Prospective Correlation Study to Assess the Association of Serum Prolactin Levels in Cases of Fibroadenoma in Women of Reproductive Age Group

Abstract

Vineet Mannan, Kalpana Vineeth, Chandrashekar, Sharanabasavaraj Javali* and Mayank Agarwal

Introduction: Fibroadenomas are one of the most common benign tumors of the breast in the adolescent population. They account for 68% of all breast masses and 44%-94% of all biopsied breast lesions. Fibroadenomas can range from asymptomatic masses to painful and rapidly growing tumors that can cause significant esthetic distortions of the breast. Benign breast disorders results from an imbalance or inappropriate target gland response to changing tide of circulating hormones. Several studies have shown that serum prolactin levels may be increased in benign breast diseases. Hence this study is intended to assess serum prolactin levels in patients presenting with fibroadenoma to our hospital. If a correlation is established between serum prolactin levels and incidence of fibroadenoma, a feasible drug treatment such as anti prolactin agents can be used which can reduce the anxiety and cosmetic problems associated with surgical interventions.

Aim and objectives: To estimate serum prolactin level in patients presenting with lump in the breast and proved to be fibroadenoma with Fine Needle Aspiration Cytology (FNAC). To assess whether prolactin level can be used as an indicator for incidence and progression of fibroadenoma.

Materials and methods: A prospective observational study of serum prolactin values of 95 female patients in the reproductive age group of 18-45 years who presented with lump in the breast proved to be fibroadenoma by FNAC and planning to undergo excision during the period of 2019-2021.

Results: Majority of the patients had no symptoms except lump in the breast. 34 participants had pain along with lump in the breast. Majority of the participants had lump in breast of size 3 cm in the greatest dimension in both right and left breast followed by 4 cm. 13 participants had lump of size 5 or more than 5 cm in right breast and 12 participants had lump of size 5 or more than 5 cm in left breast. In our study 44 out of 95 participants had lump in the right breast, 37 had lump in the left breast. 14 study participants had fibroadenomas in bilateral breast. 48 out of 95 participants had lump in the right upper quadrant followed by 44 participants with lump in left upper quadrant followed by 10 in right lower quadrant and 7 in left lower quadrant. Duration of lump in the breast ranged from 2 months to 24 months with majority of the participants having lump in the breast from past 8 months followed by past 9 months. All 95 patients had lump in the breast which was firm in consistency. FNAC was done in all 95 cases prior surgery and all cases were reported as Fibroadenoma. All 95 patients underwent excision of the lump which was sent for histopathology and all biopsy reports were consistent with FNAC findings prior to the surgery and were reported as fibroadenoma. Serum prolactin levels were measured in all 95 cases. The biological reference interval for serum prolactin in our study was 3.80 ng/ml to 23.20 ng/ml. Mean prolactin level in the study was found to be 24.29 ng/ ml with standard deviation of 14.11 ng/ml. Minimum value of 5.72 ng/ml and maximum value was reported as 80.6 ng/ml. Out of 95 participants 42 had raised serum prolactin levels and remaining 53 had normal serum prolactin levels. Approximately 44% of the study population had raised serum prolactin values. Out of total study population, 81 patients had unilateral fibroadenomas and 14 had bilateral fibroadenoma. In the unilateral fibroadenoma group, serum prolactin levels were normal in 51 patients and elevated in 30 patients. Out of 14 patients in the bilateral fibroadenoma group 12 had elevated serum prolactin levels which accounted for approximately 85% in that group. Serum prolactin level was significantly higher in bilateral fibroadenoma group compared to unilateral fibroadenoma with p value <0.001 which is statistically significant with both chi square test and unpaired t test. Out of total 95 patients 68 patients had single lump in the breast including both unilateral and bilateral fibroadenoma groups and 27 patients had multiple lumps in both unilateral and bilateral group. Mean prolactin level in single lump group was 19.14 and in multiple lump group it was 37.27. Prolactin level was significantly higher among those with multiple lumps compared to those with single lump. (unpaired t test used) Out of the 14 patients with bilateral fibroadenoma, 9 patients had multiple lumps as compared to 5 patients who had single lump in each breast. Mean prolactin level was 19.36 in single lump group as compared to 39.87 in multiple bilateral fibroadenoma group. Prolactin level was significantly higher among those with multiple lumps compared to those with single lump in the bilateral fibroadenoma patients. In the unilateral fibroadenoma group, 63 patients had single lump in the breast as compared to 18 who had multiple lumps. Mean prolactin level in single lump group was 19.12 as compared to 35.96 in the multiple lump group. Prolactin level was significantly higher among those with multiple lumps as compared to those with single lump.

Conclusion: There is a significant association between raised serum prolactin levels and incidence of bilateral as well as multiple fibroadenomas. Multiple lumps which can’t be excised can be managed with anti-prolactin therapy, requiring surgery only for symptomatic large lumps. Morbidity and anxiety due to surgery can be reduced.