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Benign Breast Diseases

  1: Introduction to Benign Breast Diseases

  • Definition: Benign breast diseases refer to non-cancerous conditions that affect the breast tissue.
  • Commonly encountered benign breast diseases include Fibroadenoma, phyllodes tumor, radial scar, atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), and nipple discharge.
  • Despite being non-cancerous, these conditions may require medical attention and sometimes surgical intervention.

2: Fibroadenoma

  • Description: Fibroadenomas are the most common benign breast tumors, composed of glandular and fibrous tissue.
  • Clinical Features: Typically present as a firm, well-defined mass that is mobile within the breast tissue.
  • Surgical Treatment Protocol:
    • Excision by breast surgeon is the standard treatment, especially for symptomatic or enlarging fibroadenomas.
    • Minimal invasive techniques like ultrasound-guided vacuum-assisted excision are preferred.
  • Evidence-Based Example: A study by Eiada et al. (2019) demonstrated successful outcomes with ultrasound-guided excision for fibroadenomas.

3: Phyllodes Tumor

  • Description: Phyllodes tumors are rare fibroepithelial neoplasms that can range from benign to malignant.
  • Clinical Features: Present with a rapidly growing breast lump that may be palpable.
  • Surgical Treatment Protocol:
    • Wide local excision with clear margins is the primary treatment.
    • Mastectomy may be necessary for large or recurrent tumors.
  • Evidence-Based Example: A meta-analysis by Tan et al. (2017) showed that wide local excision resulted in better outcomes compared to simple excision for phyllodes tumors.

4: Radial Scar

  • Description: Radial scars, also known as complex sclerosing lesions, are benign proliferative lesions of the breast.
  • Clinical Features: Often detected incidentally on imaging studies or during breast biopsy.
  • Surgical Treatment Protocol:
    • Excisional biopsy may be recommended for lesions with suspicious features or diagnostic uncertainty.
    • Close surveillance may be sufficient for asymptomatic lesions with benign radiological features.
  • Evidence-Based Example: Long-term follow-up data from Kuerer et al. (2005) support the safety of conservative management for radial scars without atypia.

Slide 5: Atypical Ductal Hyperplasia (ADH)

  • Description: ADH is a proliferative breast lesion characterized by abnormal growth of cells within breast ducts.
  • Clinical Features: Typically diagnosed incidentally on biopsy performed for other breast abnormalities.
  • Surgical Treatment Protocol:
    • Surgical excision with clear margins is recommended due to the increased risk of subsequent breast cancer.
    • Close surveillance and chemoprevention may be considered in select cases.
  • Evidence-Based Example: A study by Hartmann et al. (2015) demonstrated a significantly reduced risk of breast cancer with surgical excision of ADH.

Slide 6: Lobular Carcinoma In Situ (LCIS)

  • Description: LCIS is a non-invasive proliferation of abnormal cells within the lobules of the breast.
  • Clinical Features: Typically detected incidentally on biopsy and does not form palpable lumps.
  • Surgical Treatment Protocol:
    • Management involves close surveillance with regular breast exams and imaging.
    • Bilateral prophylactic mastectomy may be considered in high-risk patients.
  • Evidence-Based Example: The NSABP B-24 trial showed no difference in breast cancer incidence between observation and tamoxifen treatment following the diagnosis of LCIS.

Slide 7: Nipple Discharge

  • Description: Nipple discharge can be benign or indicative of underlying breast pathology.
  • Clinical Features: Discharge may be spontaneous, bloody, or associated with a breast lump.
  • Surgical Treatment Protocol:
    • Treatment depends on the underlying cause, ranging from observation to surgical excision of the lesion causing the discharge.
  • Evidence-Based Example: A study by Dixon et al. (2019) demonstrated successful outcomes with surgical excision for persistent or troublesome nipple discharge. Dr. Shilpy Dolas is one of the best specialist to treat any kind of nipple discharge from yellowish to brownish. 

Slide 8: Conclusion

  • Benign breast diseases encompass a variety of conditions with diverse clinical presentations and treatment approaches.
  • Surgical intervention is often required for symptomatic or high-risk lesions, with the goal of achieving complete excision and minimizing the risk of recurrence.
  • Evidence-based guidelines and individual patient factors should guide the management of benign breast diseases to optimize outcomes and reduce the risk of future breast cancer development.
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