ROLE OF ULTRASOUND FINDINGS AND HISTOPATHOLOGICAL DATA FROM ULTRASOUND GUIDED TRUCUT BIOPSY IN DIAGNOSIS OF SUSPICIOUS BREAST MASSES

ROLE OF ULTRASOUND FINDINGS AND HISTOPATHOLOGICAL DATA FROM ULTRASOUND GUIDED TRUCUT BIOPSY IN DIAGNOSIS OF SUSPICIOUS BREAST MASSES

By

Mahmoud Mohamed Ahmed Abd El-Aleem, Mahmoud Kadry El-Gendy, Mohamed Salah El-Din Abd El-Baky and Osama Mostafa Mostafa

Departments of Radio diagnosis and Pathology, Faculty of Medicine, Al-AzharUniversity

Corresponding author: Mahmoud Mohamed Ahmed Abd El-Aleem,

Mobile: (+20)01006401417, E-mail: drmahmoud184@gmail.com

ABSTRACT

Background: Breast ultrasound being the first tool in diagnosis of suspicious breast masses especially in combination with mammographic study.

Objective: To assess the diagnostic value of the ultrasound of suspicious breast masses by correlation of the ultrasound findings with those obtained from the histopathological data resulting from U/S guided Tru Cut biopsy.

Patients and methods: The study was carried out at the Department of Radio diagnosis, Al-HussienUniversityHospital - Cairo. The study was carried out during the period between December 2020 and June 2021. A total of 40 cases in which US revealed suspicious breast masses, all of those patients agreed to undergo tru-cut biopsy after ultrasound examination. The samples were sent for histopathological assessment to confirm the results of the ultrasound.

Results: Our results yielded a high sensitivity of 100% with 60% specificity, and a PPV and NPV, of 94.6%, 100% respectively with 95% accuracy.

Conclusion: Our study revealed that Tru-cut biopsy was an accurate diagnostic tool of suspicious breast masses with a high diagnostic accuracy of 95 % as it supplied enough tissue for pathologists to establish a correct histological assessment. So, it is a preferable procedure for the diagnosis of breast lesions prior to operation rendering to its low cost, high accuracy, minimal complications, safe and short time procedure.

Keywords: Suspicious breast masses, Ultrasound, U/S guided Tru cut biopsy, histopathological assessment.

INTRODUCTION

     The incidence of breast cancer worldwide is increasing. However, with the advent of regular screening, more women are being diagnosed with early-stage disease. With the improved understanding of the heterogeneity of the molecular subtypes of cancer and thus development of more sophisticated treatment, breast cancer mortality continues to decrease (Rojas and Stuckey, 2016).

     Detection of breast nodules for diagnosing cancer precursor lesions before clinical manifestations is essential, considering its early discovery allows a less aggressive treatment and yet more effective for these diseases. Imaging studies have greatly aided in the detection of non-palpable breast lesions, with emphasis on mammography, which identifies micro-calcifications, asymmetries and nodules, and on mammary ultrasonography (US), which is the most commonly used complementary method to characterize mammographic findings or to assist in the investigation of dense breasts. The identification of lesions suspicious of malignancy determines the need of cytological or histopathological evaluation through a minimally invasive procedure, whose arsenal consists basically of fine needle aspiration (FNAB) or core-biopsy (Silva et al., 2017).

     However, early detection requires an accurate and reliable diagnosis which should also be able to distinguish benign and malignant tumors. A good detection approach should produce both low false positive (FP) rate and false negative (FN) rate (Huang et al., 2017).

     US intervention has become a primary tool in the diagnostic workup of breast lesions. These interventions are safe, effective, and accurate owing to the lack of ionizing radiation and dynamic visualization capabilities (Reisenauer et al., 2017).

     Lumps or focal lesions in the breast detected by physical examination, mammography, or other imaging studies are subjected to US guided biopsy to differentiate between benign, malignant or grey zone lesions. A breast biopsy is performed to remove a thin core tissue from a suspicious area in the breast and give for histopathological examination. This is mostly performed by an experienced radiologist using a less invasive procedure. It is done in cases of a suspicious solid mass, a distortion in normal architecture or density of the breast tissue. This is very useful in suspicious lesions picked up by an US guided and then sampled accordingly (Rakesh et al., 2017).

     Dealing with a significant breast lesion involves the correlation of clinical imaging and the histopathological findings. This is best achieved with a multidisciplinary open forum with the clinician, radiologist and pathologist reaching a consensus on the management of each case using predefined protocols. The highest levels of diagnostics accuracy are achieved if such triple approach of imaging, clinical diagnosis and biopsy is used (Ahmed and Kadhim, 2016).

     The present work aimed to assess the diagnostic value of the ultrasound of suspicious breast masses by correlation of the ultrasound findings with those obtained from the histopathological data resulting from U/S guided Tru Cut biopsy.

PATIENTS AND METHODS

     This prospective study comprised of 40 cases in which US revealed suspicious breast masses. All of those patients, investigated by breast ultrasound and, agreed to undergo U/S guided tru-cut biopsy after ultrasound examination. The samples are sent for histopathological assessment to confirm the results of the ultrasound. The work was done at the Radiology Department, Al-HussienUniversityHospital. Ethical approval from Al-Hussien University Ethics Committee was obtained .The study was carried out during the period between December 2020 till June 2021.

Inclusion criteria: Patients presented to the radiology department at Al-hussien university hospital for breast US and /or mammographic evaluation that revealed suspicious breast masses indicative for biopsy that was performed by ultra sound guidance under complete aseptic conditions.

Exclusion criteria: Patients refusals, Patients were not candidate for the biopsy as those with bleeding tendency and Patients with sonographic benign criteria of breast masses.

Statistical analysis: The clinical data were recorded on a report form. These data were tabulated and analyzed using the computer program SPSS (Statistical package for the social sciences) version 20 to obtain both descriptive data (for quantitative data in the form of Mean, standard deviation (±SD), median and interquartile range (IQR) in addition to frequency and distribution for qualitative data) and analytical statistics (Inter-group comparison of categorical data was performed by using Fisher exact test (FET)). A P value

RESULTS

     This study included 40 patients. It was conducted in radiology department of Al-hussien university hospital. Mean age of patients was 47±9 (Mean±SD) with minimum of 38 years old and maximum of 65 years old. All of our samples were females.

There was no statistically significant difference between benign and malignant US regarding age of the patients, nipple discharge, sense of pain and lump and positions of the mass. While there was statistically significant difference according to family history (Table 1).

Table (1):   Comparison between results by US (benign and malignant) regarding the demographic data

     The total number of the patients in the study and the percentage of them in groups according to the site, echogencity, length, width, shape, margins and BIRADs of the mass (Table 2).

Table (2):   Radiologic data of the breast lesions

     There was no statistically significant difference between benign and malignant histopathology regarding the ages of the patients, nipple discharge and pain. While there was statistically significant difference according to sense of breast lump, position of the mass and family history (Table 3).

Table (3):   Comparison between results by hisopatholgy and the demographic data

     There was no statistically significant difference between benign and malignant histopathology regarding site of mass and width of the mass. While there was statistically significant difference according to echogencity, length, shape margin and BIRADs of the masses (Table 4).

Table (4):   Comparison between results by histopathology (benign and malignant) regarding breast lesions

     All malignancies proved by histopatholoy are seen by ultrasound, while only 60 % of benign lesions proved by histopathology are seen by ultrasound (Table 5).

Table (5):   Comparison between results by histopathology (benign and malignant) regarding results by US

     There was no statistically significant difference between benign and malignant US regarding site of mass, echognecity, width and length. While there was statistically significant difference according shape, margin and BIRADs (Table 6).

Table (6):   Comparison between results by US (benign and malignant) regarding the breast lesions

     The true positive, true negative, false positive and false negative values, sensitivity, specificity, positive predictive value, negative predictive value and accuracy (Table 7).

Table (7):   Results of ultrasound

     The total number of the patients in the study and the percentage of them in groups according to the results seen by ultrasound (benign or malignant), results by histopathology (benign or malignant) and all histopathological results of the all patients (Table 8).

Table (8):   Descriptive data of the results

     Invasive ductal carcinoma has penetrated through the duct wall into stroma (Figure 1).

Figure (1):  Invasive ductal carcinoma

     Intraductal papilloma with benign proliferation of the intraductal epithelial cells, fibrovascular cores and underlying myoepithelial cells (Figure 2).

Figure (2):  Intraductal papillom

     Invasive lobular carcinoma with lobular neoplasia, intracellular mucin pushing the nucleus to one side created the characteristic signet ring morphology (Figure 3).

Figure (3):  Invasive lobular carcinoma

DISCUSSION

     The patient’s age in our study ranged between 38 and 65 years with a mean of 47 years (±SD 9).

     The study included 25 patients (62.5%) were right sided breast lesions which were more common than left sided lesions that included 15 patients (37.5%). which was  similar to results of Yasemin and Mehmet (2019) in which right sided lesions include 268 patients (%56.8) that was more common than left sided lesions that include 204 patients(43.2%).

     In our study the most frequent location of the masses was breast upper inner quadrant 47.5% of cases, while 42.5% of cases located at upper outer quadrant of the breast. The other locations were respectively axillary tail with a rate of 7.5% and operative bed region with a rate of  2.5%.

     Yeniçeri et al (2015) showed that the most frequent location of the masses was breast upper outer quadrant (49.5%) and others were upper inner quadrant with a rate of 18.4%, lower inner quadrant with 8.7%, lower outer quadrant with 18.4% and retroareolar region with 4.9%.

     As regards the BIRADS (breast imaging reporting and data systems) of each lesion, our study included 5.0% of patients of BIRADS III, 5.0% of BIRADS Iva, 35.0% of BIRADS IV b, and 55.0% of BIRADS IVc. Yeniçeri et al. (2015) showed that 42% were classified as BIRADS III, 19% as BIRADS IV, and 39% as BIRADS V. Yasemin and Mehmet (2019) showed that BI-RADS III was 71.6% and, BI-RADS IV were 28.4%.

     According to family history, our study included 65.0 % of positive family history; while Yasemin and Mehmet (2019) showed that the percentage was lower than our study, i.e. 12%.

     Our results yielded a high sensitivity of 100 % with 60 % specificity, and a PPV and NPV, of 94.6 %, 100 %, respectively with 95 % accuracy. Our results with US-guided core biopsy were similar to those in other reported series in which sensitivity ranged from 90% to 100 % according to Ahmed and Kadhim (2016).

     With results seen by Yasemin and Mehmet (2019) showed different percentage due to the large number of cases. Ahmed and Kadhim (2016) showed that the sensitivity of core biopsy was 94.64%, specificity was 91.30% and accuracy rate was 94.87%. Yasemin and Mehmet (2019) showed that the sensitivity was 95.4% with 100% specificity, and a PPV, NPV, and diagnostic accuracy of 100%, 96.1%, and 98.9%, respectively.

CONCLUSION

     Tru-cut biopsy was an accurate diagnostic tool of suspicious breast masses with a high diagnostic accuracy of 95 %. It was a preferable procedure for the diagnosis of breast lesions prior to operation rendering to its low cost, high accuracy, minimal complications, safe and short time procedure.

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