Breast Disease - Volume 41, issue 1

Authors: Masannat, Yazan A. | Lazaraviciute, Gabija | Garbett, Ian K. | Shivakumar, Natesh | Brownlee, Brittany V. | Gagliardi, Tanja | Bromiley, Andrew | Heys, Steven D. | Sharma, Ravi

Article Type: Research Article

Abstract: BACKGROUND: Radiotherapy after breast surgery decreases locoregional recurrence and improves survival. This is not without risks from radiation exposure and could have implications in clinical practice. Our study investigates the correlation between tumour location and radiation dose to the heart. METHODS: Left-sided breast cancer patients who had radiotherapy at Aberdeen Royal Infirmary in 2010 were identified. Tumour location was established from notes and imaging. Radiotherapy planning scans were reviewed, and cardiac doses calculated. The mean cardiac dose, maximum dose and volume of the heart in the field, along with V5-V40, were determined. RESULTS: 40 patients had …mastectomies and 118 breast conserving surgery. The median percentage of the heart in the field and the Interquartile Range was 0.59% (0.03–1.74) for all patients, with the highest for lower inner quadrant (LIQ) tumours 1.20% (0.29–2.40), followed by mastectomy 0.94% (0.02-1.82). The mean heart dose showed a higher median for mastectomies 1.59 Gy (1.00-1.94), followed by LIQ tumours 1.58 Gy (1.31–2.28), with an overall median of 1.42 Gy (1.13–1.95). The median percentage of the heart in the field, the mean cardiac dose and V5-V30 did not reach statistical significance, however, V40 and the maximum dose did. CONCLUSIONS: The benefits of radiotherapy after breast cancer surgery are established, but with potential harm from cardiac exposure. Our cohort showed higher radiation exposure to the heart in patients with LIQ tumours and mastectomies but reached significance only for V40 and maximum dose. This highlights tumour location as a potentially important risk factor for cardiac exposure with breast radiotherapy. Show more

Keywords: Breast cancer, radiotherapy, cardiac dose

DOI: 10.3233/BD-201025

Citation: Breast Disease, vol. 41, no. 1, pp. 67-74, 2022

Authors: Huayllani, Maria T. | Torres-Guzman, Ricardo A. | Avila, Francisco R. | Advani, Pooja P. | Spaulding, Aaron C. | Cochuyt, Jordan J. | Nguyen, Minh-Doan T. | Lu, Xiaona | Rinker, Brian D. | Forte, Antonio J.

Article Type: Research Article

Abstract: INTRODUCTION: Disparities in access to reconstructive surgery after breast cancer have been reported. We aim to evaluate demographic and socioeconomic factors influencing type of autologous breast reconstruction in Florida. METHODS: We queried the Florida Inpatient Discharge Dataset to evaluate disparities in type of autologous breast reconstructive surgery between January 1, 2013, and September 30, 2017. Patients 18 years of age or older were included. Women younger than 65 years old on Medicare were excluded. Patients were categorized into three groups according to type of autologous reconstruction: latissimus dorsi pedicled flap (pedicled flap), free flap, or pedicled flap with …implant (combined flap). Demographic and socioeconomic variables were evaluated. 𝜒2 and Mann–Whitney tests were used to estimate statistical significance. A multivariate logistic regression was performed to find independent associations. RESULTS: Our results showed higher odds of reconstruction with free flap in Hispanic patients (odds ratio (OR), 1.66; 95% CI, 1.32–2.09; P < 0.0001) and patients with comorbidities (OR, 1.45; 95% CI, 1.23–1.71; P < 0.0001). However, patients treated in Central and South Florida were less likely to undergo free flap than combined and pedicled flap reconstructions compared with those treated in North Florida (P < 0.05). Patients insured by Medicaid and Medicare were less likely to undergo free flap than combined or pedicled flap reconstruction compared to patients with private insurance (P < 0.05). CONCLUSIONS: Our study identified that race, region, insurance, and comorbidity are factors associated with type of autologous breast reconstruction in Florida. Show more

Keywords: Malignant breast disease, reconstructive surgery, breast reconstruction, disparities, race, insurance

DOI: 10.3233/BD-210004

Citation: Breast Disease, vol. 41, no. 1, pp. 75-80, 2022

Authors: Brar, Jasleen | Khalid, Ayisha | Ferdous, Mahzabin | Abedin, Tasnima | Turin, Tanvir C.

Article Type: Brief Report

Abstract: BACKGROUND: The YouTube platform has great potential of serving as a healthcare resource due to its easy accessibility, navigability and wide audience reach. Breast cancer screening is an important preventative measure that can reduce breast cancer mortality by 40%. Therefore, platforms being used as a healthcare resources, such as YouTube, can and should be used to advocate for essential preventative measures such as breast cancer screening. METHODS: In this study, the usefulness of videos related to breast cancer and breast cancer screening were analyzed. Videos were first screened for inclusion and then were categorized into very useful , …moderately useful , somewhat useful , and not useful categories according to a 10-point criteria scale developed by medical professionals based on existing breast cancer screening guidelines. Two reviewers independently assessed each video using the scale. RESULTS: 200 videos were identified in the preliminary analysis (100 for the search phrase ‘breast cancer’ and 100 for the search phrase ‘breast cancer screening’). After exclusion of duplicates and non-relevant videos, 162 videos were included in the final analysis. We found the following distribution of videos: 4.3% very useful , 17.9% moderately useful , 39.5% somewhat useful , and 38.3% not useful videos. There was a significant association between each of the following and the video’s level of usefulness: video length, the number of likes, and the uploading source. Longer videos were very useful , somewhat useful videos were the most liked, personally produced videos were the most not useful , and advertisements produced the highest ratio of very useful to not useful videos. CONCLUSION: It is necessary to create more reliable and useful healthcare resources for the general population as well as to monitor health information on easily accessible social platforms such as YouTube. Show more

Keywords: Cancer screening, health literacy, information, usefulness, video

DOI: 10.3233/BD-201028

Citation: Breast Disease, vol. 41, no. 1, pp. 81-87, 2022

Authors: Gerets, J.C.W.L. | Kool, M. | Simons, P.C.G. | Aarts, F. | Vogelaar, F.J.

Article Type: Research Article

Abstract: INTRODUCTION: The management of complex cysts of the breast is an ongoing topic of discussion. The aim of this study was to determine the prevalence of underlying malignancy in radiologically diagnosed complex cysts, and to assess whether watchful waiting could be the preferred method to safely manage complex cysts of the breast. SUBJECTS AND METHODS: A single-center retrospective study was performed between May 2003 and November 2019 in the VieCuri Medical Centre. Women with a radiologically diagnosed complex cyst of the breast were included. Prevalence of underlying malignancy was calculated, as were absolute risk reduction and number needed …to treat in order to diagnose malignancy. In addition, patient characteristics were compared to determine characteristics associated with malignancy. RESULTS: Of 78 radiologically diagnosed complex cysts of the breast, five (6,4%) were found to be malignant. The number needed to treat was calculated at 12,8 (absolute riks reduction 0,078). Age (P = 0,003) was associated with malignancy. CONCLUSION: Complex cysts of the breast could be managed more conservatively. Patient characteristics can be used to assess the eligibility for radiological follow-up. This, in turn, would lead to a lower NNT and possibly a decrease in disease burden and healthcare costs. Show more

Keywords: Complex cyst, breast, excision biopsy, follow up, number needed to treat

DOI: 10.3233/BD-201057

Citation: Breast Disease, vol. 41, no. 1, pp. 89-95, 2022

Authors: Salinas-Huertas, S. | Luzardo-González, A. | Vázquez-Gallego, S. | Pernas, S. | Falo, C. | Pla, M.J. | Gil-Gil, M. | Beranuy-Rodriguez, M. | Pérez-Montero, H. | Gomila-Sancho, M. | Manent-Molina, N. | Arencibia-Domínguez, A. | Gonzalez-Pineda, B. | Tormo-Collado, F. | Ortí-Asencio, M. | Terra, J. | Martinez-Perez, E. | Mestre-Jane, A. | Campos-Varela, I. | Jaraba-Armas, M. | Benítez-Segura, A. | Campos-Delgado, M. | Fernández-Montolí, M.E. | Valverde-Alcántara, Y. | Rodríguez, A. | Campos, G. | Guma, A. | Ponce-Sebastià, J. | Planas-Balagué, R. | Catasús-Clavé, M. | García-Tejedor, A.

Article Type: Research Article

Abstract: INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1–54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor …characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92–18.16) and 3.9 (1.60–9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment. Show more

Keywords: Breast cancer, lymphedema, sentinel lymph node biopsy, axillary lymphadenectomy, mastectomy

DOI: 10.3233/BD-210043

Citation: Breast Disease, vol. 41, no. 1, pp. 97-108, 2022

Authors: Yamamura, Jun | Miyamura, Yukiko | Kamigaki, Shunji | Fujita, Junya | Osato, Hiroki | Manabe, Hironobu | Tanaka, Yumiko | Shinzaki, Wataru | Hahimot, Yukihiko | Ito, Toshikazu | Komoike, Yoshifumi

Article Type: Research Article

Abstract: BACKGROUND: Current guidelines define primary and secondary endocrine resistance according to the periods of adjuvant endocrine therapy (adj-ET); however, the relationship between adj-ET period and endocrine resistance remains unclear. OBJECTIVE: We examined progression-free survival (PFS) after primary ET for recurrent hormone receptor-positive/HER2-negative breast cancer, and evaluated the relationship between endocrine resistance and the periods of adj-ET. METHODS: We assessed PFS among 183 patients who received ET as primary treatment for the first recurrence, according to the period of adj-ET (adj-ET < 1 year, 1–2 years, ≥2 years, and completion). RESULTS: Patients who relapsed during the …first year of adj-ET had the significantly shortest PFS. PFS did not significantly differ between patients who relapsed at 1–2 years of adj-ET and patients who relapsed while on adj-ET but after the first 2 years. CONCLUSIONS: Relapse at 1–2 years after adj-ET initiation might be better classified as secondary endocrine resistance rather than primary endocrine resistance. Show more

Keywords: Recurrent breast cancer, hormone receptor-positive, HER2-negative, adjuvant endocrine therapy, endocrine resistance

DOI: 10.3233/BD-210027

Citation: Breast Disease, vol. 41, no. 1, pp. 109-114, 2022

Authors: Goyal, Shina | Jacob, Linu Abraham | Lokanatha, D. | Suresh Babu, M.C. | Lokesh, K.N. | Rudresha, A.H. | Saldanha, Smitha | Amirtham, Usha | Thottian, Antony G.F. | Rajeev, L.K.

Article Type: Research Article

Abstract: BACKGROUND: The present era of individualized treatment for breast cancer is influenced by the initial disease status including the anatomical extent, grade, and receptor status. An accurate preoperative staging is the basis of treatment planning and prognostication. Our study aims to determine the discordance between the preoperative clinical and the postoperative pathological stages of breast cancer patients. METHODOLOGY: The medical records of all non-metastatic breast cancer patients from January 2017 to December 2018 who underwent upfront surgery were reviewed. They were staged as per the eighth AJCC and the concordance between the clinical (c) and pathological T (tumor), …N (nodal), and final AJCC stage was studied. A Chi-square test was used to determine factors that significantly correlate with disease discordance. RESULTS: A total of 307 breast cancer patients were analyzed. Among these, 43.3% were hormone receptor-positive, 30.6% were Her2 positive and 26% were triple-negative. Overall stage discordance was seen in 48.5% (n = 149) patients (upstaging in 22.1%, downstaging in 26.4%). The discordance rate was 48.9% for T stage (cT versus pT) and 57.4% for N stage (cN versus pN). Among patients with clinically node-negative disease, 53.4% were found to have positive nodes on histopathology, while 27.2% had vice versa. Overall, the factors associated with upstaging were ER-positive, Her2 positive and triple-negative status (all p < 0.05), while none of the factors showed significant association with downstaging. CONCLUSIONS: About half of breast cancer patients had discordance between clinical and pathological staging with higher discordance in the nodal stage. This changes the disease prognosis, and may also affect the offered surgical treatment and radiotherapy. Thus highlighting the need for a precise pre-operative staging. Also, this information will aid clinicians in discussions with patients, keeping in mind the likelihood of change in disease staging and management.  Show more

Keywords: Discordance, upstaging, breast cancer, preoperative staging, pathological staging

DOI: 10.3233/BD-201029

Citation: Breast Disease, vol. 41, no. 1, pp. 115-121, 2022

Authors: Gomes de Oliveira, Geilson | Gonçalves, Ana Katherine | Eleutério Jr, José | Pinheiro, Luiz Gonzaga Porto

Article Type: Systematic Review

Abstract: BACKGROUND: Although widely studied, the role of HPV in the genesis of breast carcinomas remains elusive due to the diversity of results across studies, possibly caused by the wide methodological heterogeneity, some of them with inadequate methods. OBJECTIVE: To verify the association between HPV and breast cancer through the meta-analysis of studies that used the best-recognized techniques for viral detection and tissue conservation. METHODS: A systematic review and meta-analysis restricted to studies that detected HPV by PCR in fresh and frozen tissue from breast cancer were conducted to obtain greater homogeneity. PubMed, Scopus, Science Direct, Cochrane …Library, and SciELO were searched until December 14, 2019. Search terms included “breast cancer” and “HPV” without language restrictions. Eleven studies were included in the meta-analysis. The pooled relative risks and 95% confidence interval (95% CI) were calculated, and heterogeneity was assessed using the I-squared (I2 ). RESULTS: The selected studies had very low heterogeneity (2%). There is a 2.15 times higher combined relative risk (95% CI = 1.60-2.89) of detecting HPV in breast cancer than in cancer-free breast controls with a statistically significant p -value (p < 0.0001). CONCLUSION: Our data support the association of DNA-HPV with breast carcinomas. Further studies are needed to find out which breast cancer subtypes this association is most frequent. Show more

Keywords: Human papillomavirus, breast cancer, meta-analysis, fresh tissue, PCR

DOI: 10.3233/BD-201032

Citation: Breast Disease, vol. 41, no. 1, pp. 123-132, 2022

Authors: Assunção Ribeiro da Costa, Rafael Everton | da Silva Fontinele, Danilo Rafael | Medeiros, Paula Catarina Dalia Rego | Vieira, Sabas Carlos

Article Type: Case Report

Abstract: BACKGROUND: Metaplastic breast carcinoma (MBC) is a rare type of breast cancer (0.20–1.00% of all cases). With a more aggressive clinical course, MBC frequently presents as a triple-negative subtype. OBJECTIVE: To describe a case series, analyzing patients survival in four MBC cases. METHODS: The cases were obtained from 532 medical records of breast cancer patients (0.7% of the total). RESULTS: All patients were female. Mean patient age was 49 years (range: 38–60 years). Mean tumor size was 8.9 cm (range: 3.0–15.5 cm). Mastectomy was performed in three cases. One patient had axillary nodal metastasis. All …underwent chemotherapy and three received radiation therapy after surgery. CONCLUSIONS: With a mean follow-up of 36 months (range: 10–60 months), one case had a tumor recurrence (25%). Three patients (75%) died from metastatic disease and one (25%) is still alive and free of disease. Show more

Keywords: Survival, breast neoplasms, recurrence, neoplasm metastasis, medical records

DOI: 10.3233/BD-210040

Citation: Breast Disease, vol. 41, no. 1, pp. 133-136, 2022

Authors: Ghafouri-Fard, Soudeh | Sohrabi, Behnoush | Hussen, Bashdar Mahmud | Mehravaran, Elham | Jamali, Elena | Arsang-Jang, Shahram | Fathi, Mohadeseh | Taheri, Mohammad | Samsami, Majid

Article Type: Research Article

Abstract: TP53 encodes a major tumor suppressor protein which blocks carcinogenesis process in a variety of tissues including breast tissue. Expression and function of this gene is regulated by a number of long non-coding RNAs (lncRNAs) among them are PANDA , MEG3 and CASC2 . We measured expression of TP53 and these transcripts in a cohort of Iranian breast cancer patients. Expression levels of TP53 , MEG3 , CASC2 and PANDA were significantly lower in tumoral samples compared with non-tumoral samples (Posterior mean differences =  −4.26, −1.66, −5.98 and −3.13, respectively; P values < …0.0001). Expression of CASC2 was higher in Her2 1+ cases compared with Her2 negative cases (Beta = 1.85, P value = 0.037). Expression levels of MEG3 and TP53 were lower in grade 2 samples compared with grade 1 (Beta = −1.86, P value = 0.006 and Beta = −2.24, P value = 0.003, respectively). There was no other significant association between expression of genes and clinical variables. CASC2 had the best performance among these genes with area under curve value of 0.78 and sensitivity and specificity values of 56.33% and 88.73%, respectively (P value < 0.0001). The current investigation supports the role of TP53 -related lncRNAs in the pathogenesis of breast cancer. Show more

Keywords: TP53, lncRNA, PANDA , MEG3 , CASC2

DOI: 10.3233/BD-210069

Citation: Breast Disease, vol. 41, no. 1, pp. 137-143, 2022

Authors: Calis, Hasan | Karabulut, Zulfikar | Guler, Yilmaz | Sengul, Serkan

Article Type: Research Article

Abstract: BACKGROUND: Steroid therapy is an immunosuppressive treatment and may have possible side effects in a pandemic period. However, the number of studies on the use corticosteroids for the treatment of idiopathic Granulomatous Mastitis (IGM) especially during the pandemic is almost negligible. METHODS: The data of patients with the diagnosis of IGM between January–December 2020 in the General Surgery Clinic were retrospectively analyzed. The patients were explained in detail that steroid therapy is an immunosuppressive treatment and it may have possible side effects. Prednisolone 0.5–1 mg/kg/day was given as steroid therapy. The treatment was planned for 4–6 months according to …the severity of the symptoms and was completed by reducing it to a total dose of 10 mg/month. RESULTS: Eleven patients were included in the study. Five patients had completed steroid treatment and continued their follow-up. In our study, a total of six patients were receiving steroid therapy. CONCLUSIONS: There is no consensus yet on the use of the steroid in the COVID-19 pandemic. Low doses Corticosteroids (<1 mg/kg/day) don’t have an effect on increase mortality in patients with severe COVID-19. We can think that low-dose corticosteroids used by many centers in IGM treatment do not have a negative effect on mortality. Show more

Keywords: Idiopathic granulomatous mastitis, steroid treatment, COVID-19 pandemic, immunosuppressive

DOI: 10.3233/BD-210054

Citation: Breast Disease, vol. 41, no. 1, pp. 145-149, 2022

Authors: Linn, Yun Le | Tay, Timothy Kwang Yong | Tan, Eng Huat | Wong, Jill Su Lin | Madhukumar, Preetha

Article Type: Case Report

Abstract: Primary breast carcinomas often present as ill-defined, infiltrative lesions which may contain calcifications, whereas metastatic cancers from non-mammary sites are often more well-circumscribed, sharply demarcated from the adjacent breast tissue and are usually not associated with calcifications, although there are exceptions. We report an atypical case of a lady with lung adenocarcinoma with pleural involvement, who presented with diffuse breast swelling with calcifications on imaging from metastatic lung adenocarcinoma, the first of its kind in the literature. We postulate that the pathophysiology of this was due to lymphatic spread of the tumour from the pleura resulting in retrograde lymphovascular congestion …of the breast, resulting in swelling and dystrophic calcification. Show more

Keywords: Breast tumors, lung adenocarcinoma, metastasis, microcalcification, lymph node

DOI: 10.3233/BD-210035

Citation: Breast Disease, vol. 41, no. 1, pp. 151-154, 2022

Authors: Oki, Naohiko | Seki, Hirohito | Sakurai, Takashi | Horiuchi, Yosuke | Kodaka, Keiko | Shimizu, Ken

Article Type: Case Report

Abstract: The rate of metastasis to the central nervous system is high in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer patients. Metastatic cauda equina tumors are characterized by rapid progression of symptoms, thus signifying the requirement of their early treatment. However, these tumors are rarely reported, and their optimal treatment options have not been established yet. Here, we report a case study of a patient with HER2-positive breast cancer that metastasized to the cauda equina. The patient underwent urgent surgery to relieve the spinal cord compression. The pain in her back and lower limbs was greatly reduced. Unfortunately, …her ability to walk did not improve sufficiently. Overall, surgical treatment may be a favorable option to improve a patient’s quality of life. Show more

Keywords: Metastatic breast cancer, intramedullary spinal cord metastasis, cauda equina tumor, brain metastasis, human epidermal growth factor receptor 2

DOI: 10.3233/BD-210032

Citation: Breast Disease, vol. 41, no. 1, pp. 155-161, 2022

Authors: Levine, Paul H. | Veneroso, Carmela C.

Article Type: Correction

DOI: 10.3233/BD-210914

Citation: Breast Disease, vol. 41, no. 1, pp. 163-163, 2022

Authors: Jafferbhoy, Sadaf | Gowda S., Manoj | Kabeer, Kirti Katherine | Mohd-Isa, Zatinahhayu | Salehi-Bird, Seema | Marla, Sekhar | Narayanan, Sankaran | Soumian, Soni

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: MRI is generally performed to assess response to Neo-adjuvant systemic therapy (NAST) in breast cancer. OBJECTIVE: To assess role of MRI in determining the probability of having residual disease in patients undergoing NAST. We also evaluated synchronous cancers diagnosed following MRI. METHODS: This is a retrospective study which included all patients who had pre-and post-NAST MRI between June 2014 and December 2019. Data on demographics, tumour characteristics and pathology were collected and analysed. Pre- and post-MRI probability were calculated and depicted on nomograms. RESULTS: The study included 205 patients. Overall pre-MRI …probability of having residual disease was 55% (OR:1.2). The post-MRI probability was 78% (95% CI 72–83%; OR:3.5) if MRI showed residual disease and 23% (95% CI 16–31%, OR:0.3) if imaging showed complete response. The absolute benefit was higher in TNBC and HR-HER2. Additional cancers were identified in 8.78% of patients. CONCLUSION: MRI is beneficial in evaluating response to NAST specifically in TNBC and HR-HER2 cancers. Pre- and post-MRI probabilities of residual disease depicted on nomograms are a useful tool for clinicians. MRI can potentially impact the treatment decisions by identification of synchronous cancers. Show more

Keywords: Breast cancer, magnetic resonance imaging, neoadjuvant, nomogram, residual disease

DOI: 10.3233/BD-210023

Citation: Breast Disease, vol. 41, no. 1, pp. 165-173, 2022

Authors: Ahmed, Yasser S. | Abd El Maksoud, Walid M. | Sultan, Mohamed Hussein

Article Type: Research Article

Abstract: AIM: To evaluate the local dermo-glandular flap as a new reconstructive oncoplastic technique after removal of central malignant tumors of the breast, in terms of patient satisfaction and local recurrence. PATIENTS AND METHODS: This study included 60 females with centrally located breast cancer who underwent central quadrantectomy and local dermo-glandular flap with either sentinel lymph node biopsy or axillary clearance. RESULTS: The mean age of the patients was 49.68 ± 8.52 years. The duration of the operation ranged from 68–105 minutes, with a mean of 79.77 ± 9.41 minutes. Local recurrence was observed in three patients …(5.00%) with no distant metastasis. Forty-seven patients (78.33%) reported satisfaction after the operation. Ugly scarring and the existence of tissue defects were the main factors affecting patient satisfaction. Correction of these complications increased overall satisfaction to 88.33%. CONCLUSIONS: For small- and medium-sized breasts, the use of a local dermo-glandular flap for the management of centrally located malignant tumors seems to be a simple and easy technique with good oncological outcomes and acceptable few minor complications. This technique offers an immediate reconstruction of a new areola with fewer scars that will be hidden later after areola tattooing. Most of the patients reported satisfaction three months after areola reconstruction. Show more

Keywords: Breast cancer, conservative breast surgery, dermo-glandular flap

DOI: 10.3233/BD-210067

Citation: Breast Disease, vol. 41, no. 1, pp. 175-185, 2022

Authors: Geneş, Zekiye Küçükoğlu | Esendağlı, Güldal | Sütcüoğlu, Osman | Şimşek, Berkay | Özet, Ahmet

Article Type: Case Report

Abstract: The 42-year-old patient, diagnosed with Stage IIA breast cancer, completed the postoperative adjuvant chemotherapy and radiotherapy. At the 11th year of diagnosis, a 3 cm tumor was detected in the pancreas and pancreatectomy was performed. Although the diagnosis of primary pancreatic adenocarcinoma was made at first, then the pancreatic metastasis of breast cancer was discovered. Pancreatic metastasis of breast cancer is extremely rare, and a limited number of patients have been reported in the literature. Here, we report an additional case of this rare tumor and the problems correlating with its diagnosis.

Keywords: Diagnosis, pathology, chemotheraphy, breast cancer, pancreas

DOI: 10.3233/BD-210042

Citation: Breast Disease, vol. 41, no. 1, pp. 187-189, 2022

Authors: Ghanei Gheshlagh, Reza | Mohammadnejad, Esmaeil | Dalvand, Sahar | Dehkordi, Ali Hasanpour

Article Type: Systematic Review

Abstract: BACKGROUND: Breast cancer is the most common type of cancer of women across the world, which can affect the quality of life in patients due to complications caused by the disease and related treatments. Various treatments have been designed for these patients to improve their life quality. This study aimed to estimate the mean score of health-related quality of life patients with breast cancer in Iran. METHODS: In this study, we searched the national and international databases of SID, MagIran, Google Scholar, ISI/Web of Science, PubMed and Scopus with no time limits using the keywords of “health-related quality …of life”, “health related quality of life”, “quality of life”, “breast neoplasm”, “breast cancer”, and “breast tumors”. Data analysis was performed in STATA version 14 based on the heterogeneity state using random effects model. RESULTS: In this study, 15 articles with a sample size of 1883 were evaluated, and the mean global quality of life in patients was reported at 72.48 (95% CI: 64.94–79.82). In addition, the worst performance and symptoms were related to emotional functioning (56.70) (95% CI: 49.84–63.55) and financial difficulties (43.57) (95% CI: 31.47–55.67). CONCLUSION: According to the results of the present study, the Iranian patients with breast cancer had a moderate quality of life in most dimensions. Show more

Keywords: Breast cancer, life quality, systematic review

DOI: 10.3233/BD-210026

Citation: Breast Disease, vol. 41, no. 1, pp. 191-198, 2022

Authors: Gupta, Parul | Singh, Vikram | Kumar, Sandeep | Das, Ashim | Singh, Gurpreet | Bal, Amanjit

Article Type: Brief Report

Abstract: BACKGROUND: Breast cancer heterogeneity is well documented and to some extent is attributed to the presence of cancer stem cells (CSCs). Breast cancer stem cells are identified by the presence of cell surface molecule CD44 and absence of CD24. METHODS: In the present study a flowcytometric analysis was done to study the expression distribution of CSC phenotype of CD44+/CD24-/low, among different molecular subtypes of breast cancer and to find a correlation with clinicopathological features. RESULTS: CSCs were observed in all the molecular subtypes of breast cancer. The highest population of CSCs was noted in luminal B …(3.4%), followed by TNBC (1.7%), and Her-2 subtype (1.6%). The least number of CD44+/CD24- cells were seen in Luminal A subgroup (1.3%). CONCLUSION: Existence of cancer stem cells in all the subtypes may suggest the possibility of failure of current therapies in treatment of patients. Show more

Keywords: Cancer stem cells, flowcytometry, breast cancer

DOI: 10.3233/BD-210050

Citation: Breast Disease, vol. 41, no. 1, pp. 199-203, 2022

Authors: Ferre, Romuald | Kuzmiak, Cherie M.

Article Type: Systematic Review

Abstract: BACKGROUND: The implementation of digital breast tomosynthesis has increased the detection of architectural distortion (AD). Managing this finding may be experienced as a clinical dilemma in daily practice. Breast Contrast-Enhanced MRI (CE-BMR) is a known modality in case of problem-solving tool for mammographic abnormalities. However, the data about AR and CE-BMR are scant. OBJECTIVE: The purpose was to estimate the benefit of CE-BMR in the setting of architectural distortion detected mammographically through a systematic review and meta-analysis of the literature. METHODS: A search of MEDLINE and EMBASE databases were conducted in 2020. Based on the PRISMA …guidelines, an analysis was performed using the chi-square test of independence to determine if there was a significant association between the result of the test (positive or negative) and the participant condition (malignant or non-malignant). RESULTS: Four studies were available. The negative predictive value (NPV) was 98.3% to 100%. The result of the chi-square indicated that there was significant association between the participant test result and the participant condition for the included publications (X ( 1 , 175 ) 2 =   84.051 , p = 0.0001). CONCLUSIONS: The high NPV could allow for deferral of a biopsy in favor of a short-interval imaging follow-up in the setting of a negative CE-BMR. Show more

Keywords: Breast, architectural distortion, MRI, mammogram, tomosynthesis

DOI: 10.3233/BD-210045

Citation: Breast Disease, vol. 41, no. 1, pp. 205-214, 2022

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

Authors: Krishnamurthy, Kritika | Deb, Arunima | Alghamdi, Sarah | Schwartz, Michael | Cusnir, Mike | Sriganeshan, Vathany | Poppiti, Robert

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer, one of the leading causes of cancer-related mortality in women worldwide, exhibits wide-ranging histo-morphologic, clinical and molecular diversity. OBJECTIVE: This study compares the genetic alterations of breast tumors with the histo-morphological, hormone receptor status and metastatic “organotropism”. MATERIALS AND METHODS: Twenty-two cases of primary invasive breast carcinoma with local/distant metastasis were retrieved from the pathology archives. The status of estrogen and progesterone receptors by immunohistochemistry was recorded along with other pertinent case data. Next generation sequencing was performed on formalin-fixed paraffin embedded blocks of tumor. RESULTS: The mean age of the …study subjects was 57.9 ± 13.3 years. TP53 mutation was the most common gene alteration in this study and was seen in 40.9% cases. ROS1 gene was mutated in 44.4% PR negative breast cancers while being wild type in the twelve PR positive tumors. (p  = 0.021). STRING interaction network constructed with ROS1 and PR revealed a significantly higher number of interactions in this network than expected (p -value 0.000973). CONCLUSION: This study highlights the significantly higher incidence of ROS1 gene alterations in metastatic PR− breast cancers, with STRING network analysis revealing higher nodal interaction in the nodal network comprised of PR and ROS1 exclusive of ER. Show more

Keywords: Metastatic breast cancer, ER+PR−, TP53, ROS1, STRING network

DOI: 10.3233/BD-220001

Citation: Breast Disease, vol. 41, no. 1, pp. 295-301, 2022

Authors: Shahraki, Zahra | Ghaffari, Mehrangiz | Nakhaie Moghadam, Maryam | Parooie, Fateme | Salarzaei, Morteza

Article Type: Systematic Review

Abstract: INTRODUCTION: Breast cancer is the most common cancer in women worldwide. It is responsible for about 23% of cancer in females in both developed and developing countries. This study aimed to compare the diagnostic performance of contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations of breast lesions. METHODS: We searched for published literature in the English language in MEDLINE via PubMed and EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. Metadisc1.4 software was used for statistical analysis …RESULTS: A total of 1225 patients were included. The pooled sensitivity of CEM and CEMRI was 0.946 (95% CI, 0.931–0.958) and 0.935 (95% CI, 0.920–0.949), respectively. The pooled specificity of CEM and CEMRI was 0.783 (95% CI, 0.758–0.807) and 0.715 (95% CI, 0.688–0.741), respectively. The sensitivity of CEM was the most in the United States (97%) and the specificity of CEM was the most in Brazil (88%). MRI sensitivity was the most in USA and Egypt (99%) and China had the most MRI specificity (81%) in diagnosis of breast lesions. CONCLUSION: Contrast-enhanced mammography, a combination of high energy image and low energy image, can well display breast lesions and has the diagnostic efficacy equivalent to MRI. Importantly, CEM imaging shows higher specificity, positive predictive value, and diagnostic conformance rate than MRI. Despite some drawbacks such as higher irradiation and iodine usage, CEM has such advantages as convenient and fast examination, strong applicability, and low costs; thus, it can be popularized as a useful tool in breast disease. Show more

Keywords: Contrast enhanced mammography, contrast enhanced magnetic resonance imaging, breast cancer, CEM, CEMRI

DOI: 10.3233/BD-210034

Citation: Breast Disease, vol. 41, no. 1, pp. 303-315, 2022

Authors: Grubstein, Ahuva | Rapson, Yael | Manor, Moran | Yerushalmi, Rinat | Gavrieli, Shlomo | Tamir, Shlomit | Meshulam, Sagit | Atar, Eli | Stemmer, Salomon M. | Shochat, Tzippy | Allweis, Tanir M.

Article Type: Research Article

Abstract: OBJECTIVES: High background parenchymal enhancement (BPE) levels and asymmetric distribution could cause diagnostic uncertainty due to morphological similarity to breast cancer, especially invasive lobular carcinoma (ILC). We investigated BPE in ILC patients, its association with the tumor hormonal profile, and the effect of endocrine treatment (ET). METHODS: The analysis included all MRI examinations performed at our institution between 2010 and 2019 for ILC-diagnosed patients. Baseline study and the first follow-up study were reviewed. Digital medical records were reviewed to retrieve demographics/pathology results/treatment information. BPE and fibroglandular tissue were assessed qualitatively on the contralateral breast according to the criteria …of the Breast Imaging Reporting and Data System (BI-RADS). RESULTS: The study included 129 patients. Most (91%) had pure ILC. All received ET; 12% also received chemotherapy; 90% had surgery first; 70% by breast conservation. On the baseline MRI, 70% had mild or moderate BPE; whereas, on the follow-up study, the majority (59%) had minimal BPE. Most BPE reductions were by 2 degrees. In the baseline study, additional biopsies were required in 59% of cases, and in 17%, a short-term follow-up was recommended. In the follow-up study, biopsies were recommended in 10%, and a short-term follow-up was requested in 16%. A correlation between progesterone receptor intensity index and baseline BPE level was observed (r = 0.3, p = 0.004). CONCLUSION: ILC patients usually exhibit high BPE. ET decreases BPE, and therefore may decrease false-positive interpretations. Additional research is needed to explore whether study can be performed on ET without compromising sensitivity. Key points: ∙ High background parenchymal enhancement levels reduces breast MRI sensitivity, yielding high false positive rates especially when reporting cases of invasive lobular carcinoma [ILC]. ∙Treatment of ILC with endocrine therapy reduces background parenchymal enhancement and thus could decrease these false-positive interpretations. Show more

Keywords: Breast cancer, carcinoma, lobular, MRI scans, retrospective study

DOI: 10.3233/BD-220003

Citation: Breast Disease, vol. 41, no. 1, pp. 317-323, 2022

Authors: Pankratjevaite, Lina | Lind, Katrine | Mele, Marco | Lelkaitis, Giedrius

Article Type: Case Report

Abstract: INTRODUCTION: Breast adenomyoepithelioma is a very uncommon tumor, which is generally considered to be benign, however malignant transformation has been reported. PRESENTATION OF CASE: We report two cases of two women with breast adenomyoepithelioma. CONCLUSION: Diagnosis of adenomyoepithelioma is challenging because tumor may mimic other breast diseases. It has neither specific clinical signs nor radiological features, and the diagnosis is based on histopathological examination of the lesion. The treatment of choice is surgery. The type of surgery depends on the tumor factors and breast size. In malignant cases treatment such as radiotherapy, chemotherapy, immunotherapy may be …used as well. It is very important to give an adequate treatment, otherwise the risk of tumor recurrence, growth or even metastatic spread, when tumor has malignant potential, increases. Show more

Keywords: Adenomyoepithelioma, rare breast disease, surgery, case report

DOI: 10.3233/BD-210077

Citation: Breast Disease, vol. 41, no. 1, pp. 325-330, 2022

Authors: Voutsadakis, Ioannis A.

Article Type: Research Article

Abstract: INTRODUCTION: Losses of genetic material from chromosomes 5q and 16q commonly occur in sub-sets of breast cancer. Their significance from a pathophysiologic point of view is not well-defined. METHODS: This study uses publicly available genomic data from extensive breast cancer datasets to define the landscape of losses in chromosomal arms 5q and 16q in the two sub-types of breast cancer they most commonly occur, basal-like and luminal A cancers, respectively. RESULTS: It is shown that dozens of genes from these chromosomal arms are putatively hemi-deleted in few samples each. No individual gene from either 5q or …16q shows an incidence of deep deletion above 10% in the cohorts with basal-like and luminal A cancers or in the whole cohorts. A few tumor suppressor genes are deleted in a small number of samples, less than 5% in each cohort. Losses of 5q or 16q confer no survival advantage in either the basal-like or the luminal A cohorts from TCGA that harbor them. CONCLUSION: Results suggest that there are no individual genes in chromosomes 5q and 16q whose loss can be implicated in a dominant pathophysiologic sequence of events in breast cancer or its sub-sets. Show more

Keywords: Breast cancer, luminal A, basal-like, chromosome arm loss, aneuploidy, TCGA, METABRIC

DOI: 10.3233/BD-210047

Citation: Breast Disease, vol. 41, no. 1, pp. 331-341, 2022

Authors: Sogunro, Olutayo | Sayyed, Adaah A. | Aminpour, Nathan | Towfighi, Parhom | Maini, Mansi | Masanam, Monika | Deldar, Romina | Murray, Allison | De La Cruz, Lucy | Greenwalt, Ian | Son, Jennifer D.

Article Type: Research Article

Abstract: BACKGROUND: Only 42% of all breast cancer patients undergoing mastectomy elect for breast reconstruction. OBJECTIVE: We evaluate factors impacting complications, recurrence, and mortality in triple-negative breast cancer (TNBC) patients undergoing reconstruction. METHODS: Reconstructive TNBC patients at a single institution from 2010 to 2020 were retrospectively reviewed. Patient demographics, cancer characteristics, reconstruction choice, and complications were collected. Statistical significance was defined at p < 0.05. RESULTS: A total of 131 patients were identified. Average age was 47.8 years, 50.4% were Caucasian and 36.4% were African American. Most patients had invasive ductal carcinoma (90.8%), and …most underwent nipple-sparing (41.2%) or skin-sparing (38.9%) mastectomies. Twenty-one patients (16.0%) experienced postoperative complications. Patients with complications tended to be older (52.1 versus 46.9 years, p = 0.052). At mean follow-up of 52.1 months, 14.5% experienced cancer recurrence and 5.3% died. Deceased patients were significantly younger at diagnosis (42.2 versus 48.5 years, p = 0.008) and had a lower BMI compared to surviving patients (21.2 versus 26.9 kg/m2 ; p = 0.014). Patients younger than age 45 years had higher Ki-67 than those older than 45 years (80.0% versus 60.0%, p = 0.013). Outcomes in autologous- versus implant-based reconstruction were not significantly different. CONCLUSIONS: In TNBC post-mastectomy reconstruction patients, age and BMI were predictors of mortality while race, smoking history, reconstruction choice, or type of implant-based reconstruction had no significant effect on these outcomes. SYNOPSIS: The purpose of this study is to evaluate factors that impact complications, recurrence, and mortality in triple negative breast cancer (TNBC) patients undergoing reconstruction. We identified BMI, neoadjuvant chemotherapy, and age as predictors of complications, recurrence, and mortality in TNBC. Show more

Keywords: Triple negative breast cancer, post-mastectomy reconstruction, recurrence, complications, mortality, autologous-based reconstruction, implant-based reconstruction

DOI: 10.3233/BD-220005

Citation: Breast Disease, vol. 41, no. 1, pp. 343-350, 2022

Authors: Aguiar, David | Ros, Laura | Pérez, Daniel | Croissier, Laura | Mori, Marta | Hernández, María | Vargas, Ana Milena | Galván, Saray | Antonilli, Carla | Saura, Salvador

Article Type: Research Article

Abstract: BACKGROUND: High body mass index (BMI) is regarded as a poor prognostic factor in breast cancer (BC). However, its association with pathological complete response (pCR) and survival after neoadjuvant chemotherapy (NAC) remains controversial. OBJECTIVE: We wanted to assess the prognostic impact of BMI in this setting. METHODS: Single-center, retrospective review of 314 BC patients undergoing NAC from 2010 to 2018. Patients were categorized as underweight/normal weight (UW/NW) (BMI < 25) or overweight/obese (OW/OB) (BMI ≥ 25). The relationship between BMI and other traditional clinical-pathological prognostic variables with the pCR rate was investigated using logistic …regression analysis. The effect on event-free survival (EFS) and overall survival (OS) was estimated by the Cox proportional hazards regression analysis. RESULTS: One hundred and twenty-two patients were UW/NW while 192 were OW/OB. Multivariate analysis revealed that hormonal receptors negative, HER2 positive, and clinical tumor stage (cT) 1–2 were independent predictor factors for pCR. Multivariate analysis confirmed tumor grade G3 and lack of pCR as independent adverse prognostic factors for EFS, while factors associated with worse OS were cT3-4, hormone receptors negative, and lack of pCR. Non-significant differences in pCR, EFS, or OS were observed between the two baseline BMI categories. CONCLUSIONS: In our experience, BMI is not associated with pCR, EFS, or OS in BC patients receiving NAC. Achieving pCR is the most consistent factor associated with EFS and OS. Prospective and well-designed studies taking into account other important biological and anthropometric factors are needed to determine the exact role of BMI in this setting. Show more

Keywords: Body mass index, breast cancer, neoadjuvant chemotherapy, obesity, pathological complete response, prognosis, survival

DOI: 10.3233/BD-210071

Citation: Breast Disease, vol. 41, no. 1, pp. 351-361, 2022

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

Article Type: Correction

DOI: 10.3233/BD-229001

Citation: Breast Disease, vol. 41, no. 1, pp. 363-363, 2022

Authors: Barco, Israel | Chabrera, Carol | García-Fernández, Antonio | Fraile, Manel | Giménez, Nuria | Vallejo, Elena | Zarco, Patricia | González, Sonia | González, Clarisa | Larrañaga, Itziar | Garcia-Font, Marc

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Distant metastatic spread in breast cancer patients is a complex phenomenon involving several prognostic factors. We focused our analysis on early metastatic breast cancer (EMBC) (occurring during the first 36 months) versus late metastatic breast cancer (LMBC) (occurring beyond 3 years) in order to ascertain their possible differential predictive factors. METHODS: diagnostic, surgical, and follow-up data were assessed for consecutive patients with breast cancer undergoing surgery between 1997 and 2019. We analysed the predictive factors for distant metastasis using both univariate and multivariate analysis. RESULTS: The median follow-up for this cohort of 2708 …patients was 89 months. The median metastasis-free interval (FMI) for metastasis patients was 38 months (17 months for EMBC group and 76 months for LMBC group). Distant metastases developed in 12.9% (350/2708); 48% (168/350) of them as EMBC and 52% (182/350) as LMBC. Loco-regional recurrence and nodal extracapsular extension were the only common predictors for both. CONCLUSIONS: EMBC and LMBC appeared as two separate conditions, with a different outcome. In the EMBC group, tumour proliferation related factors were significant (histological grade, tumour size, body mass index), whereas for LMBC, other slow-acting factors seemed to be involved (screening program, tumour burden, bilateral tumour). Show more

Keywords: Breast neoplasms, neoplasm metastasis, early detection of cancer, survival, mortality

DOI: 10.3233/BD-210086

Citation: Breast Disease, vol. 41, no. 1, pp. 365-372, 2022

Authors: Balouchi-Anaraki, Sima | Mohammadsadeghi, Sara | Norouzian, Marzieh | Rasolmali, Reza | Talei, Abdol-Rasoul | Mehdipour, Fereshteh | Ghaderi, Abbas

Article Type: Research Article

Abstract: BACKGROUND: Interleukin-21 (IL-21) is produced by various cell types inducing positive and negative effects in immunity against tumors. OBJECTIVE: To investigate the expression of IL-21 by CD4+ T and IL-21 receptor (IL-21R) by B lymphocytes isolated from breast-tumor draining lymph nodes (TDLNs). METHODS: Fresh lymph node samples were obtained from 45 patients with breast cancer. To assess IL-21 expression, mononuclear cells were briefly stimulated whereas IL-21R expression was assessed in unstimulated B cells. Cells were stained with antibodies for CD4, IL-21, CD19 and IL-21R and acquired by flow cytometry. RESULTS: The frequency of IL-21+ …CD4+ T cells did not show significant association with disease parameters. However, the geometric mean fluorescence intensity (gMFI) of IL-21 in CD4+ T cells was significantly lower in patients with grade III tumor than grade I + II (P  = 0.042). In non-involved LNs, the intensity of IL-21 was significantly higher in patients with stage II compared with stage III (P  = 0.038) and correlated negatively with the number of involved LNs. The frequency of IL-21R+ CD19+ B cells was significantly higher in grade III than grade I + II (P  = 0.037). CONCLUSION: The higher intensity of IL-21 in CD4+ T cells showed association with good prognosticators in breast cancer and warrants further investigation of the role played by IL-21 in immunity against breast cancer. Show more

Keywords: IL-21, IL-21R, tumor draining lymph node, breast cancer

DOI: 10.3233/BD-220013

Citation: Breast Disease, vol. 41, no. 1, pp. 373-382, 2022

Authors: Salmanpour, Ali | Rezaeifard, Somayeh | Kiani, Razie | Tahmasebi, Sedigheh | Faghih, Zahra | Erfani, Nasrollah

Article Type: Research Article

Abstract: BACKGROUND: A recently introduced CD4+ T subset that mainly secretes interleukin (IL-) 22 has been reported to be associated with a variety of tumors, including colon, gastric, hepatocellular, and small- and large-cell lung carcinoma. Both tumor-promoting and - suppressing roles have been suggested for these cells. In the present study, we aimed to investigate the frequency of IL-22-producing subsets in tumor-draining lymph nodes (TDLNs) of the patients with breast cancer and determine their association with the clinicopathological characterizations of the disease. METHODS: Thirty untreated women diagnosed with breast cancer were enrolled and their axillary lymph nodes were …dissected during surgery. Mononuclear cells were isolated using Ficoll density gradient, activated, permeabilized, and stained by fluorochrome-conjugated antibodies against CD4, IL-22, IL-17, and IFNγ. The cells were then acquired on the FACSCalibur flow cytometer, and raw data was analyzed by the FlowJo software package (V10). RESULTS: Our results demonstrated that 2.39% ± 0.39 of CD4+ lymphocytes in TDLNs of patients with breast cancer produced IL-22. Among them, 0.64% ± 0.8 just produced IL-22 but were negative for IFNγ and IL-17. Statistical analysis indicated that the frequency of CD4+IL-22+ cells was significantly higher in the patients with stage III and the ones with 3–9 tumor involved lymph nodes (N2) compared to those with stage II and those having 1–3 tumor involved lymph nodes (N1) (P = 0.008 and P = 0.004, respectively). CONCLUSION: The higher frequency of IL-22-producing cells in draining lymph nodes of patients with more advanced tumors (higher stage (stage III) and more involved lymph nodes) suggests a role for IL-22-producing cells in the tumor progression and invasion. However, further studies with larger sample size and more functional studies are needed to clarify the role of IL-22-producing cells in breast cancer pathogenesis. Show more

Keywords: Breast cancer, lymph nodes, T helper 22, IL-22-producing cells

DOI: 10.3233/BD-210084

Citation: Breast Disease, vol. 41, no. 1, pp. 383-390, 2022

Authors: Jha, Chandan Kumar | Verma, Harshit | Sinha, Upasna | Singh, Prashant Kumar

Article Type: Case Report

Abstract: Increased utilization of chemotherapy in breast cancer patients has led to improved survival outcomes but it has also resulted in rising incidence of adverse effects. Occurrence of new/unreported side effect poses challenge in front of clinicians. We report the case of a 53-year lady with locally advanced, hormone receptor-positive, and human epidermal growth factor-2 (HER-2) negative right breast carcinoma. She was started on neoadjuvant chemotherapy (NACT) (doxorubicin and cyclophosphamide), to facilitate breast-conserving surgery. She developed an inflammatory reaction involving the affected breast after each of three cycles of NACT (2 cycles of doxorubicin & cyclophosphamide, and 1 cycle of docetaxel). …Infectious causes and disease progression were ruled out. She was then prescribed hormone therapy but the disease progressed after three months of therapy and the patient had to be subjected to modified radical mastectomy (MRM). She then received adjuvant radiotherapy and is currently doing well on second-line hormone therapy. Show more

Keywords: Inflammatory response, breast carcinoma, neoadjuvant chemotherapy for breast carcinoma, inflammatory response to anthracyclines, inflammatory response to docetaxel

DOI: 10.3233/BD-220007

Citation: Breast Disease, vol. 41, no. 1, pp. 391-395, 2022

Authors: Yepes, Monica M. | Feliciano, Yara | Net, Jose | Betancur, Veronica | Gomez-Fernandez, Carmen | Collado-Mesa, Fernando

Article Type: Case Report

Abstract: The presence of mammographically evident hyperdense foci within axillary lymph nodes elicits concern for calcium deposits, which in turn have a wide differential diagnosis including both benign and malignant entities. Tissue sampling, most commonly by way of image-guided core needle biopsy, is needed in many cases when a definite etiology cannot be clinically established. In this case series we present history, imaging findings, and pathology results (or long term follow-up stability as biopsy surrogate) of several women with body tattoos who at mammography were noted to have a characteristic pattern of “bubbly” pseudo-calcifications within axillary lymph nodes, and absence of …other mammographic, sonographic and clinical abnormalities. Show more

Keywords: Lymph node, tattoo pigment, pseudo-calcifications, hyper-densities, mammography, ultrasound

DOI: 10.3233/BD-220011

Citation: Breast Disease, vol. 41, no. 1, pp. 397-406, 2022

Authors: de Oliveira-Junior, Idam | Barbin, Flávia Fazzio | Watanabe, Anapaula Hidemi Uema | dos Reis, Ricardo | da Costa Vieira, René Aloisio

Article Type: Case Report

Abstract: INTRODUCTION: Metastatic disease to the breast is a rare condition, with contralateral breast metastasis being the most common primary site. CASE PRESENTATION: We present the case of a patient who underwent treatment for an HPV positive squamous cell carcinoma (SCC) of the cervix who, during follow-up, complained of a nodule in her left breast. Anatomopathological results indicating squamous carcinoma, which was not able to be differentiated from breast metaplastic carcinoma. Resection of the lesion was carried out, confirming carcinoma with squamous cell differentiation with negativity for GCDFP-15, mammaglobin, p63 and SOX10, but with positivity for p16 and for …high risk HPV, confirming a single metastatic lesion of cervical carcinoma. DISCUSSION/CONCLUSION: In the presence of SCC in the breast, the differential diagnosis may consider the presence of primary lesion, metaplastic carcinoma with squamous cell differentiation or metastatic disease. The use of markers such as p63, SOX10 and p16, may help for a definitive diagnosis. Show more

Keywords: Cervical cancer, breast metastasis, metastasis, HPV

DOI: 10.3233/BD-220027

Citation: Breast Disease, vol. 41, no. 1, pp. 407-411, 2022

Authors: Ramadan, Rabie | Koryem, Islam M. | Fayed, Haytham

Article Type: Research Article

Abstract: BACKGROUND: IGM has a diagnostic and treatment dilemma. The etiology of IGM is unknown but some conditions have been discussed as predisposing factors including Oral Contraceptive Pills, pregnancy, breast feeding, reproductive age, hyperprolactinemia, infectious and autoimmune diseases. The current study aimed to determine possible risk factors for IGM and to evaluate our experience in its management. PATIENTS AND METHODS: The study included forty patients with IGM and forty females with normal breasts as a control group. CST treatment was initiated for all patients; patients who responded completely were followed up without surgical intervention. Failure to respond to medical …therapy or incidence of corticosteroid-related complications were considered indications for surgical treatment. All patients were followed up for 6 months to detect recurrence. RESULTS: IGM had a significant higher incidence rate in young females within 5 years from the last lactation, smokers, those with hypperprolactinaemia, who had a history of breast feeding and those who received OCP (P = <0.001, <0.001, 0.006, 0.001, 0.023 and 0.027 respectively). The central part of the breast was more affected (9 cases (22.5%)). Multicenteric disease affected 8 cases (20%). Breast Mass was the most common presenting sign. After CST; the mass disappeared in 5 cases (12.5%), mass size reduced in 26 cases (65%) and mass size not affected in 9 cases (22.5%). Surgery was done in whom the mass size was reduced or not affected (35 cases (87.5%)). Disease recurrence was reported in 2 cases (5.7%). CONCLUSION: IGM usually affects females in their childbearing period with multiple risk factors mainly parity, smoking, OCP and breast feeding with wide variation regarding the presenting manifestations. We should start with CST as there is always a chance to avoid unnecessary surgery and combination of both modalities can reduce the incidence of recurrence. Show more

Keywords: Idiopathic granulomatous mastitis, corticosteroid therapy, Recurrent mastitis

DOI: 10.3233/BD-220047

Citation: Breast Disease, vol. 41, no. 1, pp. 413-420, 2022

Authors: Elnahas, Waleed | Metwally, Islam H. | Bonna, Khaled | Youssef, Marco | AbdAllah, Samar | Bonna, Mohamed | Ali Faried, Mohamed | Atef Tira, Mohamed | Hamdy, Omar

Article Type: Research Article

Abstract: BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS: This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS: …The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕− 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients’ age, marital status, and imaging criteria as measured by BIRADS score were significant (<0.001). CONCLUSION: Approaching patients with the age above 35 or with BIRADS 4 provisionally diagnosed with fibroadenomas should be cautious with biopsy and short-term follow-ups The size of the tumor alone should not be used as an indication for surgical intervention. Show more

Keywords: Breast lump, fibroepithelial tumor, breast cancer, phyllodes tumor

DOI: 10.3233/BD-210074

Citation: Breast Disease, vol. 41, no. 1, pp. 421-426, 2022

Authors: Kurniawan, Benny Nanda | Ferianto, Djonny | Pieter Jr, John

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer in Indonesia has continued to increase. One diagnostic modality is immunohistochemical examination to determine breast cancer subtypes. OBJECTIVE: To determine breast cancer metastasis and mortality rates based on molecular subtypes. METHODS: A descriptive study was conducted based on retrospective data from hospital medical records from January 2016 to December 2019. The data comprised age, clinical stage, histopathological grade, molecular subtype, location, metastasis, and breast cancer mortality. The data were processed and analyzed. RESULTS: This study involved 172 patients. The most prevalent breast cancer subtypes were luminal A (60, 34.8%), followed by …HER2 (47, 27.4%), triple-negative (38, 22.4%), and luminal B (27, 15.4%). The metastasis rate was 37.21% (64/172), with bone the tissue most affected (32 cases, 50%), followed by lung (24 cases, 37.5%) and liver (8 cases, 12.5%). The highest rates of bone, lung, and liver metastases were subtypes luminal A (31%), HER2 (29%), and triple-negative (38%), respectively. The mortality rate was 21% (36/172), with most in the triple-negative group (28.9%), followed by luminal B (25.9%), HER2 (21.2%), and luminal A (13.3%). CONCLUSIONS: Determination of breast cancer molecular subtypes through immunohistochemistry can determine the level of metastasis and mortality in breast cancer. Show more

Keywords: Breast cancer, metastasis, molecular subtype, mortality

DOI: 10.3233/BD-229000

Citation: Breast Disease, vol. 41, no. 1, pp. 427-432, 2022

Authors: Saputra, Teddy Agung | Indra, Indra | Syamsu, Salman Ardi | Sampepajung, Elridho | Nelwan, Berti Julian | Hamid, Firdaus | Faruk, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: Molecular marker analysis has become important in breast cancer diagnosis and treatment and may reveal new mechanisms in breast cancer pathogenesis. Aside from the commonly used hormonal receptors and HER2, VEGF-A has been increasingly shown to be important in breast cancer diagnosis and pathogenesis. OBJECTIVE: This study aimed to determine the relationship between VEGF-A expression on ER and PR and HER2 hormonal status in patients with late-stage breast cancer (locally advanced or with distant metastases). METHODS: This observational, cross-sectional study examined VEGF-A expression and molecule markers (ER, PR, and HER2) of breast cancer tissue using …immunohistochemistry. The Chi-square test was used to determine whether two categorical variables were correlated. Statistical significance was set at p < 0.05. RESULTS: VEGF-A showed no significant correlation with demographic characteristics, TNM staging, pathological grading, luminal or non-luminal type, or hormonal receptor markers but showed a significant positive correlation with HER2 receptors (p = 0.036). CONCLUSIONS: VEGF-A was positively correlated with HER2 expression in breast tumor tissue but showed no significant correlation with other breast cancer markers, including luminal typing or hormonal receptors. Further study is needed to understand the mechanistic interplay between VEGF and HER2 in breast cancer pathogenesis. Show more

Keywords: Breast cancer, locally advanced breast cancer, metastatic breast cancer

DOI: 10.3233/BD-229006

Citation: Breast Disease, vol. 41, no. 1, pp. 433-438, 2022

Authors: Marhaeni, Marhaeni | Rahmawati, Ros | Sonda, Maria | Noor, Hasnah M. | Prihantono, Prihantono

Article Type: Research Article

Abstract: INTRODUCTION: Breastfeeding is the first step to forming children who are not only healthier but smarter, with a better emotional quotient (EQ) and spiritual quotient (SQ). Babies need physical closeness and warmth from their mother as much as optimal nourishment. Poor knowledge and attitudes towards exclusive breastfeeding can result from information that is not intensive and maximal, due to limited breastfeeding counseling staff. Other reasons include cultural factors, especially in coastal areas, such as the belief in prelacteal feeding before the first breastfeeding; the baby has then automatically not exclusively breastfed. METHODS: This study used an intervention with …a one-group pretest–posttest design. It aimed to analyze the role of breastfeeding counseling in increasing mothers’ knowledge and attitudes regarding exclusive breastfeeding. The participants were pregnant women from the end of the second trimester to the third trimester, selected using stratified systematic random sampling. RESULTS: Counseling had a significant effect on mothers’ knowledge (p = 0.004) and attitude (p = 0.000) in changing the behavior of coastal communities towards giving exclusive breastfeeding (p = 0.03). Intensified counseling is recommended for pregnant women in the third trimester to realize exclusive breastfeeding. CONCLUSIONS: A positive and significant effect of breastfeeding counseling was found on the level of knowledge, attitudes, and changes in the behavior of coastal communities in exclusive breastfeeding. Show more

Keywords: Counseling, behavior, exclusive breastfeeding

DOI: 10.3233/BD-229002

Citation: Breast Disease, vol. 41, no. 1, pp. 439-445, 2022

Authors: Mamonto, Lidya | Nelwan, Berti J. | Sungowati, Ni Ketut | Miskad, Upik A. | Cangara, Muh. Husni | Zainuddin, Andi Alfian

Article Type: Research Article

Abstract: BACKGROUND: The histological tumor grade influences the prognosis of breast cancer. In metastatic breast cancer, stromal cells produce chemokine (CXC motif) ligand 12 or stromal cell-derived factor-1 as a chemoattractant, which binds to chemokine (CXC motif) receptor 4 (CXCR4) expressed by breast cancer cells. OBJECTIVE: This study aimed to determine the expression of CXCR4 in invasive breast cancer in relation to lymphovascular invasion (LVI) and lymph node metastasis. METHODS: This observational study retrospectively investigated a paraffin block archived sample diagnosed with invasive breast cancer. The results of immunohistochemical staining with CXCR4 antibody and expression analysis were …evaluated using light microscopy. The data were statistically analyzed using the chi-square test and presented in a table using SPSS version 18. P -values of <0.05 were considered statistically significant. RESULTS: The expression of CXCR4 was significantly associated with the incidence of LVI and lymph node metastasis in invasive breast cancer (both p  = 0.001). CONCLUSIONS: The results show that the expression of CXCR4 varies and support its decisive role in the incidence of LVI and lymph node metastasis in invasive breast cancer. Show more

Keywords: CXCR4, invasive breast cancer, metastasis, lymphovascular invasion

DOI: 10.3233/BD-229003

Citation: Breast Disease, vol. 41, no. 1, pp. 447-453, 2022

Authors: Leksono, Radityo Budi | Thabry, Rudy | Prihantono, Prihantono | Nahusuly, Fritz | Kasim, Firdaus | Hamdani, William | Pieter, John | Indra, Indra | Syamsu, Salman Ardi | Faruk, Muhammad

Article Type: Research Article

Abstract: INTRODUCTION: Identifying Ki67, a monoclonal antibody that recognizes proliferating cells, is important for defining the level of proliferative activity among patients with breast cancer. The purpose of our study was to evaluate the correlation between Ki67’s expression and histopathological grade, tumor size, disease-free survival (DFS), and overall survival (OS) among breast cancer patients. METHODS: Our retrospective cohort study involved examining 114 patients with breast cancer at our institution from January 2018 to December 2019. Participants were retrospectively followed to determine the progression of their disease, and their 2-year progress was examined with survival analysis, especially regarding whether they …had postoperative relapse (i.e., DFS) or had died since being diagnosed (i.e., OS). The data were processed with a chi-square test and Kaplan–Meier test, with significance set at p < 0.05. RESULT: The overexpression of Ki67 correlated significantly with histopathological grade (p = 0.001), tumor size (p = 0.001), DFS (p = 0.001), and OS (p = 0.003). CONCLUSION: Ki67’s overexpression is significantly correlated with the tumor size, DFS, and OS of patients with breast cancer. Show more

Keywords: Ki67, histopathological grade, tumor size, disease-free survival, overall survival

DOI: 10.3233/BD-229005

Citation: Breast Disease, vol. 41, no. 1, pp. 455-460, 2022

Authors: Kridis, Wala Ben | Feki, Ameni | Khmiri, Souhir | Toumi, Nabil | Chaabene, Kais | Daoud, Jamel | Ayedi, Ines | Khanfir, Afef

Article Type: Research Article

Abstract: BACKGROUND: Previous studies have shown that poor prognostic indicators of inflammatory breast cancer (IBC) include younger age at diagnosis, poorer tumor grade, negative estrogen receptor, lesser degree of pathological response in the breast and lymph nodes. METHODS: This is a retrospective study conducted over a period of 12 years between January 2008 and December 2019 at the medical oncology department at Habib Bourguiba University Hospital in Sfax. We included in this study women with confirmed IBC. We excluded patients with no histological evidence, those whose medical records were unusable. Data collection was done from patient files. The aim …of this study was to analyze the factors of poor prognosis of this entity. RESULTS: During a period of 12 years (2008–2019), 2879 cases of breast cancer were treated at Habib Bourguiba hospital in Sfax. 81 IBC were included. The incidence of IBC was 3%. The average age was 52.4 years (26–87 years). Invasive ductal carcinoma was the most frequent histological type (85.7%). Hormone receptor were positive in 64%. Human Epidermal Growth Factor Receptor-2 (HER2) was overexpressed in 35.9% of cases. The proliferation index Ki-67 was analyzed in 34 cases. It was >20% in 24 cases. Luminal A, luminal B, HER2+++ , triple negative were found in 13%, 50.7%, 16% and 20% respectively. Metastases at diagnosis were found in 38%. Poor prognostic factors significantly influencing overall survival in univariate analysis were metastatic stage, high SBR grade, lymph node involvement, in particular greater than 3 nodes, negative hormone receptors, triple-negative molecular profile and occurrence of relapse. CONCLUSION: Number of positive lymph nodes greater than 3 and the occurrence of relapse were independent prognostic factors in case of localized IBC. Metastatic stage was associated with a very poor prognosis. Show more

Keywords: Inflammatory breast cancer, overall survival, prognosis

DOI: 10.3233/BD-220034

Citation: Breast Disease, vol. 41, no. 1, pp. 461-469, 2022

Authors: Kshersagar, Jeevitaa | Damle, Mrunal N. | Bedge, Poonam | Jagdale, Rakhi | Tardalkar, Kishor | Jadhav, Dhanaji | Jagadale, Swapnali | Toro, Yashwant | Sharma, Rakesh | Joshi, Meghnad G.

Article Type: Research Article

Abstract: OBJECTIVE: In this study, the profiling of the expression of major histocompatibility complex (MHC) class I-related chain A and B (MICA/B) in human breast cancer tumor tissue, saliva, and urine samples of breast cancer patients and control is carried out. MICA/B is ligand of NKG2D receptor expressed on malignant cells. The release of MICA/B from tumor tissue comprises an immune escape mechanism that impairs antitumor immunity. Based on this literature we explored the potential of soluble MICA (sMICA) as a marker in breast cancer (BC). METHODS: The expression was profiled by using immunohistochemistry (MICA/B), western blot (MICA/B) and …ELISA (MICA). RESULTS: The optical density of western blot of MICA/B in different stages of BC illustrated significant difference as per one way analysis of variance and significant difference with stage III and IV by Dunnett’s multiple comparisons test respectively. Analysis of sMICA in serum, saliva and urine of BC patients revealed significantly higher levels (median 41.0 ± 4.1 pg/ml in pre-treatment sera, 181.9 ± 1.6 pg/ml in saliva and 90.7 ± 1.7 pg/ml in urine) than in control (median <1.2 pg/ml). The elevated levels of sMICA were related to the cancer stage. CONCLUSIONS: The elevated levels of sMICA were observed in patients with well differentiated cancer while the poor expression of sMICA was observed in patients with poorly differentiated tumors. Tumor immunity is impaired by the release of MICA in the biofluids and may be useful for detection and diagnosis of the stage of BC. Show more

Keywords: Breast cancer, MICA/B, sMICA/B

DOI: 10.3233/BD-220023

Citation: Breast Disease, vol. 41, no. 1, pp. 471-480, 2022

Authors: Manginstar, Christian | Oley, Mendy Hatibie | Oley, Maximillian Christian | Merung, Marselus | Langi, Fima Lanra Fredrik G. | Kepel, Billy Johnson | Rusli, Lie Venny | Islam, Andi Asadul | Faruk, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer (BC) is the most common cancer among women worldwide and a leading cause of death in Indonesia. The primary treatment of locally advanced BC is neoadjuvant chemotherapy (NAC). The rapid proliferation of tumor cells in a neoplastic microenvironment is largely due to hypoxia, which also encourages the development of chemoresistant BC. The master regulator of the hypoxia response is hypoxia-inducible factor-1α (HIF-1α). The response evaluation criteria in solid tumors (RECIST) is an objective response metric that demonstrates the efficacy of a NAC based mostly on the size of the tumor. Ca15-3 is the protein product of the MUC1 …gene and is the most widely used serum marker in BC. The purpose of this study is to investigate the relationship between HIF-1α and RECIST and between Ca15-3 and RECIST and to assess the relationship among all of them in BC. METHODS: This observational study used the prospective cohort method included 11 patients with histopathologically confirmed BC, specifically invasive ductal carcinoma. We evaluated the changes in HIF-1α and Ca15-3 serum levels using ELISA and measured tumor lesions with RECIST. The procedure was carried out twice. Serum levels were measured at baseline, and after receiving two cycles of NAC (5 weeks). RESULTS: Among the 11 patients included in this study, HIF-1α, Ca15-3, and RECIST decreased significantly after NAC. The changes in RECIST correlated with Ca15-3: each unit decrease in RECIST score was associated with a 0.3-unit decrease in Ca15-3 levels (p = 0.019). CONCLUSIONS: There was a decrease in HIF-1α, followed by a decrease in Ca15-3 and RECIST in response to chemotherapy. There was a statistically significant correlation between Ca15-3 and response to chemotherapy. This study evidences the relationship between factors that shape the local tumor microenvironment. Show more

Keywords: Breast cancer, neoadjuvant chemotherapy, ductal carcinoma, Ca15-3, RECIST, HIF1α

DOI: 10.3233/BD-229004

Citation: Breast Disease, vol. 41, no. 1, pp. 481-487, 2022

Authors: Fahdrin, Andi | Sampepajung, Elridho | Pieter, John | Kasim, Firdaus | Smaradhania, Nilam | Prihantono, Prihantono | Mariana, Nita | Sampepajung, Daniel | Faruk, Muhammad

Article Type: Research Article

Abstract: INTRODUCTION: The relationship between increased platelet count and cancer classification stage has long been established. The prevalence of thrombocytosis varies from 10% to 57% in cancer patients. The pathogenesis of thrombocytosis in malignancy is uncertain. However, there is evidence that tumor cells secrete humoral factors that can cause thrombocytosis. Preoperative thrombocytosis is a poor prognostic variable in malignancies. This study investigated the correlation between platelet count and breast cancer stage. METHODS: This cross-sectional study was conducted from February 2020 to January 2021. Patient data were collected from medical records. The study population comprised breast cancer patients at Dr. …Wahidin Sudirohusodo Makassar. The staging examinations were based on the tumor, node, metastasis (TNM) classification according to the American Joint Committee on Cancer (AJCC) 8th Edition. RESULTS: The study group comprised 171 breast cancer patients of varying ages. Metastasis was present in five (2.92%) patients and absent in 166 (97.8%) patients. Analyses found no statistically significant differences between the three staging groups based on the platelet count (p = 0.952). CONCLUSION: There was no statistically significant relationship between increased platelet count and staging according to the TNM classification in breast cancer patients. Show more

Keywords: American Joint Committee on Cancer, breast cancer, platelet counts, staging

DOI: 10.3233/BD-229007

Citation: Breast Disease, vol. 41, no. 1, pp. 489-493, 2022

Authors: Elbalka, Saleh S. | Metwally, Islam H. | Hassan, Amany | Eladl, Ahmed E. | Shoman, Ahmed M. | Jawad, Mohamed | Shahda, Eman | Abdelkhalek, Mohamed

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer is a common women's disease. Usually, oestrogen is blamed in the aetiology and correlated with the prognosis; however, androgens are recently raising concern about its role in the breast cancer treatment and prognosis. METHODS: In this study we retrieved archival paraffin blocks of breast cancer patients and stained it for androgen. Thereafter, we compared clinico-epidemiologic parameters, histopathology, neoadjuvant response and recurrence rate and pattern among patients with and without androgen receptor (AR) expression. RESULTS: In total, 119 patients fulfilled enrolment criteria; AR expression were present in 77.3% of the patients. AR expression was …associated with less grade III (6.8% versus 36.4%), and less triple negative (6.2% versus 25%), but similar overall recurrence rate (25% versus 22.2%). However, distant recurrence was significantly higher in androgen positive patients (91.3% versus 33.3% of all recurrences). CONCLUSION: Androgen expression appears to be common among breast cancer, but with no clear implication in tumour aggressiveness or effect on the rate of recurrence. However, being commonly associated with distant spread may have an impact on survival of the patients. Show more

Keywords: Hormonal receptors, androgen expression, molecular types, breast cancer recurrence

DOI: 10.3233/BD-220037

Citation: Breast Disease, vol. 41, no. 1, pp. 495-502, 2022

Authors: Muecke, Ralph | Dubois, Clara | Micke, Oliver | Keinki, Christian | Huebner, Jutta

Article Type: Research Article

Abstract: BACKGROUND: In breast cancer patients, there is an elevated risk of developing osteoporosis during treatment which should be addressed by optimizing 25(OH) levels. OBJECTIVE: The aim was to assess the prescription, information and physician-patient communication on vitamin D and bone density in Germany. METHODS: We developed a standardized questionnaire concerning bone density measurement, vitamin D (blood level testing, prescription), information and communication regarding vitamin D. The questionnaire was distributed at the annual meeting of all group leaders of the Women’s Cancer Support Association to all participants. RESULTS: Overall, 224 participants completed the questionnaire; 77.7% …reported having had at least one bone density measurement test. The number was 84.4% in patients treated with aromatase inhibitor and 43.7% reported that their bone density was too low. In total, 51.3% patients reported at least one vitamin D blood test and 45.1% reported that vitamin D had been primarily addressed by a physician. As many as 74.1% of those reporting a test result had a deficiency; 91.6% of those with a low level got a prescription and 28.4% took vitamin D autonomously. CONCLUSIONS: The awareness on risk of osteoporosis, prevention, early diagnosis and treatment are insufficiently addressed in a patient group with high risk of osteoporosis. More attention should be paid to the phenomenon of vitamin D deficiency or insufficiency in routine care. Show more

Keywords: Vitamin D, breast cancer, endocrine therapy, patient information needs, patient-physician communication, osteoporosis

DOI: 10.3233/BD-210070

Citation: Breast Disease, vol. 41, no. 1, pp. 503-511, 2022

Authors: Mosavi, Zeinb | Bashi Zadeh Fakhar, Haniyeh | Rezaei-Tavirani, Mostafa | Akbari, Mohamd Esmaeel | Rostami, Forouzan

Article Type: Research Article

Abstract: BACKGROUND AND AIM: DCIS is the most common type of non-invasive breast cancer, accounting for about 15 to 30%. Proteome profile is used to detect biomarkers in the tissues of breast cancer patients by mass spectrometry. This study aimed to obtain the expression profile of DCIS proteome, and the expression profile of invasive biomarkers, and finally to introduce a dedicated biomarker panel to facilitate the prognosis and early detection for in situ breast cancer patients. METHODS AND MATERIALS: In this study, 10 patients with breast cancer (DCIS) were studied. Benign (marginal) and cancerous tissue samples were obtained …from patients for proteomics experiments. Initially, all tissue proteins were extracted using standard methods, and the proteins were separated using two-dimensional electrophoresis. Then, the expression amount of the extracted proteins was determined by ITRAQ. The data were analysed by R software, and gene ontology was utilised for describing the protein in detail. RESULTS: 30 spots on gel electrophoresis were found in the tumor tissue group (sample), and 15 spots in the margin group (control) with P < 0.05. Healthy and cancerous tissue gels showed that 5 spots had different expression. VWF, MMP9, ITGAM, MPO and PLG protein spots were identified using the site www.ebi.ac.uk/IPI . Finally, protein biomarkers for breast tumor tissue with margin were introduced with the names of P04406, P49915, P05323, P06733, and P02768. DISCUSSION: There are 5 critical proteins in inducing cancer pathways especially complement and coagulation cascades. The hall markers of a healthy cell to be cancerous are proliferation, invasion, angiogenesis, and changes in the immune system. Hence, regulation of protein plays a key role in developing recurrence to breast cancer in margins. Show more

Keywords: Proteome, profile, DCIS, ductal carcinoma in situ

DOI: 10.3233/BD-220017

Citation: Breast Disease, vol. 41, no. 1, pp. 513-520, 2022

Authors: Dorostgoo, Zeinab | Fattahi, Asieh Sadat | Moosavi, Saide Samare | Ghafouri-Fard, Soudeh | Oskooei, Vahid Kholghi

Article Type: Research Article

Abstract: Long non-coding RNAs (lncRNAs) influence pathetiology of breast cancer. Besides, VDR and ESR1 signaling pathways are two important pathways in this malignancy. In the present mixed bioinformatics and expression assay study, we have identified lncRNAs that are co-expressed with VDR and ESR1 in breast cancer tissues and analyzed their expression in 42 paired breast cancer and non-cancerous specimens. Expression of SLC16A-AS1 was significantly lower in breast cancer tissues compared with paired non-cancerous samples (expression ratio = 0.27, P value < 0.001). Similarly, LINC00900 was down-regulated in cancer tissues compared with non-cancerous …ones (expression ratio = 0.26, P value = 0.01). There were no significant differences in the expressions of VDR and AATBC between these two sets of samples. Expression levels of VDR and AATBC were associated with histological grade (P values = 0.02 and 0.03, respectively). Moreover, expression of VDR was associated with tumor size (P  value = 0.02). Finally, expression levels of SLC16A-AS1 were associated with first pregnancy age (P value = 0.006). In brief, the results of current study further support involvement of VDR and ESR1 -associated lncRNAs in breast cancer. Show more

Keywords: Breast cancer, lncRNA, VDR, AATBC, SLC16A-AS1, LINC00900

DOI: 10.3233/BD-210083

Citation: Breast Disease, vol. 41, no. 1, pp. 521-528, 2022

Authors: Ferre, Romuald | Ghorab, Zeina | Alikhassi, Afsaneh | Curpen, Belinda

Article Type: Case Report

Abstract: Tuberculosis (TB) remains in 2022 a significant public health issue as it remains endemic in some areas of the globe, with a high prevalence in underdeveloped countries (Pujani, Khan, Hassan, Jetley, Raina, Breast Dis. , 35(3): 195–198, 2015. doi:10.3233/BD-150405 . PMID: 26406543). Pulmonary TB is the most common form, but TB can also have extrapulmonary manifestations like tubercular lymphadenopathy. Tuberculous lymphadenitis is the most extrapulmonary tuberculosis. It used to be called scrofula in the past coming from the Latin meaning breeding sow (Kokosali, Lloyd, Dent Update , 33(5): 306–308, 311, 2006. doi:10.12968/denu.2006.33.5.306 . PMID: 16841612; Oberhelman, Watchmaker, Phillips, JAMA Dermatol , 155(5): …610, 2019. doi:10.1001/jamadermatol.2018.5651 . PMID: 30942835). It is a common cause of peripheral lymphadenitis, seen mostly in the developing countries, but also reemerging among intravenous drugs users and immunocompromised population. Cervical nodes are the most commonly detected nodes in tuberculous lymphadenitis, accounting for 63% of the cases, followed by mediastinal (27%) and axillary nodes (8%) (Ahuja, Ying, Evans, King, Metreweli, Clin Radiol , 50(6): 391–395, 1995. doi:10.1016/s0009-9260(05)83136-8 . PMID: 7789023). Tuberculous lymphadenitis affects predominantly the young population and children. There is also a slight female predilection. As to our knowledge, there have not been any reported cases as post-menopausal axillary tuberculous lymphadenitis, and it is the focus of this article. Show more

Keywords: Breast cancer, tubercular lymphadenitis, mammography, ultrasound, tuberculosis, axillary lymphadenopathy

DOI: 10.3233/BD-220015

Citation: Breast Disease, vol. 41, no. 1, pp. 529-534, 2022

Authors: Lee, Shu Yi Sonia | Win, Thida | Lee, Yien Sien | Teo, Sze Yiun

Article Type: Research Article

Abstract: BACKGROUND: Tissue markers are inserted into the breast after percutaneous biopsy to mark the site of the lesion to facilitate potential re-localisation. Tissue markers are increasingly developed with improved sonographic visibility due to benefits conferred by ultrasound-guided localisation. OBJECTIVES: We aim to study the sonographic visibility of the recently-introduced UltracorTM TwirlTM tissue marker and feasibility of its pre-operative localisation under ultrasound guidance. METHODS: All patients who underwent insertion of the UltracorTM TwirlTM tissue marker in our institution from July 2017 to December 2018 were reviewed. Retrospective data including …sonographic visibility, evidence of migration and rate of successful surgical excision were collected. RESULTS: All tissue markers were visible on subsequent ultrasound with 198 (85.0%) well-visualised with high degree of confidence while 35 (15.0%) were moderately well-visualised with moderate level of confidence. None of the tissue markers were poorly visualised and none demonstrated migration. No statistical difference in sonographic visibility is seen based on interval duration between deployment and subsequent ultrasound assessment or depth of tissue marker. CONCLUSION: UltracorTM TwirlTM demonstrates consistent sonographic visibility, identifiable with a high or moderate level of confidence with no associated migration. Its use in pre-operative localisation with ultrasound guidance is therefore both reliable and feasible. Show more

Keywords: Breast ultrasound, preoperative localization, breast cancer, tissue marker

DOI: 10.3233/BD-210078

Citation: Breast Disease, vol. 41, no. 1, pp. 535-543, 2022

Authors: González Mariño, Mario Arturo

Article Type: Systematic Review

Abstract: OBJECTIVE: To review the concordance between pathologists in the diagnosis of atypical ductal hyperplasia of the breast. METHODS: Systematic review of articles registered in the PubMed database with the terms “pathologists” and “atypical ductal hyperplasia”, “atypical ductal hyperplasia” and “interobserver variability”, in Embase with “interobserver agreement in atypical ductal hyperplasia” and Lilacs with the terms in Spanish “patólogos” and “hiperplasia ductal atípica”, without the use of filters, between 03/16/2022 and 03/26/2022 searching for articles that assess inter-observer agreement in the diagnosis of atypical ductal hyperplasia by using the kappa statistic. Review articles, conference proceedings, and commentaries were excluded. …RESULTS: With the search terms, 507 publications were found. Of these, 491 were excluded from the screening by title and abstract. Of the full reading of the remaining articles, 6 were selected for qualitative analysis. The kappa values ranged from slight agreement, kappa = 0.17, to substantial agreement, 0.69 obtained from pathologists dedicated or experienced in breast pathology and who received a prior tutorial session to review the general criteria for atypia. CONCLUSIONS: This study reviews the reproducibility in the diagnosis of atypical ductal hyperplasia. A better concordance was obtained with a previous teaching process offered to pathologists dedicated or experienced in breast pathology. Show more

Keywords: Breast, breast diseases, risk factors, breast neoplasms, pathology, diagnosis

DOI: 10.3233/BD-220029

Citation: Breast Disease, vol. 41, no. 1, pp. 545-550, 2022