Correlation Between Ultrasonography And Histopathology In Breast Abnormalities At Kenyatta National Hospital

Abstract

INTRODUCTION: Previous studies on breast masses done in Kenya were based on assessing the value of ultrasonography as an adjunct to mammography in evaluating breast masses and in probing usefulness of mammography in the investigation of symptomatic patients under 30 years of age. No study has been done in Kenya to date to correlate the ultrasonographic pattern of breast masses with their histopathology findings. OBJECTIVE: To compare Ultrasonographic and histopathology findings in the diagnosis of breast abnormalities and establish the ability of ultrasonography compared to histopathology the gold standard. STUDY DESIGN: Prospective cross sectional descriptive study. METHODOLOGY: Grey scale and color Doppler breast ultrasonography (BUS) was done on fifty six patients referred on suspicion of breast disease. These patients later as per routine practice underwent core or excisional biopsy of the lesion where specimen for histopathology was obtained. Each breast abnormality was characterized in terms of shape, orientation of long axis, echopattern, margins, calcifications, acoustic shadowing or enhancement and vascularity. Ultrasonographic and histology reports were recorded in data collection forms. Data entry and statistical analysis was done using microcomputer SPSS/PC+ programme. RESULTS: A total of 56 patients were studied. The ages of the patients ranged between 15 and 74 years. The mean age was 35 years with a standard deviation of 14.1. At ultrasonography the commonest breast masses were ACR BIRADSUS category 2 lesions 26 cases {46.4%}. These were followed by category 4 lesions 17 cases {30.4%} and category 5 lesions 8 cases {14.3%}. Categories 1 and 3 had 2 cases each {3.6%} while category 6 had only one case {1.8%}. The lesions confirmed at histology included fibroadenoma 18 cases {32%}, infiltrating ductal carcinoma 21 cases {37.5%}, fibrocystic change 3 cases {5.4%}, phylloides tumor 3 cases {5.4%}, papilloma 2 cases and one case each of fibrosis, lipoma, mastitis and abscess. CONCLUSION: Analysis of ultrasonographic characteristics of breast masses such as shape, orientation, margins, lesions boundary, posterior acoustic features, calcification and assigning the mass an ACR-BIRADS assessment category will help in differentiating benign from malignant lesions. RECOMMENDATION: For all cases of breast masses referred for BUS, lesion characteristics such as shape, orientation, margins, lesion boundary, echopattern, posterior acoustic features and calcification should be analyzed and the lesion assigned an ACR-BIRADSassessment category. This will help in differentiating benign from malignant lesions.