فصلنامه بیماری های پستان ایران
سال دهم شماره 2 (پیاپی 37، تابستان 1396)

The status of the axillary lymph node is the most important factor in determining the prognosis of breast cancer. The aim of this study was to evaluate the sensitivity and specificity of Axillary Ultrasound (AUS) in the diagnosis of lymph node involvement in breast cancer patients referred to the Breast Cancer Research Center (BCRC) between March 2015 and Aug 2016.
Through a cross sectional study, all patients with a diagnosis of non-metastatic breast cancer with Stage I, II, IIIA and no chemotherapy before surgery were evaluated. The results of AUS and pathology after surgery were collected and analyzed using SPSS based on sensitivity and specificity formula.
Of a total of 140 patients, the average age was 48.87 and the mean size of masses was 2.31 cm (0.4 -10 cm). Physical examination was positive in %14.6 of patients, positive AUS in %28.6 and pathologic axillary involvement in %39.2 of the patients. Sensitivity, specificity, PPV and NPV of AUS in diagnosing lymph node involvement were %55.5, %88.3, %75 and %76 respectively. Sensitivity, specificity, PPV and NPV of clinical examination were %31.48, %97.67, %89.4 and 69.4. The combination of positive AUS and physical examination were along with pathologic axillary involvement in %92.3 of patients. False positivity and false negativity of AUS were %11.6 and %17.1 in all.
The sensitivity and specificity of AUS in our patients is the same as the results of other countries. Clinical examination alone has a high false negative and low sensitivity, however AUS in addition to physical examination has higher sensitivity which could predict axillary involvement and lead to axillary dissection without sentinel node biopsy. Negative AUS has about %24 false negativity and SLNB could not be omitted until the results of trials would be published.

3D Automated Breast Ultrasound System (ABUS) is a new imaging modality which can be utilized for early diagnosis of breast cancer. Mass segmentation plays an important role in ABUS because the segmented region is used for mass volume estimation, temporal comparison and diagnosing the type of masses as benign or malignant.
In this paper a geometric model called distance regularized level set evolution (DRLSE) has been applied for mass segmentation. This model is categorized into edge based deformable models. We implemented DRLSE in three dimensions and modified the Neumann boundary conditions as well. Afterwards, a force named balloon force was adjusted to approach the initial contour to the mass borders.
In the presented work Dice similarity measure has been used for evaluation of the proposed segmentation method. Based on the results, we concluded that using a balloon force of -5.5 we can achieve a Dice of 0.52. This result is calculated by comparing the output of the proposed computerized segmentation method and the manually segmented regions by an expert radiologist on a dataset with 50 masses.
The resulted similarity is higher than 0.4 which is an acceptable level for segmentation of masses in ABUS.

In spite of high prevalence of lymphedema in Iranian breast cancer patients, there is no valid instrument for measuring Quality of Life and its subscles in them. The aim of this study was Psychometrics of Persian Version of the Lymphedema Life Impact Scale (LLIS) Questionnaire in breast cancer induced lymphedema to provide an applicable instrument.
LLIS is an 18-item measure of physical, psychosocial, and functional impairments caused by lymphedema. The Persian version was validated by forward-backward method. It was fulfilled by 200 breast cancer patients with lymphedema and 200 patients without lymphedema. Accuracy of all questions and subscales of translated questionnaire in estimating outcome was evaluated by Confirmatory and Exploratory factor analysis.
Confirmatory Factor Analysis approeved the hypothesis of similarity of two questionnaire in predictiong the outcome. CFI and RSMA indices showed good fitness of correlation between 18 Items. Exploratoty factor analysis approved three physical, functional and psychosocial subscales. Analysis showed that infection history categorization should be replaced from functional subscale to functional subscale.
Findings of study showed an acceptable validity and reliability of Persian version of LLIS in patients with breast cancer induced lymphedema. But It seems that categorization of subscales should be revised. This can be developed in a new Iranian standardized version after taking permission from English version’s authors.

Breast cancer is known as a chronic disease to which its diagnosis and treatment is accompanied with a lot of psychological problems; and it necessitates the application of an effective and useful therapy. The aim of this study was to examine the efficacy of MBCT on emotion regulation among patients with breast cancer.
Methods A randomized controlled trial, with pre-test, post-test assessments and control group, was conducted. As a sample, 27 patients (14 patients on experimental group and 13 patients on control group) with the diagnosis of breast cancer were selected among the patients who referred to the Department of Oncology and Radiotherapy of Shohaday-e 7 Tir Hospital in Tehran using convenient sampling method, and were randomly assigned into the experimental and control groups. Experimental group received 8 sessions MBCT but control group did not receive any interventions. All the participants completed emotion regulation questionnaires on the pre-test and post-test phases. Data was analyzed through multivariate covariance analysis model using SPSS 21 software.
Findings revealed that there is significant difference between emotion regulation of experimental and control groups at pre-test and post-test phases. So MBCT significantly improved emotion regulation (p The results showed that MBCT improve patient emotion regulation by challenging the thought and correcting the emotions so MBCT could be a useful treatment for improving psycho-social consequence of breast cancer and patients’ self-care.

Apoptosis and tumor growth are inhibited by intratumoral miR-21 via upregulation of bcl-2. Hence, the aim of the present study was determine the effects of continuous endurance training (ET) and high intensity interval training (HIIT) on intratumoral miR-21 and bcl-2 of breast cancer bearing female mice.
Eighteen female BALB/c mice after inducing breast cancer through MC4-L2 cell lines injection were randomly divided into three groups (n=6) including control, continuous endurance training (ET) and high intensity interval training (HIIT). Then, both experimental groups including ET (75 min/day, constant running speed corresponding to 60–65%) and HIIT (six intervals for 3 min and 20 seconds, 85-90% V̇O2 peak, 90 second of active rest at 30-35% V̇O2 peak separating intervals) performed exercise protocols at 15% inclination, five days a week for ten weeks. Tumor volume was measured and recorded by caliper every week. miR-21 and bcl-2 gene expression were determined by qReal-time PCR. Statistic data values also were measured by One-way ANOVA.
The results of the present study showed that miR-21 gene expression was significantly reduced in both experimental groups compared to control group (p≤0.001). While, bcl-2 gene expression had no significant change in comparison with control group (p≥0.05). There was also observed a significant reduction in tumor volume of two experimental groups in comparison with control group. It should be noted that tumor volume reduction in HIIT was larger than ET.
HIIT is possibly more effective than ET in attenuating cancer cells progression via its intratumoral effects.

Nocardia are aerobic, branching, gram-positive bacterium, acid-fast and slow-growing bacteria which are lives in widely environmental resources such as water, soil, dust particles and decaying plants. This group of bacteria can enter the human body through inhalation of dust particles or traumatic inoculation, and can cause nocardiosis infection in immune-compromised patients and even healthy people (1). Patients with immune deficiency such as cancer patients, chronic granulomatous inflammation, rheumatoid arthritis, Behcet's syndrome, diabetes, systemic lupus erythematosus, pemphigus vulgaris, and transplant recipients due to use of drugs that suppress the immune system, are prone to Nocardial opportunistic infections, Trypanosoma cruzi, Giardia lamblia, Pneumocystis jiroveci, Moraxella catarrhalis, Cytomegalovirus, and Coxsackie virus B (1,2). In these cases, infections in these individuals are reported to be 70% (3).
Breast abscesses in developed countries have been reported to be 11%; breast abscesses are commonly caused by infection with Staphylococcus aureus, Streptococcus agalactia, negative coagulase staphylococci, Enterobacteriaceae and, rarely aerobic actinomycetes (for example Nocardia, Mycobacterium and Gordonia) (4,5). The prevalence of Nocardial infections is increasing worldwide (6,1). Although the statistics of Breast Nocardial abscesses are low but according to the death rates of Nocardial infections, lack of diagnosis and the long-term treatment period of this infection, it is necessary to recognize Nocardial infections (5,1). Given that Nocardial infection cannot be detected based on clinical manifestations and radiological findings; Therefore, laboratory techniques such as cultivation, gram and Kinyoun staining are still considered standard methods for detecting and diagnosing the Nocardia infections (7,1). Gram and kinyoun stains, and growth in broth lysozyme are one of the important tests for identification of the Nocardia genus (1). According to available reports, Nocardia infections can be isolated from the pus (100%), Bronchial secretions (41%), tissue samples (63%); blood and urine samples less frequently (7). The lack of proper diagnosis of Nocardia infections has caused death in over 30% of cases, which indicates the importance of identifying the genus of Nocardia at the species level (8). Studies have also shown that Nocardia spp. have a different and specific drug susceptibility patterns; in addition, The inappropriate administration of trimethoprim-sulfamethoxazole has caused some Nocardia species to be resistant to this drug; Therefore, isolation, detection of the species and determination of the antibiotic resistance pattern is great importance (9,1).