Comparative Accuracy and Complications of Palpation-Guided Versus Ultrasound-Guided Core Needle Biopsy of Palpable Breast Lumps in Ahmadu Bello University Teaching Hospital, Zaria.

Background: Breast lumps are a common complaint by women. Palpable breast lumps are accessible to core needle biopsy (CNB) with the aim of obtaining tissue for histologic diagnosis. CNB is achievable either by palpation guidance or image guidance. The superiority of either technique in returning an accurate diagnosis has not been demonstrated in our centre. Aim: This study aimed to compare the diagnostic accuracy and complications of palpation-guided versus ultrasound-guided CNB techniques in palpable breast lumps. Materials and Methods: This was a randomised, controlled, comparative study. Consenting patients were randomised into either a palpation-guided or an ultrasound-guided group. All patients subsequently had open surgical biopsy, which represented the control group. Data analysis was done using SPSS, version 21. Results: Each CNB group had 40 patients. In the palpation-guided group, 24 (54.55%) lumps were benign and 13 (29.55%) were malignant, whilst seven (15.90%) were inconclusive. In the ultrasound-guided group, 31 (65.96%) lumps were benign and 15 (31.91%) were malignant, whilst one (2.13%) was inconclusive. The sensitivity and specificity for palpation-guided CNB were 92.9% and 100%, respectively. The sensitivity and specificity for ultrasound-guided CNB were 100% each. There was no statistically significant difference in sensitivity between the two groups (P value of 0.4828). One patient (2.5%) in the ultrasound-guided CNB group had a hematoma. Conclusions: This study has shown that CNB has high diagnostic accuracy and low complications in the management of breast lumps, either by palpation-guided or ultrasound-guided techniques. There was no significant difference in accuracy or complications of CNB using either technique.

The Correlation of Sonographic and Histopathologic Findings in the Diagnosis of Palpable Breast Masses in Zaria.

Introduction: Presently, histology is the gold standard in definite diagnosis of breast masses. Ultrasound is a relatively cheap, non-invasive, and non-ionizing imaging modality which is widely available in most hospitals. An assessment of its accuracy in diagnosing breast masses is necessary to minimize unwarranted biopsies. Aim and Objectives: This study aims to correlate the ultrasonographic and histopathologic findings in the diagnosis of patients with palpable breast masses. Materials and Methods: This was a cross-sectional hospital-based study, which involved 100 consecutive patients who presented with palpable breast masses in Zaria. This was carried out for a period of 7 months (November 2016-June 2017). They had a clinical breast examination to identify the mass, which was then imaged and biopsied via ultrasound-guided fine needle aspiration cytology. Results: The generated data were analysed using SPSS version 23.0 (Chicago, IL, USA). There were more benign masses (63%) than malignant masses (29%). On correlating the final diagnosis of ultrasound to that of histology, it was found to have a sensitivity of 89%; specificity of 94%; positive predictive value of 89%; negative predictive value of 94%; and accuracy of 92%. Conclusion: This study shows that there was a correlation between ultrasound and histology findings in differentiating between benign and malignant masses. This proves that ultrasound has a significant role to play in evaluating and diagnosing clinically palpable breast masses.

Imaging classification and BIRADS assessment of cystic breast lesions with pathologic correlates. a 5-year experience in Zaria, North West Nigeria.

Background: Breast cysts encompass a variety of pathologies, both benign and malignant. Therefore, classifying cysts into different categories is needful to develop a management algorithm. This study aimed to describe and distinguish between simple, complicated and complex cysts; and compare the final BIRADS assessment with pathologic findings. Materials and methods: A 5-year retrospective review of our ultrasound database identified two hundred and seventy patients with cystic breast lesions. They were divided into simple, complicated and complex cysts according to ultrasound characteristics based on shape, orientation, margin, wall thickness, internal features (echogenicity, septa, mass) posterior acoustic features, surrounding tissue vascularity. The final BIRADS assessment was correlated with histological findings. Results: There were two hundred and sixty-six (98.5%) females and four (1.5%) males with a mean age 34.9 ± 11.8 years. The commonest presentation was a palpable mass, in 70% of the patients. There were 89 (33.0%) simple cysts, 61 (22.6%) complicated cysts and 120 (44.4%) complex cysts. Conclusion: Majority of the breast cysts (83%) were benign with overall 17% incidence of malignancy. Complex cysts were the most frequent cyst type in our study, it is also the category most frequently associated with breast cancer, obviating the need for histology.

Ultrasonographic review of pediatric breast masses among Nigerian children in a tertiary hospital.

BACKGROUND: Breast masses occur infrequently in children and adolescents. Most of these masses have proved that benign and conservative approach is the management of choice. Consequently, imaging has become crucial. The knowledge of the ultrasonographic features of childhood and adolescent breast masses is needed for age appropriate medical care. AIM: The aim of this study was to describe and document the ultrasonographic spectrum of breast masses in children and adolescents (0-19) years seen in the Ahmadu Bello University teaching hospital, Zaria. MATERIALS AND METHODS: A 2-year retrospective review of breast sonograms of 25 consecutively presenting children and adolescents (3 males and 22 females) who had palpable breast masses. Ultrasound scans were performed with a Mindray Machine DC-8 using the linear transducer at 7.5-12 MHz transducer frequency. Histopathological confirmation of the solid masses was also obtained. The statistical analysis of the data collected was done using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA). RESULTS: The patients were between 40 days and 19 years old (mean 14.8 years and standard deviation 4.1). The ultrasonographic findings were those of infections, benign tumoral lesions and pubertal endocrine changes. Overall, fibroadenoma was the most common mass, seen in 14 (56%) of the patients. Other findings were simple cysts, non-puerperal and puerperal mastitis, juvenile papillomatosis and normal glandular pubertal breast tissue. The three male patients had gynaecomstia, pseudogynaecomastia and cystic lymphangioma of the chest wall presenting as unilateral breast masses, respectively. There was no malignancy recorded in any of the patients. CONCLUSION: Ultrasonographically, benign masses predominate which is concordant with surgical findings. Familiarity with these features would obviate the need for unnecessary invasive procedures which should be reserved for only deserving cases.

Giant juvenile papillomatosis of the breast in a Nigerian girl.

Juvenile papillomatosis is a benign epithelial proliferative tumour of young women. It was recognised as a distinct clinicopathological entity with defining criteria by Rosen et al since 1980. However, giant juvenile papillomatosis is rare. We report a case of a 14-year-old girl who presented to our institution's breast clinic with a huge right breast mass measuring 20 cm × 15 cm. She had no personal history of previous breast disease and there was no family history of breast cancer. Our initial preoperative diagnosis was of a phylloides tumour. The patient had a total excision of her breast mass which revealed florid juvenile papillomatosis at histology. This presentation highlights the clinical presentation and imaging features of juvenile papillomatosis. The classical histopathological characteristics, unusual microscopic findings and management of a huge-sized tumour in an adolescent Nigerian patient are also presented.

Computerized tomographic study of normal Evans index in adult Nigerians.

BACKGROUND: The evaluation of degree of ventricular enlargement should be based on established indices rather than on personal experience as this is highly subjective. Our aim was to establish normal values for Evans index in a Nigerian adult population as none has been found in the Nigerian medical literature. MATERIALS AND METHODS: Axial computerized tomographic brain scans of 488 normal subjects were reviewed retrospectively. Of them, 319 (65.36%) of the patients were males and 169 (34.63%) were females; their ages ranged from 18 to 84 years with a mean age of 37.26 years. The images were acquired using a multi-slice GE Sigma excite scanner. Evans index was measured as the linear ratio of the total width of the frontal horns of the cerebral lateral ventricles to the maximum intracranial diameter. RESULTS: The mean value for Evans index for the studied population was 0.252 ± 0.04. The EI increased with age and it was slightly higher among males. The difference in Evans value in males and females was not statistically significant. Individuals above 60 years old had the highest Evans values in both sexes. CONCLUSION: This study has established ranges of normal value for Evans index in a Nigerian population. It agrees with the diagnostic cut-off value of > 0.3 for hydrocephalus and it compares well with that of the Caucasians.