Archives of Breast Cancer
Volume:11 Issue: 1, Feb 2024

In the 21stcentury, the main cause of death in both sexes worldwide is cardiovascular disease, followed by neoplasms. In women, the main cause of morbidity and mortality is breast cancer. Therefore, understanding the immunological mechanisms associated breast cancer and its correlation with poor prognosis is very important.

In this study, a search was done on PubMed and Google Scholar, using the following medical subject headings (MeSH) in the search engine: “triple negative breast cancer”, “breast cancer microenvironment”, “immune cells”, “prognosis”, “regulatory t reg”, “T cells” and “tumor-associated neutrophils”. Thus, a total of 81 articles were found and reviewed, published between 2002 and 2023.Results and

It is essential to understand the immunological mechanisms associated with the tumor microenvironment, to create new targeted treatment schemes for each variant of breast cancer, for example triple negative in order to reduce the mortality rate and increase disease-free survival.

Breast intraductallesions present a diagnostic challenge due to the diverse spectrum of histologic changes. Vacuum-assisted biopsy (VAB) has evolved as a pivotal diagnostic and therapeutic modality. Yet, concerns about the underestimation of malignancy using VAB persist. This review examines the underestimation rates of Ultrasound-guided VAB (US-VAB) for intraductal lesions and evaluates the effectiveness of VAB in addressing pathological nipple discharge (PND).

Following PRISMA guidelines, a comprehensive search was performed across Scopus, PubMed, and Web of Science. Studies detailing the underestimation rates of intraductal breast lesions diagnosed by US-VAB and cure rates for PND post-VAB excision were selected. Statistical analysis comprised a random effects proportion meta-analysis.

In this research,31 studies were deemed eligible: 26 for underestimation and 5 for PND cure rates post-US-VAB. Quantitative synthesis focused on studies reporting data on atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) due to limited availability for other pathologies. The pooled underestimation rate for ADH was 6.14% (95% CI: 1.59%-12.43%). The pooled underestimation rate for DCIS was 13.26% (95% CI: 6.69%-21.08%). PND's pooled cure rate post-US-VAB was 93.32% (95% CI: 82.34%-99.70%).

This systematic review and meta-analysis shows that US-VAB delivers low ADH underestimation rates, moderate DCIS underestimation rates, and acceptable PND cure ratesin breast intraductal lesions.

One of the most important factors that increases breast cancer (BC) recurrence after Breast-conserving surgery (BCS) is the positivity of the margins, which is found in permanent histological exams. Intra-operative specimen mammography (SM) can reduce the rate of margin positivity and re-operation. Our aim was to examine whether vacuum SM (VSM) is more accurate than standard SM (SSM) in detecting the positivity of the margins.

For this cross-sectional study,in the operating room, excised specimens of 55 women with breast cancer who underwent lumpectomy were oriented by metallic staples and sutures for radiologic and histological assessment, respectively. In the radiology ward, SSM was first taken; then, the specimen was vacuum packed and VSM was performed. Afterwards, the specimen was sent for histopathological analysis as a gold standard for the assessment of surgical margins. Specimens’ margins were classified according to the size of clear margins in millimeters as zero or >0; and ≤1 or >1.

The mean age of all participants was 51.22 ± 10.58 years. Totally, 220 margins were assessed. According to classified margins (zero and 1 mm), for the detection of affected margins, the accuracy values of the VSM method were 90.52%, and 87.20% while these figures were 91.51% and 88.68% for SSM. There was substantial agreement between the two methods of detecting the affected margins (VSM and SSM), with Cohen's κ =0.66, 95% CI: 0.34-0.97, P-value <0.001). Finally, there was not a statistically significant difference in the proportion of detecting margin between SSM and VSM (McNemar test P-value =0.63).

Specimen mammography with an adequate orientation of the tissue is an accurate and practical method for immediate intraoperative examination of the margin status in BCS, and VSM is not superior to SSM in the detection of affected margins.

Round block technique (RBT) is a versatile technique for theexcision of benign and malignant breast lesions with oncologic safety. Although a technically challenging procedure, it has the benefit of an inconspicuous scar and desirable aesthetic outcomes and wider exposure for tissue resection and remodelling. Thisstudy discusses the utility of RBT for the excision of different pathologies, complications, and cosmetic outcomes, as it is underutilized in developing countries.

The study was conducted at the breast surgery clinic at Liaquat National Hospital.All patients with benign (fibroadenomas, benign phyllodes) or malignant (carcinoma, malignant phyllodes) lesions undergoing the round block technique were included. The clinical size, site, distance from the nipple, pathology, pathological size, and margin status were recorded. Early and late complications were documented during the follow-up. At the time of the final study analysis, patients were interviewed for cosmetic outcome satisfaction using the Harvard scale (4-point Likert score)

Overall,49 patients were included in the study over 2.5 years. The mean clinical tumor size was 4.72cm, of which 63% were in the upper quadrant, and the average distance from the areolar margin was 1.71cm. The pathology included 21 fibroadenomas and 18 carcinomas, with a mean size of 4.14cm. Early complications were seen in 12 cases, and late complications were observed in 2 cases, which were all managed conservatively. The cosmetic outcome was found to be fair by 6.1% of the patients, good by 87%, and excellent by 6.1% of them.

RBT is a technically challenging procedure but is easily adaptable. It provides good exposure for excision of both benign and malignant tumors of the breast while maintaining the oncologic safety margin and good cosmesis, especially for young patients with large lesion in the upper inner quadrant.

This retrospective cohort study explores the long-term effects of different endocrine therapy regimens on mortality, local recurrence, and metastasisin breast cancer patients.

Data from the Referral Cancer Research Center of Shahid Beheshti University of Medical Sciences were analyzed. Records of 2262 histologically confirmed reast cancerb patients with 25 years of follow-up were included. Wecollected patient data, including treatment modalities and details of the endocrine therapy, and conducted statistical analysis to assess treatment outcome associations.

Patients had an average age of 49.45 years, and 99.1% were female. The average tumor size was 2.8 cm, with a 12.3% mortality rate. Positive expression of human epidermal growth factor receptor 2, progesterone receptor, and estrogen receptor was found in 17.3%, 71.8%, and 70.6% of patients, respectively. Tamoxifen was administeredto 1,700 patients, letrozole to 715, and exemestane to 540, with an average endocrine therapy duration of 5.2 years. Letrozole treatment duration (P = 0.001) and lymph node involvement (P=0.028) were independent predictive variables for local recurrence, with longer letrozole therapy associated with lower recurrence.

Estrogen receptor expression and endocrine therapy duration are independent predictive markers for recurrence and mortality. Longer letrozole therapy predicts lower local recurrence. Endocrine therapy duration inversely relates to mortality, recurrence, and local recurrence.

The importance of magnetic resonance imaging (MRI) screening in high-risk women is well-known; however, its utility in women at average or intermediate risk is not well-established. The main purpose of the study was toinvestigate the added value and cancer detection rate (CDR) of using abbreviated MRI protocols in average or intermediate-risk women.

A total of 431 asymptomatic women with average or intermediate risk of breast cancer who underwent screening abbreviated MRI from May 2019 to May 2022 were recruited. CDR in screening MRI among average or intermediate-risk women and in low or high-breast composition was calculated.

In 173 patients with intermediate risk, 5(1.16%) malignant lesions were detected and in 258 average-risk patients, 10(2.32%) added cancers were found in screening abbreviated MRI compared to mammography. Among the 15 malignant lesions, more cancers in high breast composition were detected (11 vs. 4 cases); however, there was no statistically significant difference between the cancer detection rate and breast composition. In intermediate-risk women with high breast composition, 3 (0.69%) malignant lesions, and in average-risk women with high breast composition, 8 (1.85%) added cancers were found.

We provided 3.48% added cancer detection in screening abbreviated MRI compared to mammography. Therefore, screening abbreviated MRI with less image acquisition and interpretation time may be useful as a supplemental screening tool for cancer detection especially in high breast composition.

Loss of projection is a very common complaint after nipple reconstruction. In this paper, we present our experience with the use of a novelhuman cadaver-donor-derived acellular dermal matrix, named MODA (Matrice Omologa Dermica Acellulata) from the Regional Skin Bank to improve and stabilize nipple projection after oncoplastic breast surgery.

We did a retrospective analysis of patients undergoing nipple reconstruction with local flap and MODA graft after breast reconstruction between February 2019 and May 2021. The analysis was done following the Declaration of Helsinki and was approved by the ethics committee; written consent was sought fromall the participants. The main evaluation criterion was nipple projection measurement, performed immediately after surgery, 6 and 12 months postoperatively. The secondary endpoints were complications and patients’ satisfaction.

In this study, 50 patients underwent nipple reconstruction, with 57 reconstructed nipples. All cases except six followed delayed breast reconstruction. The patients were divided into 3 groups, according to the breast reconstructive technique. There were three cases of delayed wound healing and two cases of partial necrosis, but all of the cases healed by secondary intention. Five percent of the patients (3/57 reconstructions) presented more than 60% of nipple projection loss and required another procedure. The other reconstructed nipples maintained an average of over 60% projection after 12 months.

The described technique presents a high success rate associated with low complications. Indeed, it provides the advantages of nipple reconstruction with ADM with low costs, appears safe after radiotherapy, and has similar results when used after different reconstructive techniques.

Neoadjuvant chemotherapy (NAC) is less effective for luminal human epidermal growth factor receptor 2 (HER2) negative breast cancer (BC) patients and generally shows a low pathological complete response (pCR) after NAC compared to HER2 positive and triple negative breast cancer (TNBC). This studyaimed to determine the factors associated with histopathologic response following NAC in luminal (HER2 negative) BC.

This is a cross-sectional study conducted on 255 estrogen (ER) positive and HER2 negative BC patients after NAC between January 2018 and July 2023. Demographic and clinicopathological characteristics of the patients were collected for the statistical analysis.Chi-Square tests were used in the qualitative comparisons between study groups. Receiver Operating Characteristic (ROC) analysis was used for the diagnostic performance of Ki-67 expression and ER in determining the pCR rates. Using the Youden index, optimum cut points were determined. Also, multivariate logistic regression analysis was applied to determine the independent variables associated with the dependent variable (pCR).

After NAC, pCR was achieved in the breast in 35 (14%) patients, in the axilla in 44 (17%) patients, and in both the breast and axilla in 18 (7%) patients. Ki-67 expression was the only common variable associated with the breast, axilla and both the breast and axilla pCR. The most appropriate Ki-67 expression cut-off value for determining the breast and axilla complete response was found to be 40%. ER positivity level was only associated with pCR in the breast and the cut-off value was found to be 85%.

The results of this study raise the possibility of patients with luminal (HER2 negative) BC with Ki-67 expression higher than 40% benefiting from chemotherapy, as they showed increased pCR rates.

The high tangent field (HTF) technique is used to provide radiation coverage of the inferior axillary nodal levels for breast cancer patients when the lower axilla is at risk for micrometastatic disease. Despite its use in clinical practice, there is concern about whether HTF provide sufficient coverage of level I and II axillary nodal regions. The purpose of this study is to quantify and evaluate the coverage of HTF at our institution.

Patients diagnosed with early invasive breast carcinoma (pT1-2 pN0-1a) who received HTF radiation between January 1st, 2012, and December 31st, 2016 were retrospectively reviewed. Level I and II axillary nodal regions were contoured on each patient’s simulation CT. Dosimetric parameters were re-calculated to evaluate coverage. Statistical analysis was conducted using Mann-Whitney-U method.

Thirty-seven patients with low-risk breast adenocarcinoma were included. For level I and II, the mean V90% was 94.63% ± 7.60% and 73.33% ± 21.83% respectively. Twenty-nine patients received adequate V90% coverage of level I and had a mean level II V90% of 76% ± 18.71% while eight patients who did not receive adequate V90% level I coverage had a mean level II V90% of 63.64% ± 30.22%. The median level II V90% of patients receiving adequate and inadequatelevel I V90% was 77.74% and 71.11% respectively; the difference was not statistically significant (P = 0.33).

HTF provides adequate coverage for level I nodes, but inadequate coverage for level II. Contouring nodal volumes may assist field placement and improve nodal volume coverage.

the study aimed to apply and validate the modified Gail Model (GM) in a group of Jordanian women to identify their estimated 5-years and lifelong breast cancer risk.

This cross-sectional study was carried out in Jordan, wherein data were gathered from women who had no previous personal history of breast cancer during the period from January 2020 to June 2020. Sociodemographic characteristics and other breast cancer-related factors were gathered from the participants. Breast cancer risks were determined using the Breast Cancer Risk Assessment Tool (BCRAT) of the National Cancer Institute Online version (Gail Model version 2). Data were analyzed using the SPSS

A total of 502 women were involved in our study. The mean age was 47±8.8 years (range: 35-83). The majority of the women were married (93.6%). Twenty-seven women (5.2%) were nulliparous. Regarding menarche age, 243 women (47.3%) had their first cycle at the age of 12-13 years. One hundred women (19.9%) reported at least one family member with a breast cancer diagnosis while 23 women (4.6%) had a member with an ovarian cancer diagnosis. The calculated median for the 5-year BC risk was 0.8 (0.5 to 1.2), while the median for the lifetime risk was 9.2 (7.8 to 11.1). Thirty-eight women (7.6%) and 12 (2.4%) were categorized as having a high risk of developing BC in five years and a lifetime, respectively.

The utilization of Gail models can help healthcare providers identify a subset of women who are at an increased risk for breast cancer and personalize their approach in selecting the timing schedule and modality for breast cancer screening.

Intraoperative radiation therapy (IORT), is a promising method which has been widely applied in breast cancer lumpectomy. Although its effect on destructing remaining cancer cells was approved, maintaining or draining post intraoperative radiation therapy wound fluids (PIWF) is challenging.Moreover, the roles of immune cells in interaction with PIWFs have not been studied before which is the main investigation of this paper.

Surgical wound fluids were collected from 24 IDC patients one day afterlumpectomy. The patients were divided into control and IORT groups. The collected wound fluids were centrifuged for 20 minutes at 2000 rpm. The concentration of tumor-associated cytokines and inflammasomes were recorded using the immunoassays.

PIWFs stimulate the residue of cancer cells in cavity sides causing disease progression. Here we have focused on the effect of PIWFs on the proactivation or deactivation of WBCs in the tumor bed environment. By sequential imaging in time-transient intervals from the interaction between WBCs and cancer cells, PIWFs have no additive proactivating effect on immune cells.

PIWFs have significant roles in proliferation of cancer cells but did not show an observable role in pro-activating immune cells against cancer cells. The functions of immune cells did not show any independent proactivation in the presence of PIWFs with respect to their activation in the presence of blood serum. It seems that draining the PIWFs may be required. In future research, we will use tumor samples of the patients instead of cell lines to better investigate the personalized immune-tumor interactions of patients.

Arteriovenous malformation (AVM) of the breast is a rare condition that is usually incidentally detected as discoloration of the skin. Patients are asymptomatic, and it is mostly left undisturbed. However, the closest differential diagnosis of primary angiosarcoma of the breast can have a similar imaging appearance. Multimodality imaging will help to differentiate between the two, and in very few cases, tissue diagnosis warrants confirmation.

We hereby report the case of a young female who initially presented with swelling and discoloration near her face and neck and who, on a one-year follow-up, incidentally noticed discoloration over her left breast. She underwent an ultrasound, a dynamic contrast-enhanced MRI of both breasts and a dedicated left breast X-ray mammogram.

With all these modalities confirmed, the discoloration was caused by an AVM of the breast.

Solitary fibrous tumors (SFT) are the rare mesenchymal tumors originally described in the pleura. SFT of breast is even rarer and to the best of our knowledge about 35 cases are reported to date, including only six malignant SFT cases.

Casepresentation: 

We report a case of a 52-year-old lady with a large left breast mass involving all the quadrants. The tumor was diagnosed as malignant SFT in a core needle biopsy which was later confirmed on the resection specimen.

Herein, we describe the approach and importance of optimal utilization of immunohistochemistry for diagnosing such rare tumors of the breast, particularly, when clinical presentation, radiology and fine needle aspiration cytology are incongruous.Copyright © 2024. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0International License,which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.INTRODUCTIONThe solitary fibrous tumor is one of the rare mesenchymal origin tumors with an incidence of <0.1/100,000 people.1,2 This tumor tends to pose diagnostic challenges due to similarity in clinical, radiological and histological features with several more common soft tissue tumors like synovial sarcoma, leiomyosarcoma, phyllodes, malignant peripheral nerve sheath tumor (MPNST), etc. The tumor was previously reported to primarily occur in pleura which is still the most common site accounting for 70% of the cases. However, now it is known to occur at any anatomical sites with a varying spectrum of histological features. Histologically, it ranges from hypocellular to hypercellular tumors to anaplastic SFT with sarcomatous transformation.3 Fibroblastic cell is considered as the cell of origin in these tumors. Historically, SFTs are sub-classified into three groups: i) Benign (local disease); ii) not otherwise specified (usually not metastatic); and iii) malignant.4The general criteria adopted for malignant SFTs include a large tumor size, mitotic rate of ≥4/10 high-power fields (HPFs), nuclear pleomorphism, and necrosis. Demiccoet al. proposed a modified four-variable risk stratification model for development of metastasis in solitary fibrous tumors based on age, tumor size, necrosis and mitotic count into three risk classes of low, intermediate, and high risk.5 The diagnosis as well as risk stratification of SFT at unusual sites like the breast are very demanding and not possible on clinical and radiological examination. Accurate diagnosis requires a combined evaluation of clinical, pathological, immunohistochemical and molecular features together. Herein, we report a case of malignant SFT in a 52 year-old lady with a focus on diagnosis.CASE PRESENTATION A 52-year-old lady presented with a progressively enlarging lump in the left breast over the last 12 Case ReportOpen Access