Breast lesions cover a wide range of conditions, from benign growths to malignant tumors. Evaluating these lesions through histopathology is crucial for making accurate diagnoses, understanding prognosis, and planning treatment. Breast cancer remains the most commonly diagnosed cancer among women worldwide, which makes it essential to continually assess diagnostic trends to enhance early detection and management strategies (Srivastava et al., 2023; Ibrahim et al., 2024) [1,7].

Histopathological research offers vital insights into the changing patterns and characteristics of breast diseases. Various studies, both local and international, have shown different distributions of benign and malignant lesions, influenced by factors like population demographics, genetic backgrounds, lifestyle choices, and access to healthcare (Boral & Jagtap, 2023; Jamal, 2001; Li et al., 2019) [4,6,8]. In places like Saudi Arabia and the Gulf region, for example, increased awareness and screening initiatives have resulted in higher detection rates, even among younger individuals (Toorani et al., 2023; Saeed et al., 2022) [2,3].

While benign breast lesions are non-cancerous, they are still clinically significant because they can resemble cancer both in clinical assessments and imaging. Common benign conditions include fibroadenomas and fibrocystic changes, while ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) are the primary malignant forms (Ibrahim et al., 2024; Di & Wong, 2010) [1,5].

Considering the differences in lesion types and frequencies across regions and institutions, long-term histopathological studies are essential for identifying trends, shaping screening policies, and guiding clinical practices. This study aims to examine the histopathological patterns of breast lesions diagnosed over a five-year span at a single center, adding to the existing literature by shedding light on local disease profiles and their implications.

Study Design and Setting 

This study was a retrospective descriptive analysis carried out at a Vadodara Clinical Laboratory over five years, from January 2019 to December 2023. The goal was to examine the histopathological patterns of breast lesions in patients who had tissue samples taken during this period. The VCL laboratory handles specimens from both inpatients and outpatients, representing a wide range of clinical presentations. Before starting data collection, We secured ethical approval before proceeding with the data collection and analysis.

Sample Collection and Inclusion Criteria 

We reviewed all breast tissue specimens submitted to the pathology department during the study timeframe. This included excisional biopsies, core needle biopsies, lumpectomies, and mastectomy specimens. Only samples with a clear histopathological diagnosis were included in the analysis. We excluded cases with insufficient tissue, inconclusive reports, or recurrent lesions from previously diagnosed cancers to ensure diagnostic accuracy. We also recorded patient demographic information such as age, sex, and laterality.

Histopathological Evaluation 

All samples were fixed in 10% neutral buffered formalin, routinely processed, and embedded in paraffin. We cut sections of 3–5 µm thickness, stained them with hematoxylin and eosin (H&E), and examined them under light microscopy by experienced histopathologists. The lesions were categorized into benign and malignant types according to the World Health Organization (WHO) classification of breast tumors. Benign lesions included fibroadenomas, fibrocystic changes, duct ectasia, and others, while malignant cases encompassed invasive ductal carcinoma, invasive lobular carcinoma, and other rare subtypes.

Data Analysis 

We gathered and analyzed data using SPSS software version 26.0. For categorical variables like lesion type, histological subtype, and laterality, we reported frequencies and percentages. Continuous variables, such as patient age, were summarized with means and standard deviations. We conducted a comparative analysis to examine how lesion distribution varied across different age groups and genders. Additionally, we looked at trends over a five-year span to spot any changes in lesion types or patient demographics.

Quality Control and Reliability 

To ensure consistent diagnoses, all histopathological slides were reviewed independently by at least two senior pathologists. If there were any disagreements in diagnoses, we reached a consensus after reviewing the slides together. We strictly followed international diagnostic standards for classification criteria, and we carried out regular internal audits to ensure the accuracy of our reports.

Over a five-year study period, we analyzed a total of 1,275 breast tissue specimens, which included both benign and malignant lesions. The ages of the patients varied widely, ranging from 14 to 85 years, with an average age of 42.7 ± 13.6 years. Notably, female patients made up the overwhelming majority at 96.7%, while male breast lesions were found in just 3.3% of the cases.

Distribution of Benign and Malignant Lesions

We found that out of all the cases, 792 (62.1%) were benign, and 483 (37.9%) were malignant. The most frequently observed benign lesion was fibroadenoma, followed by fibrocystic changes and duct ectasia. On the malignant side, invasive ductal carcinoma (IDC) was the most common subtype, representing 81.6% of all malignancies. For a more detailed breakdown, please refer to Table 1.

Table 1: Histopathological Distribution of Breast Lesions (n = 1,275)

Age-wise Distribution of Breast Lesions
Benign lesions were most commonly found in patients aged 21 to 40, while malignant lesions tended to appear more frequently in those over 40. The highest incidence of invasive cancers was observed in the 41 to 60 age group. You can see the age distribution detailed in Table 2.

Table 2: Age-wise Distribution of Benign and Malignant Lesions

Sex Distribution and Laterality
Male breast lesions were mostly found to be malignant, with gynecomastia being the most common benign condition seen in men. Interestingly, lesions on the left side (51.8%) were a bit more prevalent than those on the right (47.9%), and there were a few cases that were bilateral (0.3%).

Temporal Trends in Malignancy
When we look at the trends over time, a yearly analysis revealed a steady rise in the percentage of malignant lesions, particularly invasive ductal carcinoma, throughout the study period. This increase might be linked to better diagnostic tools and a greater awareness of screening practices.

This five-year retrospective analysis provides a detailed look at the histopathological patterns found in breast lesions, showing that benign lesions are more common than malignant ones, which aligns with both global and regional trends. In our study, benign lesions made up 62.1% of all cases, with fibroadenoma being the most frequently observed, especially among women aged 21 to 40. This finding is consistent with research by Albasri (2014) [11] in western Saudi Arabia, where fibroadenoma was also the leading benign breast condition. Likewise, Uwaezuoke and Udoye (2014)[14] reported a high occurrence of fibroadenomas in Nigerian women, confirming this lesion's prevalence across different populations.

On the other hand, malignant lesions represented 37.9% of our cases, with invasive ductal carcinoma (IDC) making up a significant 81.6%. This aligns with earlier studies, such as the one by Forae et al. (2014) [15] in an African population, where IDC was similarly the most common histological subtype. Our age-specific analysis showed that malignancies were more prevalent in women over 40, echoing the findings of Aslam et al. (2013) [12], who observed a similar trend toward malignancy in older age groups.

Interestingly, our results suggest a gradual rise in the detection of malignancies over the study period, which may reflect advancements in diagnostic methods, greater health awareness, and improved access to screening programs. This trend is in line with earlier studies conducted in Yemen and Saudi Arabia, where the incidence of breast malignancies seemed to increase alongside enhancements in diagnostic infrastructure (Al-Thobhani et al., 2006; Mansoor, 2001) [9, 13].

The low occurrence of male breast lesions in our study (3.3%) aligns with previous research, yet it remains clinically important because of the higher rate of malignancies in this group. Al-Thobhani et al. (2006) [9] also noted a small but significant presence of male breast disease, which highlights the need for careful attention when it comes to male patients.

When it comes to rare lesion types, like spindle cell lesions, we found only a handful of cases, which is in line with the work of Chhieng et al. (1999) [10]. They pointed out the diagnostic difficulties these lesions present, as their cytological features can overlap with both benign and malignant conditions.

In summary, our results support the profiles seen in various regions, including the Middle East, South Asia, and sub-Saharan Africa. They emphasize fibroadenoma as the most common benign tumor and invasive ductal carcinoma (IDC) as the primary malignancy. This highlights the critical role of histopathological examination for all breast lesions, regardless of clinical suspicion, to ensure accurate diagnosis and effective treatment.

This five-year retrospective study shines a light on the prevalence of benign breast lesions, especially fibroadenomas, within the study group. Interestingly, there's been a noticeable increase in malignancy among individuals over 40. Invasive ductal carcinoma stood out as the most frequently diagnosed cancer, aligning with global patterns. The rise in malignant cases throughout the study period points to better detection methods and heightened awareness, underscoring the vital importance of histopathological evaluation for accurately diagnosing and managing breast lesions. These results highlight the ongoing need for proactive early screening, particularly for those in high-risk age brackets, to ensure timely interventions and enhance patient outcomes.

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