Breast disease最新文献

Standard operative management for breast carcinoma has significantly shifted from extensive procedures to minor interventions.Although axillary dissection was a fundamental component of operative management, sentinel biopsy is an actual process for axillary staging. Axillary dissection may be postponed for cases that have negative SLNs or 1 or 2 infiltrated lymph nodes undergoing breast or axillary radiation. Contrarily, axillary dissection is still the conventional management for patients with clinically positive nodes.Arm lymphedema is a frequent and overwhelming complication of axillary dissection, with a worse impact on the patient's life.Axillary reverse mapping was recently introduced to map and conserve the lymph drain of the upper limb throughout axillary dissection or sentinel biopsy. A technique based on the theory that the breast's lymphatic drainage differs from those that drain the arm, so preserving lymphatic drainage of the upper limb can prevent lymphedema, thereby not raising the risk of axillary recurrence.Therefore, this technique is the reverse of sentinel biopsy, which remove the lymph nodes that drain the breast.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast pathology, which most commonly presents incidentally along with other breast pathologies. The etiology and pathogenesis of PASH are still unknown; however, there is some evidence suggesting PASH is hormone dependent. The clinical history, presentation, and imaging appearance of PASH are variable. Clinically, PASH has a wide spectrum of presentations, from being silent to gigantomastia. On imaging, PASH demonstrates various benign to suspicious features. Here we summarize PASH's clinical presentation, histopathology, imaging features, and management.

Background: The Delphi technique is a consensus method aiming to obtain statistical estimations from a qualitative approach, through an iterative process that leads to consensus within experts. The main characteristics of the technique include iteration, anonymity, feedback, and consensus reaching. When high-quality, quantitative evidence on a particular topic is insufficient, the Delphi technique can be used for making decisions in clinical scenarios. However, the quality of studies on breast cancer conducted with this technique, has not been assessed.

Objective: We aim to evaluate the quality of studies on breast cancer which used the Delphi technique as their method.

Methods: A quality assessment tool (Quali-D) was created through consensus among experts on the Delphi technique. Then, the tool was applied to studies on breast cancer which used the Delphi technique as their method.

Results: Studies conducted through the Delphi technique mainly assessed for quality indicators and expressed needs in patients with breast cancer. High-quality characteristics were reported in 63.89% of the studies. 98.61% used the Delphi technique due to lack of a more adequate method to solve their research question. 98.61% summarized and presented results in a clear way. In 91.67% of the studies, at least two rounds were conducted. 86.11% described the methods for expert selection in a complete manner. Only 54.17% of the studies reported an anonymous process and 4.17% of the studies disclosed conflicts of interest thoroughly.

Conclusions: A variety of topics were assessed through the Delphi technique in cases where no other technique would have been more appropriate for assessing these issues. Significant limitations are present in terms of anonymity and full disclosure of conflicts of interest. We found that the quality of studies conducted with the Delphi technique regarding breast cancer is overall good. However, the limitations of each study must be considered when applying their results to clinical practice.

Thoracoabdominal (TA) flaps are a good option for primary closure of small and medium defects after mastectomy for locally advanced breast tumours. Although they have a higher rate of necrosis than myocutaneous flaps, they can be easily performed by breast surgeons. Few studies on this procedure have been reported, and we have been unable to identify any prior publications reporting breast reconstruction with TA flaps.

Background: Breast cancer (BC) is the most prevalent cancer in women, with increasing incidence and death rates in recent years. Disruptions of different signaling pathways partially cause breast cancer. Hence, different genes through particular pathways are involved in BC tumorigenesis.

Methods: In this study, we evaluated the expression level of GLIS2 and CCND1 genes in 50 patients. Also, in-silico analyses were used to enrich related signaling pathways involving the mentioned genes.

Results: The results showed an increased expression level of Cyclin D1 and decreased expression level of GLIS2 in BC patients. Moreover, a relationship between aberrant expression levels of GLIS2 and CCND1 and BC development was determined.

Conclusion: These observations could help uncover new therapeutic targets for treating patients with BC in the progressive stage.

Objective: To investigate the associations between breast cancer staging and body mass index (BMI), menopausal status, and family history of breast cancer, as well as to assess the expression of tumor markers in women with breast cancer in Brunei Darussalam.

Methods: A retrospective cross-sectional study was carried out at The Brunei Cancer Centre. Cases of women with breast cancer between 2000 and 2013 were retrieved from the medical records section and entered into a clinical proforma. These were reviewed and analyzed using appropriate statistical methods.

Results: Overall, the mean age at diagnosis was 53.6 years ± 9.83. The postmenopausal women had a significantly higher risk of being diagnosed with late-onset breast cancer than premenopausal women (P = 0.022). The expressions of PR (P = 0.034), Her2 (P = 0.046), and CatD (P = 0.004) were significantly different in breast cancer staging. Other factors did not have a statistically-significant association with breast cancer staging.

Conclusion: While most of the factors studied were not significantly different in breast cancer staging, our findings showed that it is recommended that high-risk women perform regular breast screening after the age of 40 years old. A future study highly appreciates comparing breast cancer risk factors among the Bruneian and Western populations.

Introduction: Ductal carcinoma in situ (DCIS) in young women is rare and not well studied. Since they do not qualify for mammographic screening, they are more likely to present with symptoms. Young women have also been associated with poorer outcomes, but it is unknown whether presentation mode affects outcome. We aimed to compare characteristics of DCIS patients <40 years of age presenting with symptoms versus those without, and determine whether presentation mode affects recurrence.

Methods: Pure DCIS patients aged <40 years were retrospectively analyzed. Clinical presentation, pathology and recurrence data were collected. Statistical analysis was performed to investigate the correlation of presentation mode with outcomes.

Results: 40 patients with 41 cases were included. The mean age at diagnosis was 32.3 years (range 17-39). 73.2% and 26.8% presented with symptoms or abnormal imaging respectively. Of the cases who presented with symptoms, 86.7%, 10.0% and 3.3% had palpable lump, nipple discharge or breast pain, respectively. The average tumor size was 22.0 mm (range 2.0-86.9) and 12.2 mm (range 3-25) for patients who presented with symptoms and non-symptomatic group, respectively. Cases presenting with symptoms were statistically associated with higher grade (p = 0.0090). On median follow-up of 85 months, there were 3 (7.3%) recurrences, which were not statistically associated with presentation mode.

Conclusion: Young women with DCIS tend to present with symptoms, with breast lump as the commonest symptom. Symptomatic patients tend to be associated with grade III tumours, compared to non-symptomatic patients. On long-term follow-up, mode of presentation was not statistically associated with recurrence.

Background: Amyloidosis is an uncommon disorder characterized by the extracellular deposition of amorphous and insoluble proteins in an abnormal fibrillary configuration. Mammary amyloidosis is an unusual and easily overlooked diagnosis with an ambivalent presentation that could mimic breast cancer.

Case report: We here report the case of 60-year-old Caucasian woman who presented to our surgical oncology department for clinically and radiologically suspicious breast mass. A fine needle biopsy was irrelevant, so we performed a lumpectomy. Final histology revealed an amyloid deposit and further workup was consistent with nodular cutaneous and breast AL amyloidosis associated with Sjögren's syndrome.

Conclusion: Although rare, an awareness of the clinicopathologic characteristics of this easily overlooked entity is of great importance for breast surgeons.