Intraductal Papilloma Research Articles

Efficacy and safety of percutaneous ultrasound-guided vacuum-assisted excision for the treatment of clinical benign breast lesions larger than 3 cm: a retrospective cohort study.

Breast ultrasound-guided vacuum-assisted excision (US-VAE) has become a scarless solution for the removal of benign breast lesions. This procedure is now favored by more and more female patients for its satisfactory cosmetic outcome and few postoperative complications. However, controversy have been raised regarding its efficacy and safety in treating larger benign breast lesions. This study aimed to evaluate whether US-VAE is sufficient for the treatment of clinical benign breast lesions larger than 3 cm and to investigate the lesion features that affect the complete excision rate and hematoma occurrence rate. From January 2018 to July 2021, a total of 1,812 lesions in 1,367 patients underwent US-VAE at the Chinese People's Liberation Army General Hospital. A total of 89 benign breast lesions in 87 patients enrolled in this retrospective cohort study. The baseline clinical characteristics and ultrasonographic features of the lesions were recorded. Patients were followed up by US to record if there are any serious issues and the occurrence of hematoma and the recurrence of the lesions within 3 days and 6-12 months later, then at 1-year intervals. Lesions were classified to analyze the possible factors associated with complete excision rate and hematoma occurrence rate. The mean age was 35.9±9.5 years (range, 18-54 years), and the median maximum size of benign breast lesions was 3.5 cm (range, 3.1-5.0 cm). The complete excision rate was 91.0% (81/89). Histopathology (P=0.002) and vascularity (P=0.032) of lesions showed statistically significant differences in groups with or without recurrent lesions. A total of 17 cases (17/89, 19.1%) presented with hematoma after the procedure. The maximum lesion size in patients with hematoma was significantly larger than that in those without hematoma (P<0.001). US-VAE is an effective and safe alternative method for the treatment of benign breast lesions larger than 3 cm, especially for fibroadenoma, adenosis, hamartoma. For benign phyllodes tumors and intraductal papillomas larger than 3 cm and lesions with hypervascularity, the possibility of recurrence after US-VAE should be noted. The size of lesions needs to be considered when evaluating the occurrence of hematoma after US-VAE.

Upgrade Rate and Predictive Factors Associated With Breast Papillary Lesions on Core Biopsy: A Canadian Experience.

Background: Papillary lesions of the breast are a heterogeneous group, encompassing a wide range of lesions. The histologic distinction between papillary breast lesions remains challenging, especially on core biopsy specimens. Aim: This study aimed to determine the rate of upgrade to atypia or malignancy of biopsy-proven papillary lesions on surgical follow-up and to assess for factors associated with an upgrade in Greater Vancouver, BC, Canada. Materials and Methods: This is a retrospective population-based study of all breast papillary lesions diagnosed on core biopsy between 2017 and 2019 in the Fraser Health Authority in Greater Vancouver, Canada. Patients were retrieved from the laboratory information system. Patient demographics, histopathologic, and radiologic findings were analyzed. Results: A total of 269 specimens from 269 patients (mean 61.1 years), including 265 female and 4 male patients, were included in the study. Of the 269 specimens, 129 (48%) were intraductal papillomas and 140 (52%) were atypical papillary lesions. The overall upgrade rate among papillomas was 11.6% (15 of 129) on final excision. The mean age of patients diagnosed with papilloma on core biopsy was significantly younger than those with atypical papillary lesions (55.6 vs 66.1 years, P < .0001). Lesion size in patients with papillomas on core biopsy was significantly smaller than those with atypical papillary lesions (11.1 vs 15.1 mm, P = .001). The upgrade rates in patients <55 and ≥55 years were 4.9% and 13.2%. Size (P = .004) and atypia on core biopsy (P = .009) were significantly associated with upgrade. Older age (>55 years) (OR = 5.3, 95% CI: 1.04-27.08) was an independent predictor of upgrade among papillomas. Size, location, and Breast Imaging-Reporting and Data System (BI-RADS) radiologic categories in our study were not associated with predicting the upgrade of papillomas. Conclusion: Our data suggest that the risk of upgrade to atypia or malignancy is sufficient to warrant the excision of benign papillomas of any size in patients aged ≥55 years. In patients younger than 55 years, observation with close clinical and radiological follow-up without surgery may be sufficient. Our findings also support surgical excision of papillomas diagnosed on core biopsy when associated with atypia.

A Challenging Case of Atypical Papillary Proliferation of Nipple with Loss of Myoepithelial Layer Cells; a Diagnostic Dilemma

Abstract Introduction/Objective Papillary breast lesions are comprised of a broad spectrum of entities ranging from benign conditions like intraductal papilloma to invasive carcinoma. These lesions account for less than 3% percent of breast tumors and less than 2% of breast malignancies. The wide range and overlap in the clinical, imaging, and histologic characteristics of these lesions can often make them difficult to classify. Here we present a case of a challenging neoplastic nipple papillary lesion with a differential diagnosis ranging from nipple adenoma with atypia to papillary carcinoma. Methods/Case Report 48-year-old female with history of left nipple mass for 6 months, presented to the emergency department with mild bleeding from the left nipple for two hours. Breast ultrasound showed a group of fine pleomorphic calcifications within a mass arising from the left nipple, highly concerning for Paget's disease. Histopathology revealed papillary proliferation of well-formed round structures within a variably fibrous/hemorrhagic stroma. The nodules exhibited papillary fronds with epithelial hyperplasia of monotonous low-grade cells, and scattered mitoses, forming relatively rigid/luminal structures with polarization. No desmoplasia or conventional infiltrative pattern was seen. Immunohistochemical staining showed strong expression for estrogen receptor (ER). Cytokeratin 5/6, p63 and calponin did not highlight the myoepithelial layer in the papillary elements or around the round structures. A diagnosis of atypical papillary proliferation was rendered to warrant an excision. Subsequently, the patient underwent total mastectomy, which revealed conventional invasive ductal carcinoma with lymphovascular space invasion. Results (if a Case Study enter NA) NA Conclusion Atypical papillary lesions of the nipple are difficult to classify in a limited biopsy material. The loss of myoepithelial cell layer makes interpretation even more challenging. Extreme caution should be taken in assigning neoplastic nature to the lesions in biopsy which eventually guide the surgeon in making decision to preserve the nipple or not.

B3 Lesions of Breast: Two Year Retrospective Analysis of 4478 Cases Carried out in a Single Centre in the UK

Background: B3 category mainly consists of lesions that provide benign histology on core biopsy, but either are known to show heterogeneity or have increased risk of associated malignancy. However, the level of risk is very different for different entities. All the cases should be looked for atypia. The objective of this study is to compare various B3 lesions in two audits, to calculate the median rate and upgrade rates (the rate at which they turn into malignancy on subsequent excision) for different B3 lesions and to compare them with the national standards and published literature. The study aims to see whether vacuum assisted excision or surgical excision has been done in such lesions. Methods: This is a retrospective study and encompasses two audits done in 2017-18 and 2020-21 at Queen's hospital, Barking, Havering and Redbridge NHS trust. A total of 4478 cases were reviewed and 206 cases were graded as B3 on core biopsy. Results: Overall, 113 cases were graded as B3 in 2020-21 and 93 cases in 2017-18 giving the median rate of 5% and the overall upgrade rate of 12%. Intraductal papilloma was the most commonly seen lesion in both audits. Also, 31 cases underwent vacuum assisted excision and 62 cases underwent surgical excision, with 38 cases not undergoing further excision. Conclusion: The median rate was within the 'preferred median rate'- 4.5-8.5% and the upgrade rate was comparable (16.57%) with those of National Breast Cancer screening audit, 2016-2019. The type of excision for various lesions was in line with the criteria stated by the Royal College of Pathologists. The lesions which were not excised did not turn into malignancy on follow-up.

The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar.

PurposeWhen Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex Sclerosing Lesion (RS), excisional biopsy (EB) is often performed to rule out underlying malignancy with upstage rates (UR) ranging between 1 and 20%. The COVID-19 pandemic led to delayed EB for many patients. We sought to evaluate whether this delay was associated with higher UR.MethodsWe performed a retrospective analysis of women who underwent CNB and then EB for ADH, FEA, IDP, or RS between 2017 and 2021 using an IRB-approved repository. UR was evaluated by days between CNB and EB.Results473 patients met inclusion. 55 were upstaged to cancer (11.6%). 178 patients had pure ADH on CNB and 37 were upstaged (20.8%). 50 patients had pure FEA and 3 were upstaged (6%). 132 had pure IDP and 7 were upstaged (5.3%). 98 had pure RS and 1 was upstaged (1%). 7/15 (46.7%) had a combination of diagnoses or diagnosis with palpable mass and were upstaged.Days between CNB and EB were < 60 for 275 patients (58.1%), 60–90 for 108 (22.8%), 91–120 for 43 (9.1%), and > 120 for 47 (9.9%). There was no significant difference in UR (10.9% for < 60, 14.8% for 60–90, 7% for 90–120, and 12.8% for > 120, p = 0.54). UR for ADH was clinically increased after 60 days (27.8 vs. 17.5%), but this did not reach statistical significance (p = 0.1).ConclusionSurgical delay was not associated with an increased UR.

A BCC masquerading as a fungating breast mass

A 55-year-old female presented with a growth on her left chest that was increasing in size. The growth had been present for several years. The patient had no complaints of pain; just concerns about the presence of the mass. Upon examination, the patient had a polypoid, lobulated, violaceous, and red fungating mask measuring approx. 7.0 cm x 6.0 cm (Fig. 1a). Malignant breast disease encompasses many histologic types that include, ductal or lobular carcinoma, infiltrating ductal or lobular carcinoma, and inflammatory carcinoma. Benign masses can include fibroadenoma, intraductal papilloma, and abscess. Patient was referred to a general surgeon for removal due to the uncertain nature of this growth (Fig. 1b). Pathology was positive for a basal cell carcinoma with focal squamous cell differentiation, nodular type (Fig. 2). All resected margins were negative. Recovery was uneventful. Basal cell carcinomas located on the trunk account for only 10 percent of all cases. The majority are in sun exposed areas such as the face and neck [1,2].

Papillary lesions of the breast - review and practical issues.

Papillary lesions of the breast represent a heterogeneous group of neoplasm featuring fibrovascular cores covered by epithelial cells with or without intervening myoepithelial cells. According to the World Health Organization classification of breast tumors, papillary lesions of the breast are further classified into intraductal papilloma (including intraductal papilloma with atypical ductal hyperplasia /ductal carcinoma in situ), papillary ductal carcinoma in situ, encapsulated papillary carcinoma, solid papillary carcinoma (in situ and invasive) and invasive papillary carcinoma. The overlapping morphological features and immunohistochemical profiles make accurate diagnosis of breast papillary lesion a challenge for pathologists. In this review, the morphological and relevant immunohistochemical features of papillary lesions are discussed, with further emphasis on some commonly encountered practical diagnostic issues. A simple diagnostic algorithm will be established. The relevant molecular characteristics will be discussed as well.

INTRADUCTAL PAPILLOMA IN SALIVARY GLAND: CASE REPORT

A 71-year-old male patient reported an increase in volume in the face for 1 year. The patient's medical history was irrelevant. The patient began smoking (20 units/day) at the age of 15. Extraoral physical examination showed a nodular lesion hard to palpation, fixed, and painless, close to the upper lip. In the oral cavity, the lesion caused bulging of the mucosa without alteration of color or signs of bleeding. Incisional biopsy was performed, and histologic sections stained in hematoxylin and eosin revealed dilated cystic structures below the surface mucosa, limited by the layer of epithelial cells with papillary projections into the lumen, leading to the diagnosis of intraductal papilloma in the salivary gland. The patient is waiting for a computed tomography scan of the face, in addition to preoperative exams necessary to perform surgery to completely remove the lesion.

Upgrade Rates of DCIS, Intraductal Papilloma, and the Other High-risk Breast Lesions

Upgrade Rates of DCIS, Intraductal Papilloma, and the Other High-risk Breast Lesions

Upgrade rates of intraductal papilloma with and without atypia diagnosed on core needle biopsy and clinicopathologic predictors

Surgical excision of breast intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) is controversial as the risk of upgrade to malignant lesions is not well established. This study investigates upgrade rates of benign and atypical IDP to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) and clinicopathologic predictors. We identified 556 cases of IDP diagnosed on CNB at a single institution from 2010 to 2020 after excluding patients with a history of breast carcinoma, ipsilateral high-risk lesion, radiologic/pathologic discordance, or less than 2 years of follow-up if no excision within 1 year. Of these, 97 biopsies were consistent with atypical IDP and 459 were benign IDP. Surgical excision was performed for 318 (57.2%), and the remaining 238 (42.8%) underwent active monitoring. The upgrade rate for IDP without atypia was 2/225 (0.9%; 1 DCIS and 1 IC). Of 93 surgically excised atypical IDPs, 19(20.4%) upgraded (14 DCIS and 5 IC). Of 238 nonexcised IDPs followed clinically (range, 24-140 months, mean 60 months), there was no subsequent breast cancer diagnosed at the IDP site on follow-up. Mean age of patients was 56yr±12.6 SD without upgrade, 63yr±10.6 SD (P=.027) with DCIS, and 61yr±10.8 SD (P=.35) with IC. Atypical IDP was more likely to upgrade if biopsied by stereotactic guidance (8/19, 42.1% P=.035). At our institution, we had an exceedingly low upgrade rate for benign IDP. Overall, patients with upgrade to DCIS were older. For atypical IDP, upgrade was seen in higher proportions of stereotactic biopsies.

Multiple Papillomas of the Breast: A Review of Current Evidence and Challenges.

Objectives: To conduct a review of evidence about papillomatosis/multiple papillomas (MP), its clinical and imaging presentation, the association between MP and malignancy and the management strategies that follow. Methods: A computerized literature search using PubMed and Google Scholar was performed up to January 2021 with the following search strategy: “papilloma” OR “intraductal papilloma” OR “intraductal papillary neoplasms” OR “papillomatosis” OR “papillary lesion” AND “breast”. Two authors independently conducted a search, screening and extraction of data from the eligible studies. Results: Of the 1881 articles identified, 29 articles met the inclusion criteria. The most common breast imaging methods (mammography, ultrasound) showed few specific signs of MP, and evidence about magnetic resonance imaging were weak. Regarding the association between MP and malignancy, the risk of underestimation to biopsy methods and the frequent coexistence of MP and other high-risk lesions needs to be taken into consideration. Results about the risk of developing breast carcinoma of patients affected by MP were inconsistent. Conclusions: MP is a challenge for all breast specialists, and familiarity with its features is required to make the correct diagnosis. Further studies are needed to evaluate the factors to take into account to plan management, time of follow-up and imaging methods.

Second Case of Tumors Associated With Heterozygous NTHL1 Variant

Homozygous mutations to NTHL1 are known to increase cancer risk, particularly in the colon and breast. NTHL1 tumor syndrome (NTS) is an autosomal recessive genetic condition. Little is known about the cancer risk in patients who have heterozygous NTHL1 mutations. We previously published a case of benign tumors associated with a heterozygous NTHL1 mutation. In this second case, we present a patient with a heterozygous NTHL1 mutation who developed a gastrointestinal stromal tumor, pilocytic astrocytoma, tall cell papillary thyroid cancer, invasive ductal papilloma, spinal nerve sheath tumors, and spinal hemangiomas. Here, we show that heterozygous NTHL1 mutations may increase cancer risk and may even manifest similarly to NTS.

Nipple Discharge Imaging Evaluation with Mammography, Ultrasound, Galactography, and MRI

To determine the diagnostic yield of various imaging tests used to evaluate nipple discharge. A single institution, IRB-approved, retrospective study was performed of 320 consecutive patients presenting with nipple discharge. Imaging and pathology were reviewed to determine the yield for malignancy, atypical high-risk lesions (HRLs), and intraductal papillomas (IDPs). Of the 320 patients, pathology or follow up confirmed 40 breast malignancies (40/320, 12.5%),14 atypical HRLs (14/320, 4.4%), 71 IDPs (71/320, 22.2%), 48 other benign pathologies (48/320,15.0%), and 147 unknown but benign cases (147/320, 45.9%). Physiologic discharge characteristics were observed in a minority of malignant cases: nonspontaneous (4/40, 10.0%); neither bloody nor clear (4/40, 10.0%); bilateral (3/40, 7.5%). Malignancy was associated with older age (p < 0.001) and bloody discharge (odds ratio 6.5, p < 0.0001). The combination of digital mammography and ultrasound had a 93% sensitivity and a 98% NPV, while contrast enhanced MRI (CE-MRI) had a 100% sensitivity and a 100% NPV for malignancy. Only three galactography examinations were performed among the malignant cohort, with minimal contribution (1 of 3) to the diagnostic evaluation. In this case, galactography findings helped determine imaging-pathology discordance, prompting a recommendation for surgical excision and subsequently a malignant diagnosis. The combination of mammography and ultrasonography detected 93% of breast malignancies associated with nipple discharge and had a 98% NPV for malignancy. The value of CE-MRI is its ability to detect the remaining malignancies, not detected on mammography or ultrasound, and its ability to obviate the need for surgical duct excision.

Histopathologic metrics of breast tumors in Northern Saudi Arabia

The alarming liability of breast cancer, mainly among younger Saudi women, has been attributed to diverse factors requiring a manageable valuation. Therefore, this study aimed to assess the types of tumors and breast cancer presentation stages in Northern Saudi Arabia. In the present study, retrieved data regarding breast biopsies were received from the Department of Pathology at King Salman Hospital, Hail, Northern Saudi Arabia. Included data referring to breast cancer biopsies patients (including 131 females and two males) diagnosed during the period from November 2019 to November 2020. Out of the 133 patients, breast cancer was diagnosed in 49/133(36.8%) patients included 45/49(91.8%) invasive ductal carcinoma (IDC), 2/49(4.1%) invasive lobular carcinoma (ILC), and 2/49(4.1%) papillary carcinoma. The remaining 84 benign breast lesions included 40/84(47.6%) fibroadenoma, 11/84(13%) ductal hyperplasia, 9/84(10.7%) fibrocystic disease, 8/84(9.5%) adenosis, 4/84(4.8%) chronic mastitis, 3/84(3.6%) breast abscess & intraductal papilloma, 2/84(2.4%) duct ectasia & phylloides tumor, and 1/84(1.2%) lactating adenoma & lipoma. Breast cancer is highly prevalent in Northern Saudi Arabia with predominantly invasive ductal carcinoma. There is an increase in the incidence of younger patients with advanced stages of initial presentation. Fibroadenoma is the commonest benign breast lesion, followed by fibrocystic diseases in Northern Saudi Arabia.

AN EVALUATION OF BENIGN BREAST TUMORS AND ITS SURGICAL MANAGEMENT IN A TERTIARY CARE HOSPITAL

Introduction: A study has been conducted on the incidence rates of different benign breast tumors ,their presentationand outcome beneficience of surgical procedures have been compared. Material And Methods: A total of 100 cases with benign breast mass, attending surgical department of RGKMCH and meeting the inclusion criterias were studied in the given time period. Results: Fibroadenoma predominates (94%) followed by Phyllodes tumour (2%), Intraductal papilloma (2%) and Lipoma (2%).The age group of 20 to 24 years showed the maximum number of cases. The all-benign breast tumours in the present study were managed in accordance with the types of tumour. All the fibroadenomas were excised locally. Conclusion: Fibroadenoma is the commonest type of benign breast tumours than other types. . The treatment of benign breast tumours are simple excision and sometimes may require simple mastectomy.

AB0920 Safety of Apremilast in PsA patients with history of malignancies or active cancer: a retrospective study

BackgroundOne of the most intriguing aspects in the management of patients with inflammatory arthritis is the safety of novel therapies in those with a recent history of malignancy or active neoplasm. In this regard, apremilast (APR), an oral PDE4 inhibitor, is emerging as one of the safest therapeutic options in patients with PsA with comorbid cancer.ObjectivesThis retrospective study aims to assess the effectiveness and safety of APR in PsA patients with a recent history of malignancy or active cancer.MethodsWe retrospectively observed patients with a history of neoplasm diagnosed from 1997 to 2021, who underwent apremilast treatment from 2017 to 2021 in a tertiary care centre. We recorded demographic and clinical characteristics at APR baseline and last visit. Furthermore, we recorded the eventual recurrence of primary cancer or the onset of new neoplasms. Paired t-test was used to assess the difference of continuous variables at different follow-ups.ResultsThirteen patients (sex: female 6/13, 46,15%; mean age (mean ± 63,7 years sd ± 9,9 years)) started Apremilast between 2017 to 2021 in a tertiary care center. We assessed their clinical condition using DAPSA, LEI and PASI score in the baseline and in the last visit. Mean follow-up time was 32,02 ± 18,92 months.Mean DAPSA at baseline 20,55 ± 9,15 decreased to 16,21 ± 1,73 at last visit. Similarly mean LEI at baseline was 1,23 ± 1,58 and decreased to 0,61 ± 0,35 at last visit, even in absence of statistical significance (p=0,15). Conversely mean PASI at baseline (1,76 ± 2,57) did not show a decrease (1,61 ± 0,93);Ten patients were still treated with apremilast at last available follow-up. Patient 6 (Table 1) experienced the relapse of Ductal Breast Papilloma. For patient 8, a relapse of primary cancer occurred. Patient 9 had the onset of a new neoplasm. The APR was not discontinued as such malignancies were not considered as treatment associated.Three patients (4, 6, 10) discontinued APR due to intolerance or lack of efficacy.ConclusionAPR seems a safe option in PsA patients with a recent history of malignancy or active cancer, improving articular involvement.Disclosure of InterestsNone declared

Breast Density Lacks Influence on Upgrade Rates to High Risk Lesions and Cancer Among Proliferative Breast Lesion Excisions.

Breast density is an independent risk factor for the development of breast cancer. We assessed if upgrade rates to high-risk lesions and cancer were influenced by density when evaluating proliferative complex sclerosing lesions and intraductal papillomas. This is a retrospective single institution study. We evaluated 168 women aged 18-86 who received a core needle biopsy revealing a breast proliferative lesion of complex sclerosing lesion (CSL) or intraductal papilloma. We analyzed the upgrade rate to high-risk atypia (HRL) and cancer. Subgroup analysis based on age and breast density was performed. The patient collective was well balanced-51% had dense breasts and 42% were under 50years old. Half were diagnosed with papilloma based on CNB and the other half with CSL. For those proliferative lesions without atypia, the upgrade rate to cancer was 1.6%. CNB showed concomitant HRL in 23% of patients with non-dense breasts and in 22% with dense tissue. In 24 cases, the pathology was considered an upgrade by showing either a not prior noted HRL or carcinoma. Most patients with upgrade following surgical excision were over 50years old. Dense breasts did not show a higher risk of upgrade following surgical excision (P = .975). Our data did not reveal a difference between upgrade rates of proliferative lesions excised in dense and non-dense breasts. Further evaluation is warranted to establish whether density should be considered as a meaningful factor in excision vs observation of CSL and papillomas.

Intraductal Papilloma on Breast Biopsy: Upstaging Rate and Implications for Practice Guidelines

The recommendation for management of intraductal papilloma has not been clearly established and its surgical excision criteria remain controversial. This study determines the institutional malignancy upstage rate of benign intraductal papillomas and identifies risk factors for upstage. Retrospective review was conducted on female patients who were diagnosed with intraductal papillomas without atypia on core needle biopsy at Atrium Health Wake Forest Baptist Hospital between 1/2012 and 6/2021. Patients were excluded if there was a concomitant malignancy or atypia or deemed to be discordant with imaging. Features associated with upstage on imaging and histopathology were obtained from the electronic medical record. This study included 245 intraductal papillomas without atypia in 231 women (mean age, 59.1 ± 12.3 [SD] years). Approximately 31% (76/245) of the papillomas were excised, whereas 69% (169/245) of the papillomas underwent surveillance. Of the patients who underwent excisional biopsy, upstage rate for DCIS was 1.3% (1/76) and 5.3% (4/76) for atypia. All of the papillomas upstaged to DCIS or atypia had lesion size ≥10mm on imaging. Out of the 139 intraductal papillomas that underwent radiologic surveillance, two (1.4%) developed malignancy and three (2.2%) developed atypia. The risk of upstaging of intraductal papilloma without atypia to malignancy remains extremely low. Therefore, routine surgical excision may not be necessary. While the papillomas upstaged to either malignancy or atypia have size abnormality ≥10mm, other potential selective excision criteria should be explored to further decrease the risk of an upstage.

Overexpression of lncRNA MAPT-AS1 exacerbates cell proliferation and metastasis in breast cancer.

BackgroundTo investigate the function of MAPT antisense RNA 1 (MAPT-AS1) in breast cancer (BC), evaluating its potential diagnostic value for BC patients.MethodsThis study involved 498 patients with BC, 222 patients with benign breast diseases, including 74 cases each of of breast fibroadenoma, breast intraductal papilloma, and ductal hyperplasia and 429 healthy controls. We collected 20 cases of BC tissues and adjacent normal tissues and blood was taken from each participant. The expression levels of MAPT-AS1 were detected using reverse transcription polymerase chain reaction (RT-PCR). According to the median serum level of MAPT-AS1, patients were divided into a high expression group and a low expression group. We established MAPT-AS1 overexpression and knockdown in human BC cell line ZR-75-1 and MDA-MB-231 to study the function on cell proliferation [using cell counting kit-8 (CCK-8) assay], migration, and invasion (using Transwell assay).ResultsThe expression of MAPT-AS1 was significantly up-regulated in tissues and serum of BC patients compared with controls (P<0.0001 for both). Receiver operating characteristic (ROC) curve analysis showed that MAPT-AS1 had a large area under the curve (AUC) of 0.893. The expression of MAPT-AS1 in serum was closely related to the large tumor size, grade, tumor-node-metastasis (TNM) stages, and human epidermal growth factor receptor 2 (HER-2) expression status of BC patients. Overexpression of MAPT-AS1 activated the Wnt/β-catenin signaling pathway, promoting proliferation, migration, and invasion.ConclusionsOverexpression of MAPT-AS1 in tissues and serum is a reliable diagnostic marker for BC, and MAPT-AS1 regulates the proliferation and metastasis of BC cells by activating the Wnt/β-catenin signaling pathway.

The role of microductectomy in the diagnosis and treatment in women with pathologic nipple discharge

Objectives: Approximately one tenth of the patients who apply to the breast polyclinics complain of nipple discharge. Apart from pregnancy and lactation, spontaneous, unilateral, bloody or serous discharge originating from a single duct describes the Pathological Nipple Discharge (PND). The aim of this study is to show that precancerous breast lesions, which can be easily overlooked by conventional diagnostic methods, are detected with the microductectomy performed with the correct indication and it is possible to complete the appropriate treatment. Methods: Fifty-five microductectomy procedures were performed in 55 female patients who applied to the relevant clinic with the complaint of nipple discharge between January 2013 and August 2018 and who met at least two of the three criteria of pathological nipple discharge (spontaneous, single ductus, bloody or serous) except pregnancy and lactation. Prospectively collected information was evaluated retrospectively. Results: The average age of the patients in the study ranged from 23 to 73 years (mean age 45.5 years, median age 47 years). Out of 55 procedures, 28 (50.9%) were performed in women of reproductive age, 27 (49.1%) were performed in women in menopause. The discharge was localized to the right breast in 28 patients, and to the left breast in 27 patients. Forty-one of the 55 patients included in the study met all of the criteria for pathological nipple discharge, while the other 14 patients had at least two of the three criteria. Final pathologies were classified as follows; intraductal papilloma / papillomatosis with atypia, intraductal papillary carcinoma (IPC) and ductal carcinoma in situ (DCIS); Potential Neoplastic and Malignant Lesion (PNML). Conclusions: In cases where direct intraductal imaging methods cannot be applied in patients admitted to the polyclinic with pathological nipple discharge, microductectomy emerges as an effective diagnosis and treatment method that can be applied with low morbidity.