Benign Breast Disorders

Impact of loving-kindness meditation intervention vs. music intervention during biopsy on adherence to recommended breast cancer screening

PURPOSE

To evaluate the impact of providing a loving-kindness meditation (LKM) intervention vs. a music intervention during core-needle breast biopsy (CNBB) on adherence to subsequent, clinically recommended breast cancer screening and surveillance.

METHODS

Women (N = 120) were randomly assigned to receive LKM, Music, or Usual Care during CNBB. Patients in the LKM or Music groups listened to audio recordings during CNBB and were provided recordings for home use. Utilization of subsequent recommended breast imaging was assessed via health record review for 18 months into the breast cancer surveillance period.

RESULTS

The sample was, on average, 53 years old (SD = 12.4), partnered (55%), and employed (56%); 28% Black and 68% White. Adherence to recommended breast imaging post-biopsy was: 69% for Usual Care, 71% for Music, and 90% for LKM. Compared to Usual Care, there was no significant difference in adherence for the Music group (OR = 1.11, 95% CI [0.43, 2.89], p = 0.829), but the LKM group was 3.9 times more likely to be adherent (OR = 3.89, 95% CI [1.13, 13.41], p = 0.032). Comparisons between intervention arms showed adherence for the LKM group was 3.5 times higher than the Music group (OR = 3.50, 95% CI [1.02, 12.00], p = 0.046). Patterns of adherence were similar across women with an abnormal biopsy result and those with a benign result.

CONCLUSION

A LKM intervention initiated during CNBB can have significant, positive impacts on women's adherence to subsequent recommended breast imaging. Providing patients with LKM during CNBB is an easily disseminated approach that could improve adherence to breast cancer screening and surveillance after CNBB.

Eugenol inhibits NEAT1 as a ceRNA in pre-cancerous breast lesions

Objective

Eugenol (EU) from cloves is highly effective against different tumors. The long noncoding ribonucleic acids (lncRNAs), which play a role of competing endogenous RNAs (ceRNAs), suppress microRNAs (miRNAs) involved in post-transcriptional regulatory networks. The present work focused on analyzing how EU affected pre-cancerous breast lesions (PBL).

Methods

Initially, the gene expression profiles of patients (n = 880) in the National Center for Biotechnology Information (NCBI) database were analyzed. Further, we established a lncRNA-miRNA-mRNA ceRNA network through bioinformatics analysis and investigated mechanistic roles of lncRNAs as ceRNAs and the anti-tumor effect of EU using MCF-10AT cells in vitro as well as PBL model rats in vivo. Besides, Nuclear Paraspeckle Assembly Transcript 1 (NEAT1), miR-383-5p, miR-9-5p, matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor-A (VEGF-A) expression was examined through quantitative reverse transcription polymerase chain reaction (RT-qPCR), Western blotting, and immunohistochemical staining analyses.

Results

There were altogether 1162 mRNAs, 81 miRNAs, and 26 lncRNAs recognized as trend genes in breast cancer (BC) and pre-cancerous BC (pBC), constructing the ceRNA network using 3 lncRNAs, 3 miRNAs, and 38 mRNAs. It was observed that NEAT1, miR-383-5p, miR-9-5p, VEGF-A, and MMP-9 were downregulated in breast tumor cells in accordance with bioinformatics analysis. EU suppressed MCF-10AT cell growth, decreasing the NEAT1, VEGF-A, and MMP-9 levels and increasing miR-383-5p and miR-9-5p expressions in vitro and in vivo.

Conclusion

In summary, the EU reduced the VEGF-A and MMP-9 expressions via NEAT1-mediated miR-383-5p and miR-9-5p against PBL, indicating that the EU may be a promising external drug to act against PBL.

The efficacy of norepinephrine application in Mammotome-assisted minimally invasive resection for benign breast neoplasm: A retrospective study

OBJECTIVE

Although Mammotome-assisted minimally invasive resection (MAMIR) has been widely accepted for treating breast benign nodules, the procedure remains very technical and challenging. The present study aimed to assess the efficacy of norepinephrine application in MAMIR concerning intraoperative hemorrhage, postoperative pain and postoperative hospitalization.

METHODS

A total of 306 patients with breast nodules admitted at the Xishan people's Hospital of Wuxi City between June 2021 and July 2023 were included in this retrospective cohort study. The patient's age, comorbidities (hypertension and diabetes), and characteristics of the breast nodule (number, unilateral or bilateral nature, inner quadrant volume and total volume) were all meticulously documented. Operation time, intraoperative hemorrhage, postoperative hospitalization and Visual analogue scale(VAS) score (postoperative 6-hour pain score) were recorded. Based on the application of norepinephrine, patients were categorized into non-NPP(norepinephrine) and NPP group. Univariate and multivariate analyses were performed to estimate the odds ratio (OR) and the 95% confidence intervals (CIs) for outcomes.

RESULTS

A total of 155 who accepted MAMIR were included in this study. The NPP group exhibited reduced intraoperative bleeding, diminished postoperative pain, and a shorter duration of hospitalization (p < 0.05). Univariable analysis indicated that usage of norepinephrine during operation helped to reduce intraoperative hemorrhage (OR = 0.14, 95%CI: 0.07-0.31), alleviate postoperative pain(OR = 0.03, 95%CI: 0.01-0.09) and shorten hospital stay(OR = 0.50, 95%CI: 0.26-0.95). Furthermore, multivariate analysis identified the usage of norepinephrine during MAMIR as an independent factor associated with reducing intraoperative hemorrhage (OR = 0.11, 95%CI: 0.05-0.26) and relieving postoperative pain (OR = 0.02, 95%CI: 0.004-0.08) after adjusting for other factories.

CONCLUSIONS

Norepinephrine could help to reduce postoperative hospitalization and intraoperative hemorrhage, also relieve postoperative pain for breast benign nodules resection, which was an independent protective factor for relieving postoperative pain and reducing intraoperative hemorrhage.

From mammary mystery to parasitic surprise: a rare case of primary breast hydatid cyst

BACKGROUND

Primary breast hydatid cyst is an exceedingly rare manifestation of echinococcosis, with an incidence of less than 0.27% among all hydatid cyst cases.

CASE REPORT

This report presents a unique case of a 51-year-old multiparous female who initially presented with a painless left breast mass. Initial imaging studies, including ultrasonography and mammography, revealed a 4.5 × 4 cm cyst classified as BI-RADS 3. The cyst was initially managed with fine-needle aspiration and conservative treatment. However, it recurred twice over a six-month period, necessitating surgical excision. Preoperative laboratory work ups revealed eosinophilia, a finding initially overlooked but later recognized as significant. Histopathological examination of the excised specimen confirmed the diagnosis of a hydatid cyst. Post-surgical management included albendazole therapy, regular imaging follow-ups, and patient education on hygiene practices to prevent reinfection.

CONCLUSION

This case highlights the importance of considering parasitic etiologies in the differential diagnosis of breast masses, particularly in endemic regions. It also underscores the value of a multidisciplinary approach in managing such rare cases. The unexpected diagnosis of a primary breast hydatid cyst in this case serves as a reminder of the diverse presentations of echinococcosis and the need for heightened clinical suspicion in atypical breast lesions.

CLINICAL TRIAL NUMBER

Not applicable.

Clinical efficacy and safety of ultrasound-guided high-intensity focused ultrasound for breast fibroadenoma: a systematic review and meta-analysis

OBJECTIVE

The purpose of this systematic review and meta-analysis was to assess the clinical efficacy and safety of ultrasound (US)-guided high intensity focused ultrasound (HIFU) in the treatment of breast fibroadenoma in different studies.

METHODS

Studies evaluating the efficacy and safety of US-guided HIFU in the treatment of histologically-proven FA with follow-up outcomes of more than 3 months were searched through MEDLINE/PubMed databases. Volume reduction rate (VRR) and side effects were extracted and compared for further analysis.

RESULTS

Of 29 identified articles, 10 studies involving 385 women and more than 545 FAs met the inclusion criteria. The mean VRR at 6 months and 12 months after HIFU was 52.00% and 72.00%. In terms of intraoperative safety, nine studies reported mild to moderate pain, with an average visual analogue scale (VAS) score ranging from 1.60 to 7.10. The most common postoperative side effect associated with HIFU was subcutaneous ecchymosis and less frequent were pain, erythema, and skin pigmentation, most of which disappeared within weeks. No serious side effects were observed.

CONCLUSION

S-guided HIFU is an effective and safe noninvasive treatment for breast FA that does not cause serious side effects. Further studies are needed to explore crucial influencing factors of VRR.

Efficacy and safety of vacuum-assisted excision (VAE) of fibroadenomas: experience in a tertiary centre

PURPOSE

To evaluate the technical success and efficacy rates of US-guided percutaneous vacuum-assisted excision (VAE) of breast fibroadenomas, also assessing procedural complications and long-term patient satisfaction rates.

MATERIALS AND METHODS

The institutional database of a tertiary breast cancer referral centre was retrospectively reviewed to retrieve all women with fibroadenomas who underwent US-guided VAE between May 2011 and September 2019. We subsequently included in this study all fibroadenomas with a maximum diameter of 3 cm at US and an available histological confirmation obtained by core-needle biopsy before VAE. Immediately after VAE, technical success (defined as the correct VAE execution) and the occurrence of procedural complications were evaluated. Imaging follow-up (US ± mammography) after 6, 12, 24 and 36 months was performed to evaluate technical efficacy (defined as the absence of fibroadenoma recurrence at 6-month follow-up). Long-term patient satisfaction was evaluated with telephonic interviews in October 2022.

RESULTS

We retrospectively included 108 women (median age 46 years) with 110 fibroadenomas diagnosed at core-needle biopsy with a median lesion size at US of 12 mm. Technical success was obtained in 110/110 VAEs (100%). Minor procedural complications (haematomas) occurred in 7/110 VAEs (6%), whereas 8/110 patients had a fibroadenoma recurrence at 6-month follow-up, resulting in a 93% technical efficacy (102/110 VAEs). All patients available for telephonic follow-up (104/104, 100%) reported high satisfaction with VAE results.

CONCLUSION

US-guided VAE is a safe and effective procedure for the excision of fibroadenomas, representing a viable alternative to surgery, with a low complication rate and high patient satisfaction.

Prevalence, Impact, and Diagnostic Challenges of Benign Breast Disease: A Narrative Review

Benign breast diseases, which are commonly seen in clinical practice, have various clinical presentations and implications, as well as management strategies. This article describes common benign breast lesions, presentations of these lesions, and typical radiographic and histologic findings. Also included in this review are the most recent data and guideline-based recommendations for the management of benign breast diseases at diagnosis, including surgical referral, medical management, and ongoing surveillance.

Focused ultrasound ablation surgery for multiple breast fibroadenomas: pathological and follow-up results

OBJECTIVE

To investigate the histopathological findings and follow-up outcome of focused ultrasound ablation surgery (FUAS) treatment of multiple fibroadenomas (FA).

METHODS

A total of 20 patients with 101 multiple FAs were enrolled. After one session FUAS ablation, 21 lesions (≥15.0 mm) were surgically removed within one week for histopathological analysis, including 2, 3, 5-triphenyltetrazolium chloride (TTC) staining, H&E staining, nicotinamide adenine dinucleotide (NADH) -flavretin enzyme staining, Transmission electron microscope (TEM) and scanning electron microscope (SEM). The remaining 80 lesions were followed up at 3, 6 and 12 months after treatment.

RESULTS

All ablation procedures were performed successfully. Pathologic findings showed that irreversible damage of FA was confirmed. TTC, H&E and NADH staining and TEM/SEM demonstrated tumor cell death and tumor structural destruction at the gross, cellular, and subcellular levels, respectively. The median shrinkage rate at 12 months post-FUAS was 66.4 (43.6, 89.5) %.

CONCLUSION

Histopathological analysis for FAs after FUAS treatment proved that FUAS could effectively induce irreversible coagulative necrosis of FA, and the tumor volume would gradually shrink in follow-up. FUAS was safe and effective to treat multiple FAs with good cosmesis.Key pointsThis study was the first study of detailed histopathological analysis for FAs after FUAS treatment.FUAS can effectively induce irreversible coagulative necrosis of fibroadenoma cells.FUAS ablation of multiple fibroadenomas is safe and effective.

Effectiveness of acupuncture in the treatment of cyclic mastalgia: a study protocol for a randomized controlled trial

Background

About 68% of women aged 18–44 years have experienced cyclic mastalgia (CM), which occurs during the luteal phase of the menstrual cycle when elevated hormone levels induce greater breast gland thickness. CM has a moderate-to-severe impact on a woman’s quality of life. Prior research has suggested that acupuncture may be beneficial for breast pain relief. In this study, we investigate the effectiveness of manual acupuncture (MA) in the treatment of CM compared with that of sham acupuncture (SA).

Methods

This is a multicenter, randomized, controlled trial. A total of 108 eligible CM patients will be randomly assigned to either MA (n = 54) or SA (n = 54) group using a 1:1 ratio and a stratified, blocked randomization. Acupuncture will be performed two weeks prior to menstruation and discontinued when menses begins. In both the MA and SA group, participants will be given acupuncture three times per week for 2 weeks per menstrual cycle for three consecutive menstrual cycles, encompassing a total of 18 sessions. The primary outcome will be the change in the average daily Breast Pain Visual Analog Scale (VAS-BP) over the first two weeks of menstruation from baseline to endpoints. The number of nominal days of breast pain (NDBP) two weeks before menstruation, World Health Organization Quality-of-Life Scale-Short Form scores, global patient assessment, breast glandular-section thickness, and breast-duct width three days before menstruation will also be measured as secondary outcomes.

Discussion

This prospective randomized trial will help evaluate the efficacy of acupuncture in treating CM. The results of this study will provide evidence of the therapeutic effectiveness of acupuncture on CM.

Trial registration

ClinicalTrials.gov Identifier: NCT05408377, registered on June 7, 2022. 

Management of breast complaints and high-risk lesions

Benign breast disease including palpable breast mass, mastalgia, skin changes, and nipple discharge are common gynecologic symptoms. Practitioners should be well versed in the components of clinical breast care. Workup begins with taking a thorough medical and family history to assess risk and performing a clinical breast examination. Breast imaging is often indicated for further evaluation. A structured approach to the evaluation and management of these breast conditions is critical to distinguish benign disease from malignancy. High-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ are also frequently encountered, and while benign, they do increase the future risk of breast cancer and patients should be offered intensive surveillance and chemoprevention.