Analysis of False-Negative Cancer Cases Identified with a Mammography Audit

▪  Abstract: The purpose of this study was to analyze the causes of false-negative breast imaging in symptomatic and asymptomatic patients, as defined by cancer diagnosed within 1 year of a nonsuspicious mammogram. A computerized audit of 27,305 mammograms performed between November 1992 and December 1993 identified 50 patients who developed malignancy within 1 year of a mammographic report indicating negative, benign, or probably benign results. The audit revealed 26,661 mammograms interpreted as negative, benign, or probably benign. Of these, 50 patients were diagnosed with carcinoma within 1 year. Thirteen of the cancers were not visible retrospectively. Five were seen only in retrospect. Thirty-two were seen prospectively, of which 5 were interpreted as benign and 27 were interpreted as probably benign. Seventeen of the 27 probably benign were recommended for 6-month follow-up. Ten of the 27 probably benign had immediate ultrasound-guided fine needle aspiration cytology yielding unsuspected malignancy. In most (32/50) false-negative cases the lesions were seen prospectively but were interpreted as benign or probably benign. Ultrasound-guided aspiration averted a delayed diagnosis of malignancy in 20% (10/50) of the false-negative imaging interpretations. Six-month follow-up studies were helpful for 12 of 17 cases, where the lesions progressed within 1 year. ▪     

Preoperative Needle Localization of Nonpalpable Breast Lesions: Determination of Appropriate Needle Length

▪ Abstract: Determination of needle length for needle localization of nonpalpable breast lesions prior to surgical excision biopsy may occasionally be problematic. A method for more accurate needle length determination is presented for use when uncertainty arises. This method was evaluated in 46 consecutive lesions targeted for excision biopsy following mammographically guided needle localization. ▪     

Fibromatosis,a benign breast disease mimicking carcinoma. A case report

IntroductionFibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation.Case summaryWe present a clinical case in which a diagnosis and treatment dilemma existed, in terms of ultrasound findings that were not clear and suspicious, as well as results of Fine needle aspiration cytology. Our findings are compared with previous published cases. Also, literature review regarding fibromatosis presentation and diagnosis has been discussed, as well as treatment options.ConclusionManagement of breast fibromatosis remains controversial because of the low incidence and further efforts needed to establish evidence-based treatment guidelines.     

Stereotactic Percutaneous Breast Biopsy: A Comparative Analysis Between Surgeon and Radiologist

▪  Abstract: The purpose of this study was to analyze the use of stereotactic percutaneous breast biopsy in the treatment of nonpalpable breast abnormalities. In addition, we set out to compare the results of both radiologists and surgeons performing the procedure and to provide an estimation of the cost per patient. A retrospective analysis of the use of stereotactic core biopsy (SCBx) to diagnose suspicious breast lesions was performed in 193 patients between December 1995 and February 1997. The study group was compared to a similar group of 106 patients who had needle localization excisional biopsy (NleBx) performed during the same period. Statistical analysis between surgeons and radiologists was performed for the percutaneous procedures. Allowable charges for both specialists were used to compare percutaneous biopsy with open biopsy. Stereotactic percutaneous breast biopsy performed at our institution by either the surgeon or radiologist is an accurate and cost-effective way to evaluate nonpalpable breast abnormalities and saves approximately $1500–$2500 per patient as compared with needle localization excisional biopsy. Adequately trained surgeons and radiologists can achieve similar accuracy in utilizing this new technology for breast diagnosis. ▪     

Imaging and Management of Breast Masses During Pregnancy and Lactation

▪ Abstract: Detection and management of breast abnormalities that develop during pregnancy and lactation is difficult for both the clinician and the radiologist. This article reviews the hormonal and physiologic effects on the breast during pregnancy and lactation. Breast masses that occur in pregnant or lactating patients, including pregnancy-associated breast cancer, are discussed and the corresponding ultrasound and mammographic findings are presented. Finally, a rationale for the imaging evaluation and management of the pregnant or lactating patient with a breast mass are presented. ▪     

MCF-10AT: A Model for Human Breast Cancer Development

▪   Abstract: A number of lesions, collectively termed Proliferative Breast Disease (PBD), have been associated with high risk of developing breast cancer. Understanding of the natural history of PBD and its relationship to breast cancer progression has been hampered by the lack of an experimental model. MCF-10AT cells are of human, breast epithelial cell origin. They grow as xenografts in immune-incompetent mice where they produce normal-appearing ducts, atypical hyperplasia, carcinoma-in-situ, and invasive carcinoma. Estrogen supplementation of the mice accelerates development of cancer. The MCF-10AT model of PBD offers a new approach to the study of early breast cancer progression and its prevention.  ▪     

Radiation and Local Control in Early Invasive Breast Cancer

▪ Abstract: Local control in the breast after breast-conserving surgery and radiation for the treatment of early invasive breast carcinoma has long been viewed as important to the patient to avoid later need for mastectomy. Now several studies support the hypothesis that local control is related to and impacts upon a patient's survival as well. The factors that predict for local control with this treatment are reviewed. The recent studies that support the link between local breast failure and distant disease are also discussed. ▪     

Toward Understanding Women Who Request Removal of Silicone Breast Implants

▪ Abstract: Fifty-five women were surveyed prior to explantation of their silicone breast implants regarding their reasons for having implants and their reasons for wanting them removed. Open-ended questions were used and content analysis was done to identify themes in their responses. Most of the women had implants for cosmetic reasons, with 28% having them for breast reconstruction after mastectomy. About one-third were actively or passively encouraged by their male partners, while nearly the same number reported they were influenced primarily by female friends or relatives. Regarding reasons for removal, the most commonly cited reasons were breast health problems (implants ruptured, painful or uncomfortable) cited by 59%, general health problems (48%), diagnosed with connective tissue disease (25%), and concern about long-term effects of silicone (18%). Some women blamed a broad array of health problems on the implants, and a few were angry about being given bland reassurances about the safety of the devices. However, the majority were uncertain about the role of silicone in their overall health but were hopeful that removal would restore their health and end their worries about long-term effects. The average subject was 34 years old when she had the implants to feel more attractive. Now she is 44 and more concerned about her health and her family than her physical appearance. ▪     

The Use of Argon Beam Coagulation in the Management of Bleeding from an Ulcerated Breast Lesion

▪ Abstract: Skin ulceration is an uncommon, but serious manifestation of locally advanced breast cancer. When the ulcerations present with bleeding, they can be particularly difficult to treat. Cautery often fails because the electrode adheres to the skin and rebleeding begins when the instrument is pulled away. We present a case in which argon beam coagulation was used to achieve hemostasis in a bleeding breast ulceration. ▪     

Optimal Management of Primary Breast Cancer

▪  Abstract: The diagnosis and treatment of breast cancer have changed in response to not only new technologies but also cultural and social aspects of the disease. While breast-conserving surgery and adjuvant therapy are the preferred treatments for many breast cancers, neoadjuvant therapy is often used in advanced disease. In this review we examine the treatment options that are influenced by pathologic and clinical factors. Invasive breast cancer is a potentially curable disease if it is regarded and managed by a multidisciplinary approach from the outset.  ▪     

Myofibroblastoma in the Irradiated Breast

▪  Abstract: Myofibroblastoma after wide excision and radiation therapy for intraductal (duct carcinoma in situ) carcinoma is reported. Myofibroblastoma is a benign tumor, largely composed of myofibroblasts arranged in fascicular clusters with interspersed bands of hyalinized collagen, which is well circumscribed and occurs predominantly in men. This is the first documented instance of a postradiation myofibroblastoma of the breast.  ▪     

Clear Cell Ovarian Carcinoma Following Long-Term Tamoxifen Use

▪ Abstract: A case of clear cell ovarian cancer and endometriosis in a postmenopausal patient following adjuvant tamoxifen for breast cancer is presented. Immunohistochemistry demonstrated the tumor to be positive for progesterone receptor protein but not estrogen receptor protein; the endometriosis was positive for both proteins. Literature review reveals this to be the first report of both clear cell ovarian cancer and endometriosis following tamoxifen use, and the third report of epithelial ovarian cancer associated with tamoxifen.  ▪     

Intranuclear Helioid Inclusions in a Case of Breast Carcinoma

Helioid inclusions are single membrane-bounded intranuclear bodies of unknown nature which have been described in a case of breast adenoma, in mammary hyperplasia, and in a case of acinic cell carcinoma of the parotid gland. We report the detection of helioid inclusions in a case of breast carcinoma, which involves a 60-year-old woman with infiltrating ductal breast carcinoma of apocrine type. On electron microscopic examination we observed characteristic intranuclear helioid inclusions in some carcinoma cells. Occasionally intranuclear profiles of dense granules were present, some of which showed a just discernible filamentous border. The significance of these rare ultrastructural inclusions remains to be elucidated. ▪     

Breast Cancer Litigation: An Update with Practice Guidelines

▪ Abstract: Cases involving breast cancer are the second most common cause of malpractice litigation. The leading allegation is failure to diagnose, followed by improper treatment. The most common physicians involved are those giving direct care to women: obstetricians/gynecologists, family medicine physicians, and internists. This review addresses frequent areas of litigation, offering practice guidelines for avoidance of malpractice claims. In addition, two new areas of breast cancer management will be reviewed—breast cancer prevention and breast cancer genetic testing—as potential new areas of malpractice litigation. ▪     

Primary hydatid cyst of the breast: A case report

We describe herein the rare case of a hydatid cyst found in the breast of a 26-year-old woman. Clinically, the mass was at first suspected of being a fibroadenoma, but fine needle aspiration cytology (FNAC) yielded clear fluid only. Histopathologic examination of the resected speciman confirmed that it was a hydatid cyst.     

Penrose Drain as a Foreign Body in the Breast

▪  Abstract: Two cases of women who underwent breast nodule exeresis and drainage are described; in both instances a Penrose drain was used and part of the drain, remaining in the surgical cavity after the surgery, acted as a foreign body. The author discusses the reasons why it can happen, as well as the need to take this possibility into account in the differential diagnosis of clinical findings (e.g., nodules) or mammographic alterations (e.g., gross calcification) in the vicinity of a previous surgery scar. ▪     

Nodular hidradenoma of the breast: A case report with literature review

Nodular hidradenoma or clear cell hidradenoma is a rare skin adenexal tumor which arises from eccrine sweat glands. Skin adenexal tumors situated in the breast parenchyma are still very rare and is one of the differential diagnoses of breast tumors. Failure to identify its morphologic features may lead to a mistaken diagnosis and over treatment. We report a case of breast lump, in a 40-year-old lady, which was diagnosed clinically as a malignant breast lump. Final diagnosis of nodular hidradenoma was made only after excision biopsy as fi ne needle aspiration cytology was inconclusive.     

Breast Carcinoma in Childhood and Adolescence: Case Report and Review of the Literature

Secretory breast carcinoma is a rare tumor originally described in children and adolescent women with a characteristic morphology and a controversial choice of treatment. We report an additional case of a 4-year-old girl with a breast tumor diagnosed as a secretory carcinoma without involvement of the axillary lymph nodes. The therapy consisted of simple mastectomy and low axillary dissection. She presented with a local recurrence near the surgical scar 8 months later, and a wide elliptical excision of the scar and underlying tissue was performed with subsequent radiotherapy of the surgical bed. This tumor has a relatively benign behavior and rarely metastasizes. A literature review revealed only 22 cases of breast carcinoma in childhood and adolescence. ▪     

Comprehensive Breast Centers: Priorities and Pitfalls

▪ Abstract: Comprehensive breast centers are developed for a variety of reasons, but the major motivations are usually to reduce psychological morbidity, develop an interdisciplinary team, provide comprehensive services in a patient-focused manner, improve clinical and emotional outcomes, and develop an organized "system" of care. However, the development of "comprehensive" breast centers presents far more of a challenge than a breast-imaging center and must be undertaken with great care and commitment. If the medical staff and operational issues are not appropriately identified and addressed, the long-term success will be threatened. Each breast center is different, but some of the principal priorities and pitfalls are described. The priorities relate to breast subspecialization, access and coordination, prospective treatment planning, and comprehensive programmatic services. Among the many potential pitfalls, the focus in this article is operational and OncoPolitics. ▪