Breast Disease - Volume 38, issue 3-4

Authors: Tsagkaraki, Ismini Michail | Kourouniotis, Christoforos Dimitrios | Gomatou, Georgia Leonidas | Syrigos, Nikolaos Konstantinos | Kotteas, Elias Alexandros

Article Type: Review Article

Abstract: Breast cancer is the main site of origin of orbital metastatic disease. Although invasive lobular breast carcinoma accounts for 10–15% of all breast cancer cases, it has been noticed that it metastasizes to the orbit more often compared to breast cancer of no special type (NST). The pathogenesis of this metastasis is not entirely understood; however, it seems that the unique tissue-specific characteristics of orbital microenvironment might contribute to metastatic disease in this particular site. Given the increasing survival of breast cancer patients and the prolonged metastatic potential of invasive lobular breast carcinoma, it is possible that the incidence of …this rare metastasis might increase in the future. The purpose of this review is to present clinical manifestations, immunohistochemical characteristics and therapeutic options for orbital metastases from invasive lobular carcinoma. Show more

Keywords: Lobular breast cancer, ILBC, Orbital/ocular metastasis

DOI: 10.3233/BD-190398

Citation: Breast Disease, vol. 38, no. 3-4, pp. 85-91, 2019

Authors: Tandon, Megha | Ball, William | Kirby, Robert | Soumian, Soni | Narayanan, Sankaran

Article Type: Research Article

Abstract: BACKGROUND: Axillary Ultrasound (AUS) is now performed as a protocol in every newly diagnosed breast cancer in most European countries. It is an inexpensive and sensitive tool in hands of a trained operator. All AUS negative patients undergo Sentinel Lymph Node Biopsy (SLNB), while AUS positive patients bypass SLNB and undergo axillary nodal clearance (ANC) as a standard protocol. We wish to analyse these two groups to see if ANC can be foregone in these patients. AIMS AND OBJECTIVES: To compare and analyse the axillary disease burden in early breast cancer patients, with positive axilla, detected by AUS+ …Biopsy versus those patients with normal axillary ultrasound or negative axillary biopsy that underwent ANC due to positive SLNB. MATERIAL AND METHODS: A retrospective review of all patients who underwent axillary lymph node clearance following histologically confirmed positive ultrasound (US) axilla (year 2009–2014) was performed and was compared with data collected for patients with USG negative but SLNB (OSNA- One Step Nucleic Acid Amplification) positive axilla. RESULTS: Axillary clearances performed for positive US axilla yielded significantly more positive lymph nodes than SLNB/OSNA positive axilla (p = 0.00496). These patients also had larger primary tumours (median 33 mm versus 21 mm, p = 0.01242) of a higher grade. Almost half of the patients in AUS positive group (49%) had high axillary nodal burden (>4 LNs). This is in great contrast with AUS negative, SLNB/OSNA positive group where 82.7% of patients had <4 positive nodes with more than half patients (51.7%) having no further positive nodes in their final histopathology specimen. CONCLUSIONS: ANC should be a standard protocol in AUS positive patients as they invariably have high axillary disease burden while ANC can be omitted in case of select AUS negative and SLNB patients. However, further studies with more subjects may be require to substantiate the findings. Show more

Keywords: ANC (Axillary Nodal Clearance), AUS (Axillary ultrasound), SLNB (Sentinel Lymph Node Biopsy), OSNA (One Step Nucleic Acid amplification)

DOI: 10.3233/BD-160230

Citation: Breast Disease, vol. 38, no. 3-4, pp. 93-96, 2019

Authors: Krishnamurthy, Kritika | Alghamdi, Sarah | Gyapong, Sylvia | Kaplan, Stuart | Poppiti, Robert J.

Article Type: Research Article

Abstract: BACKGROUND: Fibroadenoma is a benign mixed tumor composed of epithelial and non-epithelial components. The epithelial component of a fibroadenoma may exhibit proliferation, including lobular carcinoma in-situ , atypical ductal hyperplasia, DCIS and rarely, invasive breast carcinoma. OBJECTIVE: In this series of 30 cases of fibroadenoma with epithelial proliferation, we assessed the radiological and histopathological findings of each entity. METHOD: A retrospective review was performed to identify all fibroadenomas diagnosed at our institution between January 2012 and May 2018. RESULTS: In a total of 1523 consecutive cases of fibroadenomas, thirty cases had epithelial proliferations with …an overall prevalence of 1.97%. Eight cases had fibroadenoma with lobular carcinoma in-situ , six cases had atypical ductal hyperplasia, ten cases had DCIS and six cases had invasive carcinoma. In cases of fibroadenomas with lobular carcinoma in-situ , 62.5% of the cases the neoplasia was confined to the fibroadenoma whereas only 10% of the cases with DCIS showed confinement to the fibroadenoma (p = 0.036). The most common radiological finding was the presence of a mass. The BI-RADS scores were 4 and above in all cases (p > 0.05). CONCLUSION: In our study population, the most common type of carcinoma arising in fibroadenomas was DCIS, followed by lobular carcinoma in-situ . Lobular carcinoma in-situ was more likely to be confined to the fibroadenoma while most DCIS involved surrounding breast tissue. Show more

Keywords: Fibroadenoma with DCIS, fibroadenoma with lobular neoplasia, fibroadenoma with invasive carcinoma

DOI: 10.3233/BD-180368

Citation: Breast Disease, vol. 38, no. 3-4, pp. 97-101, 2019

Authors: Abu Sharour, Loai

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer-related lymphedema (BCRL) is one of the most common complications among women with breast cancer. OBJECTIVE: This study was conducted to evaluate the oncology nurses’ knowledge about lymphedema assessment, prevention, and management among women with breast cancer, and identify the relationships between oncology nurses’ academic qualification, years of experience, and level of knowledge. METHODS: A cross-sectional descriptive design was used. A sample of 150 participants from three institutions completed the study surveys. RESULTS: 60% (N = 90) of the participants did not pass the knowledge test. 70% (N = 105) of the …participants showed lack of knowledge regarding BCRL assessment and examination. The results showed that the participants had knowledge deficit regarding BCRL anatomy, pathophysiology, assessment and examination, risk factors, prevention interventions and precautions, patient education and consultation, and follow-up appointment. Importantly, 96% (N = 144) of the participants reported that they did not receive any continue education regarding BCRL. The results showed that was no significant relationship between years of experience, and level of knowledge (r = 0.25; n = 150; p < 0.51). A significant relationship was found between the nurses’ knowledge according to their academic qualifications (𝜒2 = 6.21; p < 0.0001). CONCLUSIONS: The results indicated that there is a need for a structured educational program to improve oncology nurses knowledge regarding BCRL. Show more

Keywords: Breast cancer-related lymphedema, oncology, nurses, knowledge

DOI: 10.3233/BD-190381

Citation: Breast Disease, vol. 38, no. 3-4, pp. 103-108, 2019

Authors: Chauhan, Varsha | Pujani, Mukta | Agarwal, Charu | Chandoke, R.K. | Raychaudhuri, Sujata | Singh, Kanika | Sharma, Nimisha | Khandelwal, Aparna | Agarwal, Anu

Article Type: Research Article

Abstract: BACKGROUND: Breast cytology is a significant component of the “Triple approach” for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision. AIMS \& OBJECTIVES: The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity …and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned. MATERIALS AND METHODS: All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible. RESULTS: Out of 468 breast lesions reported on FNAC, the category wise distribution was – Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively. CONCLUSION: FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC. Show more

Keywords: FNAC, triple approach, IAC, cyto-histopathological correlation, breast lesions

DOI: 10.3233/BD-190393

Citation: Breast Disease, vol. 38, no. 3-4, pp. 109-115, 2019

Authors: Yeung, Celine | Wanzel, Kyle R.

Article Type: Research Article

Abstract: The differential diagnosis for benign breast masses is broad and ranges from common lesions like fibroadenomas to rare masses like breast hamartomas. Fibroadenomas are proliferative benign masses made up of fibroglandular tissue. Hamartomas are neoplasms comprised of different tissues that are endogenous to the area where they originate. Breast hamartomas specifically, are rare, benign slow growing tumours comprised of fibrotic stroma, adipose, glandular tissue, and epithelial components. Both lesions are painless, firm, and are typically palpable on clinical exam. Given their similarities in composition, diagnosing these masses can be challenging, but may be confirmed with ultrasonography, mammogram, computed tomography, magnetic …resonance imaging, or via histological specimen. Once diagnosed, surgical excision is the preferred treatment option. We present a 33-year-old woman with a large left breast mass that gradually increased in size and provide a review of the current literature regarding the challenge of distinguishing between breast fibroadenomas and hamartomas. Show more

Keywords: Benign breast mass, breast tumour, fibroadenoma, hamartoma

DOI: 10.3233/BD-190400

Citation: Breast Disease, vol. 38, no. 3-4, pp. 117-123, 2019