BREAST TUBERCULOSIS-A RARE PRESENTATION OF COMMON DISEASE WITH DIAGNOSTIC AND THERAPEUTIC CHALLENGE.

Background: Breast tuberculosis is a rare extra pulmonary tuberculosis presentation usually misdiagnosed as carcinoma, pyogenic abscess or idiopathic granulomatous mastitis. Detection of tubercular bacilli by ZN stain, culture and CBNAAT along with caseating granuloma on histopathology helps in diagnosis. Aims and Objectives: To study the clinico-pathological characteristic of breast tuberculosis and diagnostic accuracy of CBNAAT for early and specific diagnosis in reference to histopathological test  Material and Methods: 38 cases of BTB between August2012 to July 2017 were studied. Culture for acid-fast bacilli, smear positivity on Z-N staining, CBNAAT, and cytological and histological examination was done for confirmation.  Results: Prevalence of BTB in this study was found to be 3.95% .The risk factors were reproductive age (20-35), multiparity, lactation and low socioeconomic status. Unilateral lump in the upper outer and central quadrant of the breast was the commonest observation. Only 34.2% were diagnosed provisionally as BTB rest 73.68% were misdiagnosed as fibroadenoma, breast abscess and malignancy Clinically nodulo-caseous variety(55.6 %) disseminated (18.4%) and tubercular abscess (26.3%) were seen. Sensitivity of ZN staining, culture, FNAC and histopathology is 15.8%,5.8%, 74% ,100%respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for the CBNAAT test were 81.818%, 93.103%, 93.10%, and 81.82% respectively.39.4% were cured completely with ATT with 60.52% with residual lesions needed surgery Conclusion: This study highlights the importance of early diagnosis and aggressive medical and if required surgical management to cure this disease. CBNAAT should be used as an additional test to conventional smear microscopy, culture, FNAC and histology. Keywords: Breast tuberculosis, CBNAAT, Extrapulmonary tuberculosis, breast lump