Clinical presentation, imaging, pathological profile and management of benign breast conditions based on aberrations of normal development and involution classification: A prospective cohort study

Abstract

Aim: To map the spectrum of benign breast disorders in patients with reference to ANDI, attempt a clinicopathological and imaging correlation, and evaluate the impact of this concept on the choice of treatments and their outcome. Material and Methods: This prospective study was carried out in the Department of Surgery at tertiary care hospital in central India. A total of 176 consecutive female patients who have attended menarche and presenting with benign breast conditions classified under ANDI classification attending the surgery department From November 2012 to November 2014 for benign breast conditions were enrolled in the study. Patient parameters were recorded on a predesigned case record form. After clinical assessment, imaging and pathologic evaluation was done as indicated. Results: The mean age of presentation was 26.70±8.86 years. Most of patients presented with a commonest complaint of lump in the breast (89.2%). History of painless lump & lumpiness/nodularity was found in 99 cases. The maximum number of patients i.e. 114 (64.8%) presented within first 12 months of appearance of lump. Right breast was commonly involved i.e. in 72cases (40.90%).Mastalgia was not a predominant symptom in patients with benign breast conditions. Consistency in majority of cases was firm i.e. in 162 (92%) cases. Maximum number of breast lumps was located in the upper outer quadrant of breast i.e. 60(34.1%). Nodularity was not seen in 78% cases. Maximum no. of cases had discrete lump on presentation i.e.72%. There was no tenderness in 74% cases. 68% of patient had fibroadenoma. Most common age group was 21-30 yrs. Right upper quadrant was most commonly involved. Out of 121 cases, 84 underwent surgery, 29 conservative treatment & 8 both conservative with surgery. 57(32.38%) patients were diagnosed with mastalgia with or without nodularity. Diagnostic accuracy of Sono mammography in detection of fibroadenoma is 98.68. Diagnostic accuracy of FNAC and Histopathology in detection of fibrocystic changes is 98.8. Out of total 176 cases, 94 underwent surgery, 73 conservative treatment and 9 underwent conservative with surgery. Conclusion: The ANDI classification, a comprehensive system, can resolve most of the issues that face a clinician when dealing with benign breast diseases.