Breast Disease - Volume 35, issue 4

Authors: Chow, Ian | Hanwright, Philip J. | Hansen, Nora M. | Leilabadi, Solmaz N. | Kim, John Y.S.

Article Type: Research Article

Abstract: BACKGROUND: Recent healthcare legislation has made unplanned hospital readmission an important metric of health care quality, and current efforts center on reducing this complication in order to avoid fiduciary penalties. OBJECTIVE: There is currently a paucity of data delineating risk factors for readmission following mastectomy. To this end, we sought to develop a predictive model of unplanned readmissions following mastectomy. METHODS: The 2011 and 2012 National Surgical Quality Improvement Program (NSQIP) datasets were retrospectively queried to identify patients who underwent mastectomy. Multivariate logistic regression modeling was used to identify risk factors for readmission. …RESULTS: Of 21,271 patients meeting inclusion criteria, 1,190 (5.59%) were readmitted. The most commonly cited reasons for readmission included surgical site complications (32.85%), infection not localized to the surgical site (2.72%), and venous thromboembolism (4.39%). Independent predictors of readmission included BMI, active smoking status, and skin-sparing mastectomy. Significantly, concurrent breast reconstruction and bilateral mastectomy were not independent predictors of readmission. CONCLUSIONS: This is the first study of readmission rates after mastectomy. Awareness of specific risk factors for readmission, particularly those that are modifiable, may serve to identify and manage high risk patients, aid in the development of pre- and postoperative clinical care guidelines, and ultimately improve patient care. Show more

Keywords: 30-day, mastectomy, outcomes, readmission, risk factors

DOI: 10.3233/BD-150412

Citation: Breast Disease, vol. 35, no. 4, pp. 221-231, 2015

Authors: Charfi, Slim | Toumi, Nabil | Triki, Sana | Kallel, Rim | Kebaïli, Sahbi | Chaabane, Kais | Khabir, Abdelmajid | Daoud, Jamel | Frikha, Mounir | Boudawara, Tahya Sellami

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer is the most frequent malignant neoplasm affecting Tunisian women. It represents 25 to 35% of all female cancers. There is no published study about the features of Her-2 overexpressing breast carcinomas in North African women. OBJECTIVE: The aim of this study is to assess the prognostic significance of pathological features in a cohort of a Her-2 overexpressing breast carcinoma originating from the region of south Tunisia. METHODS: This study investigated a series of 100 patients followed from January 2006 to December 2011 for a Her-2 positive invasive breast carcinoma. Pathological features …included in this study were: histological type, histological grade, tumor size, vascular invasion, perineural invasion, mitotic index, lymph nodes stage, positive lymph node capsular effraction, inflammatory infiltrates, nipple involvement and hormone receptors status. RESULTS: Multivariate analysis showed that pT stage, pN stage, capsular effraction, vascular invasion, perineural invasion and Nipple involvement were independent prognostic factors for overall survival and disease free survival in patients free from distant metastasis at diagnosis. For patients with synchronous metastasis, there is no independent pathologic prognostic factor for survival. CONCLUSIONS: Our study demonstrates that pathological features are important prognostic factors for non metastatic Her-2 overexpressing breast carcinomas. This supports the idea that HER2-positive disease is a heterogeneous entity. We believe that these findings reinforce the need to identify molecular predictors of benefit and resistance to anti-Her-2 based therapies. Show more

Keywords: Breast cancer, HER-2, pathology, prognosis, survival

DOI: 10.3233/BD-150414

Citation: Breast Disease, vol. 35, no. 4, pp. 233-239, 2015

Authors: Ghandadi, Morteza | Haj-Ali, Negin | Behravan, Javad | Abnous, Khalil | Mohammadi, Atieh | Gharaee, Melika Ehtesham | Mosaffa, Fatemeh

Article Type: Research Article

Abstract: BACKGROUND: TNF-α is a pleiotropic cytokine which activates different downstream signaling pathways leading cells to death or survival. In some in vitro examinations, TNF-α treatment demonstrated higher cytotoxic effects on MDR cancer cell lines compared to their parental counterparts. OBJECTIVE: This study investigated effects of TNF-α in MCF-7 and its mitoxantrone (MX) resistant variant of breast cancer cell line, MCF-7/MX. Moreover, the role of Akt phosphorylation in TNF-α effect was also investigated. METHODS: Akt phosphorylation was evaluated using Western blotting and TNF-α effect was examined using cytotoxicity assay …following treatment of the cells with TNF-α . RESULTS: TNF-α treatment exerted higher cytotoxic effects on MCF-7/MX compared to MCF-7 cells. Akt phosphorylation was enhanced following TNF-α treatment in MCF-7 cells while it did not change in MCF-7/MX cells. TNF-α treatment along with inhibition of Akt phosphorylation by a chemical inhibitor triciribine, sensitized MCF-7 cells to cytotoxic effects of TNF-α. Moreover, activation of PI3K/Akt pathway by activator peptide 740 Y-P in MCF-7/MX cells enhanced resistance against TNF-α cytotoxicity. CONCLUSION: Alteration in Akt phosphorylation is involved in the resistance of MCF-7 cells and sensitivity of MCF-7/MX cells to TNF-α -induced cytotoxicity, respectively. Show more

Keywords: Tumor necrosis factor-α , cancer, multidrug resistance, PI3K/Akt

DOI: 10.3233/BD-150415

Citation: Breast Disease, vol. 35, no. 4, pp. 241-247, 2015

Authors: Aguiar, Fernando N. | Cirqueira, Cinthya S. | Bacchi, Carlos E. | Carvalho, Filomena M.

Article Type: Research Article

Abstract: BACKGROUND: Ductal carcinoma in situ is the last step preceding invasive ductal carcinoma in breast carcinogenesis. OBJECTIVE: We investigated the role of myoepithelial cells and epithelium characteristics as predictors of the risk of stromal invasion. METHODS: We selected 236 cases with initial diagnosis of DCIS followed by surgical ressection distributed in groups 1 (without invasion) and 2 (with invasive carcinoma). RESULTS: The risk of stromal invasion after a DCIS diagnosis in biopsy was associated to triple-negative profile and loss of CD10 expression by myoepithelial cells, …and inversely associated with CK5/6 expression by neoplastic cells and high expression of Smooth Muscle Myosin Heavy Chain (SMMHC) by myoepithelial cells. CONCLUSIONS: A combination of characteristics of epithelial and myoepithelial cells in DCIS in biopsy specimens is related to the risk of stromal invasion. Show more

Keywords: Ductal carcinoma in situ, myoepithelial markers, molecular profile, stromal invasion

DOI: 10.3233/BD-150416

Citation: Breast Disease, vol. 35, no. 4, pp. 249-252, 2015

Authors: Watanabe, Naoki | Otsuka, Shoko | Sasaki, Yoko | Yuasa, Takeshi | Shimada, Ken

Article Type: Research Article

Abstract: BACKGROUND: Patients with HER2-positive breast cancer, who received paclitaxel (P) followed by epirubicin at 75 mg/m2 , fluorouracil, and cyclophosphamide (FEC75) and concurrent trastuzumab (Trastuzumab Group) show good cardiac tolerability. We assessed left ventricular ejection fraction (LVEF) of these patients regularly, and compared with that of HER2-negative breast cancer patients who administered P followed by FEC100 (Standard Group), and followed for more one year, and address the longer-term issues in LVEF. OBJECTIVE & METHODS: We routinely assessed LVEF, at the time of initiation, after P, after FEC, and after 1 year, and compared them between 49 …patients in Trastuzumab Group and 45 patients in Standard Group. RESULTS: In Trastuzumab Group, LVEF was reduced from the initial level (63.1%) to 60.4 at ``After FEC'' (p= 0.007), but had recovered to 60.9% at ``After 1 year''. A two-way repeated-measures ANOVA demonstrated a significant decline in LVEF level along the time course (p< 0.002), but there was no interaction revealed between time course of LVEF and treatment with or without trastuzumab (p= 0.834). In addition, there was no significant difference between groups (p= 0.386) CONCLUSIONS: P followed by FEC75 with concurrent trastuzumab could provide enough evidence of cardiac safety. Show more

Keywords: Anthracyclines, trastuzumab, cardiotoxicity, adjuvant chemotherapy, breast cancer

DOI: 10.3233/BD-150418

Citation: Breast Disease, vol. 35, no. 4, pp. 253-261, 2015

Authors: Wong, Melody Man-Kuen | Liu, Hin-Lun

Article Type: Research Article

Abstract: With radical treatment of cancer, lymphedema of limb has become a commonly faced adverse effect. The introduction of vascularized lymph node transfer (VLNT) has provided a possible treatment option for this troublesome condition. In this case report, we describe a 66-year-old lady who developed upper limb lymphedema after operation and radiotherapy for the cancer of her left breast. Her lymphedema did not improve despite wearing pressure garment and receiving six months of regular decongestive physiotherapy. VLNT was performed for this patient, the pre- and post-operative limb circumference and bioimpedance measurements were compared. After operation, the patient continued with her previous …physiotherapy regimen. Complete resolution of pitting edema was demonstrated five months after VLNT. In addition, there was a marked improvement in both limb circumference and bioimpedance measurements. From this case report, VLNT appears to be a promising treatment option for secondary lymphedema. We suggest this case report can serve as a model for future studies. Show more

Keywords: Secondary lymphedema, lymph node transfer, groin lymph node flap, bioimpedance analysis, limb circumference

DOI: 10.3233/BD-150413

Citation: Breast Disease, vol. 35, no. 4, pp. 263-266, 2015

Authors: Pujani, Mukta | Khan, Sabina | Jetley, Sujata

Article Type: Case Report

Abstract: The epidermal cysts are benign cysts most commonly found in the head and neck region and trunk. Epidermal cysts in breast are very rare with approximately 50 cases described in literature. It is important to diagnose these correctly as they may be misdiagnosed as benign or malignant mammary gland tumor both clinically and radiologically. We hereby report a rare case of epidermal cyst of breast clinically mistaken for a fibroadenoma in a 35 year old female, which was diagnosed on fine needle aspiration cytology as epidermal cyst and later confirmed on histopathology. This case is being reported to create awareness …among clinicians as well as pathologists of this unusual entity and to reemphasize the importance of FNAC and core biopsy in diagnosis of breast lumps. Show more

Keywords: Epidermal cyst, breast, FNAC

DOI: 10.3233/BD-150417

Citation: Breast Disease, vol. 35, no. 4, pp. 267-269, 2015

Article Type: Other

Citation: Breast Disease, vol. 35, no. 4, pp. 271-274, 2015