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The Surgical Clinics of North America Dec 2022Cystic conditions are the most common disorder of the breast. Simple cysts are not malignant and do not require intervention. Patients with symptomatic simple cysts can... (Review)
Review
Cystic conditions are the most common disorder of the breast. Simple cysts are not malignant and do not require intervention. Patients with symptomatic simple cysts can undergo elective aspiration, and typical cyst fluid can be discarded. Bloody fluid should be sent for cytology. Cysts with thick walls, thick septations, or solid components have a risk of malignancy and should undergo biopsy.
Topics: Humans; Cysts; Biopsy
PubMed: 36335927
DOI: 10.1016/j.suc.2022.07.004 -
Breast Cancer Research and Treatment Dec 2022This study assessed the upgrade rates of high-risk lesions (HRLs) in the breast diagnosed by MRI-guided core biopsy and evaluated imaging and clinical features...
PURPOSE
This study assessed the upgrade rates of high-risk lesions (HRLs) in the breast diagnosed by MRI-guided core biopsy and evaluated imaging and clinical features associated with upgrade to malignancy.
METHODS
This IRB-approved, retrospective study included MRI-guided breast biopsy exams yielding HRLs from August 1, 2011, to August 31, 2020. HRLs included atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, and papilloma. Only lesions that underwent excision or at least 2 years of MRI imaging follow-up were included. For each HRL, patient history, imaging features, and outcomes were recorded.
RESULTS
Seventy-two lesions in 65 patients were included in the study, with 8/72 (11.1%) of the lesions upgraded to malignancy. Upgrade rates were 16.7% (2/12) for ADH, 100% (1/1) for pleomorphic LCIS, 40% (2/5) for other LCIS, 0% (0/19) for ALH, 0% (0/18) for papilloma, and 0% (0/7) for radial scar/complex sclerosing lesion. Additionally, two cases of marked ADH bordering on DCIS and one case of marked ALH bordering on LCIS, were upgraded. Lesions were more likely to be upgraded if they presented as T2 hypointense (versus isotense, OR 6.46, 95% CI 1.27-32.92) or as linear or segmental non-mass enhancement (NME, versus focal or regional, p = 0.008).
CONCLUSION
Our data support the recommendation that ADH and LCIS on MRI-guided biopsy warrant surgical excision due to high upgrade rates. HRLs that present as T2 hypointense, or as linear or segmental NME, should be viewed with suspicion as these were associated with higher upgrade rates to malignancy.
Topics: Female; Humans; Breast Neoplasms; Retrospective Studies; Cicatrix; Breast; Breast Carcinoma In Situ; Carcinoma, Intraductal, Noninfiltrating; Image-Guided Biopsy; Hyperplasia; Magnetic Resonance Imaging; Precancerous Conditions; Fibrocystic Breast Disease; Papilloma; Biopsy, Large-Core Needle
PubMed: 36242709
DOI: 10.1007/s10549-022-06761-7 -
Journal of the West African College of... 2022Breast lumps have been reported as the most common breast symptom among adult females in Western Nigeria and are benign in 60% of cases. In South-Eastern Nigeria,... (Review)
Review
BACKGROUND
Breast lumps have been reported as the most common breast symptom among adult females in Western Nigeria and are benign in 60% of cases. In South-Eastern Nigeria, fibroadenoma has been reported as the most common breast disease (47.5%), followed by carcinoma (30.4%) and fibrocystic disease. The aim of this study was to determine the correlation between sonographic and histopathologic findings in women who presented with breast masses.
MATERIALS AND METHODS
This was a cross-sectional study conducted among 160 consecutive female patients who presented with breast masses. A breast ultrasound scan was carried out to categorize the masses using the American College of Radiology Breast Imaging Reporting and Data System classification, and the histopathological diagnoses of the masses were obtained. The correlation of the sonographic findings and histopathological diagnoses was determined using the Statistical Package for Social Sciences (SPSS) IBM version 23.0.
RESULTS
Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were found to be 79.5%, 98.3%, 93.9%, 93.7%, and 93.8%, respectively. There was a positive correlation between the sonographic findings and histopathological diagnoses of the breast masses, which was statistically significant ( = 0.000, r = 0.846).
CONCLUSION
This study found a statistically significant positive correlation between sonographic findings and histopathological diagnoses of breast masses.
PubMed: 36213797
DOI: 10.4103/jwas.jwas_84_22 -
Breast Cancer Research and Treatment Dec 2022When Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex...
PURPOSE
When Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex Sclerosing Lesion (RS), excisional biopsy (EB) is often performed to rule out underlying malignancy with upstage rates (UR) ranging between 1 and 20%. The COVID-19 pandemic led to delayed EB for many patients. We sought to evaluate whether this delay was associated with higher UR.
METHODS
We performed a retrospective analysis of women who underwent CNB and then EB for ADH, FEA, IDP, or RS between 2017 and 2021 using an IRB-approved repository. UR was evaluated by days between CNB and EB.
RESULTS
473 patients met inclusion. 55 were upstaged to cancer (11.6%). 178 patients had pure ADH on CNB and 37 were upstaged (20.8%). 50 patients had pure FEA and 3 were upstaged (6%). 132 had pure IDP and 7 were upstaged (5.3%). 98 had pure RS and 1 was upstaged (1%). 7/15 (46.7%) had a combination of diagnoses or diagnosis with palpable mass and were upstaged. Days between CNB and EB were < 60 for 275 patients (58.1%), 60-90 for 108 (22.8%), 91-120 for 43 (9.1%), and > 120 for 47 (9.9%). There was no significant difference in UR (10.9% for < 60, 14.8% for 60-90, 7% for 90-120, and 12.8% for > 120, p = 0.54). UR for ADH was clinically increased after 60 days (27.8 vs. 17.5%), but this did not reach statistical significance (p = 0.1).
CONCLUSION
Surgical delay was not associated with an increased UR.
Topics: Female; Humans; Biopsy, Large-Core Needle; Breast; Breast Neoplasms; Carcinoma in Situ; Carcinoma, Intraductal, Noninfiltrating; Cicatrix; Fibrocystic Breast Disease; Hyperplasia; Pandemics; Papilloma, Intraductal; Retrospective Studies
PubMed: 36181604
DOI: 10.1007/s10549-022-06745-7 -
Scientific Reports Sep 2022Radio-resistance resulting from radiotherapy-induced fibrosis is a major clinical obstacle in breast cancer treatment because it typically leads to cancer recurrence,...
Radio-resistance resulting from radiotherapy-induced fibrosis is a major clinical obstacle in breast cancer treatment because it typically leads to cancer recurrence, treatment failure, and patient death. Transforming growth factor-β (TGF-β) is a key signal messenger in fibrosis, which plays an important role in radiation-induced fibrosis and cancer stem cell (CSC) development, may be mediated through the generation of oxidative stress. This study was conducted to confirm the efficacy of vactosertib, a TGF-β/ALK5 inhibitor, as a potent inhibitor in radiation-induced oxidative stress generation, fibrosis and CSC development. We used a 4T1-Luc allograft BALB/c syngeneic mouse model and 4T1-Luc and MDA-MB-231 cells for histological analysis, qRT-PCR, western blotting, ROS analysis, mammosphere formation analysis, monolayer fluorescence imaging analysis. Radiotherapy induces TGF-β signaling, oxidative stress markers (4-HNE, NOX2, NOX4, PRDX1, NRF2, HO-1, NQO-1), fibrosis markers (PAI-1, α-SMA, FIBRONECTIN, COL1A1), and CSC properties. However, combination therapy with vactosertib not only inhibits these radiation-induced markers and properties by blocking TGF-β signaling, but also enhances the anticancer effect of radiation by reducing the volume of breast cancer. Therefore, these data suggest that vactosertib can effectively reduce radiation fibrosis and resistance in breast cancer treatment by inhibiting radiation-induced TGF-β signaling and oxidative stress, fibrosis, and CSC.
Topics: Aniline Compounds; Animals; Female; Fibrocystic Breast Disease; Fibronectins; Fibrosis; Humans; Mice; NF-E2-Related Factor 2; Neoplasm Recurrence, Local; Oxidative Stress; Plasminogen Activator Inhibitor 1; Reactive Oxygen Species; Transforming Growth Factor beta; Transforming Growth Factors; Triazoles
PubMed: 36167880
DOI: 10.1038/s41598-022-20050-9 -
Radiology Case Reports Oct 2022Male breast lesions are relatively less common. The most encountered malignant lesion in the male breast is ductal adenocarcinoma; and benign lesions are gynecomastia,...
Male breast lesions are relatively less common. The most encountered malignant lesion in the male breast is ductal adenocarcinoma; and benign lesions are gynecomastia, fibrocystic disease, intramammary lymph node, fibroadenoma, lipoma and epidermal inclusion cyst (EIC), respectively [5,6]. To date, there had been published only a few cases of EIC of the male breast in literature [3,5,6]. In this case, we aimed to present a new case of EIC with its clinical, radiological and pathological characteristics in the male breast. It had benign sonographic and magnetic resonance imaging findings but had also malignant imaging findings with diffusion restriction on diffusion-weighted imaging.
PubMed: 36032200
DOI: 10.1016/j.radcr.2022.07.097 -
Journal of Obstetrics and Gynaecology... Oct 2022Tamoxifen is prescribed for chronic mastalgia at a dosage of one 10- or 20-mg tablet for 3-6 months. A topical preparation of this drug has recently been approved. The... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Tamoxifen is prescribed for chronic mastalgia at a dosage of one 10- or 20-mg tablet for 3-6 months. A topical preparation of this drug has recently been approved. The aim of this study was to meta-analyze the effectiveness of tamoxifen and its different regimens for the treatment of mastalgia. We also sought to summarize the side effects and the follow-up results of these treatments.
DATA SOURCES
We searched the databases of PubMed/ MEDLINE, Central, Embase, and EBSCO from August 2021 to September 2021.
STUDY SELECTION
Articles on the effects of tamoxifen in mastalgia were searched, and randomized controlled trials were retrieved for inclusion in this study. PRISMA guidelines were followed, and we selected 9 articles for the meta-analysis.
DATA EXTRACTION AND SYNTHESIS
A proforma was prepared for data collection. RevMan 5.4 software was used for methodological quality assessment, statistical analysis, and preparation of forest plots. Oral tamoxifen performed better than placebo (risk ratio [RR] 2.04; 95% CI 1.49-2.78, P < 0.001). No significant difference in efficacy was seen between the 10- and 20-mg dosages (RR 1.08; 95% CI 0.97-1.21, P = 0.18) when used for 3 months.
CONCLUSION
Oral tamoxifen is helpful in long-standing mastalgia. It is safe and effective at an oral dose of 10 mg.
Topics: Humans; Mastodynia; Randomized Controlled Trials as Topic; Tamoxifen
PubMed: 35752405
DOI: 10.1016/j.jogc.2022.06.006 -
Diagnostics (Basel, Switzerland) Jun 2022Microglandular adenosis is a non-lobulocentric haphazard proliferation of small round glands composed of a single layer of flat to cuboidal epithelial cells. The...
Microglandular adenosis is a non-lobulocentric haphazard proliferation of small round glands composed of a single layer of flat to cuboidal epithelial cells. The glandular structures lack a myoepithelial layer; however, they are surrounded by a basement membrane. Its clinical course is benign, when it is not associated with invasive carcinoma. In around 30% of cases, there is a gradual transition to atypical microglandular adenosis, carcinoma in situ, and invasive breast carcinoma of several different histologic subtypes, including an invasive carcinoma of no special type, metaplastic matrix-producing carcinoma, secretory carcinoma, metaplastic carcinoma with squamous differentiation, acinic cell carcinoma, spindle cell carcinoma, and adenoid cystic carcinoma. Recent molecular studies suggest that microglandular adenosis is a non-obligate precursor of triple-negative breast carcinomas. In this manuscript, we present a unique case of microglandular adenosis associated with metaplastic matrix-producing carcinoma and HER-2 neu oncoprotein positive pleomorphic lobular carcinoma in situ with apocrine differentiation in a 79-year-old patient.
PubMed: 35741268
DOI: 10.3390/diagnostics12061458 -
Clinical Breast Cancer Oct 2022B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years...
INTRODUCTION
B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" B3 lesions surgically excised, by analyzing recurrence and subsequent development of invasive/in-situ cancer.
PATIENTS AND METHODS
A 10-year retrospective review from 2010 to 2019 was performed of B3 lesions diagnosed on core needle biopsy, including patients who proceeded to surgical excision with a high-risk lesion on final histology. The database recorded 6 specific B3 lesion categories: 1. Atypical ductal hyperplasia (ADH), 2. Radial scars/complex sclerosing lesions (CSLs) with epithelial atypia 3. Classical Lobular neoplasia (ALH/LCIS), 4. Papillary lesions with epithelial atypia, 5. Mixed, 6. Flat epithelial atypia (FEA), including radiological and clinical follow-up data.
RESULTS
Six hundred sixteen patients had a B3 lesion after core biopsy. 110 patients had "high risk" lesions. This included 17 (15.5%) Atypical Ductal Hyperplasia (ADH), 22 (20%) radial scars/CSLs with epithelial atypia, 47 (42.7%) classical lobular neoplasia (LCIS/ALH), 7 (6.4%) papillary lesions with epithelial atypia, 13 (11.8%) mixed lesions & 4 (3.6%) Flat Epithelial Atypia (FEA) lesions. 4 of 110 (3.6%) developed invasive/in-situ disease and 4 of 110 (3.6%) developed recurrence during follow-up. 33 of 616 (5.4%) upgraded to invasive/preinvasive disease after surgical excision.
CONCLUSION
Five years of routine radiological surveillance may not be necessary in patients who undergo surgical excision of "high-risk" B3 lesions. Clinical surveillance appears to be of little benefit, especially in patients with radial scars, papillary lesions, and FEA. Subsequent development of invasive/in-situ disease in patients who undergo surgical excision of atypical B3 lesions remains low.
Topics: Biopsy, Large-Core Needle; Breast; Breast Neoplasms; Carcinoma in Situ; Carcinoma, Intraductal, Noninfiltrating; Cicatrix; Female; Fibrocystic Breast Disease; Follow-Up Studies; Humans; Mammography; Precancerous Conditions; Retrospective Studies
PubMed: 35732544
DOI: 10.1016/j.clbc.2022.05.009 -
Pathology International Jun 2022Acinic cell carcinoma (AcCC) of breast is a rare subtype of triple-negative breast carcinoma demonstrating a wide morphologic spectrum. In this study, we perform a...
Acinic cell carcinoma (AcCC) of breast is a rare subtype of triple-negative breast carcinoma demonstrating a wide morphologic spectrum. In this study, we perform a detailed morphologic and immunohistochemical description of two cases of the rare entity and review the published relative literature. Histologically, the two cases both showed predominantly microglandular and solid structures overlapping with the histological features of microglandular adenosis (MGA), and one case presented spindle cell metaplastic carcinoma with chondromyxoid matrix as a minor morphologic pattern. In two cases, most of the cancer cells were positive for lysozyme and antitrypsin strongly and extensively, but negative for estrogen receptor (ER), progesterone receptor (PR), androgen receptors (AR) and human epidermal growth factor receptor 2 (HER2). The true relationship between breast AcCC and MGA or carcinoma arising in MGA(CAMGA) may remain unclear; re-excision is advised when the MGA-like content extends to the surgical margins in the setting of breast AcCC. More cases and further molecular investigations are required to elucidate the true histogenesis and give the patients appropriate treatment.
Topics: Breast Neoplasms; Carcinoma; Carcinoma, Acinar Cell; Female; Fibrocystic Breast Disease; Humans; Immunohistochemistry; Triple Negative Breast Neoplasms
PubMed: 35512568
DOI: 10.1111/pin.13227