Archives of Breast Cancer
Volume:1 Issue: 1, May 2014

The management of internal mammary (IM) nodes in breast cancer lacks a well-defined consensus. Lymphoscintigraphy identifies up to one-third of breast cancer patients with extra-axillary drainage, which is mainly located in the IM chain. Our aim in this meta-analysis is to identify the lymphoscintigraphy technique variables that effect IM node identification. An internet database was utilized to review articles concerning sentinel nodes and breast cancer from 1993 through the end of 2011; 74 articles met our inclusion criteria. The total number of patients included was 22959. We grouped the citations by injection location and injection material. We then analyzed the rate of identification of IM nodes according to these groupings and their subsets. The overall IM identification rate using the random effect model was 9%. The injection location had the most significant impact on IM identification rate; the deeper injections were associated with the highest rate of identification. Variation in IM identification was associated with the particle size of injection material; the smaller particle size group had a higher rate of identification. Increased dose of the tracer was also associated with increased identification rate. The use of smaller particle size tracers and a deeper injection location achieve the highest IM identification rate. The dose of the tracer also increased the identification rate. These observations can help in the selection of patients for IM sentinel node biopsy, which can affect their prognosis and treatment management.

Inflammatory breast cancer (IBC), a subgroup of locally advanced breast cancer (LABC), is diagnosed based on clinical findings, and seems to be different from other types of LABC. The purpose of this study was to compare clinicopathological characteristics and outcomes between inflammatory and non-inflammatory LABC patients at Breast Cancer Research Center (BCRC), Tehran, Iran. The medical records of all patients who were diagnosed as LABC in BCRC since 1997 to 2011 were extracted from the database. Then, clinical and pathological characteristics and overall survival of IBC patients were compared with non-inflammatory LABC (NI-LABC). A total number of 340 patients were identified as LABC from which 17 patients (5%) were diagnosed as IBC. Menopausal status, body mass index (BMI), family history of breast cancer, nodal status, and Her2/neu and PR positivity were not statistically different between IBC and NI-LABC groups. The difference in estrogen receptor (ER) between the two groups was significant (P = 0.028). Median duration of follow-up was 26.50 months. Patients with IBC had overall survival of 27.9 months (95% CI: 22.7–33.1) which was lower than patients in the NI-LABC group with a survival of 118.9 months (95% CI: 107.3–130.6) (P = 0.015). The difference between the disease-free survivals of the two groups were also statistically significant (P < 0.001). Compared to NI-LABC, IBC is more frequently ER negative and more commonly associated with lower survival rate. These findings reinforce the idea that IBC has a more aggressive biology and more unfavorable outcome than NI-LABC and needs close follow-up.

Mammographic density has been recognized as a risk factor for breast cancer, but the association between potential effective factors and mammographic density has not been fully studied in Asian women. We conducted a study to investigate the association of mammographic breast density with several menstrual and reproductive characteristics. Screening mammography was performed in women above 40 years attending the breast clinic of Arash Women’s Hospital, Tehran, Iran, for breast cancer screening. The densities were classified by two expert radiologists according to the parenchymal mammographic classification system of the American College of Radiologists. Those with a history of breast cancer or renal disease, recent hormone replacement therapy, or consumption of vitamin D supplements were excluded. Overall, 823 patients were assessed. Mammographic density was associated with higher age at first birth (P < 0.001), lower parity (P < 0.001), BMI (P < 0.001), and premenopausal status (P < 0.001). However, no associations were observed with age at menarche (P = 0.057) and menstrual pattern (P = 0.973). Our study showed an association between mammographic density and age, parity, BMI, and age at first birth, and no association with menstrual pattern in terms of regularity and age at menarche. In addition, mammographic density was significantly higher in premenopausal women.

The purpose of this study was to examine religious, cultural, and social beliefs of healthy women about breast cancer in rural settings in Iran. In the present study, 16 in-depth interviews with health care leaders, social and religious experts and 11 focus group discussions were conducted with 79 women in the rural areas near the capital city of Tehran, Iran. Grounded theory model was used to analyze the data. Some women believed that religious customs and rituals, such as praying, taking a vow, or going on a pilgrimage to a holy place, might have healing effects if performed in addition to seeking medical care medical care. Many believed that God intervenes in the entire course of any illness, from occurrence to cure. Although few had fatalistic views toward cancer, the majority believed that patients could try to change their destiny. With respect to the relationship between moral behavior and disease, 4 types of opinions were identified; good people suffer, evil people get punished, evil people do not suffer, and everything has a scientific explanation. Participants believed that self-perception, their husbands, deficiencies in the health care system, and financial concerns influence breast cancer outcome. Our study showed that many participants were not aware of any available support in the healthcare system. They generally believed in the healing effect of prayers, only when it is sought in parallel with medical care.

Sentinel lymph node biopsy has shown to be a good alternative procedure for axillary lymph node dissection and to lead to lower frequency of morbidity, though this technique has its own side effects. It needs especial equipment and may not be available in some medical centers, especially in developing countries. This study aimed to identify a subgroup of patients with higher probability of metastasis to sentinel lymph node that can be excluded from indications of this procedure. In this cross-sectional study, the clinical data of 195 patients with breast cancer who underwent sentinel lymph node biopsy in Tehran, Iran, between 2009 and 2011 were reviewed. Whenever tumor features showed significant association with sentinel node metastasis in univariate analyses, logistic regression was used to identify independent predictors. Univariate analyses revealed that tumor size and lymphovascular invasion have significant association with sentinel lymph node metastasis (P = 0.009 and P < 0.001, respectively). Moreover, age had an significant association with positive sentinel lymph node biopsy (SLNB) (P = 0.004). Other factors, including tumor grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2, were not associated with positive sentinel lymph node biopsy in univariate analysis. All factors that showed significant association in univariate analysis remained statistically significant predictors of positive SLB in multivariate analysis. It seems that young breast cancer patients, those who have tumors larger than 5 cm and those with lymphovascular invasion, are at an increased risk of sentinel lymph node metastasis.

Skin metastases occur in 1-5% of solid tumors and are rarely the presenting sign of internal malignancies. Certain features in skin lesions raise suspicion of metastasis from solid tumors. In this article a 61-year-old woman is presented with erythematous skin nodules in upper abdomen and chest. Histopathological evaluation of lesions suggested metastatic carcinoma and a thorough search found stomach signet cell adenocarcinoma and breast lobular carcinoma. Immunohistochemical staining confirmed diagnosis of lobular carcinoma with metastasis developed in skin and stomach. Clinicians must be aware that malignancies can present by skin metastases. Since breast and stomach cancer can both metastasize to skin, immunohistochemistry evaluation is of great importance to diagnose the primary tumor.