|Year : 2021 | Volume
| Issue : 17 | Page : 53-57
Diagnostic mammography in Sokoto: A review of 123 cases
Muhammad Baba Sule1, Ibrahim Haruna Gele2, Sule Ahmed Sa'idu1, Sadisu Mohammed Ma'aji1, Yakubu Bababa Shirama2, Abacha Mohammed3
1 Department of Radiology, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
3 Department of Radiography, Usmanu Danfodiyo University, Sokoto, Nigeria
|Date of Submission||26-Nov-2019|
|Date of Decision||27-Jan-2020|
|Date of Acceptance||21-May-2020|
|Date of Web Publication||24-Apr-2021|
Prof. Muhammad Baba Sule
Department of Radiology, Usmanu Danfodiyo University, Sokoto
Source of Support: None, Conflict of Interest: None
Background: Diagnostic mammography is a radiographic examination of the breast to detect the palpable and nonpalpable lesions. More than 1.15 million women are diagnosed of breast cancer yearly worldwide. Objective: This study is aimed at evaluating the mammographic outcomes among 123 Nigerian females who had the sign and symptoms of breast diseases. Materials and Methods: This is a cross-sectional study (retrospective in nature) of 123 adult females who came for diagnostic mammography between December 2010 and November 2012 at the mammographic suite of radiology department UDUTH. MLO and CC views were done for the breast examination though compression views were occasionally employed. Results: One hundred and twenty-three females had diagnostic mammography, with a minimum age of 30 years. The prevalence of diagnostic mammography within the stated period is 61.5%. The mammographic findings were normal in 62 (50.4%) and abnormal in 61 (49.6%) of the subjects. The abnormal mammographic findings were masses in either or both breasts in 45 participants (36.6%), architectural distortion in either or both breasts in 10 participants (8.1%), isolated calcification in either or both breasts in 4 participants (3.3%), left retracted nipple in 1 (0.8%) participant while another subject (0.8%) had a retracted right nipple. Conclusion: Diagnostic mammography can detect the various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. These findings affirmed the need of routine early screening so that breast diseases can be detected early.
Keywords: Breast, diagnostic mammography, females, Sokoto
|How to cite this article:|
Sule MB, Gele IH, Sa'idu SA, Ma'aji SM, Shirama YB, Mohammed A. Diagnostic mammography in Sokoto: A review of 123 cases. N Niger J Clin Res 2021;10:53-7
|How to cite this URL:|
Sule MB, Gele IH, Sa'idu SA, Ma'aji SM, Shirama YB, Mohammed A. Diagnostic mammography in Sokoto: A review of 123 cases. N Niger J Clin Res [serial online] 2021 [cited 2022 Dec 9];10:53-7. Available from: https://www.mdcan-uath.org/text.asp?2021/10/17/53/314604
| Introduction|| |
Diagnostic mammography is a radiographic examination of the breast to detect palpable and nonpalpable lesions. Mammographically detected tumors are usually smaller than palpable lesions at the time of diagnosis. The earliest mammographic presentations of cancer include clusters of microcalcifications and spiculated or multilobulated masses. Between 30% and 50% of nonpalpable breast cancers present themselves as microcalcifications alone and these constitute one of the earliest presenting features of carcinoma which can be detected mainly with mammography. More than 1.15 million women are diagnosed of breast cancer yearly worldwide. Late diagnosis is common in developing countries.
Diagnostic mammography is limited by the fact that radiologic resolution is less than optimal in patients with dense breast, and the radiologist experience is vital in interpreting mammograms correctly. False-negative rate of up to 40% is expected on mammograms of dense breast tissue (ACR 3 and 4). Despite the presence of mammography and fine-needle aspiration cytology, excisional biopsy for histology remains the gold standard for the diagnosis of breast cancer.
In Nigeria, however, despite the increasing incidence of breast cancer and early age of cancer presentation, no government-based national breast cancer screening is yet established except for a few private initiatives., Poor knowledge of breast cancer and screening methods as well as low level of practice of breast cancer screening among health workers were also noted. This study is aimed at evaluating the mammographic outcomes among 123 Nigerian females who had the sign and symptoms of breast diseases.
| Materials and Methods|| |
This is a cross-sectional study (retrospective in nature) of 123 adult females who came for diagnostic mammography between December 2010 and November 2012 at the mammographic suite of Radiology Department UDUTH. Ethical approval for the study was obtained from the Research and Ethical committee of Usmanu Danfodiyo University Teaching Hospital Sokoto.
Within the stated period, 123 had diagnostic mammography in the department with the general electric alpha-RT machine with model number MGF-101 and serial number 34,160 (manufactured 2010). All the participants had to fill a mammographic form consisting of variables such as age, sex, occupation, family history of breast cancer, tribe, contraception, parity, and caffeine consumption, history of surgical intervention (lumpectomy, biopsy, and/or mastectomy), previous mammography, and last child birth. MLO and CC views were done for the breast examination though spot compression views were occasionally employed. The inclusion criteria include mammograms from adult females that had diagnostic mammographic examination. While the exclusion criteria includes mammograms from patients without adequate clinical information/reasons for the examination and females <30 years of age who may have dense breast were excluded for better mammographic sensitivity.
The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS Inc, Chicago, USA) version 17. Analysis began with descriptive statistics (mean and standard deviation) for quantitative data (age, parity, and BIRADS category) and frequencies with percentages for qualitative data (sex, tribe, and breast density, family history of breast cancer, contraception, and past mammographic examination). This was followed by inferential statistics (Chi-square test) to determine the association between age and breast density, abnormal mammographic findings with family history of cancer, hormonal contraception, caffeine consumption, parity, breast density, age, occupation, and tribe for diagnostic mammography.
The results were presented in the form of tables. All statistical tests were carried out using two tail tests, with level of significance set at 0.05.
| Results|| |
Mammograms from 123 adult females who had diagnostic mammography were analyzed. The age range of the participants was 30–59 years with a mean age of 42.7 ± 8.3. There were 105 (85.4%) Hausa, 10 (8.1%) Yoruba, and 8 (6.5%) Igbo participants. Among the recruited subjects, 88 (71.5%) of them were homemakers, 30 (24.4%) of the participants were civil servants, 4 (3.3%) of them were into different trades (Business women) while 1 (0.8%) of the subject was a student.
Five (4.1%) had right breast mastectomy, another 5 (4.1%) had biopsy in either or both breasts, 2 (1.6%) had lumpectomy in both breasts while 110 (89.4%) of the subjects had no history of surgical intervention. Twenty-three (18.7%) had a history of hormonal contraception while 3 (2.4%) had past history of mammography. Twenty (16.3%) subjects had a positive family history of breast cancer. Twenty-two (17.9%) of the participants had a history of caffeine consumption. All the participants were referred by the physicians, and their source of information was hospital based.
The prevalence of diagnostic mammography within the stated period is 61.5%.
Among the 123 subjects who had diagnostic mammography, 50 (40.7%) had pain in either or both breast as a presenting complaint, 46 (37.4%) had lumps in either or both breasts, 16 (13%) were confirmed cases of breast cancers in either breast, 7 (5.7%) had bloody nipple discharge in either or both breast, 2 (1.6%) had breast swelling in either breast while left nipple retraction and right axillary tender mass occurred in 0.8% (one case each). The details are depicted in [Table 1].
|Table 1: The various presenting complaints of all the recruited participants|
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The findings were normal in 62 (50.4%) and abnormal in 61 (49.6%) of the participants. The abnormal mammographic findings were masses in either or both breasts in 45 participants (36.6%), architectural distortion in either or both breasts in 10 participants (8.1%), isolated calcification in either or both breasts in 4 participants (3.3%), left retracted nipple in 1 (0.8%) subject while another subject (0.8%) had a retracted right nipple.
Thirty (66.7%) of the participants who had masses were having benign features, whereas 15 (33.3%) of these subjects had masses with malignant features. Twenty (44.4%) of the subjects with masses had associated calcification.
Sixty-two (50.4%) participants had BIRADS-1 category of mammographic findings, 23 (18.7%) participants had BIRADS-0 category, 14 (11.4%) participants had BIRADS-2 category, 9 (7.3%) participants had BIRADS-3 category, 6 (4.9%) participants had BIRADS-4 category while another 9 (7.3%) had BIRADS-5 category of mammographic finding.
Breast densities were categorized similar to that done by the ACR in to four categories; the BIRADS 1 category (entirely fatty) was seen in 54 participants (43.9%), BIRADS 2 category (mixed fatty) in 20 participants (16.3%), BIRADS 3 category (mixed glandular) in 14 participants (11.4%) while BIRADS 4 category in 35 (28.5%) participants, respectively.
The abnormal mammographic findings found in 61 (49.6%) participants following diagnostic mammography were observed to have a statistically non-significant association with tribe (P = 0.20), family history (P = 0.55), caffeine consumption (P = 0.58), breast density (P = 0.33), age (P = 0.91), occupation (P = 0.46), contraception (P = 0.41), and parity (P = 0.60). These are shown in [Table 2] and [Table 3], respectively.
|Table 2: Association between diagnostic abnormal mammographic findings with breast density, age, and family history of breast cancer|
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|Table 3: Association between diagnostic abnormal mammographic findings with occupation, caffeine consumption and tribe|
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Fifteen (33.3%) of the participants who had masses with malignant features were found to have a statistically nonsignificant relationship with a family history of breast cancer (P = 0.07), breast density (P = 0.42), age (P = 0.60), parity (P = 0.16), and occupation (P = 0.54).
In this study, it was found that age had a statistically significant association with breast density with a P value of 0.00 as shown in [Table 4].
|Table 4: Association between breast density and age of the recruited subjects|
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| Discussion|| |
The prevalence of diagnostic mammography was found to be 61.5%, and the most frequent presenting complaints were breast lumps and pain in either or both breasts which were in conformity to some studies., This is probably due to the same geographical location, race and almost similar cultural practices.
The level of awareness of diagnostic mammography was relatively higher and about 2.4%, this is relatively lower than that reported by Obajimi et al. in their study from Ibadan most likely from different sources of information about mammography and the availability of mammographic facility before Sokoto.
More literates (25.2%) had diagnostic mammography in Sokoto though lower than those observed in Lagos and Ibadan, South-western Nigeria.
More gainfully employed subjects were observed to have had diagnostic mammography in this environment, this was also observed by Awosanya et al. in Lagos, South-western Nigeria.
Most of the recruited subjects that came for diagnostic mammography in Sokoto never practiced breast self-examination, similar finding was reported by Olowokere et al. in their study. They also showed that most of the recruited subjects had knowledge of breast cancer, similar finding was also observed here in Sokoto where all the recruited subjects knew about cancer of the breast.
The diagnostic mammographic findings were normal in 62 (50.4%) subjects while abnormal in 62 (49.6%) subjects. These similar mammographic outcomes were also reported by Awosanya et al. and Akinola et al. in South-western Nigeria most likely from same racial, geographical location, and cultural practices.
Breast masses and calcifications (benign and malignant) were the most frequent abnormal mammographic findings. This agrees with the studies of Awosanya and Akinola et al., due to presumably aforementioned geographical and cultural practices.
Fifteen (16%) of the participants who had masses as abnormal mammographic findings were having the features of malignancy and had a minimum age of 37 years which conformed to that reported by Ntekim et al. in Ibadan that malignant breast lesions are more in those below the age of 40 years. This malignant mammographic finding, however, had a statistically non-significant relationship with age, breast density, and family history of breast cancer, occupation of the subjects, parity and use of hormonal contraception. This is at variance to what was reported in some studies,,, most likely from level of awareness of the subjects, geographical location, cultural practices, and availability of mammographic facility before Sokoto.
The preponderant BIRADS classification of mammographic findings in this study is BIRADS-1, and is in agreement with the study of Awosanya et al. This varies from what Akinola et al. reported from Lagos with their most frequent BIRADS classification of mammographic findings being BIRADS-2.
Breast density was categorized according to ACR classification as glandular, mixed glandular, mixed fatty, and fatty. In this study, the fatty parenchymal pattern was predominant in 43.9%. This is at variance to the predominant mixed fatty parenchyma reported by Akinola et al. in their study. This variance may be due to the fact that the predominant age population in this study was the 40–49 years age group in which involution of the breast glandular tissues has commenced.
| Conclusion|| |
This study is the first carried out in Sokoto, with the first group of patients who had breast mammographic examination (diagnostic) in UDUTH between December 2010 and November 2012. Diagnostic mammography can detect the various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Akinola RA, Akinola OI, Shittu LA, Balogun BO, Tayo AO. Appraisal of mammography in Nigerian women in a New Teaching Hospital. Acad J 2007;8:325-9.
Atoyebi OA, Atimomo CE, Adesanya AA, Beredugo BK, da rocha Afodu JT. An appraisal of 100 patients with breast cancer seen at the Lagos University Teaching Hosptal. Nig Qt J Hosp Med 1997;7:104-8.
Jackson VP, Hendrick RE, Feig SA. Imaging of the radiographically dense breast. Radiol 1993;188:297-301.
Ohlinger R, Heyer H, Thomas A, Paepke S, Warm H, Klug U, et al
. Non palpable breast lesions in initial ultrasonography and comparison with mammography. Anticancer Res 2006;26:3943-56.
Yusufu LM, Odigie VI, Mohammed A. Breast masses in Zaria, Nigeria. Annal Afr Med 2003;2:13-6.
Adenike OA, Vivian OO. Knowledge, attitude and practice of breast cancer screening among female health workers in Nigerian urban city. BMC Cancer 2009;9:203-14.
Ihekwaba FN. Breast cancer in Nigerian women. Br J Surg 1992;79:771-5.
Awosanya GO, Jeje EA, Bayagbona D, Inem VA. Screening and diagnostic Mammographic findings of 115 consecutive Nigerian women: A two year study in a city private hospital. Nig Qt J Hosp Med 2004;14:166-8.
Obajimi MO, Ajayi OI, Oluwasola OA, Adedokun OB, Adeniji-Sofoluwe TA, Mosure AO, et al
. Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-Western Nigeria. BMC Public Health 2013;13:40-7.
Olowokere AO, Onibokun AC, Oluwatosin AO. Breast cancer knowledge and screening practices among women in selected rural communities of Nigeria. J Public Health Epid 2012;4:238-45.
Akinola RA, Akinola OI, Jinaidu FO. Spectrum of mammographic findings in a tertiary hospital in Nigeria. Sci Res Essay 2007;2:502-7.
Ntekim A, Nufu FT, Campbell OB. Breast cancer in young women in Ibadan, Nigeria. Afr Health Sci 2009;9:242-6.
Elsie KM, Gonzaga MA, Francis B, Michael KG, Rebecca N, Rosemary BK, et al
. Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital. Pan Afr Med J 2010;5:9.
Lusine Y, Graham AC, Laura CC, Stuart JS, Bernard R, Celine U, et al
. Mammographic breast density and subsequent risk of breast cancer in post-menopausal women according to tumour characteristics. JNCI J Natl Cancer Inst 2011;103:1179-89.
[Table 1], [Table 2], [Table 3], [Table 4]