Archives of Breast Cancer
Volume:1 Issue: 2, Aug 2014

Lymph node status remains an important prognostic indicator for survival in breast cancer. Sentinel lymph node biopsy has become the standard method of assessment of clinically node negative breast cancers. Economic implications as well as patient related factors have lead to the development a number of intra-operative techniques. Review of the emerging trends in the last 4 years show that although routine histological examination remains the gold standard in most centres intra-operative assessment remains the most favourable, timely and cost-effective option to analyse sentinel nodes. Molecular techniques appear to be far more superior to other histological tests such as Frozen Section or Touch Imprint Cytology. Emerging research suggests that molecular techniques can be used to predict the presence of non sentinel node metastasis.

Seroma formation is a common complication after breast cancer surgery. Several techniques such as tube drainage, fibrin sealant and suturing methods have been employed to prevent or reduce seroma formation. Capitonnage, a suturing method widely used following hydatid cyst removal, has been used after breast surgery in limited studies. Our aim was to compare the effectiveness of tube drainage, fibrin sealant and capitonnage to prevent early complications. Eligible patients with breast cancer who were candidate for breast conserving surgery were enrolled and randomized into three different groups (tube drainage, capitonnage, capitonnage plus fibrin sealant). Patients were visited on 5th,12th and 19th days after surgery and were assessed for any probable complications. A total of 90 patients were enrolled. One patient developed seroma in tube drainage and capitonnage group, while no participant from capitonnage plus fibrin sealant group experienced the mentioned complication. Three patients developed skin necrosis, all of them were treated with capitonnage plus fibrin sealant protocol. Based on our observations, it seems that capitonnage alone or in combination with fibrin sealant do not lead to significant differences in frequency of complications after breast cancer surgery such as hematoma, seroma and surgical site infection.

Time of day can affect the outcome of medical procedures and surgical operations. The current study was designed to assess whether time of day can influence the quality of breast cancer surgery or not. Patients who underwent breast cancer surgery and axillary lymph node dissection in Tehran, Iran between March 2012 and March 2013 were enrolled. Surgeries were categorized into two group based on the time of initiation (before and after 1 pm). We considered the number of dissected lymph node as an indicator of operation quality. In this way, dissection of at least six lymph nodes was considered as an adequate number of lymph node examinations. A total of 134 patients were enrolled. Median start time of surgery was 11 am. Surgeries were performed before and after 1 pm in 105(78.4%) and 29(21.6%) patients, respectively. The association between time and the number of dissected lymph nodes was significant when they were considered either as a categorical (P = 0.002) or continuous variables (P = 0.039). Based on our results, it can be suggested that breast surgeries with later start time might have lower quality.

Sonoelastography (SE) is introduced as a complementary technique for ultrasoungraohy (US) to evaluate breast lesions. This method is based on tissue strain in response to compression and decompression. The current study was designed to investigate the diagnostic performance of SE for differentiating between benign and malignant breast lesions A total of 35 women with 45 breast lesions who were referred to a university affiliated hospital in Tehran were enrolled. All patients were visited and examined by a same radiologist. A five-point scale was applied for categorizing lesions in SE as malignant or benign. The results of US and SE were compared with histopathological results to calculate sensitivity and specificity of each mentioned techniques. Histopathological evaluations in 12 cases were in favor of malignancy, and the rest of cases were classified as benign. The sensitivity and specificity for US were 100% and 69.7%, respectively. On other hand, SE obtained a lower sensitivity (58.3%) and higher specificity (90.9%) in comparison with US. simultaneous evaluation of suspicious breast lesions with both US and SE can have high sensitivity and specificity and prevent the unnecessary invasive interventions.

Superoxide radicals are produced during oxidative metabolic processes, and removed by superoxide dismutase (SOD) enzymes. Controversial results have been reported regarding the tissue and plasma concentration of SOD in patients with breast cancer. Venous blood was obtained from study participants and activity of SOD enzyme was determined in 100 women. Comparison was made between 50 patients with breast cancer and 50 individuals in control group. The activities of SOD in patients with malignancy and control group were 553.56±53.67 U/gr Hb and 1218.60±98.55 U/gr Hb, respectively (P <0.001). Patients with higher stage and nuclear grade had lower SOD activity. lower levels of SOD activity was observed in women with breast cancer compared to healthy individuals. Considering the existing controversy regarding the SOD level in breast cancer patients, further studies to explore the reason of these differences are warranted.

Since the introduction of silicone based medical devices in to clinical practice, several reports appeared in the medical literature regarding their adverse effects. However, there are few reports of immunologic reactions to these implants. A case of systemic reaction to a breast implant inserted for immediate breast reconstruction in a breast cancer patient is presented. The patient developed fever and skin rash two months after the surgery. Investigations disclosed no infectious origin for the fever and a dramatic response to steroid therapy was observed. Immunologic reaction should be considered in case of systemic signs and symptoms after silicone breast implant placement as a rare complication.