Breast Disease - Volume 39, issue 3-4

Authors: Sisti, Andrea | Huayllani, Maria T. | Restrepo, David J. | Boczar, Daniel | Advani, Pooja | Lu, Xiaona | Spaulding, Aaron C. | Ball, Colleen T. | McLaughlin, Sarah A. | Forte, Antonio J.

Article Type: Research Article

Abstract: BACKGROUND: Paget’s disease of the breast is rare. The National Cancer Database (NCDB) is one of the largest tumor databases in the United States. METHODS: We queried the NCDB to identify male and female patients with Paget’s disease of the breast who were treated from January 1, 2004, through December 31, 2015. No age limitations were applied. Descriptive statistical analysis and survival analysis were performed. RESULTS: We analyzed the demographic, disease, and treatment characteristics of 7,191 patients with Paget’s disease of the breast. The median (range) age was 64 (20–90) years. Only 2.1% of patients were …men, and 85.4% were white. The most common treatment was complete mastectomy (65.3%), followed by partial mastectomy (30.3%). Tumor destruction was performed in 0.1% of patients, and 4.3% of patients did not undergo any surgery. We examined survival in the subset of 6,864 patients who were treated surgically with complete mastectomy or partial mastectomy. The 5-year survival rate after surgery was 82.5% (95% CI, 81.1%–83.9%). Factors associated with shorter survival were older age, black race/ethnicity, higher tumor grade, regional lymph node metastasis, higher cancer stage, metastatic cancer, and larger tumor size. CONCLUSIONS: Paget’s disease of the breast usually affects patients older than 60 years, and the most common treatment is complete mastectomy. The 5-year overall survival rate of patients with Paget’s disease of the breast is greater than 80% but is lower among older and black people. Show more

Keywords: Paget’s disease, breast, NCDB, characteristics, survival

DOI: 10.3233/BD-200439

Citation: Breast Disease, vol. 39, no. 3-4, pp. 119-126, 2020

Authors: Krishna, Kanyadhara Lohita | Srinath, B.S. | Santosh, Divya | Velusamy, Shanthi | Divyamala, K.P. | Sariya Mohammadi, J. | Kurpad, Vishnu | Kulkarni, Sanjeev | Yaji, Prabhat | Goud, Sandeep | Dhanireddy, Subhashini | Ram, Janaki

Article Type: Research Article

Abstract: BACKGROUND AND AIM: Traditionally lumpectomy as a part of breast-conserving surgery (BCS) is performed by palpation-guided method leading to positive margins and large excision volumes. There is no evidence suggesting that wide margin excisions decrease intra-breast tumour recurrence. Various perioperative techniques are used for margin assessment. We aimed to compare three commonly used techniques, i.e., ultrasound-guided surgery, palpation-guided surgery and cavity shaving for attaining negative margins and estimating the extent of healthy breast tissue resection. METHOD: A prospective comparative study was performed on 90 patients who underwent breast conservation surgery for early breast cancer between August 2018 and …June 2019. Tumour excision with a minimum of 1 cm margin was done either using ultrasound, palpation or cavity shaving. Histopathological evaluation was done to assess the margin status and excess amount of resected normal breast tissue. Calculated resection ratio (CRR) defining the excess amount of the resected breast tissue was achieved by dividing the total resection volume (TRV) by optimal resection volume (ORV). The time taken for excision was also recorded. RESULTS: Histopathology of all 90 patients (30 in each group) revealed a negative resection margin in 93.3% of 30 patients in palpation-guided surgery group and 100% in both ultrasound-guided surgery and cavity shaving groups. Two patients (6.7%) from the cavity shaving group had positive margins on initial lumpectomy but shave margins were negative. TRV was significantly less in the ultrasound-guided surgery group compared to the palpation-guided surgery group and cavity shaving group (76.9 cm3 , 94.7 cm3 and 126.3 cm3 respectively; p < 0.0051). CRR was 1.2 in ultrasound group compared to 1.9 in palpation group and 2.1 in cavity shave group which was also statistically significant (p < 0.0001). Excision time was significantly less (p < 0.001) in palpation-guided surgery group (13.8 min) compared to cavity shaving group (15.1 min) and ultrasound-guided group (19.4 min). CONCLUSION: Ultrasound-guided surgery is more accurate in attaining negative margins with the removal of least amount of healthy breast tissue compared to palpation-guided surgery and cavity shaving. Show more

Keywords: Breast-conserving surgery, intraoperative ultrasound, cavity shaving technique, palpation-guided lumpectomy, normal breast tissue preservation

DOI: 10.3233/BD-200443

Citation: Breast Disease, vol. 39, no. 3-4, pp. 127-135, 2020

Authors: Liaghati, Pegah | Momeni, Parto | Oskooei, Vahid Kholghi | Ghafouri-Fard, Soudeh | Taheri, Mohammad

Article Type: Research Article

Abstract: Breast cancer as the most common female cancer is a malignancy with heterogeneous course. Dysregulation of several genes has been associated with development of this malignancy. Among these genes are the stem cell markers CD61 and breast cancer resistance protein (BCRP or ATP-binding cassette super-family G member 2 (ABCG2)). ABCG2 is one of the major efflux transporters implicated in multidrug resistance in cancer cells. In the present study, we compared expression of CD61 and ABCG2 transcripts between 30 breast cancer tissues and matched adjacent non-cancerous tissues (ANCTs) using real time qPCR technique. There was no significant difference …in expression of CD61 or ABCG2 between tumoral tissues and ANCTs (Expression ratios = 1.21 and 0.98, P values = 0.55 and 0.96, respectively). There was a trend toward association between relative expression of CD61 (tumoral tissues versus ANCTs) and patients’ age (P = 0.05) in a way that older patients tended to over-express this marker in their tumoral tissues compared with the matched ANCTs. Moreover, there was a significant association between expression of this gene and tumor size (P = 0.04) in a way that all tumors with sizes less than 2 cm showed down-regulation of CD61 (as compared with the matched ANCTs). Expression of CD61 was significantly higher in tumor tissues with extracapsular nodal extension compared with confined lesions (P = 0.007). Moreover, expression of ABCG2 was significantly higher in tumor tissues of patients aged less than 55 years compared with older patients (P = 0.04). There was no significant correlation between expression of CD61 and ABCG2 either in tumoral tissues or in ANCTs. The current investigation shows association or trends toward association between expression of two cancer stem cell markers and some clinical data of breast cancer patients such as extracapsular nodal extension, age and tumor size which might imply their importance in the pathogenesis of breast cancer. Show more

Keywords: Breast cancer, cancer stem cell, CD61, breast cancer resistance protein, BCRP, ATP-binding cassette super-family G member 2, ABCG2

DOI: 10.3233/BD-200448

Citation: Breast Disease, vol. 39, no. 3-4, pp. 137-142, 2020

Authors: Liaghati, Pegah | Momeni, Parto | Esfandi, Farbod | Kholghi Oskooei, Vahid | Sattari, Ali | Ghafouri-Fard, Soudeh | Taheri, Mohammad

Article Type: Research Article

Abstract: BACKGROUND: The importance of cancer stem cells (CSCs) in initiation and progression of breast cancer has been well established. This population of cells is characterized by high expression of CD44 and low expression of CD24. OBJECTIVE: However, the relative abundance of CD24 and CD44 transcripts in breast cancer tissues and adjacent non-cancerous tissues (ANCTs) has not been quantified yet. METHODS: In the present investigation, we assessed expression of CD24 and CD44 at transcript level in breast cancer tissues and ANCTs in association with clinical determinants of patients’ outcome and parameters that predict response to therapeutic options. …RESULTS: There was no significant difference in expression of CD24 and CD44 in breast cancer tissues compared with ANCTs (Expression ratios: 1.03 and 0.84, P values: 0.92 and 0.61, respectively). However, CD44 expression was associated with tumor size in a way this gene was up-regulated in all of small sized (≤2 cm) tumors compared with the corresponding ANCTs (P value = 0.04). Besides, CD44 expression was significantly higher in tumors with extracapsular nodal extension compared with those without extension (P = 0.04). Expression of CD24 was higher in grade 3 tumors compared with grade 2 tumors (P = 0.04). CONCLUSION: Expression levels of CD24 and CD44 were correlated with each other in ANCTs but not in tumoral tissues. The current study shows another aspect of CSC markers in the development of breast cancer. Show more

Keywords: CD44, CD24, breast cancer

DOI: 10.3233/BD-200441

Citation: Breast Disease, vol. 39, no. 3-4, pp. 143-148, 2020

Authors: Tsuji, Wakako

Article Type: Case Report

Abstract: Bilateral ectopic axillary breast carcinoma is extremely rare. Here, we report the case of a 68-year-old woman who presented with a palpable mass in the right axilla. After ectopic breast carcinoma diagnosis, the patient underwent partial mastectomy and sentinel lymph node biopsy, followed by radiotherapy of the whole breast. Adjuvant endocrine therapy was administered for 5 years. Seven years after the first carcinoma diagnosis, the patient noticed a second tumor in the left axilla by herself at the age of 75 years. Core needle biopsy revealed second primary breast carcinoma of the axilla. She underwent partial mastectomy and sentinel lymph …node biopsy followed by chemotherapy, radiotherapy, and endocrine therapy. No recurrence has been observed so far. Therefore, ectopic breast carcinoma should be treated as typical breast carcinoma. Show more

Keywords: Axilla, bilateral, breast carcinoma, ectopic, family medical history, invasive ductal carcinoma, second primary

DOI: 10.3233/BD-200452

Citation: Breast Disease, vol. 39, no. 3-4, pp. 149-153, 2020

Authors: Salemis, Nikolaos S. | Christofyllakis, Charalambos | Spiliopoulos, Kyriakos

Article Type: Case Report

Abstract: Breast carcinoma en cuirasse is a very rare form of cutaneous metastases of breast cancer. The clinical presentation is that of a diffuse indurated carcinomatous infiltration of the skin and subcutaneous tissues of the mammary region and the anterior aspect of the chest. In most cases, breast carcinoma en cuirasse develops post-mastectomy and represents a dramatic presentation of an aggressive tumor associated with a dismal prognosis. Because of the rarity of this type of malignancy, the optimal approach to treatment has not been clearly defined. The systemic treatment has been associated with limited efficacy, and the primary goal is palliative …care and preservation of the quality of life through skin-directed therapies. Herein, a very rare case of primary breast carcinoma en cuirasse is presented, along with a review of the literature. Early diagnosis and prompt treatment of any potential skin metastases of breast cancer are essential to prevent the catastrophic natural progression of the disease. Show more

Keywords: Breast carcinoma, cutaneous, metastases, en cuirasse

DOI: 10.3233/BD-201020

Citation: Breast Disease, vol. 39, no. 3-4, pp. 155-159, 2020