Angeline Anyona Aywak
University of Nairobi, Kenya
Angeline A Aywak MBCHB (UON) Mmed Radiology (UON) Fellowship in Ultrasound Jefferson University PA USA. She is the Senior lecturer University of Nairobi College of Health Sciences School of Medicine Dept Diagnostic Imaging & Radiation Medicine.
Purpose: To establish the prevalence of cancer in patients referred for breast ultrasound guided biopsy at Kenyatta National Hospital, Nairobi, Kenya.
Methods and Materials: A total number of 115 patients were included after approval from the local ethical review committee. The patients were referred by clinicians for ultrasound-guided biopsy for palpable breast lesions confirmed by imaging as solid masses. Detailed ultrasound examination per American College of Radiology (ACR) guidelines was performed before core biopsy or fine needle aspiration (FNA). Histological diagnosis was made and the prevalence of cancer analyzed.
Results: Of the 115 patients, final histology was available for 112 lesions; two cases could not be traced and one was inconclusive. Females accounted for 96.5% of cases; median age 28years (range of 15-79years). The median age of patients with cancer was 48years (range 28-79years). Cancer was diagnosed in 28(25%) specimens, the remaining 84 revealing benign histology, with 74/84(88%) fibroadenomas. There were 32/112 patients aged >40years (28.6%), of which 22(78.6%) had cancer (p<0.0001). BI-RADS final assessment categories were assigned prior to biopsy; all solid masses in BI-RADS 2 and BI-RADS 3 were histologically benign. One of 11 lesions in BI-RADS 4 category and 2 of 20 in BI-RADS 5 were histologically benign. Elastography assisted in identifying all cancers in these groups as suspicious, based on strain ratio.
Conclusion: Most breast masses in our cohort (75%) were benign. Patients with a breast lump, especially young ones, need not assume it is cancer until thorough clinical and imaging evaluation has been done to characterize lesions and biopsy performed when indicated. Of the 25% of patients with cancers in this study, almost 79% were >40years of age; younger women had benign lesions, mostly fibroadenomas.