Archives of Breast Cancer
Year:2020 | Volume:7 | Issue:3|Papers Count:9

As the role of local therapy in multidisciplinary management breast cancer has been evolving over the past few of decades, so has the concept of oncoplastic surgery. While the safety of breast conserving therapy, or BCT, which consists of lumpectomy and adjuvant breast radiotherapy, for invasive and in situ breast carcinomas is wellestablished1, 2, the idea of a lumpectomy for larger lesions has been a challenge, even when neoadjuvant systemic therapy could be expected to downsize the lesion of interest...

Doctor Robidoux was a full professor in the department of surgery at the University of Montreal and holder of the Scotiabank Chair in Breast Cancer Diagnosis and Treatment from 2000 until recently. He died of cancer at the age of 72 on Saturday, July 25, surrounded by loved ones. . .

Background: Papillary lesions of the breast are a heterogeneous group of neoplasms, the diagnosis and treatment of which is challenging. Typically surgical excision is recommended for papillary lesions after core needle biopsy (CNB) to rule out concurrent malignancy when a diagnosis of papilloma with atypia is yielded on CNB. For papilloma without atypia, however, making a decision about excision versus observation is challenging. Case Presentation: A 14-year-old female with nipple discharge, and a 2 cm mass in the right breast, with the pathology of intra-ductal papilloma without atypia on CNB presented. The question to be answered by multi-disciplinary team was the best management of this papillary lesion and whether the follow up was adequate or excision was mandatory. Question: What is the best plan for management of the young patient according to the primary pathology report of Juvenile Papillomatosis? Conclusion: Histoathology review of CNB specimen in rare and high risk lesions may have some advantages. On the other hand, in high risk circumstances, the excision of the lesion is recommended. Thus, in this case, the multi-disciplinary team recommended excision of the lesion.

Background: Little information is available about breast cancer (BC) in Sudan. Therefore, the present study aimed to provide baseline information about the demographic features and tumor characteristics, and also to investigate the associations between demographic variables and presentation stage in BC patients attending the National Cancer Institute-University of Gezira (NCI-UG), Sudan. Methods: In this cross-sectional study, we included all BC patients treated at the NCI-UG from January to December 2013. Patients' demographic, clinical and pathological data were retrieved from the hospital records and analyzed using SPSS version 20, and associations between these factors were tested as well. Results: A total of 232 cases were included in this research. The majority (97. 8%) of subjects were females and 2. 2% were males. The median age at diagnosis was 50 years (range, 22-90). The mean time between identification of symptoms and diagnosis was 13 months (SD=16. 1). Clinical stages I, II, III, and IV represented 6. 9%, 37. 0%, 40. 9% and 15. 2%, respectively. Advanced stage at diagnosis was associated with longer duration between identifying the symptoms to diagnosis (P=0. 006). Also the level of education of BC patients was significantly associated with clinical stage at presentation (P = 0. 01). Conclusions: Sudanese patients with BC present at a younger age and with more advanced stage at diagnosis than those in developed countries. Patients' education level and duration from identification of BC symptoms to diagnosis significantly impact the stage at the time of presentation. In limited resource setting, early diagnosis of symptomatic BC is crucial in reducing the disease burden.

Background: Breast cancer (BC) is a leading cause of cancer related death worldwide. Unfortunately, data concerning clinicopathologic features of this malignancy in non-developed countries is scarce. This study aims to characterize a cohort of Guatemalan female patients with non-metastatic BC and to determine risk factors for overall survival (OS). Methods: We retrieved data on consecutive patients from the Instituto Guatemalteco de Seguridad Social that were treated from 2008 to 2014. Clinical features and long-term outcomes were retrieved from medical records. Univariate and multivariate Cox regression analyses were conducted to identify variables associated with OS. Results: 954 BC patients were identified during the time frame. A total of 436 women (46%) were younger than 50 years old. BC molecular subtypes categorized 537 patients (56. 3%) with luminal A disease, 186 (19. 5%) patients with triple negative tumors, 153 cases (16. 1%) with HER-2 enriched tumors, and 78 patients (8. 2%) with luminal B tumors. Clinical stage at presentation was stage I: 4. 7% (n=45); stage II: 48. 1% (n=459), and stage III: 47. 2% (n=450). The overall 5-year survival rate was 75. 2% (95% Confidence Interval: 72. 0– 78. 3). In the multivariate analysis clinical stage, triple negative tumors and HER2 enriched tumors were independently associated with poor survival. Conclusion: The majority of patients with non-metastatic BC are diagnosed with advanced disease and many of them are younger than 50 years old. OS in this cohort of Guatemalan patients is lower than that reported in developed countries.

Background: Improving health-related quality of life (HRQOL) has become a fundamental goal of breast cancer management. This study aimed to examine the differences between the QOL outcomes of breast-conserving surgery (BCS) and mastectomy. We also established structural equation models for BCS and mastectomy to elucidate their unique effects on QOL. Methods: Between July 2019 and November 2019, 254 patients, who were scheduled to visit one of four clinics, were recruited for this study. We evaluated HRQOL using various questionnaires, such as the BREAST-Q, EQ-5D-5L, and Hospital Anxiety and Depression Scale (HADS). The relationships among the examined clinical indicators were evaluated using structural equation modeling (SEM). Results: The QOL scores of the BCS group were better than those of the mastectomy group (0. 85± 0. 129 vs. 0. 81± 0. 12, P=0. 020). Also, anxiety (2. 94± 2. 95 vs. 3. 81± 3. 08, P=0. 025) and depression (2. 55± 2. 77 vs. 3. 74± 3. 19, P=0. 002) were less severe in the BCS group than in the mastectomy group. Furthermore, the relationships among QOL status and mental health status were more complex in the BCS group than in the mastectomy group (Chi-square minimization p-value: 0. 231 vs. 0. 469, respectively). Also, depression directly affected QOL in the mastectomy group (R=-0. 47), but not in the BCS group. Conclusions: There were differences in QOL and mental health between the BCS and mastectomy groups. SEM is useful for identifying such differences, which can be used to develop strategies for improving QOL.

Background: Ultrasonography and mammography are two radiologic approaches for screening breast cancer; however, the pathology report is required for the ultimate diagnosis of malignancy. This study aimed to assess the concordance of ultrasonography (US) and mammography with the pathology in breast cancer. Methods: A cross-sectional study was conducted to assess the breast US and the mammography findings based on the BI-RADS model in comparison with the definitive pathology reports in a single medical center. The sensitivity, the specificity, positive (PPV) and negative predictive value (NPV) and also the concordance between the US and the mammography data were analyzed. Results: In this study, 126 patients were included. The sensitivity, specificity, PPV, and NPV for the US were 69. 8, 71. 9, 75. 6 and 81. 3 and for mammography were 91. 9, 76. 6, 80. 8 and, 94. 6 percent, respectively. The ROC-curve for either the US or the mammography showed that the BI-RADS 4 was accompanied with the highest sensitivity and specificity for the screening of the malignant breast lesions regarding the final diagnosis. Although an overall higher correlation between mammography report and presence of a malignant lesion was observed, the total relative concordance between the results of US and mammography as screening tools proved to be statistically significant (P<0. 01). Conclusion: Both the US and the mammography were sensitive and specific screening tools, particularly for the malignant breast lesions. Furthermore, when evidence of the BI-RADS? 4 in either the mammography or the US was present, utilization of the other test could be ignored before biopsy.

Background: Pseudoaneurysm of the breast is a very uncommon disease mostly occurring following traumatic injuries including biopsy. Increasing the use of core needle biopsy in breast pathologies could lead to more cases of the iatrogenic pseudoaneurysm. Case presentation: Here we described a breast pseudoaneurysm case that occurred after core needle biopsy. The diagnosis was made by color doppler ultrasonography and MRI with contrast. Ultrasound-guided compression was used to treat the lesion. The lesion was followed up with ultrasonography and finally it was resolved. Conclusion: Although hematoma is a more common complication of breast biopsy, other complications including pseudoaneurysm should be kept in mind. Ultrasound is a useful technique for both the diagnosis and non-surgical treatment of the disease. Ultrasound-guided compression and follow up exams could be helpful to prevent invasive procedures.

Background: Phyllodes tumors are rare fibroepithelial neoplasm of the breast, representing 0. 3 to 0. 5% of all female breast neoplasms. The term ‘ ‘ phyllodes tumor” by the World Health Organization (WHO) categorizes it into benign, borderline, and malignant tumors based on histopathological characteristics. Malignant phyllodes tumor is an uncommon but aggressive breast malignancy and accounts for approximately 25% of all phyllodes tumors. Case Presentation: A 23-year-old female patient Gravida 0 Para 0, previously healthy, with no family history of breast or ovarian cancer was referred to our institution for managing a right breast mass increasing in size over a period of 1 month associated with reddish-brown discoloration of the skin. Breast ultrasound showed an isodense oval mass measuring approximately 16x14x12cm in the right lower outer quadrant of her breast. Core biopsy and FNA done revealed a low grade phyllodes tumor. MRI of breasts showed a huge mass of the right breast occupying all quadrants, measuring 15x14. 5 cm in its greatest axis with involvement of the pectoralis major muscle, with no evidence of suspicious axillary lymphadenopathy. Distant metastatic work-up with CT scan of chest abdomen and pelvis and a PET scan did not show distant metastasis. Hence, the patient underwent right total mastectomy with a final pathology compatible with malignant phyllodes tumor. She is on regular follow up and 18 months post-surgery is still disease free. Conclusion: Management of malignant phyllodes tumor remains debatable, especially when it comes to the effect of adjuvant radiotherapy and chemotherapy. From a surgical perspective, whether phyllodes tumors should be considered as epithelial breast cancers or as soft tissue sarcoma is another debate. On the other hand, although challenging, accurate identification of phyllodes tumor initially may aid in decreased recurrence.