CLINICAL PRESENTATION AND HISTOPATHOLOGICAL CO - RELATION IN THE MANAGEMENT OF BREAST TUMOUR

: AIM: To plan the line of management for carcinoma breast as per the clinical and histopathological findings. OBJECTIVES: To study various clinical presentations of breast cancer and its co-relation with histopathological pattern. METHOD AND MATERIALS: All the patients coming to the OPD and admitted to IPD of the surgery dept. with a mass in the breast will be screened and the data will be collected in a pre-structured and pre-formed Performa. A detail history about all vital information and other parameters will be collected in the Performa along with information regarding diagnosis, lab and histopathological examination. Then after taking consent from the patient standard histopathological examination will be done. The clinical information will be correlated with histopathological report and plan of management of the patient will be drawn accordingly. CONCLUSION: Our result shows that the size of the primary tumour directly corresponds to the axillary metastasis. All pathological types of breast cancer can occur in all quadrants of breast. Axillary dissection with removal of lymph nodes up to level II is a must for accurate staging and treatment. If the histopathological evaluation of lymph node has tumor tissue it should be taken as systemic disease and adjuvant chemotherapy is warranted. Irrespective of the tumor size or the stage at which they presented all patients in our study underwent modified radical mastectomy and our follow up over a period of 0- 18 months showed no recurrence. But some of the patients who presented with early breast tumor were over treated because of inability to rule out axillary metastasis. This problem can be avoided with newer methods like sentinel lymph node biopsy and cryotyping. Awareness must be raised and regular screening for breast cancer must be under taken to direct the cases in its early stage. proper planning of surgery for breast cancer is established by biopsy of a palpable or image guided lesion. Image guided core biopsy is the approach of choice for diagnosis, with open biopsy being reserved for lesion not amenable to core biopsy or when core biopsy being non-diagnostic. F.N. A.C. biopsy is also diagnostic in diagnosing breast lesions but false negative rate is high. Examination of biopsy material gives results about ER/PR/HER 2 receptors and the presence of lymphatic vessel invasion. The patient should undergo preoperative staging to assess the current extent of disease. Common site of metastases from breast cancer- the liver, lung, bones are assessed in all patients by chest radiograph, USG abdomen, and bone scans. Other investigations are reserved for patients with large or clinically positive lymph nodes. Through imaging of the contra lateral breast is performed to look for additional areas of concern, and breast MRI is performed in selective cases. In the absence of metastases the first intervention is surgery to excise the tumor and surgically stage the axilla when appropriate. Pathology results from the tumor and the axillary nodes define the pathology stage and provide an estimate of prognosis to inform systemic therapy decisions. Selection of surgical procedures takes into account patient characteristics, as well as the properties of tumor and its stage.