Archives of Breast Cancer
Volume:7 Issue: 4, Nov 2020

Male breast cancer (MBC) accounts for less than 1% of breast cancer, requiring extrapolation of results from studies in women. The aim of the study is to evaluate prognostic and therapeutic factors with special focus in endocrine treatment (ET) on the disease outcome.

Observational, retrospective, single-center study of 53 MBC treated between January 1997 and December 2018 participated in the study. Among the participants, 48 patients had a performance status (PS) 0-1 (91%), 48 were hormone-receptor-positive (91%) and 4 were human epidermal growth factor 2 receptor (HER2) positive (8%). A total of 45 patients (85%) were treated with ET, with 36 patients (68%) receiving treatment in an adjuvant setting. The association analysis was performed using Chi-square test and survival was estimated using Kaplan-Meier with SPSS v25.

The cohort had a median age of 68 years old (range: 40-88). We found that 84% had a non-metastatic breast cancer. A breast cancer gene (BRCA) analysis was carried out in 43% of the patients, showing BRCA2 mutated in 26.1% of those analyzed, without obtaining a benefit in overall survival (P=0.698). The analysis showed higher 5-year overall survival (OS) for PS 0 (P=0.010), absence of vascular invasion (P=0.033), Ki67 ≤14% (P=0.041) and absence of metastasis at diagnosis (p<0.0001). Patients receiving adjuvant ET above 5 years had a longer median OS (89 vs 69.6 months, P=0.024), disease-free survival (DFS), and distant relapse (84 vs 48 months; P=0.005, and P=0.002, respectively).

Several prognostic factors for male breast cancer have been described. Noteworthy, patients receiving adjuvant ET above 5 years had a higher OS and DFS. BRCA did not show prognostic value in OS in this cohort. Further studies with larger sample size are necessary.

Triple negative breast cancer (TNBC) is a heterogeneous disease group with a higher recurrence risk and poorer prognosis. In this study, we aimed to investigate the frequency and prognostic value of androgen receptor (AR) expression in tissues of TNBC patients.

In this study a total of 60 TNBC patients treated between 2011 - 2016 in Shahid Sadoughi and Mortaz Hospital were included and their medical records were analyze. The available paraffin blocks were assessed immunohistochemically to determine AR expression. Tumors with ≥10% nuclear staining were considered AR-positive, while the ones with <10% staining were considered AR-negative. The association between AR expression, and clinical-pathologic characteristics and prognosis in TNBC was analyzed.

The result showed that AR expression in TBNC correlated with high risk of recurrence but no significant correlation with the age, grade, tumor size, lymph node status, type of diagnosis, tumor location, and Ki-67 level was observed. Positive immunoreactivity for AR was observed in 19 out of 60 (11%) specimens. No correlation was observed between the AR expression and the age, grade, tumor size, lymph node status, type of diagnosis, tumor location, and Ki-67 level. The AR-positive patients exhibited high risk of recurrence (P=0.016) and death (P=0.015) in comparison with the AR-negative patients. Concusions: AR may not be a suitable biomarker and treatment target for the Iranian Yazd patients with TNBC.

This study aimed to document referral-based barriers impeding Australian women's informed decision-making about breast reconstruction (BR) and to propose a designated BR referral pathway to help overcome these barriers.

Semi-structured, in-depth interviews were conducted with ten women previously treated for breast cancer, 9 breast and reconstructive surgeons and 6 health professionals [n=25] who had identified problems with referrals for BR.

Referral-based barriers to BR discussion were identified at three different levels: from a public or private screening centre to a General Practitioner (GP) or breast surgeon; from a GPto a breast surgeon; and from one breast surgeon (without BR skills) to another breast or plastic reconstructive surgeon (with BR skills). A lack of designated referral pathways has meant that clinically eligible women who are interested in considering immediate BR have been denied this opportunity.

Streamlining referral processes, along with patient and clinician education, would help to ensure that women are at least seen by the most appropriate clinicians to discuss BR options and to maximise their opportunity for BR should they choose that option. Designated referral pathways could also be useful in ensuring that preference-sensitive treatment decisions are facilitated in settings with varying degrees of resources and in a range of clinical conditions.

Encysted papillary carcinoma (EPC) is a rare breast neoplasm that mainly affects postmenopausal women. The purpose of this study was to examine whether a sentinel node biopsy would be deemed necessary in patients with a diagnosis of EPC and to determine if evidence of invasiveness can be diagnosed on a core needle biopsy with sufficient confidence to guide decision making for upfront axillary SLNB.

The available data of patients with EPC of the breast were reviewed at a tertiary breast cancer unit over a period of 10 years (2009-2019) and the concordance between core needle biopsy and final histology was assessed. We also carried out a detailed review of the available literature to inform best practice guidance for management of the axilla.

During the study, a total of 37 EPC patients were identified, of whom 10 were excluded as they declined further treatment, providing us a study sample of 27 patients. The median age at diagnosis was 72 years (range 47-97) and the vast majority of patients (96%) were Estrogen Receptor (ER) positive. Of the 27 patients treated, 17 (63%) underwent a diagnostic axillary Sentinel Lymph Node Biopsy (SLNB). On the final histology, 13/27 (48%) proved to have invasive disease. Atotal of 5 (18%) patients had evidence of metastasis in the axillary nodes, of whom only 7% had macro-metastatic disease that warranted further axillary treatment. None of the treated patients had evidence of recurrence or distant metastatic disease, to date (median of 5 years of follow up).

Encysted papillary carcinoma is associated with a low incidence of axillary node involvement. SLNB should only be carried out when there is evidence of invasive cancer. An algorithm was developed to help guide management of the axilla in cases diagnosed with EPC on diagnostic core needle biopsy

In women undergoing breast surgery, Measurement of Patient Related Outcome Measures (PROMs) is important for improving the process of care, focusing on the patient's perspective. BREASTQ is a validated patientreported outcome measure used increasingly in aesthetic and recostructive surgery. Only recently a breast conserving therapy module (BREASTQ-BCT) has been available. The aim of this study was to assess patient satisfaction and quality of life using BREAST-Q questionnaire in patients undergoing breast conserving surgery (BCS) plus IORT.

Women undergoing BCS plus IORT for an early-stage breast cancer for at least a year were invited by telephone to partecipate. We scheduled dedicated outpatient visits to our center. The medical interviewer collected medical history information and administered the BREASTQ-BCT in paper format. Data were inserted in a de-identified database. Univariate regression analysis was used to identify clinicopathological variables associated with "satisfaction with breast" domain score.

Overall, 38 women completed the questionnaire. The domains of the questionnaire that obtained the lowest scores were ‘satisfaction with IORT information’ and ‘satisfaction with breasts’(median score 59, IQR 55-73 and 51- 69.5). Weight of specimen and vascular invasion were risk factors for lower ‘Satisfaction with breasts’ at univariate analysis. There was a moderate-strong correlation between 'satisfaction with the breasts' and 'psychosocial wellbeing' and 'Sexual wellbeing'.

In this retrospective study, without a pre-operative questionnaire, changes in individuals’satisfaction and quality of life could not be identified. A prospective study comparing BCS plus external RT group and BCS plus IORT group could be informative.

Breast malignant growth is the most widely recognized disease in women in both highly and less developed nations where early detection is vital for life-saving and fast recovery. Recently, Photonic technologies has played a vital role in medical applications. Their satisfactory and viable implementation in therapy and diagnosis requires reliable information on the optical properties of human tissues. This study presents an outline of recent outcomes on the magnitude of breast tissue optical properties.

We established two different system setups utilizing hyperspectral (HS) camera and multiple excitation source lights with wavelength (380~1050 nm) for this investigation. The first setup (Transmission Mode) was applied for light transmission measurement of ex-vivo breast sample. Thereby, we made calculations of sample absorption. The second setup (Reflection Mode) was used for the measurement of breast sample light diffuse reflectance. The outcomes of both setups were used to select the optimum spectral image to differentiate between the normal and tumoral regions in the ex-vivo breast sample by exploring the optical properties spectroscopy in the Near and visible (NIR-VIS) spectrum. Finally, we applied the custom system on the case study technique for breast tumor detection.

Experimental investigations results showed that due to the various excitation wavelength light source (380~1050 nm) generates variable depths of penetration depth in the ex-vivo breast sample. Consequently, experimental results of the diffuse reflectance (Ŗd) provide the optimum spectral image at 600 nm for the diagnostic applications. However, the statistical calculation of the normalized signal validated the outcome at wavelength 680 nm. Additionally, we noticed the optimum spectral image for therapy applications at 700 nm by measurement of breast tissue transmission (Ţ) and attenuation absorption (Ą) calculation. Moreover, the statistical calculation of the normalized signal validated the outcome at wavelength 760 nm.

The proposed novel approach successfully provided promising results of the investigated breast sample optical properties in both diagnostic and therapy applications to assist the pathologist and the surgeon. The trail outcomes of the investigated case study were impressive for selecting optimum wavelength for diagnostic and treatment (680, 760 nm), respectively.

Breast leiomyosarcoma is a rare subtype of breast sarcoma, constituting 5–10% of the cases. Less than one-third of reported cases are located in the nipple papillary region, making it an extraordinarily rare malignancy, responsible for less than 0.1% of all malignant breast tumors. As no radiological criteria allow definitive diagnosis of papillary leiomyosarcoma, histopathological and immunohistochemical examination of suspicious lesions is required. The prognosis is generally optimistic compared with those for other breast sarcomas.

A 54-year-old previously healthy woman reported the appearance of a nodule in her right nipple in the preceding 9 months, associated with pruritus. Physical examination revealed that the lesion had a cystic consistency and measured approximately 3.0 cm. Imaging examinations showed no involvement of the adjacent breast parenchyma or axillary region and the lesion was classified as Breast Imaging-Reporting and Data System (BI-RADS) category IV. The lesion was excised, and the histopathological diagnosis was well-differentiated leiomyosarcoma of the mammary papilla, with immunohistochemical examination showing positivity for smooth-muscle tissue antigens. A staging CT examination was performed, showing no evidence of distant metastasis. After 2 years of followup, the patient shows no sign of tumor recurrence.

Although rare, leiomyosarcoma must be included in differential diagnosis of breast masses, especially those involving the periareolar region. Due to its good prognosis, reporting on this type of tumor is important to guide therapeutic planning, and to identify and track possible complications of its underdiagnosis.