Chapter 20: Diagnostic investigations
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Source: Adapted from Hughes ([72]). Reproduced with permission of OUP; permission conveyed through Copyright Clearance Center, Inc.
Related theory
Benign breast disease is a term used to describe a variety of breast changes that are prevalent in the population. This is unsurprising when the stimulatory nature of the menstrual cycle on breast tissue is considered. Benign changes are hugely varied and can be developmental, inflammatory, fibrocystic or neoplastic in nature. They are often proliferative but not atypical in nature. Most can be safely left without intervention once biopsy proven (Guray and Sahin [59]). The most common benign presentations are listed in Table 20.8, related to age. Breast cancer is, however, the most commonly diagnosed cancer amongst women in the UK with 54,800 cases diagnosed per year (Cancer Research UK [22]) and has a high media and social profile (Xu et al. [175]).
Table 20.8 Benign breast changes across ages
berration of normal development and involution (ANDI) | ||||
---|---|---|---|---|
Age | Normal process | Clinical presentation | Underlying condition | Disease |
15–24 | Duct and lobule formation | Discrete lump | Fibroadenoma | Giant or multiple fibroadenoma |
Stroma formation | Uneven or excessive breast development | Juvenile hypertrophy
Asymmetrical development | Uni‐ or bilateral macromastia
Poland's syndrome | |
25–34 | Cyclical hormonal effects causing mild breast pain and alterations in size which fluctuate | Exaggerated hormonal effects causing moderate breast pain, nodularity and tenderness
Generally cyclical | None | Severe breast pain and tenderness interfering with normal activities
Cyclical or non‐cyclical in nature
Continued nodularity |
Discrete lump | Fibroadenoma or macrocysts | Malignancy (uncommon in absence of family history) | ||
35 onwards | Cyclical hormonal effects causing mild breast pain | Multiple microcysts
Sclerosing adenosis
Lobular hyperplasia | ||
Lobular involution – microcysts, apocrine change, fibrosis, adenosis
Ductal involution | Discrete lumps
Nipple discharge
Nipple retraction | Isolated macrocysts
Duct ectasia
Ductal hyperplasia
Nipple discharge | Malignancy
Multiple macrocysts
Periductal mastitis
Atypical ductal hyperplasia
Multiple papillomata | |
Normal | Periductal fibrosis
Nipple retraction | Discrete lumps requiring biopsy |