An audit of patients clinically deemed as high risk or for immediate intervention at the Helen Joseph hospital breast clinic, Johannesburg

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2022

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Brink,Heila

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BACKGROUND: The Helen Joseph Hospital Breast Clinic has implemented a clinical triage system for patients presenting with a variety of breast concerns. The goal of this system is to expedite the process from initial presentation to radiological assessment of patients with suspected breast malignancy or breast abscess in a resource limited setting. OBJECTIVES: To assess the clinical, imaging and histological diagnoses of breast disease in these patients with malignancy and sepsis. METHODS: A retrospective audit of patients clinically deemed high risk for malignant breast pathology referred to the Breast Imaging Unit (BIU) in 2018. Patients were triaged based on strict clinical criteria: presence of a breast mass with or without lymph nodes or a breast abscess. Patients that were subsequently referred for mammography/ultrasound were identified using the patient files in the BIU. Results were recorded on Microsoft Excel and analysed using SAS version 9.2. RESULTS: There were 325 patients included in this study. A total of 87 (26.8%) were diagnosed with breast cancer and 236 (72.6%) with benign disease. The most common presenting complaint was a palpable mass (n=227; 69.9%). Of the BI-RADS 5 patients, 95% had malignant disease. The majority of malignancies (55.8%) diagnosed on ultrasound had locally advanced disease. The most common histological diagnosis of malignancy was invasive ductal carcinoma (n=67, 77%). The most commonly diagnosed benign disease was breast abscess (n=42, 17.8%). CONCLUSION: BI-RADS findings correspond to similar studies, however a large number of benign breast disease was diagnosed. This may indicate heightened clinical awareness of breast cancer diagnosis and early detection. A significant percentage of malignancies presented as locally advanced. Except for a lower number of invasive lobular carcinoma, the histological spectrum of malignant disease is similar to comparative studies.

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A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Medicine (Diagnostic Radiology) to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021

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