Breast Disease - Volume 41, issue 1

Authors: Boonjunwetvat, Darunee | Rengganis, Anggraeni Ayu | Manasnayakorn, Sopark | Vongsaisuwon, Mawin | Tantidolthanes, Warisa | Sampatanukul, Pichet

Article Type: Case Report

Abstract: We report three cases of focally thickened ductal lesions found on screening ultrasonography with fine needle aspiration (FNA)-proven benign cytology in order to demonstrate the different fates of this radiographic finding. All three patients, aged 74, 69 and 68 years old, had their first time mammography and concurrent ultrasonography. Their mammograms did not show abnormalities except a focal asymmetry in one case. The sonographic focally thick ducts were the lesions of concern and all the patients had long-term follow-up. One patient had a slightly decreased lesion size on follow-up, likely to be a non-proliferative alteration of the breast. One …patient’s FNA revealed a benign papillary lesion whose ductal diameter slightly increased in size with internal echo after two years with repeat FNA demonstrating epithelial papillae consistent with intraductal papilloma. The final patient had an alteration of the imaged ductal lesion in the third year of follow-up and the final specimen after surgical wide excision that was done in the fourth year confirmed cancer. We emphasize the importance of focally thickened ductal lesions found on screening sonography and underscore their need for scrutinized characterization and long term follow-up. Show more

Keywords: Screening breast sonographic focally thick duct

DOI: 10.3233/BD-210075

Citation: Breast Disease, vol. 41, no. 1, pp. 215-219, 2022

Authors: Locicero, Paola | Weingertner, Noëlle | Noblet, Vincent | Mondino, Marie | Mathelin, Carole | Molière, Sébastien

Article Type: Research Article

Abstract: OBJECTIVE: Preoperative diagnosis of phyllodes tumor (PT) is challenging, core-needle biopsy (CNB) has a significant rate of understaging, resulting in suboptimal surgical planification. We hypothesized that the association of imaging data to CNB would improve preoperative diagnostic accuracy compared to biopsy alone. METHODS: In this retrospective pilot study, we included 59 phyllodes tumor with available preoperative imaging, CNB and surgical specimen pathology. RESULTS: Two ultrasound features: tumor heterogeneity and tumor shape were associated with tumor grade, independently of CNB results. Using a machine learning classifier, the association of ultrasound features with CNB results improved accuracy of …preoperative tumor classification up to 84%. CONCLUSION: An integrative approach of preoperative diagnosis, associating ultrasound features and CNB, improves preoperative diagnosis and could thus optimize surgical planification. Show more

Keywords: Phyllodes tumor, Ultrasound, preoperative diagnosis, machine learning classifier

DOI: 10.3233/BD-210025

Citation: Breast Disease, vol. 41, no. 1, pp. 221-228, 2022

Authors: Youssry, Sara | Hussein, Amina | Ramadan, Rabie | Alkarmouty, Ahmad | Elsheredy, Amel

Article Type: Research Article

Abstract: BACKGROUND: The presence of human cytomegalovirus (HCMV) in breast cancer has been reported, suggesting a potential association between HCMV infection and breast carcinogenesis. OBJECTIVE: To evaluate the association between HCMV infection and immune activation and inflammatory markers in breast cancer. METHODS: HCMV DNA was detected from all patients using real-time PCR, Anti HCMV IgM and IgG antibodies were measured. IL-17 and IL-22 concentrations were detected by ELISA. Assessment of NLR and PLR was done, and cell proliferation was assessed using MTT assay. RESULTS: The results revealed a significantly increased prevalence of anti-HCMV IgG and …HCMV DNA in patients compared to both benign and control groups where positive HCMV prevalence was significantly associated with vascular invasion, proliferation rate, high neutrophil-to-lymphocyte ratio (NLR), and elevated IL-17 serum level. Furthermore, we demonstrated that increased serum IL-17 in patients was markedly associated with tumor stage, vascular invasion, and high NLR. CONCLUSION: It can be concluded that HCMV infection may have vital roles in breast cancer pathogenesis. Moreover, altered peripheral blood cells and cytokines may result in disordered immune response in breast cancer patients. Show more

Keywords: HCMV, breast cancer, NLR, PLR, IL-17, IL-22

DOI: 10.3233/BD-210060

Citation: Breast Disease, vol. 41, no. 1, pp. 229-239, 2022

Authors: Kumar, Sandeep | Bhattacharyya, Shalmoli | Das, Ashim | Singh, Gurpreet | Bal, Amanjit

Article Type: Research Article

Abstract: BACKGROUND: Agents targeting the PI3K pathway in triple negative breast cancer did not show any significant efficacy so far mostly because of the complex nature of these targeted inhibitors. Targeting the cancer cells with the combination of inhibitors may help in decelerating the regulatory pathways further achieving optimum clinical benefit. In this study, we investigated the effect of PIK3CA and mTOR inhibition in-vitro in triple-negative breast cancer (TNBC) cell lines. OBJECTIVE AND METHODS: Three TNBC cell lines; MDA MB231, MDA MB468, and MDA MB453 were subtyped using immunohistochemistry and were screened for hotspot mutations in PIK3CA and …AKT1. All cell lines were treated with different concentrations of inhibitors; PI3K inhibitor (BKM 120), mTOR inhibitor (AZD 8055), and dual PI3K/mTOR inhibitor (BEZ 235), and cell viability was assessed by MTT (3-(4, 5-Dimethylthiazol-2-yl)-2, 5-Diphenyltetrazolium Bromide), Trypan blue and Annexin-V/PI Assays. RESULTS: Using immunohistochemistry, TNBC cell lines were subtyped as; mesenchymal subtype-specific cell line (MDA MB231), basal subtype-specific cell line (MDA MD468), and Luminal androgen receptor (LAR) subtype-specific cell line (MDA MB453). PIK3CA hot spot mutation (p.H1047R) in exon 20 was identified in the Luminal androgen receptor subtype (MDA MB453 cells) cell line. Cell viability assays showed that the Mesenchymal subtype-specific cell line (MDA MB231) was the most resistant to all inhibitors and the Luminal Androgen subtype (MDA MB453 cells) cell line was more sensitive to BKM120 (PI3K inhibitor) inhibition compared to other subtypes. CONCLUSIONS: This study identified that the Luminal androgen receptor subtype of triple-negative breast cancer with PIK3CA mutation may be targeted with PIK3CA inhibitors with a favorable outcome. Show more

Keywords: TNBC, molecular subtypes, PIK3CA signaling pathway, PIK3CA/mTOR inhibitors, cell lines

DOI: 10.3233/BD-210066

Citation: Breast Disease, vol. 41, no. 1, pp. 241-247, 2022

Authors: da Silva Fontinele, Danilo Rafael | Assunção Ribeiro da Costa, Rafael Everton | da Silva Magalhães, Maria Kamila | Vieira, Sabas Carlos

Article Type: Research Article

Abstract: BACKGROUND: Around 5%–10% of breast cancers are due to hereditary breast and ovarian cancer syndrome. Genetic testing is important to identify these cases, enabling the adoption of specific risk-reducing treatment strategies. OBJECTIVE: To analyze the performance of genetic testing and its implications in patients with indication of genetic testing to identify hereditary predisposition to breast cancer. METHODS: This is a retrospective observational cross-sectional study, including 176 patients with clinical indication of genetic testing for pathogenic variants related to breast, ovarian and pancreatic cancers (among others), managed from 1999 to 2021 in an Oncology private clinic located …in the city of Teresina (PI), Brazil. RESULTS: There was a predominance of female patients (98.9%) and those with a family (91.0%) and personal history (64.2%) of cancer. In the study, 102 patients (57.9%) received genetic testing. BRCA1 and BRCA2 pathogenic variants occurred in 26 cases (90%). Another three PALB2 and TP53 pathogenic variants were detected. Eleven pathogenic variant carriers (38%) underwent risk-reducing surgeries. CONCLUSIONS: BRCA1 /BRCA2 pathogenic variants occurred in around 25% of tested patients. Approximately 42.0% of the patients did not undergo genetic testing, despite clinical indication. Show more

Keywords: Genetic testing, mutation, genes, breast neoplasms, ovarian neoplasms, pancreatic neoplasms, disease prevention

DOI: 10.3233/BD-210082

Citation: Breast Disease, vol. 41, no. 1, pp. 249-254, 2022

Authors: Kharel, Zeni | Nemer, Omar P. | Xi, Wang | Upadhayaya, Bimala | Falkson, Carla I. | O’Regan, Ruth M. | Dhakal, Ajay

Article Type: Case Report

Abstract: Inflammatory breast cancer (IBC) is a rare variety of breast cancer accounting for two percent of breast cancer diagnoses in the United States. It is characterized by peau d’orange, breast edema and erythema on physical examination and dermal lymphatic invasion by tumor emboli on histological examination. Micrometastases to lymphatics and bone marrow at the time of diagnosis and angiogenic properties of IBC explain the high propensity of this cancer to relapse and metastasize, its aggressiveness and poor prognosis. Preoperative sequential anthracycline and taxane (plus trastuzumab and pertuzumab if HER2-positive) based chemotherapy is the current standard of care for IBC. We …herein report a case of stage IIIC triple-negative IBC treated with pembrolizumab plus chemotherapy based neoadjuvant therapy with a complete clinical and complete pathological response. This is the first case of triple-negative IBC treated with this regimen reported in the literature, thereby providing clinical data on the tolerability and efficacy of pembrolizumab plus chemotherapy based neoadjuvant regimen for the treatment of IBC. Show more

Keywords: Breast cancer, inflammatory breast cancer, pembrolizumab

DOI: 10.3233/BD-210041

Citation: Breast Disease, vol. 41, no. 1, pp. 255-260, 2022

Authors: Vakaet, Vincent | Van Hulle, Hans | Quataert, Viktor | Deseyne, Pieter | Schoepen, Max | Paelinck, Leen | Post, Giselle | Van Greveling, Annick | Speleers, Bruno | Mareel, Marc | De Neve, Wilfried | Monten, Chris | Veldeman, Liv

Article Type: Research Article

Abstract: INTRODUCTION: Postmastectomy radiotherapy reduces the risk of locoregional recurrence in breast cancer patients. The first results on accelerated radiotherapy in five fractions after breast conserving surgery are promising. The data on postmastectomy radiotherapy in five or six fractions is limited. We now present the data on acute and one-year toxicity and health related quality of life (HRQoL) after postmastectomy radiotherapy in patients of sixty years or older. METHODOLOGY: 119 patients received five fractions of 5.7 Gy to the chest wall and five fractions of 5.4 Gy to the lymph nodes over ten to twelve days. Physician-assessed toxicity were scored using …the Common Terminology Criteria for Adverse Events version 4.03 toxicity scoring system and the LENT-SOMA scale. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI-206). HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire the breast cancer specific module and the BREAST-Q questionnaire. RESULTS: Fatigue and edema were the most frequently observed physician-assessed toxicities. One year after radiotherapy only 12.9% experienced a clinically important deterioration in chest wall symptoms and in 22.9% of the patients were improved. Future perspective at one year after radiotherapy was improved in 40.0% of the patients. Patient-reported fatigue showed the greatest improvement. CONCLUSION: Accelerated radiotherapy should be considered to minimize the burden of breast cancer treatment, especially in older patients. Show more

Keywords: Radiation oncology, radiation side effects, radiation therapy techniques

DOI: 10.3233/BD-210080

Citation: Breast Disease, vol. 41, no. 1, pp. 261-266, 2022

Authors: Clement, Zackariah | Egbeare, Donna | Kollias, Jim | Gill, Grantley | Whitfield, Robert | Bingham, Janne | Bochner, Melissa

Article Type: Research Article

Abstract: PURPOSE: Immediate autologous breast reconstruction (IABR) offers fewer surgeries with better psychosocial, quality of life and aesthetic outcomes. In high-risk patients or those with locally advanced breast cancer (LABC), adjuvant postmastectomy radiotherapy decreases local recurrence and improves survival. However, it has negative effects on the reconstructed flap. Reversing the treatment protocol using neoadjuvant radiotherapy may minimise the negative effects on the reconstructed breast in women requesting IABR. We assessed the safety and efficacy of women who underwent mastectomy and IABR post-neoadjuvant chemoradiotherapy (NACRT) for LABC. METHODOLOGY: A cohort study using a retrospective and prospective analysis was performed on …women with LABC who underwent mastectomy and IABR post-NACRT between 1998 and 2018. All reconstructions were performed by oncoplastic breast surgeons from a single unit. Outcome measures analysed included surgical complications, flap failure, loco-regional recurrence, overall and disease-free survival. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the institutional review board. RESULTS: A total of 28 women with a median age of 50 (33–64) were included. 25% underwent TRAM flap and 75% underwent LD flap reconstruction. The median period of follow-up was 61 months. Post-NACRT, 35.7% achieved complete pathological response (PCR). 3/28 (10.7%) had early complications (2 implant and 1 donor site infection). 7% underwent revision surgery. There was no flap loss. 1/28 (3.5%) had loco-regional recurrence, 3.2% had distant metastasis, and 2.5% had breast cancer related mortality. CONCLUSION: In women with LABC, NACRT followed by mastectomy and IABR is safe and may not compromise oncological and cosmetic outcomes. If offers the benefits of immediate breast reconstruction and avoids delaying adjuvant therapy. Show more

Keywords: Neoadjuvant radiotherapy, neoadjuvant chemoradiation, breast cancer, mastectomy, breast reconstruction

DOI: 10.3233/BD-210062

Citation: Breast Disease, vol. 41, no. 1, pp. 267-272, 2022

Authors: Ito, Hiroshi | Ogawa, Yasuhiro | Shimojo, Nobutake | Kawano, Satoru

Article Type: Research Article

Abstract: BACKGROUND: Mondor disease is superficial thrombophlebitis of the thoracoabdominal wall, mid-upper arm, and penis. Although it is usually a benign disease requiring no specific treatment, little is known about this disease owing to its rarity. OBJECTIVE: The aim of this retrospective observational study was to investigate the epidemiology and prognosis of Mondor disease. METHODS: We conducted a single-center observational study of patients with Mondor disease. Patients who received a diagnosis of Mondor disease between 2015 and 2020 were analyzed. The patients’ medical records were manually reviewed to obtain the following variables: date of diagnosis, patient’s age, …sex, department of diagnosing physicians, underlying diseases, medications, surgery, and time until resolution of the lesion. We also reviewed the 1-year mortality, 1-year occurrence of malignancy, and recurrence of Mondor disease. RESULTS: 20 patients were included in the study. The age of the patients ranged from 7 to 83 years, with a median of 47.5 years. Most of the patients presented with thoracoabdominal wall lesions. The underlying conditions included skin diseases, surgical procedures, breast cancer, smoking, and collagenous diseases, although more than half of the patients did not have plausible predisposing factors. About three-quarters of the patients saw a spontaneous resolution of the lesions within 4 weeks without medical or surgical treatments. CONCLUSIONS: Considering the good prognosis of this disease, it is essential to avoid unnecessary invasive tests or treatment once the diagnosis is confirmed. Show more

Keywords: Mondor disease, thrombophlebitis, breast cancer

DOI: 10.3233/BD-210056

Citation: Breast Disease, vol. 41, no. 1, pp. 273-278, 2022

Authors: Kalan Farmanfarma, Khadijeh | Mahdavifar, Neda | Kiasara, Somayeh Heidarpour | Hassanipour, Soheil | Salehiniya, Hamid

Article Type: Systematic Review

Abstract: BACKGROUND: Mammography is the most effective method for early detection of breast cancer (BC), however, it has performed in low-level. The aim of this study was to investigate the determinants of mammography in Iran. METHODS: This study was a systematic review which was performed based on articles published in both Persian and English languages among Iranian patients in the period of 2000 to 2020 by using keywords of “Iran and mammography”. Papers were selected from national databases including (SID, Magiran) and international database including (Scopus, PubMed and web of science), finally related articles to mammography were reviewed. …RESULTS: Findings indicated that 35–50% of breast cancer can be detected in the early stages by mammography, however, it is in low rate of performance among Iranian women. Age, age of menarche, occupation, family history, marital status, family support, number of pregnancies, physician recommendations, perceived sensibility and severity, self-efficacy and perceived benefits are the most important predictors of performing mammography in Iran. CONCLUSION: Due to the growing trend of breast cancer cases in the country and low mammography rates in Iranian population, high risk groups such as women with BC family history, low income level, low education level, older age and people with history of breast complications were more emphasized for performing mammography through health centers. Therefore, appropriate planning to reduce the barriers of mammography could be helpful. Show more

Keywords: Screening, mammography, breast cancer, systematic review, Iran

DOI: 10.3233/BD-210037

Citation: Breast Disease, vol. 41, no. 1, pp. 279-294, 2022