Archives of Breast Cancer
Volume:3 Issue: 4, Nov 2016

Electrochemotherapy is a relatively new technique in the treatment of skin metastases that are not amenable to conventional therapy. Its use in breast cancer is now established in many European centers.
Published literature of electrochemotherapy in terms of its scientific basis, current clinical practice of breast cancer treatment providers, as well as the future directions for the technology has been reviewed.
Collective global experience of the last 10 years has demonstrated Electrochemotherapy is a safe, well-tolerated and effective treatment of cutaneous breast cancer metastases and good outcome characteristics have been identified. However, successful treatment requires appropriate patient selection.
Electrochemotherapy is now established as a standard of care for cutaneous metastases. Its future use may extend to gene therapy and the treatment of visceral tumors.

Transvaginal ultrasound is one of the most common means to examine endometrial cavity lesions although its negative results are more valuable. Saline sonohysterography can reduce the number of false negative rates of endometrial lesions diagnoses in Tamoxifen consumers. The Objective of this study was to determine the diagnostic values of saline infusion sonohysterography (SIS) and hysteroscopy as gold standard in diagnosis of endometrial pathologies in patients with breast cancer receiving adjuvant therapy with Tamoxifen for at least 6 months.
This cross-sectional study was conducted on 40 patients with breast cancer who were treated with for at least 6 months and referred by the gynecologist for evaluation. Age, duration of Tamoxifen use and symptoms were recorded. Patients were examined by saline sonohysterography. Ultrasonic endometrial findings were recorded. Patients with positive findings were referred for hysteroscopy and biopsy was taken for pathologic examination. Then we compared the results.
In total, 40 patients with a mean age of 46.5±7.81 years and mean duration of Tamoxifen treatment 18.4 ±13.98 months were included. There were intrauterine lesions in 22 patients and they did not undergo hysteroscopy. For others, 9 patients with endometrial polyp (21.41%), 3 patients with endometrial hyperplasia (7.14%) were found. The accuracy of SSH in diagnosing endometrial polyp, endometrial hyperplasia and submucosal fibroma were 87.5%, 92.5% ,97.5%, respectively.
Saline sonohysterography is a viable option for screening of the patients instead of endometrial biopsy as it has great negative predictive value. Sonohysterography is easy, non-invasive, inexpensive and has great accuracy.

Axillary nodal spread is an established prognostic factor in breast cancer. Axillary nodal dissection and subsequent pathological examination is considered the gold standard technique of assessing the axilla for metastatic disease. A minimum of ten level I axillary nodes are required to be examined before an axillary specimen can be reliably labeled as disease free. This recommendation is based on a mathematical prediction model and such methodology has certain inherent limitations. In this study, we sought to revisit this concept of minimum nodes required to deem an axilla as true negative by using a linear correlation model.
Medical records of 165 consecutive breast cancer patients attending a medical oncology department for adjuvant therapy were assessed for inclusion. One hundred and forty-five breast cancer patients in clinical stages I-III met the inclusion criteria. Patients referred after neoadjuvant chemotherapy, breast conservation surgery, palliative mastectomy, and mastectomy for metastatic disease were excluded from the study. The study samples were segregated into groups of 1-5, 6-10, 11-15, 16-20, 21-25, and more than 25 nodes. A linear regression model was used to assess the association between the nodal positivity and nodal groups. The spearman rho with P value was calculated for the model. Factors influencing the nodal yield of an axillary specimen were selected from the published literature and the same variables were evaluated in the study cohort.
A total of 1882 nodes were harvested from 145 axillary specimens and 320 nodes were positive for metastatic disease. The mean nodal harvest per axillary specimen was 11 nodes. The linear correlation model evaluating the association between nodal positivity and total nodal yield showed a spearman correlation coefficient of Rho = - 0.82 with P=0.04. To avoid bias due to the uneven sample size, the nodal ratio was calculated for each group and the linear association model reapplied to test the association with the total nodal harvest. A spearman rho of R = -0.94 with P=0.004 was obtained. The nodal groups tested for significance showed P= 0.0001 for the group 1-15 nodes. Evaluation of the factors likely to influence nodal yield showed that age (P=0.15) and obesity (P=0.67) had no effect on the nodal harvest. Tumor stage (P The recommendation of a minimum of ten axillary nodes to be examined to determine true negativity of an axillary specimen needs reassessment. A new minimum of fifteen nodes is suggested before an axillary specimen is reliably deemed free of metastatic disease.

The role of diagnostic pathology has become more prominent. This study aimed to compare the accuracy of frozen section compared with permanent section in the morning and afternoon working hours.
In this cross-sectional study, 99 patients with stage 1 and 2 breast cancer who underwent sentinel and non-sentinel lymph node biopsy between 2013 and 2015 were included.
The results of frozen section and permanent pathology of the lymph nodes were compared with one another. The time of pathologic evaluation including morning (before 2pm) and afternoon (after 2 pm) was also considered in the comparative analysis.
The mean age of the patients was 48.58±8.96 years. The accuracy of frozen section biopsy of the sentinel lymph node was 79.80%, 81.0%, and 78.0% in general, before 2 pm, and after 2 pm, respectively. The accuracy of frozen section biopsy of the non-sentinel lymph node was 62.32%, 65.1%, and 57.7% in general, before 2 pm, and after 2 pm, respectively.
There was no difference in the accuracy of the frozen section biopsy before and after 2 pm for the sentinel or non-sentinel lymph node biopsy.

Breast implant associated anaplastic large T- cell lymphoma is a rare type of non-Hodgkin lymphoma, with a reported incidence of 0.3% per 100,000 women with breast prosthesis per year. It presents most commonly as a peri-implant seroma, but may also present as a capsular mass, tumor erosion through skin, in a regional lymph node, or found incidentally during revision surgery.
We report a 68-year-old female patient who presented with a four month history of marked pain and swelling of the right breast, who upon implant removal and right sided capsulectomy, revealed pathology consistent with ALK negative, CD 30 positive anaplastic large T- cell lymphoma.
Breast implant associated anaplastic large cell lymphoma, although a rare clinical occurrence is of clinical significance. Prognosis is favorable in the majority of reported cases. Definitive treatment guidelines have yet to be determined after review of long-term follow-up data.

Breast conservation therapy (BCT) is the standard of care for early stage breast cancer. The procedure can be a challenge for the surgeon if the lesion is non-palpable. For excision of non-palpable breast lesions, they should be localized precisely before surgery. There are different techniques such as the WGL (Wire Guided Localization), ROLL (Radio-guided Occult Lesion Localization), etc. Some centers consider ROLL as the gold standard technique for excision of non-palpable breast lesions.
A 44-year-old woman with multifocal breast cancer presented to the breast clinic. Her imaging including MRI scan confirmed the presence of three tumors in the left breast and malignant looking nodes in the left axilla. Under ultrasound guidance, Core Needle Biopsy (CNB) of the breast lesions and Fine Needle Aspiration (FNA) of two lymph nodes in the left axilla were performed. Pathology of all three masses confirmed Invasive Ductal Carcinoma (IDC) and FNA of the lymph nodes was suspicious for malignancy. She was treated with breast conserving surgery using the ROLL technique. All three tumors were excised with adequate margins and axillary lymph node dissection was performed. The cosmetic results were satisfactory.
The ROLL technique is simple to perform and has several advantages compared to the WGL. We recommend this procedure, especially in multifocal non-palpable lesions.