European journal of breast health最新文献

Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast lesion frequently discovered incidentally during imaging or biopsy for other conditions. We present two cases of PASH associated with fibroadenomas in premenopausal women, both presenting as palpable, symptomatic breast masses. In the first case, a 26-year-old woman exhibited a 5.2 cm hypoechoic lesion, initially diagnosed as PASH on core biopsy, later confirmed as fibroadenoma with PASH components post-excision. The second case involved a 37-year-old woman with a painful 5.6 cm mass, diagnosed similarly via biopsy, and later confirmed as fibroadenoma fully colonized by PASH after surgical removal. Both cases highlight the diagnostic challenge in distinguishing PASH from fibroadenomas, given overlapping clinical and imaging features. Hormonal factors, particularly contraceptive use, may contribute to PASH development. Management remains controversial, with surgery indicated for symptomatic lesions, while conservative approaches may suffice for smaller, asymptomatic cases. Based on our findings and current literature, we propose a management algorithm to guide clinicians in differentiating cases warranting surgical intervention from those suitable for monitoring. Further studies are needed to validate this approach.

The increasing use of cardiac artificial devices, such as cardiac implantable electronic devices (CIED) and left ventricular assist devices (LVAD), results in longer life expectancy and thus may eventually coincide with a risk of cancer diagnosis and requirement for radiotherapy. Safe irradiation dose limits are better studied and reported for CIEDs, but data on LVAD irradiation are scarce. We present a case of a patient diagnosed with breast cancer who developed heart failure and was given an LVAD, received appropriate oncological care including chemotherapy, surgery, and, after careful multidisciplinary review, radiotherapy. The patient's right-sided initial stage II (T1N1) disease necessitated radiation treatment to the chest wall and regional lymphatic nodal areas. Meticulous radiotherapy planning and treatment delivery were performed, and daily LVAD performance checks were done. Maximum and mean doses received by the LVAD system were 767 cGy and 227 cGy, respectively, for the whole treatment period (5000 cGy/25 fractions). During radiotherapy and after 41 months of follow-up, no VLAD malfunction was observed. As this case shows, having an LVAD does not appear to be a contraindication for radiotherapy delivery. Possible risks and consequences should be evaluated in a multidisciplinary setting.

Mastectomy is often performed using unipolar electrocautery. However, for patients with a pacemaker, alternative methods are necessary, as the use of unipolar cautery is not recommended. In the case presented herein, we made half-centimeter incisions on the skin to be removed. We then pumped air under the mastectomy flaps through these incisions using a hand pump and a lipoplasty cannula equipped with a filter. Following this, we made a Stewart incision and conducted the dissection using a LigaSure vessel-sealing device from the plane formed by the air. The surgery was successfully completed without any significant bleeding, and the patient was discharged without any complications. Notably, this innovative surgical technique was employed for the first time in a breast cancer patient. The cannula we developed has facilitated the creation of a dissection plane using air, similar to endoscopic mastectomy, without requiring additional ports or equipment. This technique has the potential to facilitate surgery for selected patients.

Objective: The use of neoadjuvant chemotherapy (NAC) has improved outcomes in breast cancer (BC). The residual cancer burden index (RCB) predicts prognosis. This study evaluated RCB as a prognosticator in BC subtypes treated with NAC.

Materials and methods: A retrospective cohort of BC patients was analyzed. Five-year distant recurrence-free survival (DRFS), disease-free survival (DFS), and overall survival (OS) were analyzed. Statistical analyses included descriptive statistics, ANOVA, chi-square test, Fisher's exact test, Kaplan-Meier curves, Log-Rank test, and Cox regression.

Results: Among 562 women, RCB correlated with BC subtypes and predicted worse DRFS, DFS, and OS. In stratified analyses by molecular subtype, the association was significant only for luminal B and triple-negative subtypes, with inconsistent findings for luminal A and human epidermal growth factor type 2-overexpressed subtypes.

Conclusion: The RCB index was shown to be a prognostic marker in BC in a Brazilian population with BC. Significant associations were found only for the luminal B and triple negative subtypes. Further research is required to investigate the prognostic utility of RCB in other larger populations.

Objective: The utility of three-dimensional surface imaging (3DSI) for measuring breast volume in the upright position has not been established.

Materials and methods: First, the accuracy of 3DSI measurements was evaluated using plastic models with known breast volumes. Then, the breast volumes of 30 patients were measured using 3DSI in the upright position, computed tomography (CT) in the supine position, magnetic resonance imaging (MRI) in the prone position, and mammography (MMG) of the compressed breast. To determine the impact of 3DSI measurements, the correlation coefficients between 3DSI and CT, between MMG and CT, and between MRI and CT were calculated.

Results: The accuracy of 3DSI measurements was confirmed using plastic models. The correlation coefficients between 3DSI and CT, between MRI and CT, and between MMG and CT were 0.83, 0.997, and 0.84, respectively. Although the breast volume measured by 3DSI was closely associated with that measured by CT, this correlation was weaker than that between the MRI- and CT-measured volumes and comparable with that between the MMG- and CT-measured volumes.

Conclusion: 3DSI can be used to measure breast volume in the upright position with clinically acceptable accuracy for the evaluation of cosmetic surgical outcomes.

Breast lymphedema is a common but underdiagnosed condition that affects the quality of life of patients. It may be caused by any pathology that disrupts lymphatic drainage in the breast. We present the case of a woman with axillary lymph node tuberculous infection with breast edema, clinically and radiographically indistinguishable from tuberculous mastitis. After six months of comprehensive antituberculosis pharmacological treatment, the persistence of breast edema required repeating diagnostic tests searching for malignancy, all of which were negative. Rehabilitation treatment with complex physical therapy improved the patient's clinical and symptomatic condition. Clinical suspicion of secondary lymphedema is crucial to avoid unnecessary diagnostic procedures and ensure adequate and timely treatment.

Objective: Breast cancer (BC) is a global concern due to its high incidence worldwide. The alarming increase in BC cases highlights the need for careful management of the disease at multiple levels. This study investigated the diagnostic value of hemoglobin, albumin, lymphocyte and platelet counts (HALP score), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) in newly diagnosed BC patients.

Materials and methods: A total of 84 individuals, including 42 healthy volunteers (group I) and 42 patients newly diagnosed with BC (group II), were included. Serum albumin levels were determined using spectrophotometry. The levels of tumor-markers carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA 15-3) in serum were analyzed by electrochemiluminescence immunoassay. Hemogram parameters were analyzed using fluorescence flow cytometry.

Results: The median PLR was significantly lower in group II than group I (p = 0.014). There were no statistical differences in HALP score, NLR, LMR, and prognostic nutrition index between the two groups (p = 0.133, p = 0.993, p = 0.591, and p = 0.294, respectively). The sensitivity and specificity of PLR in predicting BC were 61.90% and 64.29%, respectively, with an area under the curve of 0.665 (p = 0.009, 95% confidence interval: 0.5480 to 0.7819, cut-off value ≤124). PLR, CEA and CA 15-3 were independent risk factors for BC (p<0.05).

Conclusion: The findings suggest that PLR may serve as a potential biomarker for the early diagnosis of BC; however, further validation is required. Conversely, the HALP score and other parameters did not demonstrate a significant association with early BC diagnosis. These results warrant corroboration through regional and community-based studies.

Primary breast leiomyosarcoma is an extremely rare malignancy, accounting for approximately 1% of breast tumors and less than 5% of soft tissue sarcomas. Due to its rarity, standardized treatment guidelines remain unclear. We report the case of a 38-year-old woman who presented with a 3 cm, freely mobile breast nodule, initially classified as American College of Radiology Breast Imaging Reporting and Data System 4 on imaging. Core needle biopsy confirmed primary breast leiomyosarcoma, with histopathological and immunohistochemical analysis revealing strong positivity for α-smooth muscle actin, desmin, and H-caldesmon, consistent with smooth muscle differentiation. Epithelial, neural, and vascular markers were negative, ruling out differential diagnoses. The Ki-67 index was 15%, indicating moderate proliferative activity. Staging classified the tumor as T2N0M0 (Stage IIA, the American Joint Committee on Cancer 8^th edition), and the patient underwent radical mastectomy with sentinel lymph node exploration, followed by adjuvant radiotherapy. Despite the aggressive nature of leiomyosarcomas, this case exhibited favorable prognostic factors, including small tumor size, intermediate grade, negative margins, and no lymphatic spread, suggesting a less aggressive course. After four years of follow-up, the patient remains free of complications, underscoring the importance of long-term monitoring and the need for further research to refine therapeutic approaches.

Objective: Aromatherapy is widely used in the management of symptoms caused by interventional procedures. This randomized controlled trial evaluated the effectiveness of lavender and lavender-peppermint aromatherapy before breast biopsy for reducing women's pain and anxiety.

Materials and methods: This trial was conducted in the breast outpatient clinic of a university hospital in İstanbul between July 2021 and March 2023. Patients were randomly assigned to one of two intervention groups; lavender or lavender-peppermint or the control group. Twenty minutes before the breast biopsy, a small pad impregnated with lavender or lavender-peppermint essential oil was attached to each patient at shoulder level, allowing for inhalation. The patients' anxiety and pain levels were assessed before and after the biopsy procedure using the state anxiety inventory and visual analogue scale, respectively.

Results: Study population was 135 patients, equally divided between lavender, lavender-peppermint or control groups (each n = 45). The mean age of the patients was 46.30±10.31 years, 76% were married, 65.9% were employed, and 64.4% underwent thick-needle biopsy. After the biopsy, reported anxiety and pain levels had decreased significantly more in the aromatherapy groups compared to the control group (p<0.05). However, no significant difference was found between the lavender and lavender-peppermint groups in terms of anxiety and pain reduction (p>0.05). Anxiety and pain levels were positively correlated (r = 0.406; p<0.001).

Conclusion: The use of lavender and lavender-peppermint essential oil via inhalation before breast biopsy was effective in reducing reported anxiety and pain levels. Implementing lavender and lavender-peppermint essential oil inhalation before interventional procedures may offer a simple and cost-effective approach to improving patient outcomes.

Objective: Breast cancer is the most prevalent cancer among women worldwide. In developing countries, fine needle aspiration cytology (FNAC) is commonly used for screening to reduce mortality rates. The International Academy of Cytology has established the Yokohama system to enhance diagnostic clarity and communication between pathologists and clinicians. A triple test approach, incorporating clinical evaluation, imaging, and FNAC, can further improve patient care for breast lesions and may enhance the Yokohama System's effectiveness.

Materials and methods: A prospective study about breast FNAC was done over a period of one year, from October 2022 to September 2023. The study involved patients with breast lesion referred for FNAC in the department of Pathology. The FNAC results were further classified using the Yokohama system for reporting breast cytopathology, 2016. The cytological findings were correlated with available histopathological results.

Results: In the study of 104 cases, 60 (57.7%) of whom had available histopathology results, breast lesions were categorized using the Yokohama system as: 7.7% insufficient, 47.1% benign, 26.9% atypical, 2.9% suspicious of malignancy, and 15.4% malignant. The risk of malignancy varied by category: 0% for category 1, 3.2% for category 2, 47% for category 3, and 100% for categories 4 and 5. The maximum sensitivity was 94.7% when considering atypical, suspicious, and malignant cases as positive. The highest specificity was 97.56% for malignant cases alone, while the best diagnostic accuracy was 83.3% when both malignant and suspicious cases were counted as positive.

Conclusion: The Yokohama system effectively classified borderline lesions, facilitating early detection and improved management options. By integrating FNAC with standardized reporting, healthcare providers can make informed decisions, enhancing the diagnosis and treatment of breast lesions.