{'fraction_non_alphanumeric': 0.01909100770148606, 'fraction_numerical': 0.017246989912137977, 'mean_word_length': 4.820707070707071, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A clinicopathological profile of benign breast diseases in women in a tertiary care hospital

Benign breast conditions are associated with morbidity and great concern for the patient and are 4-5 times more common than breast cancer. It is 10 times more common than cancer in west. Benign breast diseases are the most common cause of breast problems in females and it is more frequent than malignant ones up to 30 % of women will suffer from a benign breast disease requiring one or other sort of treatment at some part of their lives.


INTRODUCTION
The breast is the most important feature of female anatomy and an integral part of female reproductive system. 1 They are symbols of female fertility and womanhood. However, a reluctance on the part of the patient to complain about breast problems is universal and have led to a neglect of it and often delayed detection even in well-educated females. 1 Benign breast conditions are associated with morbidity and great concern for the patient and are 4-5 times more common than breast cancer. It is 10 times more common than cancer in west. Benign breast diseases are the most common cause of breast problems in females and it is more frequent than malignant ones up to 30 % of women will suffer from a benign breast disease requiring one or other sort of treatment at some part of their lives. [2][3][4][5][6][7][8][9][10] During the past decade there has been increasing interest in benign breast disease. More patients demand investigations and treatment for symptoms of benign disease, which in turn has increased the number of women referred to specialist breast disease units. 11 Many women have symptoms of breast disease but few have cancer. Yet these symptoms are understandably a source of great concern for women for women. The challenge for physician is to distinguish between benign and malignant lesions and to know when to treat and when to reassure. Making such discrimination is not easy as the condition are diverse and vary in presentation. 12 There is a question of premalignant disorders and histologic features that may imply an increased risk of breast cancer. Increasing understanding of these conditions may prove important in understanding the pathogenesis of breast cancer and in defining high risk group in whom regular surveillance may be beneficial.
Clinicians must therefore provide a high degree of diagnostic accuracy while at the same time ensuring that an excessive rate of biopsy is prevented. 11 This is now easier with a systematic approaches and careful history and physical examination and development of diagnostic aids such as mammography, ultrasonography and aspiration cytology.

Objective
The objective of the study was to find out the proportions of various benign breast lesions among women aged 18 years and above.

METHODS
A prospective study was conducted in the Department of Surgery, Shree Gokulam Medical College, Thiruvananthapuram for a period of 18 Months from January 2016 to June 2017.
Based on the study done by Dr Uma krishnaswamy 12 in 2003 regarding clinico pathological profile of benign breast diseases in urban females in India where the prevalence was found to be 12.75%, considering the confidence interval at 95% and absolute precision at 5 the sample size derived was found to be 180.
All the women aged more than 18 yrs. old attending the surgery OPD with palpable or immunologically detected breast lesions will be consecutively selected for the study.

Inclusion criteria
Inclusion criteria were all female patients aged more than or equal to 18 years; clinically or immunologically detected breast lesions.

Exclusion criteria
Exclusion criteria were clinically suspicious or pathologically proven malignancy; prepubertal age group and male sex; non breast parenchymal lesions.
After obtaining written informed consent a performa will be filled with patient particulars, history and clinical findings in female patient attending surgery OPD with breast related symptoms. patients will be followed up with histopathological, cytological and radiological studies in indicated cases. The patients will be followed up for 1 year. Most common benign breast related symptoms and condition among the study group and probable risk factors for the same will be analyzed. The percentage and proportions of patients with different benign breast diseases and their presenting symptoms will be obtained.
The data obtained will be entered in excel sheet and the statistical analysis of the results will be done with SPSS. The significance of the study will be analyzed at p value less than 0.05.

RESULTS
A total of 180 study subjects were selected for the purpose of the study and analyzed.
The mean age of patients presenting with benign breast disease in this study was 35.6 (SD-12.7). About 117 patients were below 40 yrs of age and about 20 % were above 60 yrs. Around 81.7% of patients in this study were married. 43% of the patients were nulliparous. Majority of the patients in this study didn't had any previous history of benign breast disease (Table 1). Unlike previous studies this study showed 7 cases of granulomatous mastitis. There was 1 case of benign phyllodes tumor. There was 1 case of parasitic cyst. There were 3 cases of carcinoma breast diagnosed in biopsy in which cytology and radiology was reported as benign (Table 2). Lump alone detected either by patient herself or by the clinician was the most common presenting complaint in around 71 (39.4%) patients, followed by lump with pain in around 65 (36.1%) patients, followed by either pain (10.6%), nipple discharge (8.9%) ( Table 3).  Table 4).
The diagnosis of lumps was confirmed either by cytology or histopatjhology or in both ways. Fibroadenoma could be diagnosed clinically with an accuracy of about 88% (56 cases) out of total 69 cases. Abscess breast, phyllodes tumor and galactocele and few cases of granulomatous mastitis was also able to be diagnosed clinically. There were 3 cases of carcinoma breast which could not be diagnosed either clinically or cytological and was evident only in histopathology (Table 5).   Definitive diagnosis of fibrocystic diseases, phyllodes tumor and duct ectasia, duct papilloma, dirofilarial cyst was also diagnosed on histopathology. All together the clinical suspicion of benign breast disease turned out to be true with exception of 3 cases being turning out to be malignant. The diagnostic accuracy ranged up to 88 % for fibroadenoma (Table 6).

DISCUSSION
Benign breast diseases include a heterogeneous group of conditions which range from normal, to aberrations in physiology to frank disease. The patients of BBDs are generally presented with one or more of these complaints-Breast lump, breast pain or nipple discharge. It has been recommended that all patients with discrete breast lump should undergo a triple assessment to make an early assessment.by this approach we provided the diagnosis of most of the benign breast conditions within 72 hrs of initial consultation. In the study of foncroft LM et al 13 they found that 87.4% of the women who attended the Wesley breast clinic had presented with breast lump, while in the series of Ratnachaikanont a breast lump was the presenting symptom in 75.35% of 331 benign breast patients. The corresponding figure for our study was 39.3%. 14 Most western studies have shown that oral contraceptive pills with decreased progesterone reduced risk of benign breast disease. A study in black population revealed number of relationships between use of oral contraceptives and incidence of benign breast disease. Use of oral contraceptives is extremely low in Indian population and the effect protective or otherwise cannot be ascertained with certainity. 15 In this study none of the patients had the history of OCP or HRT treatment.
Acute breast abscess was found in 25 (13.9%) case in our study. However, no cases of gangrene breast are found in our study as compared to the study done by Shukla and Kumar which reported two case of breast abscess progressing to gangrene as a result of neglect. Majority of inflammatory conditions of breast are found in the lactating mother.
A study conducted among Indian women shows that pain was the most common breast related complaint and mastalgia was the most common clinical problem occurring in the 3rd decade of life.
In the present study pain was the 2nd common presentation where as mastalgia (cyclical and noncyclical together was found to be the 2nd common clinical problem occurring in 3rd and 4th decade. Mastalgia was essentially a clinical diagnosis and USG and mammography were used as ancillary tools for diagnosis.
Sonography can be used to accurately classify some solid lesions as benign allowing imaging follow up rather than biopsy. 16 The Sample size is very less and in-depth analysis of the tumors with tumor markers will give better picture about the benign breast disease.

CONCLUSION
In short, a comprehensive clinical history and a triple assessment would suffice the tool for effective diagnosis of Benign breast diseases within 72 hrs. With correct radiological and cytological assement unnecessary morbidity associated with surgeries can be avoided in some patients.