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An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital Breast Imaging
N C Christofides1, G Rubin2, C-A Benn3
1Department of Diagnostic Radiology, University of the Witwatersrand, South Africa.
Insights
A study of 1,263 patients with clinically benign breast conditions found only 3.6% malignancies. This confirms the accuracy of the breast clinic
Area of Science:
- Radiology
- Pathology
- Oncology
Background:
- Benign breast pathology is common and requires careful assessment to rule out malignancy.
- Helen Joseph Hospital (HJH) uses a clinical triage system with color-coding to manage patient waiting times for mammography.
- Understanding the spectrum of benign breast disorders and the accuracy of clinical assessment is crucial.
Purpose of the Study:
- To evaluate the association between clinical breast examination findings and subsequent radiological and pathological diagnoses for clinically benign conditions.
- To determine the range of benign breast disorders encountered at HJH.
- To validate the effectiveness of the existing clinical triage system.
Main Methods:
- Retrospective analysis of imaging and biopsy results for patients presenting with clinically benign breast disorders at HJH (January-June 2018).
- Documentation of Breast Imaging-Reporting and Data System (BI-RADS) scores.
- Recording of core biopsy results and patient demographics where applicable.
Main Results:
- Out of 1,263 patients, radiological assessments included BI-RADS 1 (12.5%), BI-RADS 2 (54.2%), BI-RADS 3 (23.1%), BI-RADS 4 (8.7%), and BI-RADS 5 (1.9%).
- 133 biopsies revealed 46 (3.6%) confirmed malignancies.
- Combined mammography and ultrasound sensitivity was 91.30%, with a specificity of 65.52%.
Conclusions:
- The study confirms a low malignancy rate (3.6%) among clinically benign breast conditions, validating the HJH triage system.
- Radiological imaging demonstrates high sensitivity but moderate specificity for diagnosing breast conditions.
- The combination of clinical, radiological, and histological assessments remains the gold standard for accurate breast disease diagnosis.
Background:
Benign breast pathology is a common presenting complaint, and its assessment is important to characterise not to miss malignant pathology. At Helen Joseph Hospital (HJH), patients are triaged at the breast clinic according to the clinical suspicion of benign versus malignant disease. The patients are assigned a colour label based on their clinical presentation. This triage system affects waiting times between clinical examination and mammography appointments. This study aims to assess the association between clinical examination and the radiological and pathological findings of disorders deemed clinically benign, and to ascertain the spectrum of benign breast disorders encountered at HJH.
Method:
A retrospective study of imaging results of patients at HJH presenting as clinically benign breast disorders from January to June 2018 was conducted. Assessed Breast Imaging-Reporting and Data System (BI-RADS) score was noted and if core biopsies were performed, their results and patient demographics were documented.
Results:
Of the 1 263 clinically benign patients presenting from January to June 2018, the radiological assessment was: BI-RADS 1: 158 (12.5%), BI-RADS 2: 685 (54.2%), BI-RADS 3: 292 (23.1%), BI-RADS 4a: 54 (4.3%), BI-RADS 4b: 29 (2.3 %), BI-RADS 4c: 21 (1.7%), BI-RADS 5: 24 (1.9%). There were 133 biopsies (including eight BI-RADS 3 patients), with 46 (3.6%) confirmed malignancies. The combined specificity of mammography and ultrasound was 65.52% (54.56-75.39%) and combined sensitivity 91.30% (79.21-97.58%).
Conclusion:
There is a vast spectrum of benign conditions presenting in this population group with only 3.6% confirmed malignancies, confirming an accurate triage system utilised at the breast clinic. Radiological imaging is highly sensitive but less specific, emphasising the triad of clinical, radiological and histological assessment as the gold standard with regard to diagnosis of breast disease.
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