Breast Disease - Volume 41, issue 1

Authors: Casella, Donato | Fusario, Daniele | Neri, Alessandro

Article Type: Brief Report

Abstract: During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents. We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period …October–December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems. Show more

Keywords: Breast cancer, COVID-19, patient’s pathway, neoadjuvant therapy

DOI: 10.3233/BD-210007

Citation: Breast Disease, vol. 41, no. 1, pp. 1-3, 2022

Authors: Avau, Fiona | Chintinne, Marie | Baudry, Sarah | Buxant, Frédéric

Article Type: Case Report

Abstract: Intracystic papillary carcinoma (IPC) is a rare tumor with good prognosis that occurs in only 5% to 7.5% of male breast cancer. We report a case of a 46-year-old man who presented a brown nipple discharge a few months ago. He had a bilateral IPC and an invasive ductal carcinoma on the right breast. A double mastectomy was then performed with a bilateral sentinel lymph node biopsy, and he received chemotherapy, radiotherapy, and hormonotherapy. Two years after the diagnosis, the patient recovered and was free of recurrence. Considering the scarcity of this tumor type, we conducted a systematic literature review …on the PubMed of all the cases of IPC in men. The clinical presentation, imaging, and treatment of the 43 case reports from the 41 articles selected were described. Furthermore, no clear guidelines for IPC management are available. Conservative surgery should also be preferred, and a sentinel lymph node biopsy should be performed systematically. Moreover, radiotherapy should be proposed in the case of conservative surgery, and hormone therapy could be proposed in the case of invasive IPC or IPC associated with a ductal carcinoma in situ. Show more

Keywords: Intracystic papillary carcinoma, encapsulated papillary carcinoma, male breast, management

DOI: 10.3233/BD-210001

Citation: Breast Disease, vol. 41, no. 1, pp. 5-13, 2022

Authors: Kwok, Hiu Tat | Van, Minh | Fan, Ka Siu | Chan, Jeremy

Article Type: Review Article

Abstract: BACKGROUND: Male breast cancer is a considerably rare condition and only accounts for 1% of all breast cancer cases. Due to limited public awareness, the condition is likely to present late, leading to late diagnosis and treatment worsening morbidity and mortality. This article aims to identify the focus and most influential research on male breast cancer. Objective Identify the most influential papers in male breast cancer. METHODS: Search on Web of Science using the search terms ‘Male’, ‘Breast Cancer’ and “Male breast cancer” to identify all full manuscripts in English language and were ranked by the total …number of citations. The top 100 articles were then further analysed according to subject, author, journal, year and country of publications. RESULTS: The mean number of citations per paper was 96. Most cited paper was by Thorlacius, S et al. evaluating the relationship between BRCA2 and female breast cancer, prostate cancer, pancreatic cancer and ovarian cancer. Cancer is the journal with the most published papers and received most citations in the male breast cancer research field. The USA contributed 49 of the manuscripts in the top 100. The most studied topic was risk factors for male breast cancer, with 20 articles. CONCLUSIONS: The most cited papers identified in this study described the advance in the knowledge of genetics and epidemiology in male breast cancer and has led to improvements in the 4 management of the disease. Most of the highly cited articles in this field were published in high impact journals and had accumulated at least 100 citations to date, reflecting their quality and impact. By collating the most influential publications in this field, this analysis can serve to identify knowledge gaps in male breast cancer research as well as to help identify what makes a paper impactful and citable. Show more

Keywords: Male breast cancer

DOI: 10.3233/BD-201024

Citation: Breast Disease, vol. 41, no. 1, pp. 15-20, 2022

Authors: Tansawet, Amarit | Nakchuai, Panupong | Techapongsatorn, Suphakarn | Sukhvibul, Pakkapol | Lolak, Sermkiat

Article Type: Brief Report

Abstract: Seroma is a common complication after mastectomy. To the best of our knowledge, no prediction models have been developed for this. Henceforth, medical records of total mastectomy patients were retrospectively reviewed. Data consisting of 120 subjects were divided into a training-validation data set (96 subjects) and a testing data set (24 subjects). Data was learned by using a 9-layer artificial neural network (ANN), and the model was validated using 10-fold cross-validation. The model performance was assessed by a confusion matrix in the validating data set. The receiver operating characteristic curve was constructed, and the area under the curve (AUC) was …also calculated. Pathology type, presence of hypertension, presence of diabetes, receiving of neoadjuvant chemotherapy, body mass index, and axillary lymph node (LN) management (i.e., sentinel LN biopsy and axillary LN dissection) were selected as predictive factors in a model developed from the neural network algorithm. The model yielded an AUC of 0.760, which corresponded with a level of acceptable discrimination. Sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 52.9%, 66.7%, 46.7%, and 100%, respectively. Our model, which was developed from the ANN algorithm can predict seroma after total mastectomy with high sensitivity. Nevertheless, external validation is still needed to confirm the performance of this model. Show more

Keywords: Seroma, mastectomy, breast cancer, artificial neural network

DOI: 10.3233/BD-201051

Citation: Breast Disease, vol. 41, no. 1, pp. 21-26, 2022

Authors: Bharath, S. | Lodhi, Naresh | Yadav, Sanjay Kumar | Silodia, Ashutosh | Baghel, Arvind | Bhatia, Neeta

Article Type: Case Report

Abstract: INTRODUCTION: Primary rhabdomyosarcoma (RMS) of breast is an uncommon entity and axillary lymph node (ALN) involvement is exceedingly rare. METHODS: Herein, we are reporting a case of RMS of breast with ALN metastasis in an adolescent girl. We searched Pubmed and Cochrane databases with keywords rhabdomyosarcoma and breast. All studies published in English language literature were included. Articles describing metastatic involvement of breast with RMS were excluded. RESULT: The initial search yielded a total of 8468 studies, out of which 03 were found to be duplicate. 8420 studies were excluded based on title and abstract as …they did not fulfill inclusion criteria. Full text of the remaining 48 studies was screened. After full text screening, 26 case reports describing primary breast RMS were included. Overall 21% patients had axillary lymph node metastasis. CONCLUSION: Axillary staging should be considered in every patient undergoing surgery for breast RMS. However, it’s impact on recurrence and survival could not be determined based on current review. Show more

Keywords: Breast cancer, rhabdomysarcoma, axillary lymph node metastasis

DOI: 10.3233/BD-210008

Citation: Breast Disease, vol. 41, no. 1, pp. 27-30, 2022

Authors: Hussein, Osama | Roshdy, Sameh | Hamdy, Omar | Denewer, Adel

Article Type: Case Report

Abstract: INTRODUCTION: Breast conservation is the standard of care for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects. PATIENTS AND TECHNIQUE: Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40–50% breast defect. The parenchymal defect was repaired …with an advancement muscle flap of the ipsilateral pectoralis major muscle. RESULTS: All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient. CONCLUSION: The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A–B breasts. Show more

Keywords: Breast cancer, breast conservative surgery, oncoplastic surgery, pectoralis major flap

DOI: 10.3233/BD-201042

Citation: Breast Disease, vol. 41, no. 1, pp. 31-36, 2022

Authors: Michalopoulos, Nikolaos V. | Frountzas, Maximos | Karathanasis, Panagiotis | Theodoropoulos, Charalampos | Kolia, Aikaterini | Zografos, Constantinos G. | Triantafyllou, Tania | Larentzakis, Andreas | Danias, Nikolaos | Zografos, George C.

Article Type: Research Article

Abstract: BACKGROUND: Despite the dominance of implant-based breast reconstruction after mastectomy, during recent years, it has been correlated to some complications. The aim of this study is to present the Greek experience about management of implant infections after breast reconstructions and to investigate the relationship between possible risk factors and breast pocket fluid cultures. METHODS: In total, 260 patients underwent implant-based breast reconstruction due to breast cancer in our center from 2016 until 2020. 46 patients, that underwent implant or expander replacement after breast reconstruction due to mastectomy were included in the present study. RESULTS: 260 patients …underwent breast reconstruction in our center and in 46 (18%) of them an implant replacement was required. 21 patients (8%) presented clinically with an implant infection, but 12 of them (5%) had positive cultures from the breast pocket fluid. On the contrary, 25 patients (10%) presented no clinical signs of implant infection, but 5 of them (2%) had a positive culture. In addition, we demonstrated a correlation between implant infection and positive cultures (p = 0.009), along with an association between chemotherapy before implant placements and negative cultures (p = 0.035). Finally, the most common pathogen was Staphylococcus epidermidis (29%), followed by Escherichia coli (24%) and Staphylococcus aureus (18%). CONCLUSION: Implant infection still remains a very serious complication after breast reconstruction surgery. The establishment of a therapeutic protocol, with specific antimicrobial and surgical targets seems as an effective strategy against implant infections. Show more

Keywords: Implant, infection, breast, cancer, reconstruction

DOI: 10.3233/BD-201077

Citation: Breast Disease, vol. 41, no. 1, pp. 37-44, 2022

Authors: Cerimele, Federico | Tagliati, Corrado | Salvatori, Fabio | Baldassarre, Silvia | Di Martino, Antonietta | Calamita, Valentina | Pressanti, Gabriella Lucidi | Mingliang, Ying | Giuseppetti, Gian Marco | Giovagnoni, Andrea

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. METHODS: Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or B BC) and dense (C or D BC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and …69; group 3: ≥70 years of age). RESULTS: Significant results of multinomial logistic regression were the association between mass and non-dense breast (p < 0.0001) and the association between mass and tumor size larger than 15 mm (p = 0.0049). CONCLUSIONS: Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size. Show more

Keywords: Breast cancer, mammographic findings, age groups, breast composition, tumor size

DOI: 10.3233/BD-201072

Citation: Breast Disease, vol. 41, no. 1, pp. 45-49, 2022

Authors: Moini, Ashraf | Eslami, Bita | Alipour, Sadaf

Article Type: Brief Report

Abstract: BACKGROUND: The etiology and incidence of Fibroadenoma (FA) as the most frequent benign breast mass and uterine fibroma (UF) as the most benign gynecological disorders are unknown. OBJECTIVE: Considering the dependency of FA and UF to sex hormones, our objective was to investigate the association of these two neoplasms. METHODS: Among women attending the hospital Gynecology Clinic, those with typical uterine fibroids in their pelvic ultrasound constituted cases and those with no pathology the controls. All participants underwent breast ultrasound for FA. Criteria for diagnosis of FA were a typical image for lumps <2 cm in women …aged <40 and <1 cm in ages ≥ 40, and a histologic diagnosis for all other participants or larger lumps. RESULTS: The mean age of cases and controls was 42.4 and 41.7 years, respectively. FA were detected in 140 (23%) of all participants; 19.7% of the cases, and 26.2% of the controls (p = 0.07). FA and UF had a borderline reverse association (OR = 0.69, 95% CI = 0.46–1.02, p = 0.07). CONCLUSION: The incidence of FA is lower in patients with UF. Further studies are needed to find the selective effects of estrogen and progesterone on hormonal receptors of these two tumors. Show more

Keywords: Breast, case-control study, fibroadenoma, sex hormones, uterine fibroma

DOI: 10.3233/BD-210009

Citation: Breast Disease, vol. 41, no. 1, pp. 51-54, 2022

Authors: Finkelman, Brian S. | Meindl, Amanda | LaBoy, Carissa | Griffin, Brannan B. | Narayan, Suguna P. | Brancamp, Rachel | Siziopikou, Kalliopi P. | Pincus, Jennifer L. | Blanco, Jr., Luis Z.

Article Type: Research Article

Abstract: BACKGROUND: Ki-67 immunohistochemistry (IHC) staining is a widely used cancer proliferation assay; however, its limitations could be improved with automated scoring. The OncotypeDXTM  Recurrence Score (ORS), which primarily evaluates cancer proliferation genes, is a prognostic indicator for breast cancer chemotherapy response; however, it is more expensive and slower than Ki-67. OBJECTIVE: To compare manual Ki-67 (mKi-67) with automated Ki-67 (aKi-67) algorithm results based on manually selected Ki-67 “hot spots” in breast cancer, and correlate both with ORS. METHODS: 105 invasive breast carcinoma cases from 100 patients at our institution (2011–2013) with available ORS were evaluated. …Concordance was assessed via Cohen’s Kappa (κ). RESULTS: 57/105 cases showed agreement between mKi-67 and aKi-67 (κ 0.31, 95% CI 0.18–0.45), with 41 cases overestimated by aKi-67. Concordance was higher when estimated on the same image (κ 0.53, 95% CI 0.37–0.69). Concordance between mKi-67 score and ORS was fair (κ 0.27, 95% CI 0.11–0.42), and concordance between aKi-67 and ORS was poor (κ 0.10, 95% CI −0.03–0.23). CONCLUSIONS: These results highlight the limits of Ki-67 algorithms that use manual “hot spot” selection. Due to suboptimal concordance, Ki-67 is likely most useful as a complement to, rather than a surrogate for ORS, regardless of scoring method. Show more

Keywords: Breast carcinoma, Ki-67, OncotypeDX, digital image analysis

DOI: 10.3233/BD-201011

Citation: Breast Disease, vol. 41, no. 1, pp. 55-65, 2022