The Histopathological Spectrum of Breast Lesions in Bangladeshi Women

Background and objective Breast lesions represent a wide clinicopathological spectrum, with breast cancer being the most common malignancy in Bangladeshi women. It often presents at a younger age and at an advanced stage, placing strain on the country's limited oncology services. This study aimed to observe the histopathological pattern of breast lesions in women attending a tertiary care center in Dhaka and to identify clinical predictors of pathologically confirmed malignant breast cancer. Methods A retrospective, hospital-based study was conducted in the Department of Pathology, Medical College for Women and Hospital, Dhaka, from June to November 2025, including 160 women with histologically confirmed breast lesions. Clinical data and histopathology reports were analyzed using descriptive statistics, chi-square/Fisher's exact tests, and multivariable logistic regression. Results The mean age was 31.79 ± 11.88 years, with most patients aged 30-39 years. The predominant diagnoses were fibroadenoma (52; 32.5%), granulomatous mastitis (24; 15.0%), invasive breast carcinoma (24; 15.0%), and fibrocystic change (13; 8.1%). Overall, 47.5% of lesions were benign, 35.6% inflammatory, and 16.9% malignant. Age ≥40 years (OR 2.582; 95% CI 1.754-3.802), bilateral involvement (OR 2.088; 95% CI 1.391-3.134), and a clinical impression of malignancy (OR 2.290; 95% CI 1.536-3.414) independently predicted malignancy. Histopathology-based classification demonstrated a sensitivity of 98.68%, a specificity of 74.07%, and an overall accuracy of 89.82% in differentiating benign from malignant lesions. Conclusions Benign and inflammatory lesions, particularly fibroadenoma and granulomatous mastitis, predominate among Bangladeshi women; however, a substantial malignant burden is evident, especially in older and bilaterally affected patients. Because the histopathology-based classification showed moderate specificity, further robust studies incorporating immunohistochemistry and molecular subtype analysis are warranted. Strengthening clinicopathological correlation and maintaining high-quality histopathology services are essential to support earlier diagnosis and targeted management in this setting.