal with different patients according to their urgency.


This thesis included the clinical examination, mammographic study, sonographic study and pathological study of breast lesions in 45 cases with breast masses or induration or nipple discharge from AL Hussein, Bab Alshe’eria, Om Almasreen Hospitals and the National Cancer Institute. Patients referred from surgical or obstetric departments and as out patients. Their ages ranged from (17 – 80) years.

The results of this study show that the number of benign lesions is 24 and the number of malignant lesions is 21. Malignant lesions occurred in patients with mean age of 46±6 y. while cases proved to be benign have a mean age of 34±4y. In our study the lesion is usually discovered accidentally due to unawareness of self-breast examination .All women over age 20 years should be advised to examine their breasts monthly. Our study results show that the clinical presentation of malignant lesion is usually with mass, pain, skin change and/or nipple retraction but nipple discharge is not a common finding.
In this study the physical examination diagnosed 3 cases as malignant out of 45 cases (about 7%) .The rest of the cases were diagnosed as suspicious for malignancy.


The frequency of breast carcinoma at various anatomical sites was 70% in the upper outer quadrant. Our sonographic findings suggest that the number of focal sonographic lesions in the malignant cases proved to be solitary and the lesion with a depth greater than the width (D>W) is more likely to be malignant than benign.


Borders with jagged outline and deranged, non- homogenous internal echoes were set up in all malignant cases as major criteria. Posterior acoustic Shadowing is not specific for malignancy as benign neoplasm and cooper’s ligaments also exhibit posterior shadowing.


Cancers presenting as isolated microcalcification is not usually detected at ultrasound. Breast carcinoma is usually incompressible and immobile.


Our results show that axially lymph nodes involved with carcinoma are seen often as multiple oval, round or lobulated echo-poor masses.


The sensitivity of sonography in the predilection of benign lesion was 76% and in the cystic type of benign lesions, the sensitivity of ultrasound is almost 100%. Strong posterior enhancement is an appearance of cysts and fibroadenoma.


The results of our study confirm that most breast tumours manifest themselves with a hypoechoic “nidus” on ultrasound .


Ultrasound has the advantages over mammography in showing lesions in dense breast which is seen in (Adolescents, pregnant and lactating women).Also Ultrasound has the advantages over mammography in showing in differentiation of simple cysts from solid breast masses. Use of ultrasound to confirm the cystic nature of palpable lesion could obviate unnecessary surgery. Ultrasound plays a role in upgrading of breast cancers especially in case of nonconclusive findings on mammography. But downgrading of tumours on ultrasound requires an extensive sonographic analysis.


Combined reading of mammography and ultrasonography offers a high diagnostic accuracy as cancers presenting with characteristic malignant features on mammography also present more commonly as typical malignant tumours on ultrasound. Our study results show that ultrasonography may play a role in imaging of non-palpable lesions identified by mammography to rule out true pathology in cases of false positive mammography and in imaging of tender breast where compression for mammography is not possible.


In conclusion:


Ultrasonography has become the most widely used adjunct to mammography in the diagnosis of breast lesions.


Ultrasonography has advantages in:


-Attaining clinical agreement between the different observers in breast cancer detection.


-Differentiation of cystic from solid lesions.


-Showing lesions in dense breast, which is seen in adolescents,


pregnancy, and lactating.


-Imaging of tender breast as compression for mammography is not possible.


-Palpable lump with negative mammographic findings.


-Non-palpable lesions identified by mammography to rule out


true pathology