European Journal of Cardiovascular Medicine

The term "benign breast diseases" refers to a range of lesions that present various symptoms or may be identified as accidental microscopic findings. This disorder is rather common among younger persons, with incidence rates rising around the second decade of life and peaking in the fourth and fifth decades. Conversely, there is an increased incidence of malignant disorders subsequent to the onset of menopause. [1-6] Benign processes may present many clinical symptoms, including palpable nodularity, thickening, mass development, discomfort, inflammation, or nipple discharge. In certain instances, these processes may potentially be completely asymptomatic. Many indications and symptoms associated with various breast disorders are non-specific, requiring further evaluation using imaging methods and, in some instances, later biopsy to confirm a definitive diagnosis. Benign lesions can arise from different cell types and may present as inflammatory or proliferative. This category includes skin lesions, vascular lesions, lymph nodes, fat necrosis, foreign bodies, infections, fibroadenomas, other benign tumours, cysts, galactoceles, adenosis, fibrosis, duct ectasias, papillomas, radial scars, and various forms of epithelial hyperplasias, with or without atypia.[7]Benign epithelial lesions can be classified into three categories according to their associated risk of breast cancer development.[8]Non-proliferative breast alterations, including fibrocystic changes, do not demonstrate an increased risk for breast cancer development.[7]Proliferative breast disease, marked by the proliferation of non-atypical epithelial cells, is associated with a modest increase in the risk of cancer in either breast. These characteristics are seen as markers of possible risk, although they are not commonly perceived as direct antecedents of carcinoma. [9] This study aimed to investigate the age distribution of benign breast diseases and analyse the spectrum of benign breast lesions concerning their clinical presentation.

Study Design and Setting

This observational study was conducted over a period of six months at a tertiary care center. The study included 100 female patients presenting with benign breast diseases.

Study Population

The study population comprised women of all age groups who visited the outpatient department with breast-related complaints and were clinically diagnosed with benign breast diseases.

Inclusion Criteria

• Female patients presenting with clinically suspected benign breast disease.
• Patients who underwent fine-needle aspiration cytology (FNAC) and/or histopathological examination (HPE).
• Patients willing to provide informed consent.

Exclusion Criteria

• Patients with clinically or radiologically suspected malignant breast lesions.
• Patients with a prior history of breast malignancy.
• Incomplete medical records or lost follow-up cases.

Methodology

1. Clinical Examination: All patients underwent a thorough clinical breast examination, including assessment of lump characteristics (size, location, mobility, tenderness), nipple discharge, and axillary lymphadenopathy.
2. Radiological Evaluation: Ultrasound and/or mammography were performed where indicated to further characterize the lesion.
3. Cytological and Histopathological Analysis:
• FNAC was performed in all cases using a 22- to 25-gauge needle. The smears were stained and analyzed for cytological diagnosis.
• Excisional or core biopsy was conducted in cases requiring further histopathological confirmation.
4. Correlation Analysis: The clinical findings were compared with FNAC and/or HPE results to establish diagnostic accuracy and correlation between clinical and pathological diagnoses.

Statistical Analysis

The collected data were entered into Microsoft Excel and analyzed using SPSS software. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in diagnosing benign breast diseases were calculated. A p-value of <0.05 was considered statistically significant.

Table 1: Age wise distribution

The age distribution of the 100 patients with benign breast diseases shows that the majority of cases (60%) were in the 21-30 years age group, indicating a higher prevalence in young adult women. The 31-40 years age group accounted for 22% of cases, followed by 8% in the 11-20 years group. The occurrence of benign breast diseases decreased with age, with 6% of cases in the 41-50 years group and only 4% in women above 50 years. This distribution suggests that benign breast diseases are more common in reproductive-age women, with a declining trend in older age groups.

Table 2: Clinical presentation

Among the 100 patients with benign breast diseases, the most common clinical presentation was a painless, mobile breast lump, observed in 68% of cases. Breast lump associated with pain was reported in 24% of patients, while 6% presented with a lump accompanied by both pain and nipple discharge. Only 2% of cases had nipple discharge as the sole symptom. This distribution highlights that the majority of benign breast disease cases manifest as painless lumps, with a smaller proportion experiencing additional symptoms like pain and nipple discharge.

Table 3: Age wise distribution of benign breast lesions on histopathology.

Among the 100 patients diagnosed with benign breast diseases, fibroadenoma was the most common lesion, accounting for 58% of cases, predominantly affecting women aged 21-30 years. Fibrocystic disease was the second most frequent diagnosis, seen in 13% of cases, followed by proliferative breast disease with hyperplasia (8%). Less common lesions included simple cysts (5%), proliferative breast disease without atypia (5%), and benign phyllodes tumors (3%). Conditions such as duct ectasia, intraductal papilloma, breast abscess, tuberculosis, and gynecomastia were observed in a small proportion of cases (≤2% each). The overall distribution highlights that benign breast diseases are more prevalent in younger women, particularly in the reproductive age group.

Table 4: Cytological and histopathological correlation.

Among the 100 patients, fibroadenoma (58%) was the most common benign breast lesion, followed by fibrocystic disease (13%). Proliferative breast disease was seen in 12% of cases, with 5% without atypia and 7% with hyperplasia. Less frequent conditions included simple cysts (5%), benign phyllodes tumors (3%), duct ectasia (2%), and intraductal papilloma (2%). Rare cases of breast abscess (2%), tuberculosis (1%), galactocele (1%), and gynecomastia (1%) were also observed. The histopathological findings closely correlated with cytological diagnoses, with only minor discrepancies, primarily in differentiating fibroadenoma from fibrocystic disease and intraductal papilloma. This emphasizes the reliability of cytology in diagnosing benign breast diseases, though histopathology remains essential for confirmation in certain cases.

The present study included total 100 cases of benign breast lesions in whom the clinical findings were correlated with cytological, histopathological and radiological findings.

Age and gender incidence

Sixty percent of the cases in our study were found in people between the ages of 21 and 30. People over the age of 50 were least likely to have benign breast tumours. Ilaiah et al. (n=60 cases) also found that 58.3% of their cases of benign breast tumours were in people between the ages of 21 and 30.[10] Chalya et al. also looked at 346 cases of benign breast lesions. The patients' ages ranged from 14 to 72 years, with 26 years being the usual age and 69.9% of the cases being between the ages of 21 and 30.[11] Mallikarjuna et al. looked at 50 cases and found that 44% of them were between the ages of 21 and 30.[12] The things we found agree with what the other authors said. Bhargava et al. also said that 47% of the cases were in people aged 25 to 40.[13] In our study, there were only 8% cases in people aged 11 to 20, but Ilaiah et al. and Mallikarjuna et al. found higher rates of 23.3% and 40% for those same age groups.[10] Only 1.2% of the cases in our series were men.12 Also, only 1% of the people who took part in the study by Deshpande et al. were men, even though it was about cancerous breast tumours.[14] In the study by Danadapat et al., many of the men who took part were also men with gynaecomastia.[15] Male breast lumps are rare, and our results are similar to those of the other writers.

Clinical presentation

In this study, 68% of the breast lumps were flexible and didn't hurt. Only 24% of the lumps hurt, and only 2% of those cases had only nipple discharge. Other cases had painful lumps and nipple discharge. The most common sign in the study by Chalya et al. was a lump in the breast in 67.6% of their subjects.[11] 12.4% of patients said they had lumps in their breasts that were accompanied by other symptoms like pain and/or nipple discharge. According to the study by Ilaiah et al., the most common sign was a lump that didn't hurt (58.3% of cases), followed by a lump that did hurt.[10] Only one person had fluid from both nipples, and that person was diagnosed with duct ectasia.

Laterality and site of lesions

52% (130/250) of the cases in this study had a lesion on the right breast, 32% (80/250) had a lesion on the left breast, and 16% (40/250) had a lesion on both breasts.Also, Chalya et al. found that the right breast was affected in 53.8% of cases and the left breast was affected in 42.8% of cases.[11] In their study, 3.4% of patients had tumours on both breasts. Sangma et al. found that mild disease affected the right breast 48% of the time and the left breast 40% of the time.[16] In 12% of cases, both parties were involved, which is close to what we found.This study found that most breast lumps (60%) were in the upper outer quadrant, while only 8% were in the upper inner quadrant. In their study, Chalya et al. also found that most breast lumps (63.5%) were in the upper outer quadrant and the fewest (6.8% of the cases) were in the upper inner quadrant.The study [11] found that a clinical check was 98.6% sensitive and 59.6% specific for finding fibroadenoma, which is the most common benign breast lesion. This was compared to the results of a biopsy. With 480 cases, Smallwood et al. found that the clinical detection accuracy was 86.7%.[17] Dandapat et al. found that all types of breast lesions, including neoplastic lesions, had an average clinical accuracy of 91.3%.[15] In their study, Furnival et al. also found an accuracy of 85%.[18] It is normal for the clinical and cytological and/or histopathological diagnoses to be different. This is because some histopathological conditions, such as proliferative breast disease with or without atypia, florid epithelial hyperplasia, and others, can't be seen on a clinical test. On the other hand, fibroadenoma is usually easy to diagnose based on the patient's medical history and physical test.

Women aged 21 to 30 often have benign breast diseases. A common clinical sign is a lump in the breast that moves around without hurting. The other signs are breast pain and discharge from the nipple. In our study, fibroadenoma was the most common type of change, followed by fibrocystic changes. Cytology and histopathology were linked to the clinical findings.

1. Caleffi M, Filho DD, Borghetti K Graudenz M, Littrup PJ, Freeman-Gibb LA et al. Cryoablation of benign breast tumours: evolution of technique and technology. Breast. 2004;13:397-407.
2. Kelsey JL, Gammon MD. Epidemiology of breast Epidemiol Rev. 1990;12:228-40.
3. Fitzgibbons PL, Henson DE, Hutter Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Cancer Committee of the College of American Pathologists. Arch Pathol Lab Med. 1998;122:1053- 5.
4. Sarnelli R, Squartini F. Fibrocystic condition and at risk, lesions in asymptomatic breasts: a morphologic study of postmenopausal women. Clin Exp Obstet Gynecol, 1991;18:271-9.
5. Cook MG, Rohan TE. The Patho-epidemiology of benign proliferative epithelial disorders of the female J Pathol. 1985;146:1-15.
6. La Vecchia C, Parazzini F, Franceschi S, Decarli A. Risk factors for benign breast disease and their relation with breast cancer risk. Pooled information from epidemiologic studies. Tumori. 1985;71:167-
7. Jackson VP, Yao SF, Karin Benign Breast lesions. Bassett: Diagnosis of Diseases of the Breast, 2^nd Edition, 1997 by Elsevier Inc.; 2005.
8. Hughes L, Mansel R, Webster DT. Aberrations of normal development and involution (ANDI): a new perspective on pathogenesis and nomenclature of benign breast The Lancet. 1987;5;330(8571):1316-9.
9. Robbins and Cortan pathologic basis of diseases. 9^th Edition Elsevier; 2015:1045-1066.
10. Ilaiah M, Purnaiah M, Pasha Evaluation of Benign Breast Diseases with Clinico, Pathological and Radiological Correlation. Indian J Appl Res. 2015;5(11).
11. Chalya PL, Manyama M, Rambau PF, Kapesa A, Ngallaba SE, Masalu N et al. Clinicopathological pattern of benign breast diseases among female patients at a tertiary health institution in Tanzania. Tanzania J Health 2016;18(1).
12. Mallikarjuna, Maralihalli Clinico-pathological study of benign breast disease. Indian J Basic Appl Med Res. 2015:4(2):39-46.
13. Bhargava GS, Gupta A, Grover A, Ded KS. Benign breast disorders: rural Punjab population study
14. compared with urban population studies. Int Surg J. 2015;2(4):629-33.
15. Kumar AD, Jayashankar E, Shailaja P, Ramamurti
16. Expression of Estrogen, Progesterone and HER2/ neu Receptors in Breast Carcinoma- Study in a Tertiary Care Hospital. J Evolut Med Dent Sci. 2015;4(58):10170-7.
17. Dandapat MC, Panda Fine needle aspiration as a primary adjunct in the diagnosis of palpable breast lumps. J Indian MA. 1986;84(1):3.
18. Sangma MMB, Panda K, Dasiah Clinico- Pathological Study on Benign Breast Diseases. J Clin Diagnost Res. 2013;7(3):503-6.
19. Smallwood J, Herbert A, Guyer P, Taylor Accuracy of aspiration cytology in the diagnosis of breast disease. Br J Surg. 1985;72:841-3.
20. Furnival CM, Hughes HE, Hocking MA, Reid MM, Blumgart LH. Aspiration cytology in breast cancer, its relevance to diagnosis. 1975;2:446-9.