Archives of Breast Cancer
Volume:9 Issue: 3, Aug 2022

With an increasing rate of lymphadenopathies (LAP) reported following COVID-19 vaccination with various vaccines, which can mimic breast cancer (BC), a comprehensive review, can disclose some practical information about BC workup that reduces the incidence and mortality of the disease along with unnecessary steps.

We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar. Keywords of literature search included “COVID-19”, “coronavirus disease”, “Vaccine”, and “Vaccination”, “LAP”, “Adverse event*”, “Lymph node”, “Cancer, breast”, and “Lymphadenopathy”.

In total, 59 studies (n=880 cases), including 412 (46.8%) females, 146 (16.6%) males, and 322 (36.6%) cases with unknown gender were reviewed. We reviewed the LAP presentation after vaccination of the first or second dosage of Pfizer-BioNTech (n=754, 85.7%), Moderna (n=38, 4.3%), Oxford-AstraZeneca (n=39, 4.4%), Sputnik V (n=1, 0.1%), Johnson & Johnson/Janssen (n=1, 0.1%), and CureVac (n=1, 0.1%). In 46 (5.3%) cases, the type of vaccine was not reported. The most common LAP locations were axillary (n=540), followed by axillary and supraclavicular (n=271). We found that imaging findings of LAP associated with vaccination were seen from the first day to two months after vaccination of the first or second dosage of different types of COVID-19 vaccines.

This review study can draw a broad perspective by focusing on patients with cancer, especially BC, for clinicians to proceed with the right approach at the right time without additional invasive measures and not to delay the necessary measures in high-risk patients at the same time.

Breast cancer is the most common cancer in women. Breastconserving surgery (BCS) has been increasingly applied to eligible patients. One of the most important points in BCS is to provide clean surgical margins. This study aimed to share the re-excision results of those having positive surgical margins in intra-operative evaluation among BCS patients, and to discuss the intra-operative evaluation in the light of the literature.

The data (patient files, surgery notes and pathology reports) of 203 patients who had undergone BCS for breast cancer between January 2016 and January 2022 and whose excision materials had been evaluated with intraoperative frozen sections in terms of surgical margins, were scanned retrospectively. Absence of ink on tumoral cells (“no ink on tumor”) for invasive ductal carcinoma (IDC), and a margin width of ≥2mm for ductal carcinoma in situ (DCIS) were considered as a clean surgical margin.

Median age was 51 years (range, 22-75). There were reportedly 27 patients with positive surgical margins, five of whom had positive margins in reexcision. Re-excision specimens of all these 5 cases (18.5%) had been reported to have no positive surgical margins. No patients had been reported to require a second re-excision or mastectomy.

Intraoperative surgical margin assessment eliminates the need for repetitive surgery. We recommend routine application of intra-operative surgical margin assessment.

Several studies have reported the role of platelet activation, platelet volume (MPV) and other indices in breast cancer but the data isinconsistent and diverse. The aim of this study was to systematically evaluate the role of platelet activation and platelet volume indices in women with BC as predictors of cancer progression and poor prognosis.

The patients were recruited from our local oncology center from 2019 to 2020 following ethics approval. In total, 80 patients with locally invasive BC, 20 metastatic, and 100 controls were recruited. ADP-induced platelet activation was assessed by light-transmission aggregometry. Platelet P-selectin (CD62P) expression with and without ADP stimulation was assessed by flowcytometry. The comprehensive analysis of platelet count and platelet volume indices (PVIs) (MPV, PDW, MPV/P and PDW/P) was conducted. Data was analyzed in relation to tumor pathology, hormone receptors (ER, PR, HER-2) and proliferation index Ki-67. Regression analyses were conducted to predict poor prognosis, tumor aggression and metastatic potential.

We found a significant increase in platelet aggregation (MA), CD62P expression, CD62P+ADP, MPV, PDW, MPV/P and PDW/P in the metastatic group compared to the locally invasive group. Univariate regression analysis showed significance for ADP MA, CD62P+ADP, MPV and PDW/P.

MPV/P and PDW/P can be used as simple low-cost predictors of cancer progression and poor prognosis. We conclude platelet activation and specific platelet indices can help predict prognosis in females with BC.

The aim of the study was to determine if the use of an intensive regimen (dose-dense) of chemotherapy may improve the response rate and outcome in patients with primary breast lymphoma (PBL), which is considered as lymphoma presentation with a poor prognosis.

Patients with pathologically confirmed diagnosis of diffuse large B-cell lymphoma with clinical presentation in the breast (PBL), > 18 years old, stage I and II, negative for immunodeficient syndrome, hepatitis A and B, previously untreated, and having non-germinal center cells were included in an open label clinical trial. Phase II patients received a dose dense regimen of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone).

Between July 2006 and December 2016, seventy-eight patients were enrolled in the study. Complete response was achieved in 76 (94.4%) patients. Five patients relapsed, so progression free survival at 5 years was 94.0% (95% confidence interval (CI: 87% to 98%%): three patients achieved a second response and are alive; the overall survival at 5-years was 95.3 (96% CI: 89% to 102%). Relapse at central nervous system has not been observed. Severe granulocytopenia was observed in 42.8 (93.0%) cycles, but no death associated with treatment was observed.

The use of a dose-dense regimen of chemotherapy improved the outcome in these patients; although severe acute toxicities were frequent, they were well-controlled. Relapse in central nervous system was not observed. Thus, we considered that dose-dense chemotherapy should be employed for this group of patients.

Cancer-Related Fatigue (CRF) is one of the most common complaints among cancer patients, which is experienced by 50-90% of them. It can affect several physical, emotional, and social aspects of cancer patients' lives and reduce their quality of life. In recent decades, the number of studies has increased in this regard, and several different ways for CRF management have been introduced. We aimed to assess the effect of Honey Jell ® on reducing cancer-related fatigue among breast cancer patients undergoing cancer treatment.

The current study was a 9-week, double-blind, randomized phase III clinical trial, which was carried out on 40 breast cancer patients at the Cancer Institute of Iran. The participants were randomly assigned to two groups by the Balanced-Block Randomization method. The study group received Honey Jell ® (natural product based on honey, royal jelly, and extract of Ziziphus zizyphus) while we used ordinary honey as a placebo for the control group. We assessed CRF at baseline, 2 and 4 weeks after the start of the study and four weeks after finishing the intervention using three different approaches. The mean score of fatigue was compared between the study groups during the study period using the T-test.

Mean of fatigue score for intervention and control cases was 39.80 (±9.6) and 38.4 (±11.1) at the baseline (P-value= 0.698). The figure reduced to 31.55 (±6.08) for the intervention group in the 2nd week, while for controls, it was 35.55 (±8.2) (P=0.041). The mean score of fatigue continuously reduced to 30.65 (±6.86) in the fourth week in the intervention cases, which was considerably lower than the figure for controls (36.05±5.20) (P=0.024). The mean score of CRF in the intervention group increased 31.80 (±6.91) four weeks after the end of the study, while it was almost unchanged for controls (36.64±6.13) and the observed difference was not statistically significant (P=0.148).

Honey Jell ® could be considered as an effective treatment to alleviate cancer-related fatigue. However, more studies are required in this regard.

Metastasis is the main cause of death toll among breast cancer patients. Since current approaches for diagnosis of lymph node metastases are timeconsuming, deep learning (DL) algorithms with more speed and accuracy are explored for effective alternativest.

A total of 220025 whole-slide pictures from patients’ lymph nodes were classified into two cohorts: testing and training. For metastatic cancer identification, we employed hybrid convolutional network models. The performance of our diagnostic system was verified using 57458 unlabeled images that utilized criteria that included accuracy, sensitivity, specificity, and P-value.

The DL-based system that was automatically and exclusively capable of quantifying and identifying metastatic lymph nodes was engineered. Quantification was made with 98.84% accuracy. Moreover, the precision of VGG16 and Recall was 92.42% and 91.25%, respectively. Further experiments demonstrated that metastatic cancer differentiation levels could influence the recognition performance.

Our engineered diagnostic complex showed an elevated level of precision and efficiency for lymph node diagnosis. Our innovative DL-based system has a potential to simplify pathological screening for metastasis in breast cancer patients.

Triple negative breast cancer (TNBC) is the most aggressive and worst prognosis group among breast cancer molecular subtypes. This retrospective study aimed at determining the prognostic factors affecting survival in the TNBC group.

Between 2010 and 2020, patients with invasive ductal carcinoma who received curative radiotherapy were included in the study. The patients were divided into two groups as TNBC and non-TNBC. Clinicopathological and treatment parameters of both groups were compared. Survival rates were evaluated using the Kaplan Meirer method.

One hundred ten (11.1%) of 992 patients were triple negative.The TNBC group showed more grade 2-3 tumors (95.8% vs 87.8%, P=0.019), a higher ki-67 value (72.7% vs 44.9%, P<0.001), more metastasis presence (28.2% vs 16.2%, P=0.002) and more exitus (28.2% vs 14.5%, P<0.001) than the non-TNBC group. Brain metastasis was observed more frequently in the TNBC group. In the TNBC group, being ≥70 years of age (P=0.05), having the T3-4 disease (P=0.040), the presence of perineural invasion (P=0.022), the presence of metastasis (P<0.001), and the presence of brain metastasis (P=0.049) had a negative effect on OS in univariate analysis. Having TNBC was determined as an independent variable that negatively affected both overall and disease-free survival in multivariate analysis.

This single-center study showed that having TNBC had a negative impact on survival. The treatment in TNBC patients should be determined by considering all factors affecting recurrence and survival and should be individualized.

This study aims to understand the factors that support occupational engagement of working mothers who are breast cancer survivors based on their experiences. These factors are vital for occupational therapists and other health professionals in the promotion of their health and well-being.

Using phenomenology, through in-depth interviews, this study explored experiences of mothers who survived breast cancer and have returned to work. Ten participants from ICanServe Foundation in Cebu, Philippines participated in one-on-one interviews.

Thematic analysis identified three themes: (1) Baggage and uncertainties of life with cancer, (2) Lessons on grit, and (3) Beating the odds through occupational adaptation. Findings suggest that mothers face obstacles both in the home and in the workplace.

Obstacles identified include mother-child role reversals, physical and cognitive changes, stigma and discrimination in the workplace, and fear of death and uncertainty, which indicate the need for support. Findings based on their experiences can help inform collaborative efforts from occupational therapists and professionals across disciplines to support breast cancer survivors such as maternal support groups, informing employment or workplace policies, and community opportunities.

Multidisciplinary care in quality-assured specialized Brest Centre (BC) is nowadays considered optimal management of breast cancer and is associated with better patient outcomes. Modern breast cancer surgery should provide optimal oncological outcomes and preserve the quality of life. European Society of Breast Cancer Specialists (EUSOMA) set up the minimum requirements for a specialized BC and a set of 15 mandatory quality indicator (Q.I.) benchmarks for BC certification purposes. Six Q.I. are intended for breast cancer surgery quality assessment.

In BC of Clinical Hospital Centre Rijeka, data were collected retrospectively for 2019 and prospectively thereafter in a clinical register, encrypted according to the EUSOMA instructions and uploaded into collective EUSOMA database. Following database validation, all Q.I. were calculated for our BC for 3 consecutive years. In addition, a comprehensive on-site audit was performed in 2021 for all services included in breast cancer management in Rijeka.

All mandatory surgical Q.I. were above the EUSOMA benchmarks in all 3 years. Non-compliance with EUSOMA recommendations were reported as major, minor, recommendations and observations. For BC surgical department, no major or minor non-conformities were reported. At the national level, mastectomy rates were above the permitted EUSOMA benchmark in 4 consecutive years.

We have voluntarily initiated and performed quality control of our BC. The certificate obtained is a confirmation of the high quality of care. Concerning the mastectomy rate in Croatia, other centres should consider quality evaluation to determine the status of detected suboptimal surgical management.

Phyllodes tumours of the breast are benign, borderline or malignant fibroepithelial lesions. They are uncommon and usually treated with surgical or radiological excision. The association with local recurrence has led to much debate over the extent of excision margins. It has traditionally followed that clinical surveillance for local recurrence is necessary following surgery. Follow-up is without any nationally agreed protocol and is therefore variable.

After exclusions, 116 cases of benign (n=81), borderline (n=30) and malignant (n=5) phyllodes tumours were identified in a single centre, between 2005 and 2018. These were analysed using a database, electronic patient records and notes-based review.

Benign recurrence occurred in six patients with complete excision of benign PTs (7.4%) and one with borderline PT (3.3%). No malignant Phyllodes tumours developed following excision of benign or borderline lesions.

This study of 13 years experience with 111 non-malignant Phyllodes tumours provides support for no routine clinical surveillance, but it supports patient education and open access to breast clinic.

Breast cancer in the male transgender patient is a great challenge for the medical team, because it is completely different from the usual clinical scenario and there is a lack of scientific knowledge and protocols for managing this special medical situation.

We present a 32-year-old transmasculine patient, who developed a palpable nodule on the left breast during the androgen hormonal treatment. Imaging showed a BIRADS5 nodule and core biopsy detected a luminal B breast invasive carcinoma (IDC) with androgen receptor expression. He underwent a gender reaffirmation oncological mastectomy, chemotherapy and hormonal therapy.

In the transgender male scenario, the surgical technique should take into consideration the patient’s aesthetical desire and the oncological result. In this context, it is controversial if the hormonal and oncological therapies should also be changed.

External compression, thrombosis, or stenosis of the superior vena cava can lead to superior vena cava syndrome, a diagnosis that should be considered swiftly in patients presenting with classic symptoms such as facial and neck swelling, plethora, and distended neck veins.

We report a case of acute port-a-cath associated superior vena cava thrombosis in a longstanding, previously uncomplicated vascular access device in a patient with stable ER+/PR+/HER2+ metastatic breast cancer. After initial treatment, there was limited clinical improvement with subcutaneous low molecular weight heparin (LMWH). Following multidisciplinary team discussion, catheter-directed thrombolysis was performed, which resulted in complete symptom resolution.

The recognition of signs and symptoms is crucial in diagnosing acute superior vena cava syndrome, particularly in patients with a malignancy history or a central venous access device in situ. The thrombotic complications of port-a-cath symptoms can occur at any time and management should be guided by multidisciplinary discussion. In appropriately selected patients, catheter-directed thrombolysis can be successful and can lead to rapid symptom resolution.

The carcinoma of ectopic breast tissue represents a rare condition. The ectopic glandular tissue is frequently located in the axilla, so ectopic breast lesions must be distinguished from other subcutaneous masses arising in this location.

We describe the case of a 75-year-old woman presented to our department for the recent manifestation of an axillary cutaneous lesion. She underwent mammogram, breast ultrasound, fine-needle aspiration cytology, breast magnetic resonance imaging, thoraco-abdominal computed-tomography scan and punch biopsy, and was subsequently treated as a carcinoma of unknown primary syndrome case. The final pathologic report showed the evidence of an ectopic breast tissue cancer.

Despite the rarity of this condition, physicians should always keep in mind the possibility of ectopic breast cancer in order to make an early diagnosis and adequately treat these patients.