Undergoing Breast Biopsy Research Articles

Factors influencing prophylactic surgical intervention in women with genetic predisposition for breast cancer.

In the United States, 5%-10% of breast cancer cases are due to genetic predisposition. Among this population, prophylactic mastectomy is viable risk-reducing option. The objective of this study is to understand the timing to prophylactic mastectomy in patients with genetic predisposition to breast cancer and uncover factors influencing this decision. This study is a retrospective review of patients diagnosed with genetic predisposition for breast cancer from 2010 to 2020. In a cohort of 506 patients with genetic predisposition for breast cancer, 154 (30.4%) underwent prophylactic mastectomy, the remainder opted for surveillance alone. The median time from diagnosis to mastectomy was 1.1 years (IQR, 0.5-3.1 years). During the surveillance period, 118 patients (33.5%) underwent breast biopsy. Of the patients with benign or atypical findings, 35 (36.8%) pursued prophylactic mastectomy, a median of 0.5 years (IQR, 0.2-1.6 years) after their gene diagnosis. The most common factor impacting the decision to undergo prophylactic mastectomy was having a family member with cancer (54.7%) followed by a personal diagnosis of other cancer(s) (27.5%). Understanding the factors influencing the decision to undergo prophylactic surgery will allow for more effective shared decision-making for primary care providers, breast surgeons, and reconstructive surgeons.

Factors associated with delay in breast biopsy in a vulnerable population.

e13526 Background: Prompt diagnosis and treatment of breast cancer can improve outcomes and reduce stress and anxiety in patients. Race, socioeconomic status, and education level are associated with delays in diagnosis in breast cancer patients. 63% of Louisiana’s parishes are classified as rural, and 18.8% of the population is below the poverty line (the second highest in the country). The above factors make access to care challenging. Our study aimed to identify factors associated with delay in breast biopsy after abnormal diagnostic imaging in our patient population. Methods: A retrospective cohort study including female patients >18 years undergoing breast biopsy for abnormal diagnostic imaging findings from 1/1/2022 to 12/31/2022 at LSU Health, Shreveport, was done. Patients with a prior history of breast cancer, pregnant females, and patients with cognitive defects were excluded. Patients were followed from abnormal diagnostic imaging to biopsy. Descriptive analysis was done for baseline cohort characteristics. Univariate and multivariate logistic regression models were used to find 95% Confidence Interval and Odds ratio (ORs) for independent factors associated with time to biopsy (TTB). The study was approved by IRB. Results: 148 women (mean age [SD]: 54 [12] years) were included in the analysis. 67.5% were African American, and 25.6% lived in rural areas. The mean distance from the patient’s home to our center was 26.7 miles (Range: 3-219). The mean TTB from abnormal diagnostic imaging was 13.79 days (Range: 0-84), and 67.5% of patients had TTB of =<14 days. A TTB of more than 14 days was considered a delay in biopsy. After adjusting for age, multivariate logistic regression showed rural residence was associated with TTB of >14 days. (OR: 2.5, 95% CI: 1.15-5.67, p=0.02) (Table). A distance more than 40 miles from the hospital was associated with a higher likelihood of TTB of >14 days on a multivariate model adjusted for age and race revealed (OR: 2.2, 95% CI: 1.004-5.10, p= 0.04). Conclusions: Patients residing in rural parishes and at a distance more than 40 miles from our center have a higher likelihood of delay in time to biopsy from the diagnostic imaging. Same-day breast biopsy should be prioritized in such patients to ensure timely diagnosis and treatment. Cancer Centers serving the safety net population can conduct similar studies and implement changes to ensure equitable access to care. [Table: see text]

Is fibroblast growth factor 11 (FGF11) a predictive marker for breast cancer?

The prognostic role of fibroblast growth factor 11 (FGF11) has only been reported in cancers such as nasopharyngeal carcinoma and prostate cancer. The role of FGF11 in breast cancer is not fully known. It was aimed to compare FGF11 expression levels in de novo metastatic hormone receptor-positive, human epidermal reseptor-2-negative breast tumor tissue and healthy breast tissue and investigate the effect of the FGF11 expression on survival in breast cancer patients. To determine the FGF11 expression rate, breast tumor tissue of breast cancer patients diagnosed by breast biopsy and healthy breast tissue of healthy individuals who underwent breast biopsy due to benign lesions were used. The study population included 38 breast cancer patients and 24 healthy controls. The number of patients with a FGF11 expression level score of 1 (15.8% vs 12.5%), score of 2 (18.4% vs 12.5%), and score of 3 (31.6% vs 0%) was significantly higher in the patient group compared to the healthy control group. The median overall survival and progression-free survival were numerically better in the group with a FGF11 expression score of 0 to 1 than the group with a FGF11 expression score of 2 and 3, but this difference was not statistically significant. FGF11 may be a predictive marker for breast cancer formation. Additionally, with new FGF11-targeted treatment agents to be developed, endocrine resistance may be reduced, and better survival results may be achieved in hormone receptor-positive, human epidermal reseptor-2-negative breast cancer.

The Relation between Breast Cancer Fear and Breast Cancer Prevention Behaviors of Female Healthcare Professionals

Objective: The aim of this study was to investigate the relationship between breast cancer fear and breast cancer prevention behaviors of female healthcare professionals (HCPs). Materials and Methods: This descriptive correlational study involved a convenience sample of 338 nurses, midwives and physicians working at a state hospital in Turkey. Data were collected in face-to-face interviews with the participants using Personal Information Form, Breast Cancer Fear Scale (BCFS), and Scale of Factors Affecting Women’s Breast Cancer Prevention Behaviors (ASSISTS).The data were analyzed by using Independent Samples t Test, One-way ANOVA, Tukey and Pearson’s correlation tests. Results: The mean scores on BCFS and ASSISTS were 26.71±7.65 and 123.36±15.49 respectively, indicating breast cancer fear were high and breast cancer prevention behaviors were moderately. The higher breast cancer prevention behavior scores among the HCPs who were working longer years, working longer years in night shift, those having breast problems, and undergone breast biopsy, those performing breast self-examination, undergone clinical breast examination and mammography (p0.05). Conclusion: Professional education in breast cancer prevention behaviors and addressing fear on breast cancer are likely to result in reduced barriers to develop prevention behaviors.

Evaluation of the applicability of Gail's method in patients undergoing breast biopsy at a brazilian hospital

OBJECTIVES: To verify the accuracy of the Gail Model (GM) in risk assessment in patients with suspected breast cancer and to determine the need to adapt the GM or develop a new model for accurate risk assessment of these patients. METHODS: This is a descriptive, cross-sectional and retrospective study, based on the analysis of data provided by the medical records of 200 patients treated between 2017 and 2021, from the Mastology Outpatient Clinic of the Hospital Universitário Evangélico Mackenzie (HUEM). RESULTS: 155 women were diagnosed with breast cancer and 45 were not. The mean age was 54.23 years and the mean age at menarche was 13 years. Also, only 13 medical records contained information on age at birth of the 1st child or absence of children, and the mean age obtained was 26.77 years. Ethnic prevalence was white and most patients had no first-degree relatives with breast cancer. Regarding previous breast biopsies, most had already performed at least one, but few received a result of atypical hyperplasia. Furthermore, most of the study patients diagnosed with breast cancer had no positive family history of the disease. CONCLUSION: The study shows that the GM isn't reliable in assuming the risk of the studied population to develop breast CA, since, when comparing the GM data between groups that had and didn't have the disease, there was no significant difference.

Identifying and addressing barriers to screening mammography in a medically underserved community.

e18685 Background: Breast cancer mortality is 41% higher for Black women than for Non-Hispanic White women. This difference is partly due to disparities in access to high quality screening and timeliness of follow-up of abnormal mammographic findings. This study aimed to identify barriers to mammographic screening and follow-up among a medically underserved, low-income, predominantly Black community in West Philadelphia during a free community screening initiative. Methods: Free breast cancer screening was provided for eligible, average-risk members of the community via a mobile mammography unit for two weeks in June 2022. This initiative was situated as part of a larger, multidisciplinary cancer screening fair that was organized by a collaborative of faculty and staff from our academic hospital and community volunteers. Women attending the fair were offered surveys on access to breast cancer screening. For those who subsequently underwent mobile mammographic screening, health insurance and time to follow-up testing, if needed, were collected from the electronic medical record. Results: 233 women completed surveys (mean age 54±13 years). Among respondents, 93% identified as Black, and 82% reported having a PCP. Of those with a PCP, 55% reported having previously had a breast physical exam, and 56% had been counseled on their personal breast cancer risk. 49% were advised to begin screening by age 40, while the remainder were either counseled to begin at an older age, or were not advised on when to initiate screening. 74% of the cohort endorsed at least one barrier to screening mammography. The most frequently cited barrier was cost and/or lack of insurance coverage (30%), followed by time limitations due to work schedule (21%), fear/anxiety of screening results (20%), fear/anxiety of pain or discomfort (20%), and difficulties with scheduling (19%). Of 181 women who underwent mobile screening mammography, 24 (13%) received a BIRADS 0 assessment, and 11 (6%) went on to undergo breast biopsy. There was a trend toward longer delays between screening and biopsy for women who did not have a PCP (median 45 days, IQR 31–52) compared to those who did (median 24 days, IQR 16–29) (p = 0.072). Three patients who received BIRADS 0 assessments have not yet followed up, all of whom lack health insurance. Conclusions: In this cohort of women from a predominantly Black, medically-underserved community, significant logistical barriers to mammography and follow-up were identified both by self-report and by documented delays in care. Free mobile mammography initiatives that bring medical professionals into the community can help address these barriers, while also providing education and personalized risk assessment. Importantly, sustained engagement is necessary to ensure appropriate follow-up for women found to have additional care needs after screening and is area of future growth for our program.

Domestic medical travel from non-Seoul regions to Seoul for initial breast cancer treatment: a nationwide cohort study.

This study was conducted to investigate the trend of domestic medical travel from non-Seoul areas to Seoul for initial breast cancer treatment, and identify factors associated with medical travel in breast cancer patients. A nationwide retrospective cohort study was performed using the Health Insurance Review and Assessment data of South Korea. Patients were classified according to the regions in which they underwent breast biopsy (Seoul vs. metropolitan cities vs. other regions). Frequencies of biopsy, diagnosis, treatment, and domestic medical travel were analyzed according to regions, and factors associated with medical travel were investigated. A total of 150,709 breast cancer survivors who were diagnosed between January 2010 and December 2017 were included. The total rate of medical travel from non-Seoul regions to Seoul had increased from 14.2% (1,161 of 8,150) in 2010 to 19.8% (2,762 of 13,964) in 2017. Approximately a quarter of patients from other regions traveled to Seoul, and over 40% of patients from Chungbuk, Gyeongbuk, and Jeju regions traveled to Seoul for initial treatment in 2017. The difference in the annual frequencies of upfront surgery between Seoul and non-Seoul regions increased over time. Younger age and regions other than metropolitan cities were significantly related to medical travel. Patients covered by medical aid or past medical histories were significantly less likely to travel to Seoul for initial breast cancer treatment. Medical travel to Seoul for upfront breast cancer surgery is increasing. Policies for appropriate healthcare delivery need to be established in the near future.

An audit of clinically triaged women at low risk for breast cancer presenting to the Helen Joseph Mammography Unit.

The Helen Joseph Hospital (HJH) breast clinic utilises a clinical triage system to stratify patients based on their risk of breast cancer into high-, medium-, or low-risk profiles. This allows for timeous imaging and subsequent management of those patients at increased risk for breast cancer. The primary objective was to determine the cancer detection rate (CDR). The secondary objective was to correlate biopsy results with the Breast Imaging-Reporting and Data System (BI-RADS) risk assessment. A retrospective audit of the patients at low risk for breast cancer who were referred to the breast imaging unit (BIU) in 2019 at HJH. Patients were clinically assessed as low risk based on a triage form and were identified using the imaging files stored in the BIU. Results were recorded on Microsoft Excel and calculated as per the American College of Radiology guidelines. The total population sample consisted of 398 patients. Two patients were characterised as BI-RADS 4 and underwent breast biopsies. One patient was diagnosed with histologically proven breast cancer. The CDR was 2.51%. The most representative groups were the age group of 60-69 years, BI-RADS breast density B and BI-RADS risk assessment 2. Amongst the low-risk population, both the CDR and spectrum of disease was comparable to that of a screening population. This may be due to the use of a triage system prior to imaging, as well as an increase in clinical awareness of breast cancer within a tertiary institution.

Application of the Kaiser score by MRI in patients with breast lesions by ultrasound and mammography.

PURPOSE This study aimed to verify whether the use of the Kaiser score can improve the diagnostic performance in breast magnetic resonance imaging (MRI) for suspicious lesions and avoid further invasive diagnostic approaches. METHODS This retrospective study enrolled 97 patients who underwent breast MRI before undergoing breast biopsy or surgery. Evaluations were conducted on all MRI images individually by 2 radiologists using the Kaiser score. Neither radiologist had the knowledge of the final histopathological diagnosis. The ability of the Kaiser score in diagnosis was established via a receiver performing characteristic (ROC) analysis, which was measured by the area under the ROC curve (AUC). Youden index was used to define the optimal cutoff value. Kaiser score categories were dichotomized into positive (cutoff score > 4) and negative scores (cutoff score ≤ 4). Cohen's kappa coefficient was used to analyze the inter-rater agreement. RESULTS Histopathology revealed 56 malignant and 41 benign lesions. The AUC for all lesions evaluated by the Kaiser score was 0.992 (95% CI: 0.981-1.0) and 0.958 (95% CI: 0.920-0.996) for 2 radiologists, respectively. Inter-rater agreement of the dichotomized Kaiser score was excellent (κ=0.894, P < .001). A total of 20 lesions (33.8%) previously categorized as BI-RADS 4 were reduced to BI-RADS 2/3 (19 benign lesions and 1 malignant lesion). CONCLUSION The Kaiser score is a valuable auxiliary diagnostic tool for improving the diagnostic ability of radiologists, whose experiences in breast MRI are diverse. In some cases, the application of the Kaiser score could possibly avoid unnecessary breast biopsies.

Time to biopsy of screening mammography-detected abnormalities: Evaluating the impact of same-day services implemented during the COVID-19 pandemic.

1511 Background: Screening mammography programs often require patients undergo multiple visits (screening exam, diagnostic exam, and biopsy) before tissue diagnoisis of screen-detected abnormalities. During the COVID-19 pandemic, same-day breast imaging services were leveraged to decrease the number of visits following abnormal screening exams. Specifically, in May 2020, we implemented an immediate-read screening mammography program to synergize with our pre-existing same-day breast biopsy program, such that every effort was made to perform diagnostic imaging during the same visit after an abnormal screening mammogram. This study aims to evaluate the impact of these same-day breast imaging services on time and number of patient visits to undergo breast biopsy after an abnormal screening mammogram. Methods: Consecutive screening mammograms performed during normal business hours pre- (6/1/16 to 5/30/17) and post-implementation (6/1/20 to 5/30/21) of same-day services were identified. Patient demographics, imaging and biopsy results, and visit dates were extracted from the medical record. Multivariable logistic, linear, and ordinal regression models estimated with generalized estimating equations were fit to assess the association of period (pre- versus post-implementation), patient age, and race and ethnicity (White versus races other than White) with having a same-day biopsy (biopsy on the same day as the abnormal screening exam), number of days to biopsy, and number of visits. Adjusted odds ratios (aOR) and beta estimates (aBeta) of each covariate and corresponding 95% confidence intervals (CI) were estimated. Results: A total of 409/25,922 (1.6%) of patients (median age 61, IQR 50-70) pre-implementation and 221/20,452 (1.1%) patients (median age 62, IQR 49-71) post-implementation had screen-detected abnormalities leading to diagnostic breast imaging and biopsy. Median number of days from screening to biopsy decreased from 16 days pre-implementation to 5 days post-implementation (p &lt; 0.001). Pre-implementation, 86.8% of patients required 3 visits between screening and biopsy, while post-implementation only 23.1% required 3 visits (p &lt; 0.001). Compared to pre-implementation, the post-implementation period was associated with increased odds of undergoing same-day biopsy (aOR 20.7, 95% CI 8.3-51.7), p &lt; 0.001), fewer days from abnormal screening mammogram to biopsy (aBeta -13.3, 95% CI -15.7 to -10.9, p &lt; 0.001), and fewer visits (aOR 0.05, 95% CI 0.02-0.09), p &lt; 0.001), controlling for age and race and ethnicity. Conclusions: Same-day breast imaging services decreased time and patient visits between abnormal screening mammogram and breast biopsy. Same-day services implemented out of necessity during the COVID-19 pandemic should be continued after the pandemic has subsided to improve timeliness of care.

Pain levels of patients undergoing ultrasound guided biopsies and associated factors: a cross-sectional study

Aim: Patients may experience pain in minimally invasive biopsy procedures. It is important to evaluate the degree of pain and to know the factors that determine the level of pain felt by patients for adequate pain management. The aim of this study is to determine the pain levels felt by patients and socio-demographic and clinical factors associated with higher pain levels in breast and liver biopsy procedures.&#x0D; Material and Method: In this cross-sectional observational study, patients who will undergo ultrasound-guided breast and liver biopsy procedures in the study center were invited to the study. The pain level was measured with the Visual Analogue Scale (VAS). Pain measurements above 45mm were classified as moderate-to-high pain levels. The State-Trait Anxiety Scale was used to measure the anxiety levels of the patients and the radiologist. Sociodemographical (sex, age, education level, job, income) and clinical factors (biopsy site, duration, bosy mass index, anxiety level of the patient and the radiologist) that may be associated with the pain levels of the patients were analyzed.&#x0D; Results: The sample consisted of 76 patients, 62 were female (81.6%). The procedures consisted of 43 breast biopsies (56.6%), 33 liver biopsies (43.4%). The median pain level measurement determined by the VAS is 20.0mm (IQR: 9.3- 38.5). Most of the sample (59.2%) stated that they felt mild pain. It was found that patients with higher anxiety levels and patients underwent liver biopsy had statistically significantly higher moderate-to-high pain levels than patients with lower anxiety (OR: 3.683 95% CI: 1.159- 11.705, p=0.220), patients who underwent breast biopsies (OR: 3.521, 95% CI: 1.153- 10.752, p=0.023). A positive correlation was found between the level of pain and the level of anxiety (r=0.267, p=0.020).&#x0D; Conclusion: This study demonstrated that most ultrasound-guided biopsy procedures were performed with mild or no pain although higher patient anxiety levels were associated with higher pain levels during the procedures. Patients undergoing liver biopsy procedures had higher pain levels than breast biopsy procedures.

Development of a hoRizontal data intEgration classifier for NOn-invasive early diAgnosis of breasT cancEr: the RENOVATE study protocol

IntroductionStandard procedures aimed at the early diagnosis of breast cancer (BC) present suboptimal accuracy and imply the execution of invasive and sometimes unnecessary tissue biopsies. The assessment of circulating biomarkers...

Prospective assessment of adjunctive ultrasound-guided diffuse optical tomography in women undergoing breast biopsy: Impact on BI-RADS assessments

PurposeTo assess the impact of adjunctive ultrasound guided diffuse optical tomography (US-guided DOT) on BI-RADS assessment in women undergoing US-guided breast biopsy. MethodThis prospective study enrolled women referred for US-guided breast biopsy between 3/5/2019 and 3/19/2020. Participants underwent US-guided DOT immediately before biopsy. The US-guided DOT acquisition generated average maximum total hemoglobin (HbT) spatial maps and quantitative HbT values. Four radiologists blinded to histopathology assessed conventional imaging (CI) to assign a CI BI-RADS assessment and then integrated DOT information in assigning a CI&DOT BI-RADS assessment. HbT was compared between benign and malignant lesions using an ANOVA test and Tukey’s test. Benign biopsies were tabulated, deeming BI-RADS ≥ 4A as positive. Reader agreement was assessed. ResultsAmong 61 included women (mean age 48 years), biopsy demonstrated 15 (24.6%) malignant and 46 (75.4%) benign lesions. Mean HbT was 55.3 ± 22.6 µM in benign lesions versus 85.4 ± 15.6 µM in cancers (p < .001). HbT threshold of 78.5 µM achieved sensitivity 80% (12/15) and specificity 89% (41/46) for malignancy. Across readers and patients, 197 pairs of CI BI-RADS and CI&DOT BI-RADS assessments were assigned. Adjunctive US-guided DOT achieved a net decrease in 23.5% (31/132) of suspicious (CI BI-RADS ≥ 4A) assessments of benign lesions (34 correct downgrades and 3 incorrect upgrades). 38.3% (31/81) of 4A assessments were appropriately downgraded. No cancer was downgraded to a non-actionable assessment. Interreader agreement analysis demonstrated kappa = 0.48–0.53 for CI BI-RADS and kappa = 0.28–0.44 for CI&DOT BI-RADS. ConclusionsIntegration of US-guided DOT information achieved a 23.5% reduction in suspicious BI-RADS assessments for benign lesions. Larger studies are warranted, with attention to improved reader agreement.

Added value of abbreviated breast magnetic resonance imaging for assessing suspicious microcalcification on screening mammography-a prospective study.

To investigate the added diagnostic value of abbreviated breast magnetic resonance imaging (MRI) for suspicious microcalcifications on screening mammography. This prospective study included 80 patients with suspicious calcifications on screening mammography who underwent abbreviated MRI before undergoing breast biopsy between August 2017 and September 2020. The abbreviated protocol included one pre-contrast and the first post-contrast T1-weighted series. MRI examinations were interpreted as either positive or negative based on the visibility of any significant enhancement. The positive predictive value (PPV) was compared before and after the MRI. Of the 80 suspicious microcalcifications, 33.8% (27/80) were malignant and 66.2% (53/80) were false positives. Abbreviated MRI revealed 33 positive enhancement lesions, and 25 and two lesions showed true-positive and false-negative findings, respectively. Abbreviated MRI increased PPV from 33.8 (27 of 80 cases; 95% CI: 26.2%, 40.8%) to 75.8% (25 of 33 cases; 95% CI: 62.1%, 85.7%). A total of 85% (45 of 53) false-positive diagnoses were reduced after abbreviated MRI assessment. Abbreviated MRI added significant diagnostic value in patients with suspicious microcalcifications on screening mammography, as demonstrated by a significant increase in PPV with a potential reduction in unnecessary biopsy. • Abbreviated breast magnetic resonance imaging increased the positive predictive value of suspicious microcalcifications on screening mammography from 33.8 (27/80 cases) to 75.8% (25/33 cases) (p < .01). • Abbreviated magnetic resonance imaging helped avoid unnecessary benign biopsies in 85% (45/53 cases) of lesions without missing invasive cancer.

Comparison of clinical and magnetic resonance imaging findings of triple-negative breast cancer with non-triple-negative tumours.

PurposeTriple-negative breast cancer (TNBC) has some distinctive features. The aim of the study was to compare clinical and breast magnetic resonance imaging (MRI) findings of TNBC with non-triple-negative breast cancer (nTNBC) in molecular subtypes such as ADC (apparent diffusion coefficient) values, T2-weighted (T2W) image intensity, shape, margin, lymph node involvement, grade, multifocality, multicentricity, bilaterality, and enhancement pattern differences between tumour subtypes.Material and methodsA total of 141 patients who underwent breast biopsy at our institution between January 2010 and June 2018 were included in this study. Patients were divided into molecular subtypes according to hormone receptor status, and Ki-67 index. Tumour grade, enhancement patterns, age, lymph node involvement, ADC values, breast imaging reporting and data system (BI-RADS) category, bilaterality, multifocality, multicentricity, margin, shape, and T2W image intensity were evaluated for these subtypes.ResultsADC values were higher in triple-negative tumours than in luminal A and luminal B tumours (p = 0.010 and p = 0.002, respectively). Circumscribed margin, type 2 enhancement curve, and rim enhancement were significantly higher in triple-negative tumours (p < 0.001). No significant difference was found between the groups in terms of other MRI findings including bilaterality, multifocality, multicentricity, shape, and T2W image intensity (p > 0.05).ConclusionsADC values, circumscribed margin, and rim enhancement can provide important information about the tumour’s biological behaviour and the course of the disease.

The prognostic impact of mode of detection of axillary metastases for women with invasive breast cancer: A retrospective observational study

AimTo identify the breast cancer specific survival (BCSS) associated with nodal metastasis identified by axillary core biopsy (ACB), and by sentinel node biopsy (SNB) compared with node negative patients. A further aim was to assess the prognostic effects of axillary ultrasound (US) features and amount of tumour in ACB specimens. MethodsConsecutive patients with cancer were identified from a database of US lesions undergoing breast biopsy. The three study groups were: a) those with metastasis identified by ACB, b) those undergoing immediate surgery with positive SNB and c) those undergoing immediate surgery with a negative SNB. US features and the amount of tumour in the ACB specimen were assessed by review of US images and pathological reports. BCSS was assessed using Kaplan Meier survival curves. Results967 patients were included, with mean follow-up of 6.0 yrs. There were 90 breast cancer deaths: 26% of those with a positive ACB, 11% with a positive SNB and 4% of those with a negative SNB. BCSS was significantly different between the groups (p < 0.001) with hazard ratio, compared with the negative SNB group, of 7.8 (95% CI 4.4–13.7) for patients with positive ACB and 2.5 (95% CI 1.3–4.6) for positive SNB. Axillary US findings and assessment of the amount of tumour in the ACB did not influence survival. ConclusionThis study suggests that women with a positive ACB have a worse BCSS compared to those with a positive SNB. This should be borne in mind when systemic therapy is being considered.

Music during image-guided breast biopsy reduces patient anxiety levels

PurposeInterventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. Materials and methodsThis randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann–Whitney U test. ResultsBaseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 control, p = .11). Patients in both groups showed lower state anxiety levels after the biopsy (45.6 to 34.3 music, 41.0 to 33.8 control, p < .001 for both). Patients who listened to music showed a greater reduction in anxiety (mean decrease 11.2 music, 7.3 control, p = .03). Post-biopsy anxiety levels were similar to normative values for working women in the same age group. ConclusionListening to self-selected music reduces anxiety in patients undergoing breast biopsy.

Relationship of Serum Progesterone and Progesterone Metabolites with Mammographic Breast Density and Terminal Ductal Lobular Unit Involution among Women Undergoing Diagnostic Breast Biopsy.

The association of progesterone/progesterone metabolites with elevated mammographic breast density (MBD) and delayed age-related terminal duct lobular unit (TDLU) involution, strong breast cancer risk factors, has received limited attention. Using a reliable liquid chromatography-tandem mass-spectrometry assay, we quantified serum progesterone/progesterone metabolites and explored cross-sectional relationships with MBD and TDLU involution among women, ages 40–65, undergoing diagnostic breast biopsy. Quantitative MBD measures were estimated in pre-biopsy digital mammograms. TDLU involution was quantified in diagnostic biopsies. Adjusted partial correlations and trends across MBD/TDLU categories were calculated. Pregnenolone was positively associated with percent MBD-area (MBD-A, rho: 0.30; p-trend = 0.01) among premenopausal luteal phase women. Progesterone tended to be positively associated with percent MBD-A among luteal phase (rho: 0.26; p-trend = 0.07) and postmenopausal (rho: 0.17; p-trend = 0.04) women. Consistent with experimental data, implicating an elevated 5α-pregnanes/3α-dihydroprogesterone (5αP/3αHP) metabolite ratio in breast cancer, higher 5αP/3αHP was associated with elevated percent MBD-A among luteal phase (rho: 0.29; p-trend = 0.08), but not postmenopausal women. This exploratory analysis provided some evidence that endogenous progesterone and progesterone metabolites might be correlated with MBD, a strong breast cancer risk factor, in both pre- and postmenopausal women undergoing breast biopsy. Additional studies are needed to understand the role of progesterone/progesterone metabolites in breast tissue composition and breast cancer risk.

Epidemiological Profile of Breast Neoplasia in the Municipality of Valen&amp;#231;a (RJ Brazil): Study from 2009 to 2017

Breast neoplasms are the main oncological pathology in Gynecology and Obstetrics, with increasing rates of incidence and mortality in the female population. According to the World Health Organization (WHO), more than 1 million new cases of breast cancer are diagnosed worldwide every year. This study aims to understand and analyze the epidemiological profile of patients diagnosed with breast cancer in the last nine years in the city of Valença—RJ, Brazil. A descriptive, documentary-retrospective analysis was carried out from January 2009 to December 2017, on 96 records of women who underwent breast biopsy at the Escola Escola de Valença (HEV), referred by the HEV Gynecology outpatient clinic. The results compared the variables age, race, parity, alcoholism, smoking, comorbidities, histological type, family history and screening performed with the scenario of breast cancer in the world, concluding that it is essential to identify patients at risk development of breast cancer to guide prevention, screening and early detection of pathology. The cases in the municipality are similar to other studies in relation to smoking, alcohol consumption, associated comorbidities, histological type and family history. However, the prevalence in younger people stands out, as well as the high percentage of women who have not had previous screening, which highlights the importance of the development and spread of women’s health in this city in the south of the state.

Circulating cell-free DNA (cfDNA) levels in BRCA1 and BRCA2 mutation carriers: A preliminary study.

Female carriers of BRCA1 or BRCA2 germline mutations are at a substantially increased risk for developing breast and ovarian cancer. The lack of effective early detection schemes for ovarian cancer, mandate surgical removal of adnexa at age 35-40 years in these high-risk women. The role of circulating cell-free DNA (cfDNA) levels as a marker for early detection in high-risk women has rarely been reported. To quantify cfDNA levels in BRCA1BRCA2 carriers. Serum cfDNA levels, measured by direct fluorometric assay in cancer-free female BRCA1BRCA2 mutation carriers were compared with cancer-free controls recruited from among women undergoing breast biopsy or routine colonoscopy. Overall, 10 BRCA1 (185delAG) and 10 BRCA2 (6174delT) mutation carriers, 20 breast biopsy controls, and 20 colonoscopy controls participated. cfDNA levels [Median (95% CI)], were 472 (317-589) ng/ml and 525 (339-621) ng/ml in breast biopsy and colonoscopy controls, respectively. Median levels of cfDNA in BRCA1 and BRCA2 mutation carriers combined were 921 (835-1087) ng/ml, significantly higher than in both controls (P< 0.0001). cfDNA levels are significantly higher in BRCA1 and BRCA2 mutation carriers compared with non-carriers. This finding, if validated, may facilitate development of early detection breast/ovarian cancer biomarker in high-risk women.