Hadfield’s procedure for Duct Ectasia; The histopathological spectrum.
Objectives: Mammary duct ectasia, a benign condition of breast is a diagnostic challenge both for surgeon and histo-pathologist. Duct ectasia is commonly encountered in clinical practice and its histo-pathological spectrum needs to be studied in detail in our patients. Study Design: Descriptive cross sectional study. Setting: Sir Syed College of Medical Sciences Karachi after ethical approval. Period: 24 months from June 2016-June 2018. Material & Methods: Total 104 female patients (>18 years) were included after informed consent. Patients presenting with lump in breast, breast pain, tenderness or nipple discharge were screened by ultrasound breasts or mammography. Pregnant women, patients having high grade fever, hematological abnormalities, coagulopathy, axillary lymphadenopathy, papilloma of nipple, galactocele, lactating mothers and those with past history of malignancy were excluded. Only those cases were included that had diagnosis of duct ectasia on ultrasound breast. Cone excision (Hadfield’s operation) was performed after pre-requisites and histo-pathological findings were documented. Patients were kept admitted under observation for minimum 24 hours and then followed up with histo-pathology report. Results: Amongst 104 cases, mean age was 41+6.35(range=30-50) years. The mean duration of symptoms was11.6+5.76 (range=1-24) months. 72(69%) women were married and 32(30.8%) were unmarried. As per histo-pathology report duct ectasia was found in 102(98%), hyperplasia in 61(58.7%), metaplasia in 41(39.4%) and atypical cells in 2(1.9%) samples. Conclusions: Current study demonstrated final outcome of metaplasia in thirty nine percent cases with initial clinical and sonographic diagnosis of duct ectasia. This suggests the triple technique evaluation (i.e. clinical assessment, ultrasound breast/mammography along with histo-pathological assessment) to identify cases with metaplasia. The high risk cases should be frequently followed with clinical assessment and imaging along with BRCA 1 & 2 gene for timely detection and intervention of breast malignancy.