Radiologic evaluation of breast disorders related to tuberculosis amongst women in Durban, KwaZulu-Natal, South Africa.

Abstract

Women in KwaZulu-Natal Province, South Africa, are at high risk of developing breast tuberculosis (BTB) due to the increased incidence of HIV. However, there is a general lack of knowledge regarding the various diseases that can affect the breast. This is compounded by lack of the national breast screening program. As a result, many patients with breast cancer (BCA) and BTB are initially misdiagnosed by clinicians. It was evident from the study that much still has to be done in educating the public and healthcare workers about breast diseases. This project endeavoured to compare the effectiveness of various radiological technologies to identify breast problems. The study consisted of three phases all based at Ethekwini Municipality tertiary referral hospitals. The first phase aimed to determine the prevalence of the BTB using retrospective data over a period of 13 years. The same data further provided information of the clinical and radiological manifestations of BTB. This study concluded that while BTB is not common, it shares the clinical and radiology features with BCA, and is difficult to diagnose with current pathology methods. The second phase was done prospectively by recruiting patients who were newly diagnosed with BTB. The aim was to evaluate the use of modern imaging techniques to further describe the radiology patterns of BTB and to determine the radiological parameters that may be used in disease monitoring. The results provided insight into disease extent, and showed that it is usually more severe than perceived with current diagnostic methods. The third phase was performed using retrospective image analysis of patients who had BCA and BTB by using modern radiology techniques. The purpose was to identify the salient features that can differentiate BTB from the BCA. Several radiology parameters were identified as possible biomarkers for differentiation between the two conditions. The knowledge of their respective features would aid in the timeous diagnosis of both conditions, particularly in cases where the pathology results are inconclusive for various reasons. Overall the study highlights the lack of evidence based information on BTB. Recommendations and conclusions are provided in the last chapter.