Evolving surgical treatment decisions for male breast cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database

Background

Male breast cancer (MBC) is a rare malignancy, and gender-specific treatment outcomes are currently lacking. The use of a large, multi-national surgical-outcomes database may provide a better understanding of treatment patterns and postoperative morbidity in men who undergo oncological breast surgery.

Methods

A retrospective cohort analysis was conducted between 2007 and 2016 using the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP), examining MBC treatment patterns and postoperative complication rates. All men undergoing surgery for the treatment of invasive or in situ carcinoma of the breast were identified. Clinical characteristics, demographics, and surgical treatment options most frequently used for this population were described. In addition, the 30-day postoperative complication rates in the surgical treatment of male breast cancer were evaluated.

Results

A total of 1773 MBC patients with a median age of 65 years (IQR 56–74 years) were included in this analysis. Mean body mass index (BMI) was 29.1 (IQR 25.4–33.8). In this study population, 177 (10.0%) had a diagnosis of in situ breast cancer, while the remaining 1596 (90.0%) had invasive disease. While most men underwent mastectomy, 282 (15.9%) had breast-conserving surgery. There were 74 (4.2%) patients who underwent immediate breast reconstruction. In addition, 118 (6.7%) patients elected to have a contralateral prophylactic mastectomy. Overall, the rate of morbidity was 4.6%, comprising mostly of wound complications (3.2%).

Conclusion

Analysis of this large, prospective multi-institutional cohort revealed that complication rates are low and comparable to reported rates in the female breast cancer population. What is also significant about this analysis is that the cohort demonstrated the importance of cosmetic considerations in MBC patients, as some men decide to undergo breast-conserving surgery or immediate breast reconstruction. Contralateral prophylactic mastectomy in the treatment of MBC is also performed.

     

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.     

Utilization of screening mammography: comparison of different physician specialties

Data obtained on 426 consecutive patients referred to a breast center by 122 physicians, including family practitioners, general surgeons, and other specialists, showed that the obstetricians-gynecologists referred the greatest average number of patients per physician, with more than 50% of these referrals for screening mammography. Internists referred fewer patients by nearly a factor of ten, with only one-third of these patients referred for screening mammography. Internists may be the weakest link in the utilization of screening mammography.     

Radioimmunoscintigraphy of squamous carcinomas of the head and neck

A pilot study was carried out to assess the value of a radiolabeled antibody against epidermal growth factor receptor (EGFR1) in localizing tumors in patients with squamous carcinomas of the head and neck. Positive images of large tumours (greater than 3 cm diameter) were obtained in 8 of 11 patients after intravenous administration of 111indium-labeled EGFR1. Two patients gave equivocal results, while negative scans were obtained from the patient with the smallest tumor (1 cm diameter). There were no false-positive images. The success of this study in localizing relatively large squamous carcinomas indicates that the antibody should be evaluated in patients with smaller tumors to establish the limits of detection of the technique.     

Measurement of radiation dose to the thyroid using positron emission tomography

Measurements of the functioning volume of thyroid tissue have been made in 22 patients undergoing radioiodine therapy for thyrotoxicosis, using a prototype multiwire proportional counter positron camera. Tomographic images were produced of the distribution of 124I in the thyroid. Functioning volumes were found to be in the range 21-79 cm3 with volume errors of the order of +/- 4% to +/- 14%. Radioiodine uptake varied from 28% to 98%. Using a value of 6 days for the effective half-life of radioiodine in hyperactive thyroids, radiation doses from a standard therapy administration of 75 MBq of 131I varied from 11 to 48 Gy (compared with a recommended 50-70 Gy). In five cases PET imaging showed a non-uniform distribution of radioiodine in thyroids thought to have uniform uptake from conventional pinhole scintigraphy.     

The effect of chelating agents on the distribution of monoclonal antibodies in mice

The potential for altering the biodistribution of radiolabel from gallium- and indium-labeled mouse monoclonal antibodies was investigated in mice using metal chelating agents. The chelating agents used were desferrioxamine (DFO), diethylenetriaminepentaacetic acid (DTPA), ethylenediamine-di (O-hydroxyphenylacetic acid) (EDHPA), and 2,2' dipyridyl (DIPY). The mouse monoclonal antibody LICR-LON-M8 was labeled with 111In after conjugation to DTPA, and with 67Ga after conjugation to DFO. All the chelating agents except DIPY altered the biodistribution of [67Ga]citrate and [111In]citrate but did not affect the 48-hr tissue uptake of label from [111In]DTPA-M8 or [67Ga]DFO-M8, confirming the in vivo stability of the antibody conjugates. Label fixed in the tissues was inaccessible to the chelating agents, indicating that they will not be suitable for reducing the high background liver radioactivity in patients undergoing scanning with indium-labeled antibodies.     

Management of patients with breast cancer

Breast cancer is the most common cancer in the UK, with over 39,500 women diagnosed every year (Cancer Research UK 2003). The author examines the biological, psychological and social aspects of managing patients with breast cancer. This article also highlights the importance of the nurse's role in supporting patients throughout their illness and in some cases at the end of life.