Outer Quadrant Research Articles

Clinical and histological characteristics of breast lumps: A 20-year single private sector tertiary care center experience

Background and objective: The presence of a breast lump is an alarming experience. This is because of the growing awareness of breast cancer among the public. Therefore, a comprehensive diagnosis of breast lumps is vital. This study aims to identify the clinical and histological characteristics of breast lumps of patients presenting to a tertiary care center in Colombo, Sri Lanka. Methods: This 20 year, retrospective study analyzed the clinical and histological characteristics of all patients with breast lumps who were admitted only to Nawaloka Hospital, Colombo from 2003 to 2023. Data were retrieved through past medical records and a computer-based health information system from Nawaloka Hospital. A general surgeon analyzed all the records. The records were analyzed with relation to demographics, presenting symptoms, presence of a lump or mass, and histological diagnosis. This study was aimed to determine the characteristics of breast lumps in a selected sample of patients who were admitted with breast lumps to a single private sector tertiary care hospital. Ethical clearance was granted. No conflict of interest. Results: Total of 352 patients had breast lumps [female-342 (97.1%): male-10(2.9%)]. Data from 342 female and 10 male patients who were admitted with breast lumps or masses were analyzed. There were 252 /352 self-referrals, 60 / 352 referrals were from general practitioners and 40 / 352 were referred following screening. Most females were 21 to 50 years (n=219, 64%). Ninety-seven per cent of the female patients had palpable breast lumps. Most males with breast lumps were in the age group of 51-60 years. Males had relatively larger lumps (> 2cm, 80%) at the time of their presentation. In both genders, the most common quadrant for occurrence of breast lumps was the upper outer quadrant (F: 55% & M: 60%). Fibroadenoma was the commonest variety of lump in both sexes (F: 49% & M: 60%). However, most males who presented with breast lumps were found to have breast cancer (M: 40% vs. F: 10%). Histologically, invasive carcinoma of no specific type (NST) was the most common type (M: 75% & F: 63%). Thirty-five female patients had carcinoma, ten were below the age of 50 years, and two were in their early 30s. Conclusion: Our study sample showed that most of the patients were females. The most common benign breast lump was fibroadenoma and the malignant variant was invasive carcinoma of no specific type (NST). Furthermore, it showed that at the time of presentations males had larger breast lumps with and raised percentage of malignant breast lumps.

Spindle cell carcinoma of the breast: a case study report from Mankweng hospital & literature review

Spindle cell carcinoma of the breast is a rare breast malignancy, and it accounts for <1 % of breast neoplasms. Tumours are usually large, well-circumscribed, and cystic-containing lesions in the upper outer quadrant of the breast.
 The aim: The main objective of the case report is to highlight our experience with Spindle cell carcinoma of the breast.
 Result: A case presentation of a 58-year-old female who was referred from the peripheral hospital to our breast oncology clinic with a left breast mass rapidly growing for the past five months. The mass measured 23cm x 20 cm, palpable in all quadrants of the breast but more in the upper outer quadrant of the breast. Mammography and ultrasound showed a massive heterogeneous left breast solid mass involving the entire breast and all quadrants, with areas of cystic components and increased flow. There were no calcifications noted. She was assessed as BI-RAD 5. A core needle biopsy showed spindle cell carcinoma of the left breast. The patient was offered a modified radical mastectomy.
 Conclusion: Spindle cell carcinoma of the breast poses a diagnostic challenge due to the rarity of the disease; overlapping morphological features on histology and biomarkers specific to spindle cells have not been extensively studied

ERECTILE DYSFUNCTION TREATMENT USING SUBCUTANEOUS IMPLANTS WITH A LONG-TERM EFFECT

Introduction. The article describes a new method of improving erectile function by incerting long-acting subcutaneous implants with the phosphodiesterase 5 (PDE 5) inhibitor.
 The aim of the study: To evaluate the effectiveness of tadalafil in the treatment of erectile dysfunction using bioidentical pellets.
 Materials and methods: The study included 10 men under 65 years of age who had suffered from erectile dysfunction for more than 1 year.
 For the examination before and 4 months after the intervention, the following were performed: filling out the MIEF-5 questionnaire, phical examination, Doppler of penile vessels, «Erection Hardness Scale», laboratory examination (general and biochemical blood tests, general urine analysis and hormonal testing, including determination of the levels of total testosterone, free testosterone, prolactin, estradiol and dehydroepiandrosterone sulfate.
 All patients received implants with bioidentical tadalafil 75 mg. The pellet was inserted in a sterile operating room through a 3 mm skin incision in the outer quadrant of the gluteal region and inserting the substance into the subcutaneous fat.
 Results: All patients showed an improvement in MIEF-5 from 14.7 ± 2.75 to 20.7 ± 1.49, an increase in systolic blood flow velocity and penile rigidity at the tenth minute after prostaglandin E1 injection on Doppler vascular examination.
 Conclusion: This study demonstrated the efficacy of tadalafil by pellet administration in the treatment of erectile dysfunction in men younger than 65 years.

Pattern Of Breast Cancer: Experience At Ayub Teaching Hospital, Abbottabad.

Breast cancer is the most common malignancy found in females all over the world and the second leading cause of cancer death in European countries. The purpose of this study was to find out the pattern of disease presentation in our region where a proper tumour registry system is lacking. This descriptive study was carried out in the Department of Surgery, Ayub Teaching Hospital Abbottabad, from July 2021 to June 2022. All female patients with biopsy-proven breast cancer were included in the study: benign lumps, refused to enrol, and those who were lost to follow-up were excluded. A total of 87 patients with carcinoma breast were included: 92 % (n=80) had invasive ductal carcinoma. Axillary lymph nodes were involved in 88.5% (n=77), 75.8% of the tumours, (n=66), were Grade 2, 34.5% (n=30) were in the 40-49 years age group, and 30 % (n=27) of the disease was categorized as Stage III or IV. In 55 % (n=48), the tumour was on the right side and in 39% (n=34), the upper outer quadrant was involved. Most of the patients, 90.8% (n=79), were married and had used contraceptive measures. Only 19.5% of patients (n=17), had a history of nipple discharge and 56% (n=49) had a positive family history: 71% (n=62) had nipple retraction, and 54% (n=47), proved to be ER PR positive. Our patients presented late: axilla was commonly involved and a third had advanced disease. Screening and community awareness programs may help in early detection. Hormone use for contraception needs to be weighed carefully. Better data collection may help in designing screening and care programs.

Factors Associated With Node-Positive Disease in Estrogen Receptor-Positive Breast Cancer Patients

IntroductionLarger tumor size and shorter tumor-to-nipple distance at diagnosis are associated with greater risk of lymph node involvement in breast cancer. However, the relationship between receptor subtype status and lymph node metastasis remains unclear. Our objective was to examine the association between primary tumor size, location, and nodal metastasis across estrogen receptor (ER)+/ progesterone receptor (PR)+/ human epidermal growth factor receptor 2 (HER2)-, ER+/PR-/HER2-, ER+/PR+/HER2+, and ER+/PR-/HER2+ tumors. MethodsA single-institution retrospective chart review was conducted of breast cancer patients diagnosed between 1998 and 2019 who underwent nodal evaluation during primary surgery. Neoadjuvant chemotherapy, pure ductal carcinoma in situ, inflammatory, recurrent, metastatic, bilateral, multicentric, and multifocal disease were excluded. Descriptive statistics (proportions and frequencies for categorical variables and medians [Q1-Q3] for continuous variables) were used to summarize patient characteristics. Kruskal–Wallis test was applied to test the association of outcome variables and continuous variables. Chi-square test or Fisher exact test was applied to test the association of outcome variables and categorical variables. ResultsSix hundred eighteen ER + patients had a median tumor size of 1.7 cm (1.1-2.5 cm). Two hundred ninety six out of 618 (47.9%) were node-positive and 188/618 (30.4%) had axillary dissection. Eighty four point three percent of patients were ER+/PR+/HER2-, 6.31% were ER+/PR-/HER2-, 6.96% were ER+/PR+/HER2+, and 1.13% were ER+/PR-/HER2+. Median tumor size was significantly larger in node-positive cases compared to node-negative cases in ER+/PR+/HER2-, ER+/PR+/HER2+, and ER+/PR-/HER2- subgroups. In ER+/PR+/HER2-patients, median tumor-nipple distance was significantly shorter in node-positive patients compared to node-negative patients. Upper outer quadrant location was significantly associated with nodal positivity in ER+/PR-/HER2- patients. ConclusionsAcross ER + patients, the significance between tumor size, location, and lymph node positivity varied significantly when differentiating by PR and HER2 status.

PRISE EN CAHRGE D’UN CANCER CANALAIRE INVASIF DU SEIN CHEZ UN HOMME DE 61 ANS A L’HOPITAL GYNECO-OBSTETRIQUE ET PEDIATRIQUE DE YAOUNDE

Introduction: Breast cancer, the leading malignant pathology in women, is still relatively rare in men. It accounts for less than 1% of malignant diseases in Men. Management strategies of breast cancer in males are copied from that of breast cancer in females. These therapies in men are in the experimentation stage despite the peculiarities observed. Hence, we are reporting the diagnosis and multidisciplinary management of a case of Invasive Ductal Carcinoma. Case presentation: we report the case of a 61-year-old male who consulted for a lump in the right breast discovered 3 years ago. Physical examination revealed an indurated nodular plaque (4x4x3cm) of the right breast located in the upper outer quadrant, not very tender not adherent to the superficial fascia. The overlying skin was macroscopically normal. Axillary palpation revealed homolateral axillary lymph nodes. The tumor was classified T2N1Mx. A breast ultrasound done revealed a lump of the right breast classified ACR4. Fine needle aspiration of the nodule as well as micro biopsy evoked an invasive grade 2 carcinoma. Neoadjuvant chemotherapy was done with cyclophosphamide. A right total Madden Mastectomy with homolateral lymphadenectomy was done. Progress postoperative was marked by local recurrence. Treatment with hormone therapy was initiated and radiotherapy delayed after secondary excision. We intended to show that tumor size, lymph node involvement and absence of hormone receptors are elements of poor prognosis just as a delay in radiotherapy is a risk for local recurrence. Conclusion: Male breast cancer is a rare pathology. Its management is copied exactly from that of the woman. Poor prognostic factors are: the size of the tumor, the presence of lymph nodes and the absence of hormone receptors.

The addition of a leaded arm sleeve to leaded aprons further decreases operator upper outer quadrant chest wall radiation dose during fluoroscopically guided interventions

ObjectiveBreast cancer most commonly occurs in the upper outer quadrant (UOQ) chest wall (CW). The effectiveness of routine leaded aprons to protect this region of the body in interventionalists during fluoroscopically guided interventions (FGIs) is unknown. Given the high lifetime attributable risks of prolonged occupational exposure to ionizing radiation and the increasing number of practicing female vascular surgeons and interventionalists, we sought to determine if the use of a leaded arm shield would offer additional protection to the lateral CW and axilla in operators compared with routine leaded aprons. MethodsEffectiveness of leaded sleeves in attenuating radiation dose to the axilla and UOQ was evaluated in clinical practice and simulated scenarios. In the clinical setting, optically stimulated luminescence nanoDot detectors were placed at the UOQ lateral CW position, both over and under a standard leaded apron vest with and without the addition of an antimony/bismuth Enviro-Lite sleeve on two vascular surgeons performing FGIs. In the simulation, nanoDots were similarly placed on an anthropomorphic phantom positioned to represent a primary operator performing right femoral access. Fluorography was performed on 12-inch-thick acrylic scatter phantom at 80 kVp for an exposure of 3 Gy reference air kerma. Experiments were done with and without the sleeve. Paired Wilcoxon and χ2 tests were performed to identify the statistical significance of radiation attenuation. ResultsOperator UOQ CW dose was measured during 61 FGIs: 33 cases (54%) with and 28 cases (46%) without the sleeve. Median procedure reference air kerma and fluoroscopy time was 180 mGy (interquartile range [IQR], 85-447 mGy) and 21 minutes (IQR, 11-39 minutes) when the sleeve was worn vs 100 mGy (IQR, 67-270 mGy) and 11 minutes (IQR, 6.3-25 minutes) without the sleeve. Radiation dose to the operator’s UOQ was reduced by 96% (IQR, 85%-96%) when the sleeve was present and by 62% (IQR, 44%-82%; P < .001) without the sleeve. In the simulated setting, the sleeve reduced the radiation dose to the UOQ compared with the apron alone (96% vs 67%; P < .001). ConclusionsRoutine leaded aprons do attenuate the majority of UOQ chest wall radiation dose; however, the addition of a lead-equivalent sleeve further significantly reduces this dose. Because this area of the body has a high incidence of cancer formation, additional protection, especially to female interventionalists, seems prudent. Vascular surgeons should consider using a protective sleeve with their personal protective equipment when performing complex fluoroscopically guided procedures.

An Innovative Non-Linear Prediction Model for Clinical Benefit in Women with Newly Diagnosed Breast Cancer Using Baseline FDG-PET/CT and Clinical Data.

Objectives: We aimed to develop a novel non-linear statistical model integrating primary tumor features on baseline [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), molecular subtype, and clinical data for treatment benefit prediction in women with newly diagnosed breast cancer using innovative statistical techniques, as opposed to conventional methodological approaches. Methods: In this single-center retrospective study, we conducted a comprehensive assessment of women newly diagnosed with breast cancer who had undergone a FDG-PET/CT scan for staging prior to treatment. Primary tumor (PT) volume, maximum and mean standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured on PET/CT. Clinical data including clinical staging (TNM) but also PT anatomical site, histology, receptor status, proliferation index, and molecular subtype were obtained from the medical records. Overall survival (OS), progression-free survival (PFS), and clinical benefit (CB) were assessed as endpoints. A logistic generalized additive model was chosen as the statistical approach to assess the impact of all listed variables on CB. Results: 70 women with newly diagnosed breast cancer (mean age 63.3 ± 15.4 years) were included. The most common location of breast cancer was the upper outer quadrant (40.0%) in the left breast (52.9%). An invasive ductal adenocarcinoma (88.6%) with a high tumor proliferation index (mean ki-67 expression 35.1 ± 24.5%) and molecular subtype B (51.4%) was by far the most detected breast tumor. Most PTs displayed on hybrid imaging a greater volume (12.8 ± 30.4 cm3) with hypermetabolism (mean ± SD of PT maximum SUVmax, SUVmean, MTV, and TLG, respectively: 8.1 ± 7.2, 4.9 ± 4.4, 12.7 ± 30.4, and 47.4 ± 80.2). Higher PT volume (p < 0.01), SUVmax (p = 0.04), SUVmean (p = 0.03), and MTV (<0.01) significantly compromised CB. A considerable majority of patients survived throughout this period (92.8%), while five women died (7.2%). In fact, the OS was 31.7 ± 14.2 months and PFS was 30.2 ± 14.1 months. A multivariate prediction model for CB with excellent accuracy could be developed using age, body mass index (BMI), T, M, PT TLG, and PT volume as predictive parameters. PT volume and PT TLG demonstrated a significant influence on CB in lower ranges; however, beyond a specific cutoff value (respectively, 29.52 cm3 for PT volume and 161.95 cm3 for PT TLG), their impact on CB only reached negligible levels. Ultimately, the absence of distant metastasis M displayed a strong positive impact on CB far ahead of the tumor size T (standardized average estimate 0.88 vs. 0.4). Conclusions: Our results emphasized the pivotal role played by FDG-PET/CT prior to treatment in forecasting treatment outcomes in women newly diagnosed with breast cancer. Nevertheless, careful consideration is required when selecting the methodological approach, as our innovative statistical techniques unveiled non-linear influences of predictive biomarkers on treatment benefit, highlighting also the importance of early breast cancer diagnosis.

Investigating the trends of incidence rates of breast cancer in Southern Iran: a population based survey

BackgroundThe overall incidence of breast cancer is different all over the world and even within a nation. The present study aims to investigate the stratum-specific incidence trends of breast cancer in southern Iran.MethodsIn this retrospective cohort study, the data of Fars Population-Based Cancer Registry was used during 2001–2018. New cancer cases with ICD-O-3 codes C50.0 to C50.9 were categorized based on age group, morphology, and topography. Age-specific incidence rates of breast cancer were calculated during 2001–2018. Annual overall and truncated age-standardized incidence rates and their 95% Confidence Intervals (CIs) were also calculated. Afterward, the Annual Percentage Changes (APCs) of the age-specific and age-standardized incidence rates of breast cancer during 2001–2018 were calculated using Joinpoint regression software.ResultsAn increasing trend was observed in the incidence of breast cancer among women during 2001–2018 (APC of age-standardized incidence rates: 9.5 (95% CI: 7.5, 11.5)).However, the trend was increasing less during the recent years. The APC of age-standardized rates decreased from 15.03 (95% CI: 10.4, 19.8) in 2007 to 6.15(95% CI: 4.0, 8.4) in 2018. The most common morphology of breast cancer was invasive ductal carcinoma (77.3% in females and 75.1% in males) and its trend was similar to the general trend of different types of breast cancer. The most common site of breast cancer was the upper outer quadrant. Most breast cancer cases were female and males accounted for 2.45% of the cases. Among females, 40–55 was the most prevalent age group.ConclusionThe incidence of breast cancer among women living in southern Iran showed an increasing trend from 2001 to 2018. However, the rate of increase exhibited a milder slope during the more recent years. Based on the higher prevalence of breast cancer in the 40–55 age group observed in the present study, it offers valuable insight into the potential reduction of the breast cancer screening age from 50 to 40 years for healthy Iranian women. However, before implementing such a policy change, it is crucial to conduct additional studies that specifically examine the cost-effectiveness, as well as the potential benefits and risks associated with this alteration.

Clinicopathological Evaluation of Idiopathic Granulomatous Mastitis: A Retrospective Analysis of Sixty Women at Shohada-e-Tajrish Hospital from 2010 to 2019

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon inflammatory disorder, which tends to occur in childbearing women. Although IGM has a benign nature, it can mimic a vast spectrum of diseases and may lead to an erroneous diagnosis of carcinoma. Also, the patients usually experience a prolonged course of the disease, which is distressing. But, the clinicopathological of IGM is nonspecific and not clear enough. Objectives: This study aims at evaluating the clinicopathological aspects of IGM. Methods: This cross-sectional retrospective study was performed in Shohada-e-Tajrish Hospital, Tehran, Iran on patients between 20 to 50 years old, preliminary diagnosed with IGM from 2010 to 2019. Then, the demographic, clinical, ultrasound, and histopathologic features of patients enrolled were evaluated. Results: A total number of 60 women aged 20 to 50 years old and initially diagnosed with IGM were enrolled in this study. Their mean age was 34.5 ± 6.73. Among all participants, 38.3% of patients had a family history of breast cancer. The most common location of the lesion was the upper outer quadrant (UOQ) with the predominance of the left side (36.6%). They were more likely to present with pain, erythema, swelling, and warmth (51.6%) of the breast followed by palpable mass (38.3%). With ultrasound assessment, the results were matched with a tubular hypoechoic mass in 43.3% of the patients, while the remainder showed a tumor-like lesion (21.6%) and abscess formation (15%). Histologically, non-caseating granulomas associated with mixed inflammatory cells (70%) and cystic space formations surrounded by neutrophil aggregations (15%) composed the dominant features. Conclusions: Despite the rarity of the disease, IGM is a diagnostic challenge as it can masquerade various breast conditions. A definite diagnosis needs collaboration of clinical, radiological, and histopathological findings.

Cavernous hemangioma of breast: A case report

Cavernous hemangioma of the breast is a rare benign vascular tumor, whose clinical diagnosis is challenging. We describe a case of cavernous hemangioma in an 81-year-old female, who presented with a history of a slow-growing lump in the left breast from the past few months. Mammography revealed a circumscribed high-density mass with microlobulated margins in the lower outer quadrant with no associated findings. Targeted sonography revealed an isoechoic heterogeneous solid mass in the subcutaneous plane with no associated vascularity on color doppler. It was assigned as BI-RADS IV B and an image-guided core biopsy was done. The histopathology report was of cavernous hemangioma. A close follow-up was advised.

Analysis of multicatheter interstitial brachytherapy: Accelerated partial breast irradiation in a retrospective cohort of early-stage breast cancer patients

To determine cardiac dose received by patients treated with high dose rate interstitial brachytherapy. Patients with early-stage, node negative breast cancer can be treated using multi-catheter interstitial brachytherapy accelerated partial breast irradiation (MIB-APBI), with the benefit of reduced treatment volumes and favorable toxicity. We conducted a retrospective review of left-sided breast cancer patients treated using MIB-APBI at our institution since 2014. The mean heart dose (MHD) was calculated using the Oncentra 3.2 planning system. The minimum distance between the planning target volume (PTVeval) and heart contour was measured manually. 81 patients were included. The upper outer quadrant was the most common site. The MHD was 97.8 cGy (EQD2a/b=2) (range 22-229 cGy). MHD significantly correlated with the closest distance between PTVeval and heart contour (correlation coefficient -0.823, p <0.001); size of PTVeval (cc) and quadrant location did not. Appropriately selected women with early-stage, low-risk, left-sided breast cancer who received MIB-APBI had acceptable MHD. There was a strong correlation between the distance of PTVeval and MHD. Quadrant breast tumor is in cannot be used as a surrogate for MHD in brachytherapy. Our findings contribute to the growing evidence of the utility and safety of MIB-APBI.

Observational analysis of clinical and pathological characteristics and their prognostic impact in Mexican patients with breast cancer: A multi-center study.

Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p <0.0001) symptomatic presentation (p =0.009) and histologic grade (p =0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.

Early Clinical Experience of Utilizing Online Adaptive Radiotherapy for Accelerated Partial Breast Irradiation with Stereotactic Body Radiation Therapy for Early-Stage Breast Cancer Patients

Accelerated partial breast irradiation (APBI) with stereotactic body radiation therapy (SBRT) is becoming popular for early-stage breast cancer (ESBC) due to decreased treatment time and dose to healthy breast tissue. With variability in lumpectomy cavity size post-surgery, CBCT-guided online adaptive RT (oART) may improve target coverage and reduce normal tissue exposure by accounting for inter- and intrafractional cavity variations. In this study, we report our initial clinical experience utilizing APBI oART for patients with ESBC. A total of 15 patients with 17 ESBC cavities (2 with bilateral disease) were treated with SBRT using oART over one year. Patients were immobilized using standard breast simulation setup with free breathing and breath hold (if left sided). The clinical target volume consisted of an isometric 1 cm expansion off the lumpectomy cavity, which was expanded another 3 mm (cropped 3mm from surface) to create the planning target volume (PTV). 95% of the PTV received prescription dose (30 Gy in 5 fractions). The oART delivery process (supervised by physician and physicist) initially coregisters the daily CBCT to the treatment planning CT with alignment to lumpectomy cavity. Target volumes and organs-at-risk were modified at each treatment and the plan re-optimized. Either the re-optimized oART plan or scheduled plan was chosen for each fraction pending which plan best met prespecified clinical goals. Acute toxicity was assessed at one-month follow-up using CTCAE. Patients were age 56 or older, ECOG 0-1, with no known genetic abnormality, and with anatomic stage 0-1A ESBC. Most tumors were located in the upper outer quadrant (n = 12, 70.6%) at middle or posterior depth (n = 15, 88.2%). Final margins were negative. 88% had tantalum clips placed. One patient had an Oncotype DS score of 34 and received systemic therapy. 82.3% met suitable APBI criteria and 3 met cautionary criteria due to high grade, of which 2 had ipsilateral trimodality treatment 10+ years prior and denied mastectomy at recurrence. Mean time to starting RT after lumpectomy was 2.5 months. Mean PTV to breast ratio was 0.12. From simulation to end of treatment, lumpectomy cavity size decreased a median of 27%. oART plans were chosen 89% of the time. VMAT was utilized 52.9% of the time compared to static-field IMRT (47.1%). Three patients were treated with breath hold. 93% of patients were treated on non-consecutive days with average treatment lasting 9.1 ± 2.2 days. CTCAE grade 1 toxicities were hyperpigmentation (n = 6, 40%), breast pain (n = 2, 13.3%), persistent seroma (n = 1, 6.7%), and fatigue (n = 7, 46.7%). No patients experienced fat necrosis, telangiectasias, breast shrinkage, lymphedema, or CTCAE grade 2+ toxicities. oART for APBI using SBRT for patients with ESBC is clinically feasible and allows for variations in lumpectomy cavity size. Nearly half of patients had no complaints or breast changes at one-month follow-up and the remaining had CTCAE grade 1 toxicities alone.

Cabergoline and Low-Dose Steroid Therapy İn Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis(IGM) is a rare, chronic granulomatous inflammatory disease of the breast. It is mostly seen in young women with a history of breastfeeding. It typically presents as a painful lump in the breast, erythema, focal abscess formation, skin ulceration, or fistula. The etiology and pathogenesis of IGM could not yet be well understood. It is thought to be caused by a localized autoimmune response against fat and protein-rich secretions leaking from the lobules due to previous hyperprolactinemia. There is no definite treatment protocol defined for IGM. Pharmacological agents and surgical interventions are used alone or in combination in the treatment. In this study, we aimed to examine the results of patients who were treated with cabergoline and low-dose steroids for IGM in our center.&#x0D; Methods: In this study, the files of patients who were treated with cabergoline and steroids for idiopathic granulomatous mastitis in our clinic were reviewed retrospectively. 36 patients were included in the study. The patients were invited to the outpatient clinic for the final examination. Demographic characteristics of the patients, symptoms at presentation, examination findings, laboratory tests, radiological imaging, tru-cut biopsy results, microbiological culture results, treatment doses and durations, remission times, surgery requirements, and recurrence were recorded.&#x0D; Results: All 36 patients included in the study were women of childbearing age. The most common presenting complaint was a palpable painful mass. Abscesses were present in 12 patients. Ulcers were observed in 9 patients and fistulas were observed in 4 patients. The most common involvement was in the lower outer quadrant. S.aureus was detected in the culture of 1 patient. Complete recovery was observed in 20 of 36 patients as a result of the treatment. The mean duration of remission was 2.85±2.54 months. The treatment of 29 (74.3%) patients was completed medically. Surgical excision was performed in 7 patients with a residual lump. No recurrence was observed during the follow-up period of 27.88 ± 8.21 months.&#x0D; Conclusion: The treatment of IGM is still controversial. The fact that cabergoline and low-dose steroid therapy provides remission in a short time, minimizes the need for surgery, and does not relapse in medium-term follow-up shows that it is a successful option in IGM treatment.

Diagnostic Accuracy of Fine Needle Aspiration Cytology, Triple Test and Tru-cut Biopsy in the Detection of Breast Lesion

Background: The majority of breast illnesses manifest as a palpable mass. The vast majority of breast lesions are not malignant, and the vast majority of benign lesions do not progress to cancer; however, the accuracy of diagnosis can be improved by a combination of preoperative tests such as physical examination, mammography, fine-needle aspiration cytology (FNAC), and Trucut needle biopsy (TCNB) or core needle biopsy (CNB). FNAC has gained in popularity and is now the primary treatment performed after a history and clinical examination to diagnose solid and cystic breast masses. This study was designed to assess the accuracy of FNAC in comparison to Triple Test and TCNB for the diagnosis of breast masses. Methodology: From January 2023 through May 2023, this study was conducted in the Tezpur Medical College and Hospital. The research included all female patients over the age of 20 with clinically palpable lumps. Palpable breast lumps need a complete clinical breast examination, imaging, and tissue sample for a clear diagnosis to rule out cancer.The Ultrasonography/Mammography, FNAC and tru-cut biopsy procedures were performed concurrently in the same region, and the results were compared to final histopathology as the gold standard. Result: The majority of the patients in the study were in age group of &gt; 60 years. In our study Left breast was involved in 41 (58.5%) patients and right breast in 29 (41.4%) patients. The most frequent site involved was upper outer quadrant in 38 (54.2%). The overall sensitivity of FNAC in our study was 93.75%, tru-cut biopsy is 100% and that of triple test is 100% and specificity for malignancy was 91.6%, 93.6 and 95.6% for FNAC, tru-cut biopsy and triple test respectively. Conclusion: All three techniques have advantages and disadvantages. Core Needle Biopsy cannot be used in place of FNAC, and it is not required to identify all breast lesions. It can be utilised as an adjuvant in circumstances when cytology is definitive and biomarker tests are required. triple test and trucut were more accurate than FNAC in our testing.Trucut biopsy was able to provide histological diagnosis, and the findings were 100% consistent with the final histopathology report.&#x0D;

Chronic Wound to Marjolin’s Ulcer: A Threatening Complication

Abstract Awareness of the potential for an ulcer to become a Marjolin’s ulcer is important for chronic wound management. Here we describe four cases of chronic ulcers progressing to malignant transformation with four completely different scenario and injury pattern. First case was a 41 years old male who presented with 24 years old complete traumatic paraplegia with ulcer as fungating mass at outer inferior quadrant of left gluteal region. The second case was a 15 year old traumatic knee injury with open wound which resulted in insensate foot and chronic osteomyelitis with recurrent ulcer with transformation to malignant ulcer. Third case is again 12 years old recurrent wound due to crush injury and osteomyelitis in the involved lower limb and last 57 years old case is different from the others, developed chronic wound from a minor cut without any specific precipitating factor which finally resulted in to marjolin’s ulcer. All the cases highlight the progression of chronic ulcer in to marjolin’s ulcer which is a very rare but deadly complication of recurrent or non-healing type of ulcers.

Idiopathic Granulomatous Lobular Mastitis: A Mimicker of Inflammatory Breast Cancer.

Idiopathic granulomatous lobular mastitis (IGLM) is a rare, chronic inflammatory breast disease without a known etiology. Even though the current literature proposes several treatment strategies, there is no universal consensus for long-term management. A 43-year-old White woman (gravida 5, para 4) presented with a 2-week history of right lower outer quadrant breast tenderness, heaviness, warmth, and redness. Mammography and ultrasound were concerning for inflammatory breast cancer. Biopsies returned as granulomatous mastitis without malignancy. After 8 months of unsuccessful therapy with prednisone and methotrexate, surgeons excised the breast tissue. Cultures and special stains were negative for other organisms. At the 7-month follow-up, no evidence of recurrence was seen. As there remains no consensus behind the etiology or management of IGLM, our case demonstrates a reasonable and successful stepwise treatment beginning with medical therapy before proceeding to surgical cure. Because of possible malignancy risk with chronic IGLM, patients should not delay surgical excision if their condition remains refractory to medical therapy alone.

Meme Koruyucu Cerrahide İntraoperatif Ultrason ve Frozen Patoloji Kullanımının Güvenli Cerrahi Sınır Üzerindeki Etkinliği

Background: Breast cancer is the most common cancer in women over the age of 40. The lifetime risk is around 12%. Today, breast cancer patients are diagnosed at an early stage thanks to screening programs, and thus mortality has decreased to around 25-30%. The positivity or closeness of surgical margins in breast conserving surgery varies between 5-60%. Negativity of surgical margins is very important to prevent future recurrent breast cancer, to pre-vent recurrent surgeries, and to prevent additional treatments. In this study, we aimed to investigate the efficacy of intraoperative ultrasonography and frozen section use in breast cancers treated with breast conserving surgery in obtaining safe surgical margins and in postoperative cosmetic terms. Materials and Methods: This study includes 150 patients diagnosed with breast cancer and treated with breast con-serving surgery in between January 2015 and January 2019. The presence of distant metastases and multifocal or centrally located tumor involvement in the breasts were investigated. The localization of the tumor was marked anatomically by preoperative ultrasonography in all patients. The operation was started 15 minutes after the injec-tion. The tumor was completely excised, leaving at least 1 cm of intact tissue around the tumor, including the skin, on the preoperatively marked area, including the underlying muscle fascia. Medial and superior borders were marked with string. This excised tissue block was examined with intraoperative ultrasonography. Results: The mean age of the patients was 48,3± 9.7 years. While the tumor was located in the right breast in 83 (55.3%) of the patients, it was located in the left breast in 67 (44.7%) patients. The tumor was located in the upper outer quadrant in 67 (44.7%) patients, in the upper inner quadrant in 53 (35.3%) patients, and in the lower outer quadrant in 30 (20%) patients. Axillary dissection was performed in 21 (14 %) of the patients because sentinel lymph node was positive. In histological typing, 141 (94 %) patients were ductal carcinoma and 9 (6 %) patients were lobular carcinoma. Conclusions: As a result of our study and literature review, we think that frozen examination together with intraope-rative ultrasonography is a simple, easily applicable and cosmetically good method to determine the safe surgical margin in breast conserving surgery.

Secretory Carcinoma of Breast: A Population-Based Study.

In this study, it was aimed to evaluate the characteristic features and survival of secretory carcinoma of the breast (SCB), which is one of the rare malignant tumors of the breast. Data of patients with histopathological diagnosis of SCB between 2010 and 2019 were extracted from the SEER database. These patients were evaluated in terms of age, race, molecular subtype, grade, estrogen receptor (ER), progesterone receptor (PR), HER2 receptor, TNM stage, surgical status, chemotherapy and radiotherapy treatment. Overall survival (OS) and breast cancer-specific survival (BCSS) of the whole population and subgroups [in terms of surgery procedure (mastectomy/breast-conserving surgery), and hormone receptor status (positive/negative)] were analyzed. 70 patients were included in the study. The mean age was 57years (range 2-82). 32.9% of the patients were diagnosed under the age of 50. 97.1% of the patients were female; 2.9% were male. The vast majority of patients were white race (81.4%). Although the rates of localization were higher in the upper outer quadrant (31.4%), centrally located tumors (18.5%) were also quite common. The most frequently detected molecular subtype was hormone positive/HER2 negative. All patients were non-metastatic, 81.4% of patients did not have lymph node metastases, and most of the patients were stage IA. Median follow-up was 37months (range 0-118months). Considering all patients, OS was 76.3%, 5-year OS was 91.8%, and BCSS was 88%, 5-year BCSS was 97.8%. There was no statistically significant difference in OS and BCSS according to subgroups (P > .01). SCB, a rare histopathologic type, has high OS and BCSS rates.