In Africa, many studies have concerned breast tumors but very few studies have been done on breast pathology in general. In Mali, this study is the first to our knowledge.

Frequency:

We carried out 1543 mammographic examinations and the mammography-ultrasound couple represented 24.76% of the examinations carried out, i.e. 382 cases.

Of these 382 (echo-mammographic examinations), we collected 254 breast pathologies, i.e. 66.49%. A study carried out in 2010 in Cameroon [7] gave a similar result with 65.19%, another study carried out in Abidjan in 2007 found a lower result than ours with 39.5% of breast pathologies [8].

These different results show us a lesional variability from one region to another but with a high frequency in all cases.

Age:

Age is considered to be one of the most important risk factors for breast cancer.

The most represented age group in our series was 35 - 44 with 26.70%. The average age was 41.06 years with extremes ranging from 12 years to 84 years. This correlates with data from the African literature, for example Zaki Amal in Morocco [9] found an average age of 49 years with extreme ages between 20 and 80 years, his study mainly concerned breast cancer.

Adjenou K [10] in Benin on a series of 80 cases had extreme ages ranging from 13 - 78 years with an average age of 34 years for benign pathologies, 52 years for pathologies suspected of malignancy.

The incidence of breast cancer has an age-dependent curve: the older the age, the greater the risk, approximately 64% of women are over 55 when their cancer is diagnosed, as evidenced by a European study [11]. There are, however, breast cancers occurring at a young age and about 15% to 20% of breast cancers are diagnosed before the age of 50 [9]. This assertion is observed in the relatively young African population like ours, Keita M. [12] in 2018 obtained 14% of breast cancer in those under 35 years old out of a series of 695 cases. Young age is therefore not a necessarily low risk factor, it is necessary for us health professionals in developing countries to make every effort to evolve towards the search for genetic factors in order to better fight the scourge.

More than half of the examination requests came from public structures with 58.38% of the cases. This is explained on the one hand by the fact that consultations are less expensive in public structures than in private ones and on the other hand by the high frequency and availability of specialists in public structures.

Most prescribers were physicians with 347 cases (90.84%). This is explained by the fact that the breast examination is a gynecological examination and most patients are consulted by doctors specializing in gynecology and obstetrics.

Mastodynia was the most frequent clinical information with 41.88% of cases, followed by nodule in 26.70%. This same predominance of clinical data was found with 68.75% by Adjenou K [10]. As for Zaki A [9], he had the opposite with a nodule frequency of 84%. This is explained by the fact that our study and that of Adjenou K focused on all breast pathologies while that of Zaki [9] only focused on breast tumors that can evolve silently. It would be useful in areas where diagnostic means are difficult to access to focus on awareness and education in breast self-examination, which remains a means of preventing breast tumours.

Topography of pathologies:

The seat varies according to the studies. The upper outer quadrant is the most frequent site of malignant breast tumors with 37.55% of cases [13]. This topography is explained by the ever-increasing quantity of glandular tissue in the central and upper-external part [13]. In our series, the lesions were in the left breast in 36% of cases, bilateral in 28% of cases and in the upper outer quadrant in 31.5% of cases. This predominance has been described in the European literature [14] which finds 51.9% on the left and 44.9% in the upper outer quadrant. On the other hand, in another African series, the quadrants (infero-internal and superior-external) each shared 24.3% and the right breast was the most affected [1].

The type of pathology:

Breast pathologies are varied, mainly grouping together tumoral lesions, dystrophic lesions and inflammatory lesions. They are dominated by benign pathologies as evidenced by the different series. Tumor pathologies represented 66.54% in our series among them 45.27% were benign, 11.8% suspicious and 9.45% were malignant. Non-tumor pathologies represented 33.46%, mainly made up of mastitis (16.14%), galactophoric dilatations (11.02%) and abscesses (5.51%).

This predominance of benign pathology was found in the literature, a similar study carried out in Benin by Adjenou K [10] showed that 43 patients had benign pathologies, namely: 37% fibro-adenoma, 21% solitary cysts, 16% fibrocystic mastosis, 14% fibrous dysplasia, 7% galactophoric dilatation, 2.3% post nodulectomy sequelae and 2.3% abscess. 17/60 or 28.33% had pathologies suspected of malignancy.

Another study done in Abidjan in 2007 by Taday Moussa [7] found in a series of 147 cases, 89 normal cases (60.5%), 41 cases of benign pathologies (27.8%) and 17 cases of malignant pathologies (11.7%).

Classification of lesions:

In our series we found: 50.3% of lesions classified ACR2, 17.75% ACR3 and 4, and 14.20% ACR5. This result corroborates that of Guegang E. [1] where the lesions were classified as ACR0 (18.4%), ACR1 (36.4%), ACR2 (33%), ACR3 (1%), ACR4 (4.9%) and ACR5 (5.8%). A contrary result was obtained by Kaoutar Lagraoui [3] in his study with 12% ACR3, 22% ACR4 and 66% ACR5 and another result obtained by Marianne [13] 17% ACR (1 and 2), 5.5% ACR3 and 69.1% ACR (4 and 5). Their high ACR4/5 levels are explained by the fact that their studies only concerned breast cancers.

These results prove to us that the BI-RADS classification of lesions according to the ACR is a predictive sign.

Lymph node damage:

Lymph node exploration concerns not only the axillary hollow, but also the interpectoral region (Rotter’s lymph node), the supraclavicular hollow, the subclavicular region and, in the case of central or internal tumors, the internal mammary lymph node chain located along the intercostal spaces. The local metastasis detection rate is highly variable, thus MRI is playing an increasing role in the assessment of local extension of breast cancer, but ultrasound exploration of lymph node areas is systematic [11].

The adenopathies were present in 73.21% including 39.29% ipsilateral and 33.92% bilateral in our series, a similar result was observed in KEITA M [12] with 72.22%, the opposite results were observed in the study by Kaoutar Lagraoui [3] with 41% lymph node involvement and by Marianne [13] with 25% of cases.

Thus, in the face of any suspicion of malignancy, the radiologist suggested a cytopuncture or biopsy for histological research for better management of these patients.