Breast Disease - Volume 36, issue 2-3

Authors: Soran, Atilla | Bhargava, Rohit | Johnson, Ronald | Ahrendt, Gretchen | Bonaventura, Marguerite | Diego, Emilia | McAuliffe, Priscilla F. | Serrano, Merida | Menekse, Ebru | Sezgin, Efe | McGuire, Kandace P.

Article Type: Research Article

Abstract: BACKGROUND: Oncotype DX®  test is beneficial in predicting recurrence free survival in estrogen receptor positive (ER+) breast cancer. Ability of the assay to predict response to neoadjuvant chemotherapy (NCT) is less well-studied. OBJECTIVE: We hypothesize a positive association between the Oncotype DX®  recurrence score (RS) and the percentage tumor response (%TR) after NCT. METHODS: Pre-therapy RS was measured on core biopsies from 60 patients with ER+, HER2− invasive breast cancer (IBC) who then received NCT. Pre-therapy tumor size was measured using imaging. %TR, partial response (PR; >50%), pathologic complete response (pCR) and breast conserving …surgery (BCS) rates were measured. RESULTS: Median RS was 20 (2–69). Median %TR was 42 (0–97)%. PR was observed in 43% of patients. There was no association between %TR and pre-NCT tumor size, age, Nottingham score or nodal status (p > 0.05). No statistically significant association with %TR was seen with RS as a categorical or continuous variable (p = 0.21 and 0.7, respectively). Response to NCT improved as ER (p = 0.02) by RT-PCR decreased. Lower ER expression by IHC correlated with response (p = 0.03). CONCLUSIONS: In patients with ER+ IBC receiving NCT, RS did not predict response to NCT using %TR. The benefit of the assay prior to NCT requires further study. Show more

Keywords: Estrogen positive, 21 gene assay, tumor volume reduction, breast cancer, neoadjuvant, response

DOI: 10.3233/BD-150199

Citation: Breast Disease, vol. 36, no. 2-3, pp. 65-71, 2016

Authors: de Fátima Guerreiro Godoy, Maria | Silva, Edivandra Buzato | de Godoy, Jose Maria Pereira

Article Type: Research Article

Abstract: BACKGROUND: One of the dreaded complications after the treatment of breast cancer is lymphedema. Therapies used in the treatment of breast cancer such as surgery, radiotherapy, hormone therapy and chemotherapy may be adversely affected by obesity. AIM: The objective of this study was to use bioimpedance to assess abdominal fat in women with breast cancer treatment-related lymphedema and suggest this as a screening method. METHODS: Forty-five female patients with clinical diagnosis of breast cancer treatment-related lymphedema were evaluated in this quantitative cross-sectional study. A control group, composed of 38 patients with varicose veins and women attending …a social support group, was matched for age and body mass index (BMI). All participants were submitted to a bioimpedance evaluation (In Body S 10), with particular attention being paid to abdominal fat and their BMI. The unpaired t -test, Fisher Exact test and Mann–Whitney test were used for statistical analysis and an alpha error of 5%. RESULTS: There was no significant difference (p -value = 0.23) in the mean BMI between the study group (27.79  kg ∕m 2 ) and the control group (28.80  kg ∕m 2 ). The mean abdominal circumference, a measure of abdominal fat, of the women in the study group was 130.54  cm 2 and for the control group it was 102.24  cm 2 (p -value = 0.0037). Thus the study group had more abdominal fat (p -value = 0.0003). Moreover, on comparing obese patients in the two groups, the study group had more abdominal fat (p -value = 0.02). However, no significant difference was observed comparing non-obese patients (p -value = 0.6). The comparison of obese patients with non-obese patients in the control group identifies an association between obesity and abdominal fat (p -value < 0.04). CONCLUSION: Overweight and obese women with breast cancer treatment-related lymphedema are more likely to have increased abdominal fat than the general population with bioimpedance. Show more

Keywords: Lymphedema, breast cancer, fat, abdominal, bioimpedance

DOI: 10.3233/BD-160215

Citation: Breast Disease, vol. 36, no. 2-3, pp. 73-76, 2016

Authors: Din, Natasha | Allen, Isabel Elaine | Satariano, William A. | Demb, Joshua | Braithwaite, Dejana

Article Type: Research Article

Abstract: OBJECTIVE: To determine the association of prediagnostic alcohol consumption with long-term mortality from breast cancer and other causes in a cohort of women with breast cancer. METHODS: We studied a Michigan-based cohort of 939 women aged 40–84 years, who provided complete information about the type, amount and intensity of prediagnostic alcohol consumption. Associations of alcohol consumption, based on weekly volume of alcohol consumption during the year prior to breast cancer diagnosis, with mortality were evaluated in Cox proportional hazards models, with adjustment for sociodemographic factors, body mass index, smoking, comorbidity, tumor characteristics, and treatment. Differences among covariates were …assessed with Pearson χ 2 , Student t -tests and Wilcoxon Rank Sum tests. All statistical tests were two-sided. RESULTS: During a median follow-up of 11 years, 724 deaths occurred overall, with 303 from breast cancer. Fifty-five percent of the women were categorized as drinkers with volume of alcohol consumption ranging from 0.75 to 36.00 drinks/week. In multivariable models, a decreased risk of other-cause mortality was associated with low alcohol drinking (0.75–3.75 drinks/week; HR = 0.61, 95% CI = 0.47–0.78), moderate volume alcohol drinking (4.00–9.75 drinks/week; HR = 0.57, 95% CI = 0.39–0.85) and low frequency (0.75–3.75 drinks/week) beer and wine intake (HR = 0.69, 95% CI = 0.50–0.96 and HR = 0.68, 95% CI = 0.52–0.88 respectively). Although the risk of breast cancer-specific mortality was not statistically significantly associated with moderate (4.00–9.75 drinks/week) and high volume (10.00–36.00 drinks/week) alcohol drinking in the overall cohort (HR = 1.43, 95% CI = 95% 0.97–2.12 and HR = 1.53, 95% CI = 0.87–2.70 respectively), there was a positive association of alcohol consumption with breast cancer-specific mortality among current smokers (HR = 1.92, 95% CI = 1.03–3.57; P interaction = 0.04). CONCLUSION: In this prospective cohort study, regular consumption of 0.75–36.00 alcoholic drinks per week during the year prior to breast cancer diagnosis was associated with a reduction in other-cause mortality and with an increase in breast cancer-specific mortality among current smokers, after taking into account clinical and sociodemographic factors. Show more

Keywords: Breast cancer, mortality, alcohol consumption, prospective cohort study

DOI: 10.3233/BD-150202

Citation: Breast Disease, vol. 36, no. 2-3, pp. 77-89, 2016

Authors: Elgebaly, Ahmed | Menshawy, Ahmed | El Ashal, Gehad | Osama, Omnya | Ghanem, Esraa | Omar, Ahmed | Negida, Ahmed

Article Type: Research Article

Abstract: INTRODUCTION: Sunitinib is an orally delivered tyrosine kinase inhibitor that exhibits antiangiogenic effects. FDA has approved sunitinib for the treatment of metastatic renal cell carcinoma. However, its efficacy for the treatment of advanced breast cancer (ABC) remains controversial. Therefore, we performed this systematic review and meta-analysis to synthesize evidence from published randomized controlled trials (RCTs) about the efficacy of sunitinib alone and in combination with chemotherapy for the treatment of ABC. METHODS: We followed PRISMA statement guidelines during the preparation of this systematic review and meta-analysis. A computer literature search of PubMed, SCOPUS, web of knowledge, and Cochrane …Central Register of Controlled Trials (CENTRAL) has been conducted using relevant keywords. Studies were screened for eligibility and data were extracted to an online data extraction form. Progression free survival (PFS) and overall survival (OS) were pooled as Hazard ratio (HR) in a meta-analysis model using generic inverse variance method. Objective response rate (ORR) and complications were pooled as relative risk (RR) in a random effect model meta-analysis using Mantel–Haenzel method. RESULTS: Six RCTs, with a total sample size of 2273 patients, met our eligibility criteria and were included in this meta-analysis. Sunitinib monotherapy was not superior to chemotherapy in terms of PFS (HR = 1.00, 95% CI [0.86 to 1.16], P = 0.99), OS (HR = 1.07; 95% CI [0.87 to 1.32], P = 0.5), or ORR (RR = 0.70, 95% CI [0.74 to 1.03], P = 0.07). Sunitinib in combination with chemotherapy did not show superiority to chemotherapy in terms of PFS (HR = 0.99, 95% CI [0.86 to 1.14], P = 0.89) and OS (HR = 1.04, 95% CI [0.85 to 1.28], P = 0.69). However, the ORR favored sunitinib in combination with chemotherapy group (RR = 1.15, 95% CI [1.01 to 1.31]) with a statistically significant P value (P = 0.03). CONCLUSIONS: Current evidence shows that sunitinib, either alone or in combination with chemotherapy, has no clinical benefit for patients with advanced breast cancer. However, previous studies did not considered patient stratification and outcome assessment based on molecular markers. In terms of safety, toxicity was common with sunitinib treatment. Show more

Keywords: Breast, cancer, sunitinib, tyrosine kinase inhibitor, vascular endothelium growth factor, metastasis, chemotherapy

DOI: 10.3233/BD-160218

Citation: Breast Disease, vol. 36, no. 2-3, pp. 91-101, 2016

Authors: Shirah, Bader Hamza | Shirah, Hamza Assad

Article Type: Research Article

Abstract: BACKGROUND: The increased risk for malignant tumors associated with male gynecomastia has been well established and many authors have reported cases of concurrent gynecomastia and ductal carcinoma in situ (DCIS) in the same breast. Synchronous bilateral breast cancer in association with gynecomastia is exceptionally rare. We aim to report and evaluate the management outcome of 5 cases of gynecomastia associated with DCIS (1 bilateral and 4 unilateral). METHODS: A retrospective database analysis of the surgical treatment outcome of 74 male patients who had gynecomastia was done. A bilateral subcutaneous nipple-preserving mastectomy approach was done to all. Histopathology …reports were reviewed. RESULTS: 74 patients diagnosed and treated for gynecomastia were included. The incidence rate of gynecomastia in our hospital male patients was 0.17%. The mean age was 22 years, range 17–29 years. Five (6.76%) patients were found in histopathology specimens to have DCIS, 1 patient (23 years old) had bilateral DCIS of low grade, 4 patients had unilateral positive involvement, 3 had right breast DCIS, and 1 had left breast DCIS, and all were of low-grade papillary subtype. The incidence of ductal carcinoma in situ among our series gynecomastia patients was 6.76%. CONCLUSION: We conclude that gynecomastia is a benign breast disease but recent reports had described malignant variants, mostly DCIS, including 5 young males in our series. Therefore, regardless of the age group, histopathological examination of the resected gynecomastia tissue should be carefully done in all patients. Further evidence-based studies are needed to investigate the optimum management of incidental DCIS in gynecomastia specimens. Show more

Keywords: Gynecomastia, breast hypertrophy, DCIS, male, surgical treatment

DOI: 10.3233/BD-160223

Citation: Breast Disease, vol. 36, no. 2-3, pp. 103-110, 2016

Authors: Shetty, Archana | Narasimha, Aparna | Jayalakshmi, V. J.

Article Type: Case Report

Abstract: The physiological changes of the breast during pregnancy and lactation make the clinical, radiological and pathological evaluation of a breast mass challenging. Galactoceles are benign lesions containing milk, and generally occur post partum. Fine needle aspiration cytology is a simple, quick and effective technique for the diagnosis of the same during this period, and in case of galactocele the same can be both diagnostic and therapeutic. Although the cytological features of galactocele are straight forward, a few rare interesting variations can be encountered posing a diagnostic challenge to the reporting cytopathologist. We present a case of galactocele in a …twenty five year old lactating female with tyrosine crystals on cytology. Milk is composed of a wide variety of proteins and minerals, leading to the formation of calcium lactate or tyrosine crystals under rare circumstances when the milieu is acidic. This is one of the rare cases of crystallizing galactoceles reported in literature till date. Show more

Keywords: Galactocele, FNAC, crystals, cytology

DOI: 10.3233/BD-150214

Citation: Breast Disease, vol. 36, no. 2-3, pp. 111-114, 2016