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Chi Y, Chen J, Zhou M, Xu F. Hamartoma of the breast: A rare case report. Asian J Surg 2024; 47:1849-1850. [PMID: 38182521 DOI: 10.1016/j.asjsur.2023.12.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Yongxing Chi
- Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Jia Chen
- Shaoxing People's Hospital, Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | - Minghui Zhou
- Shaoxing People's Hospital, Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | - Feng Xu
- Shaoxing People's Hospital, Shaoxing, 312000, China.
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Makineli S, Filipe MD, Vriens MR, van Diest PJ, Witkamp AJ. A Second Ductoscopy Procedure in Patients with Recurrent and Persistent Pathological Nipple Discharge. Breast Care (Basel) 2023; 18:256-261. [PMID: 37900554 PMCID: PMC10601673 DOI: 10.1159/000530817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/18/2023] [Indexed: 10/31/2023] Open
Abstract
Background Most patients suffering from pathological nipple discharge (PND) undergo local surgical procedures because standard radiological imaging often fails to reveal the cause. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization and can avoid unnecessary diagnostic surgical procedures. Hence, patients with recurrent or persistent PND after an unsuccessful ductoscopy procedure still undergo unnecessary surgery. This study describes the experience of a second ductoscopy procedure in patients with recurrent or persistent PND without suspicious radiological findings. Methods Patients with recurrent or persistent PND who underwent two ductoscopy procedures between 2010 and 2017 were retrospectively analyzed. The second ductoscopy was performed when the first ductoscopic attempt was unsuccessful due to technical problems. The primary outcome was the number of preventable surgical procedures. Results A total of 17 patients underwent two ductoscopy procedures. The first ductoscopy showed a polypoid lesion in 10 patients (58.8%), no abnormalities in 3 patients (17.6%), and in 4 patients (23.5%), it was not possible to visualize the ductal tree. Post-procedure, all patients suffered from PND. After two ductoscopic attempts, PND stopped in 10 patients (58.8%), and 7 patients (41.2%) still suffered from PND and were operated on. Pathology of the resection specimens showed no abnormalities in 1 patient, a papilloma in 5 patients, and ductal carcinoma in situ in 1 patient. Conclusion A second ductoscopy procedure can be considered in the diagnostic work-up of patients suffering from persistent or recurrent PND after an unsuccessful first ductoscopic attempt to avoid unnecessary surgery in about 59% of the cases.
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Affiliation(s)
- Seher Makineli
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - Arjen J Witkamp
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
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Luigi B, Carlo V, Corrado C, Orlando C. The nipple-areolar complex: anatomy, methods and pathologic findings, between senologist and dermatologist. J Ultrasound 2023; 26:239-247. [PMID: 36085438 PMCID: PMC10063719 DOI: 10.1007/s40477-022-00722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022] Open
Abstract
The purpose of this presentation is to show the ultrasonography findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. Many of which have unspecific clinical and radiological presentations that can present a challenge for medical specialists. Experienced specialists need to know the different imaging modalities used to study the nipple-areolar complex and the aspect not exactly senology, as well as dermatologist who approach the ultrasound must know the anatomy of this complex area. We will show you a combined clinical and radiological approach to evaluate the nipple-areolar complex, the findings for the normal morphology and the most common benign and malignant diseases that can affect this region. We discuss the characteristics of the different ultrasonography findings and provide guidance on how to avoid artifacts and pitfalls.
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Affiliation(s)
- Basile Luigi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini 5, 80138, Naples, Italy.
| | - Varelli Carlo
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
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Ao F, Yan Y, Zhang ZL, Li S, Li WJ, Chen GB. The value of dynamic contrast-enhanced magnetic resonance imaging combined with apparent diffusion coefficient in the differentiation of benign and malignant diseases of the breast. Acta Radiol 2022; 63:891-900. [PMID: 34134527 DOI: 10.1177/02841851211024002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) histogram analysis for the diagnosis of breast cancer has not been evaluated in previous studies. PURPOSE To investigate the diagnostic value of DCE-MRI combined with ADC in benign and malignant breast lesions. MATERIAL AND METHODS The clinicopathological imaging data included 168 patients (177 lesions) with breast lesions who underwent convention breast MRI, DCE-MRI, and diffusion-weighted imaging (DWI); they were divided into the benign lesion group (n = 39) and malignant lesion group (n = 129) based on pathology. RESULTS Using the type III outflow curve as a diagnostic criterion for malignant breast lesions, the diagnostic sensitivity was 76.9%, the specificity was 80%, the correct rate was 72.2%, and its area under the curve (AUC) was 0.823. Using an enhancement ratio > 100% as a diagnostic criterion for malignant breast lesions, the sensitivity was 61.5%, specificity was 80%, and AUC was 0.723. Using > 3 ipsilateral vessels as a diagnostic criterion for malignant lesions in the breast resulted in a diagnostic sensitivity of 81.6%, a specificity of 80.8%, and an AUC of 0.805. CONCLUSION The type of time intensity curve DCE-MRI, the early enhancement rate in the first phase, the number of ipsilateral vessels, and the ADC full volume histogram of the blood supply score and DWI are valuable in the diagnosis of benign and malignant breast lesions.
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Affiliation(s)
- Feng Ao
- Department of Medical Imaging Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Yi Yan
- Institute of Ophthalmology Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Zi-Li Zhang
- Department of Medical Imaging Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Sheng Li
- Department of Medical Imaging Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Wen-Jing Li
- Department of Medical Imaging Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Guang-Bin Chen
- Department of Medical Imaging Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
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Makineli S, van Diest PJ, Fernandez MA, Witkamp AJ. Idiopathic granulomatous mastitis after ductoscopy: A case report. Int J Surg Case Rep 2021; 88:106540. [PMID: 34741856 PMCID: PMC8577070 DOI: 10.1016/j.ijscr.2021.106540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Idiopathic granulomatous mastitis (IGM) is an uncommon, benign, chronic inflammatory breast disease of unknown etiology, unpredictable duration, and unclear therapy. Presentation of case A 41-year-old woman presented with pathological nipple discharge for which ductoscopy was performed. Post-ductoscopy, the patient developed abscesses in her breast with histopathological confirmation of granulomatous mastitis (GM). Clinical discussion and conclusion IGM has an unknown etiology and atypical presentation. This is the only case described in which IGM occurred after ductoscopy. This can be related to trauma-induced GM or underlying IGM aggravated by ductoscopy. Idiopathic granulomatous mastitis (IGM) has an atypical presentation. Radiological findings are non-specific in diagnosing IGM. GM can occur after ductoscopy. Whether this is trauma-induced GM or underlying IGM aggravated by ductoscopy remains unknown.
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Affiliation(s)
- S Makineli
- Department of Surgical Oncology, University Medical Center, Utrecht, the Netherlands.
| | - P J van Diest
- Department of Pathology, University Medical Center, Utrecht, the Netherlands
| | - M A Fernandez
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - A J Witkamp
- Department of Surgical Oncology, University Medical Center, Utrecht, the Netherlands.
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Singh S, Gaur K, Puri A. Mammary Fibrocystic Change in a Pre-Pubertal child- A Case Report with a Histopathological Perspective. Fetal Pediatr Pathol 2021; 40:535-539. [PMID: 32075463 DOI: 10.1080/15513815.2020.1721739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Fibrocystic change in the breast is one of the entities under the spectrum of benign breast disease. It occurs primarily in females of the reproductive age group. Though the exact etiology is unknown, estrogen-progesterone imbalance is possibly one of the causative factors. Its occurrence in the pediatric age group is infrequent and is hitherto unreported in the pre-pubertal age group. Case report: We present the case of a 2-year-old female presenting with an ill -defined lump approximately 4 cm in diameter, with an unremarkable hormonal status for the age. Histopathology revealed fibrocystic change in the resected tissue. Conclusion: Fibrocystic breast change in children may represent an exaggeration of the normal developmental involution process.
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Affiliation(s)
- Smita Singh
- Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Kavita Gaur
- Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Archana Puri
- Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India
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7
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Wang K, Nakano K, Naderi N, Bajaj-Elliott M, Mosahebi A. Is the skin microbiota a modifiable risk factor for breast disease?: A systematic review. Breast 2021; 59:279-285. [PMID: 34329949 PMCID: PMC8335652 DOI: 10.1016/j.breast.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/07/2021] [Accepted: 07/16/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE High prevalence, unreliable risk discrimination and poor clinical outcomes are observed in malignant and benign breast diseases (BD). The involvement of microbial communities in the development of BD has become topical, and distal influences of microbial dysregulation in the breast have been well established. Despite advances, the role of the breast skin microbiota in BD remains unclear. Interactions between the skin microbiota and the underlying mucosal immune system are complex. In homeostasis, the skin offers a physical barrier protecting underlying breast tissue from skin commensals and noxious environmental triggers. Our review aims to illuminate the role of the skin microbiota in the development of BD. METHODS Adhering to the PRISMA protocol, a systematic review was conducted utilising the Medline and Embase search engines. RESULTS Through a comprehensive search of the last ten years, twenty-two studies satisfied the inclusion criteria. Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were identified as the most prevalent phyla of both breast tissue and skin in healthy controls and BD. High abundance of skin commensals, specifically some species of Staphylococcus, have been linked in breast cancer and metastases. Similarly, dysregulated microbial abundance is also seen in inflammatory and implant-associated BD. These findings raise the hypothesis that the skin microbiota plays a role in tissue homeostasis and may contribute to a range of breast pathologies. Several mechanisms of microbial transfer to underlying tissue have been proposed, including retrograde transfer through ductal systems, breakdown of the skin barrier, and migration through nipple-aspirate fluid. CONCLUSION Our review provides preliminary insights into the skin microbiota as a modifiable risk factor for BD. This raises opportunities for future studies in antimicrobials/probiotics as an adjunct to, or replacement of surgery; a diagnostic and/or prognostic tool for BD; and the possibility of conditioning the microbiota to manage BD.
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Affiliation(s)
- Katie Wang
- Royal Perth Hospital, Western Australia, Australia.
| | - Kento Nakano
- University of Western Australia, Western Australia, Australia
| | - Naghmeh Naderi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Mona Bajaj-Elliott
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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Liu Y, Hou J, Zhu Z, Liu B, Cao M, Qin W. Assessment of breast arteries and lymph nodes by 3D MR angiography enhancement imaging: feasibility and pilot clinical results. BMC Med Imaging 2021; 21:97. [PMID: 34098896 PMCID: PMC8185933 DOI: 10.1186/s12880-021-00629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. Methods We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. Results The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e−8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients’ (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. Conclusions The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment.
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Affiliation(s)
- Yang Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China
| | - Jiaxin Hou
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, 1068 Xueyuan Avenue, Shenzhen, 518055, People's Republic of China
| | - Zhijun Zhu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China
| | - Bingguang Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China
| | - Manrui Cao
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China.
| | - Wenjian Qin
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, 1068 Xueyuan Avenue, Shenzhen, 518055, People's Republic of China.
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Abstract
BACKGROUND Mondor's disease of the breast (MDB) is a rare and benign disorder of the breast. It is characterized by thrombophlebitis of the superficial veins of the chest wall. Clinically, it manifests as a cord-like induration of the breast area. MDB resolves spontaneously without sequela. CASE PRESENTATION We report cases of three Caucasian African patients aged 29, 40 and 34, respectively. One patient was under progestative contraception. All the patients had a cord-like induration on the chest wall. Ultrasonography was performed in all patients and was normal in two cases and showed a thrombotic vein in one case. All the patients had symptomatic treatment with total resolution of symptoms within 1 to 4 weeks. No relapse was observed. CONCLUSION MDB is benign in most cases. However, it is not to be taken lightly, because it can be the manifestation of an underlying disease such as breast cancer. The diagnosis is based on clinical findings; ultrasonography can be helpful for the diagnosis. Treatment is based on analgesic and anti-inflammatory drugs.
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Affiliation(s)
- K. Ben Hamida
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - M. Ghalleb
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - A. Triki
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - I. Jebir
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - R. Makhlouf
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - H. Touinsi
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
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Goh T, Dao K, Rives AF, Fishman MDC, Slanetz PJ. Systemic diseases affecting the breast: Imaging, diagnosis, and management. Clin Imaging 2021; 77:76-85. [PMID: 33652268 DOI: 10.1016/j.clinimag.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.
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Ghalleb M, Seghaier S, Adouni O, Bouaziz H, Bouida A, Hassouna JB, Chargui R, Rahal K. Breast tuberculosis: a case series. J Med Case Rep 2021; 15:73. [PMID: 33608057 PMCID: PMC7896393 DOI: 10.1186/s13256-020-02646-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIM Breast tuberculosis is a rare disease, even in endemic areas. The diagnosis can be challenging, as it can mimic breast cancer. We aim to report our experience and discuss diagnoses and management modalities. RESULTS We encountered twelve cases of breast tuberculosis in our institution from 2004 to 2019. The average age of our Caucasian North African patients was 42 years old (22-63). The classic presentation was a breast lump found in half of the cases. On physical examination, we suspected breast carcinoma in seven patients. The average size of the tumors was 39 mm (15-80 mm). Nine patients had a mammogram. In five cases, there was a suspicious breast mass mimicking a malignant tumor with an average size of 33 mm (25-60 mm). A ultrasonography was performed in 6 cases and revealed a suspicious ill-circumscribed nodule in four patients with an average size of 37.5 mm (10-60 mm). Five patients had a lumpectomy, and seven women underwent drainage of the abscess and the biopsy of its hull. The association of epithelioid cell granulomas and caseous necrosis was mandatory for the histological diagnosis of tuberculosis. All of them had an antitubercular therapy. The median period of follow-up was of 43 months (3-156 months). One patient presented with a recurrent abscess of the breast. CONCLUSION Our study found that clinical examination and radiological imaging were not specific. Positive cultures for Koch bacillus or histological confirmation are mandatory for the diagnosis. A meta-analysis of the existing cases is needed.
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Affiliation(s)
- M. Ghalleb
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - S. Seghaier
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - O. Adouni
- Immuno-Histo-Cytology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - H. Bouaziz
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - A. Bouida
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - J. Ben Hassouna
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - R. Chargui
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
| | - K. Rahal
- Surgical Oncology Department, Institute Salah Azaiez of Oncology, Tunis, Tunisia
- Faculté de Médecine de Tunis, Institut Salah Azaiz, Université Tunis el Manar, Boulevard Avril 1938, 1006 Tunis, Tunisia
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12
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Suñén I, García Maroto J, Dieste I, Ciotti M, Romeo Tris A, García Barrado AI, García Mur MC. Spanish radiology residents' views on breast imaging. Radiologia (Engl Ed) 2021; 64:S0033-8338(21)00018-7. [PMID: 33549316 DOI: 10.1016/j.rx.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To evaluate radiology residents' opinions about breast imaging and the possibility of choosing this subspecialty after completing their residency. MATERIAL AND METHODS We elaborated a 15-question survey aimed at radiology residents in Spain. The survey was approved by the Spanish Society of Breast Imaging (SEDIM) and the Spanish Society of Medical Radiology (SERAM), and it was disseminated by the SERAM through links to Google Forms via social networks and emails. Responses sent between February 21, 2020 and July 31, 2020 were accepted. RESULTS A total of 72 residents responded to the survey (7.83% response rate); 69.44% of these were third- or fourth-year residents. Of the respondents, 73.61% knew about the SEDIM, and 18.06% knew about the European Society of Breast Imaging. The duration of training programs was three months for 70.83% of respondents. In 7.84% of the responses, residents stated that their supervision was less than 50%, and 70.59% of the residents stated that the rotation exceeded their expectations. One-third of the respondents would consider a fellowship in breast imaging. In all hospitals, residents did diagnostic mammography and breast ultrasound; not all did interventional procedures. Aspects of breast imaging that were rated negatively included the lack of CT studies and the possible legal repercussions of errors. Aspects that were rated positively were dynamics, interventionism, and the role of the radiologist in the process of care for patients with breast cancer. CONCLUSIONS Most residents considered that their rotations in breast imaging exceeded their expectations; however, only a small percentage of residents would consider specializing in the field.
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Affiliation(s)
- I Suñén
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - J García Maroto
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - I Dieste
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Ciotti
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Romeo Tris
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A I García Barrado
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M C García Mur
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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13
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Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
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Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
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14
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Yu CC, Cheung YC, Ueng SH, Chen SC. Impact of Non-Calcified Specimen Pathology on the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia by Stereotactic Vacuum-Assisted Breast Biopsy. Korean J Radiol 2020; 21:1220-1229. [PMID: 32729266 PMCID: PMC7462764 DOI: 10.3348/kjr.2019.0786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Stereotactic vacuum-assisted breast biopsy (VABB) is considered a reliable alternative to surgical biopsy for suspicious calcifications. In most cases, the management of flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) after VABB with residual calcifications requires surgical excision. This study aimed to evaluate the impact of pathology of non-calcified specimens on the underestimation of malignancy. Materials and Methods We retrospectively reviewed 1147 consecutive cases of stereotactic VABB of suspicious calcifications without mass from January 2010 to December 2016 and identified 46 (4.0%) FEA and 52 (4.5%) ADH cases that were surgically excised for the retrieval of residual calcifications. Mammographic features and pathology of the calcified and non-calcified specimens were reviewed. Results Seventeen specimens (17.3%) were upgraded to malignancy. Mammographic features associated with the underestimation of malignancy were calcification extent (> 34.5 mm: odds ratio = 6.059, p = 0.026). According to the pathology of calcified versus non-calcified specimens, four risk groups were identified: Group A (ADH vs. high-risk lesions), Group B (ADH vs. non-high-risk lesions), Group C (FEA vs. high-risk lesions), and Group D (FEA vs. non-high-risk lesions). The lowest underestimation rate was observed in Group D (Group A vs. Group B vs. Group C vs. Group D: 35.0% vs. 20.0% vs. 15.0% vs. 3.6%, p = 0.041, respectively). Conclusion Considering that the calcification extent and pathology of non-calcified specimens may be beneficial in determining the likelihood of malignancy underestimation, excision after FEA or ADH diagnosis by VABB is required, except for the diagnoses of FEA coexisting without atypia lesions in non-calcified specimens.
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Affiliation(s)
- Chi Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.
| | - Yun Chung Cheung
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan
| | - Shir Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan
| | - Shin Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan
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15
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Liang MMS, Teo SY, Gudi M, Lim SH, Win T. Breast Microcalcifications as the Only Imaging Manifestation of Metastatic Serous Peritoneal Adenocarcinoma in the Breast. J Radiol Case Rep 2019; 13:1-10. [PMID: 32184921 PMCID: PMC7060008 DOI: 10.3941/jrcr.v13i10.3769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of a 65 year old female with newly diagnosed primary peritoneal serous carcinoma who was found to have indeterminate segmental microcalcifications in the right upper outer quadrant with a mildly enlarged right axillary node on mammogram. There was no associated breast mass on ultrasound. Core biopsy of the right axillary lymph node and right upper outer quadrant breast microcalcifications confirmed the presence of breast metastases at both sites from primary peritoneal serous carcinoma. This case highlights the importance of histopathological correlation of any breast and axillary abnormalities in patient with primary extramammary malignancy. Imaging features of metastatic lesions to the breast are also reviewed.
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Affiliation(s)
- Mary Moon-Sun Liang
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Sze Yiun Teo
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Mihir Gudi
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Swee Ho Lim
- KK Breast Centre, KK Women’s and Children’s Hospital, Singapore
| | - Thida Win
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
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16
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Türkyılmaz Z, Aydın T, Yılmaz R, Önder S, Özkurt E, Tükenmez M, Müslümanoğlu M, Acunaş G, İğci A, Özmen V, Dinçağ A, Cabioğlu N. Our 20-Year Institutional Experience with Surgical Approach for Breast Hamartomas. Eur J Breast Health 2019; 15:171-175. [PMID: 31312793 DOI: 10.5152/ejbh.2019.4624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/06/2019] [Indexed: 11/22/2022]
Abstract
Objective Hamartomas are rare, slowly-growing breast tumours. Clinical, radiological and histopathological examination together increase the diagnostic accuracy. To evaluate the clinicopathologic features of hamartomas and outline our clinical approach to hamartomas in our 20-year experience at our Breast Clinic. Materials and Methods Between 1995 and 2015, 24 cases were retrospectively analyzed with a diagnosis of breast hamartoma at our Breast Clinic followed by excisional biopsy. Data was obtained on patient demographics, clinical examination, radiological findings and histopathological subtypes. Results Of 1338 benign breast tumours excised from January 1995 to January 2015, 24 (1.8%) were identified as breast hamartoma. Median age of patients was 42 (range, 13-70), whereas the median tumour size was 5 cm (1-10 cm). On preoperative imaging, hamartoma was most commonly misdiagnosed as fibroadenoma. Pathological examination of the 24 biopsy specimens revealed 3 cases with pseudoangiomatous stromal hyperplasia, and another hamartoma associated with a radial scar within the centre of the lesion. Of those, one patient was diagnosed with malignant phylloides tumour in the same breast. At a median follow-up 58.4 months, none of the patients recurred or developed malignancy. Conclusion Hamartomas can often be missed by clinicians, due to its benign nature which is poorly understood. Despite their slow growth, hamartomas can reach large sizes and can cause breast asymmetry. Although it is rare, hamartoma can be seen along with malignancy, as it is formed from similar components of breast tissue. Therefore, careful diagnosis and appropriate management including surgery are required.
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Affiliation(s)
- Zeliha Türkyılmaz
- Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
| | - Tahacan Aydın
- İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Ravza Yılmaz
- Department of Radiology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Semen Önder
- Department of Pathology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Enver Özkurt
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Mustafa Tükenmez
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Mahmut Müslümanoğlu
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Gülden Acunaş
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Abdullah İğci
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Ahmet Dinçağ
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Neslihan Cabioğlu
- Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
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17
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Angarita FA, Price B, Castelo M, Tawil M, Ayala JC, Torregrossa L. Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum. Breast Cancer Res Treat 2018; 173:439-445. [PMID: 30315436 DOI: 10.1007/s10549-018-4993-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Clinical breast examination (CBE) is an important step in the assessment of patients with breast-related complaints. We developed a standardized simulation and multimedia-based (SSMBI) curriculum using current evidenced-based recommendations. This study aimed to determine if SSMBI training resulted in better performance (examination scores and detection of abnormal findings) than the traditional teaching method. METHODS Novice fourth-year medical students were exposed to the SSMBI curriculum (n = 68) or traditional (n = 52) training. The traditional group was taught by a lecture and attending weekly clinics where they had hands-on experience. The SSMBI group underwent a structured lecture followed by an instructional video and dedicated simulated teaching. Both groups were assessed through a written knowledge exam and an objective structured clinical examination (OSCE). Student's t test and χ2 tests were used to assess differences in CBE technique and knoweldge. RESULTS Students who underwent SSMBI training had significantly higher numbers of correct answers describing the different steps and justifications of CBE. OSCE performance was significantly higher in the SSMBI group. SSMBI-trained students were more likely to complete all the necessary CBE steps compared to traditionally-trained students (88.2% vs. 28.2%, p < 0.00001). The SSMBI group was also more systematic and more likely to perform adequate inspection, palpation, examination of the nipple-areolar complex, and identify and characterize a palpable lesion (p < 0.05). CONCLUSIONS Formal SSMBI training is an important asset when teaching medical students how to perform a CBE. Real clinical experience is still necessary to refine this skill and the physician-patient interaction.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin Price
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Matthew Castelo
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mauricio Tawil
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia.,Department of Surgery, Hospital Universitario San Ignacio, Carrera 7 Nº 40 - 62, Oficina 718, Bogotá, Colombia
| | - Juan Carlos Ayala
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Lilian Torregrossa
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia. .,Department of Surgery, Hospital Universitario San Ignacio, Carrera 7 Nº 40 - 62, Oficina 718, Bogotá, Colombia.
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18
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Boulanger L, SidAhmed-Mezi M, Dhollande A, Bouhassira J, Meningaud JP, Chauvet MP, Hersant B. [How I do…for the surgical management of gestational gigantomastia]. ACTA ACUST UNITED AC 2018; 46:550-554. [PMID: 29776839 DOI: 10.1016/j.gofs.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- L Boulanger
- Service de chirurgie sénologique, centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France
| | - M SidAhmed-Mezi
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - A Dhollande
- Pôle femme mère nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France
| | - J Bouhassira
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - J P Meningaud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - M-P Chauvet
- Service de chirurgie sénologique, centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France
| | - B Hersant
- Service de chirurgie sénologique, centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France; Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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19
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Park HL, Kim KY, Park JS, Shin JE, Kim HR, Yang B, Kim JY, Shim JY, Shin EA, Noh SM. Clinicopathological Analysis of Ultrasound-guided Vacuum-assisted Breast Biopsy for the Diagnosis and Treatment of Breast Disease. Anticancer Res 2018; 38:2455-2462. [PMID: 29599377 DOI: 10.21873/anticanres.12499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate the usefulness and safety of vacuum-assisted breast biopsy (VABB) for breast lesion diagnosis and treatment. PATIENTS AND METHODS Clinical and histopathological data of 8,748 patients, who underwent 11,221 VABB procedures were analyzed. RESULTS Most patients (58.2%) were <40 years old. Most lesions (39.6%) were 0.6-1.0 cm in diameter while 3.2% were ≥3.0 cm; fibroadenomas were the most common (46.6%). Eight (14% of 57) cases of atypical ductal hyperplasia were underestimated. The positive predictive values (PPVs) of breast imaging reporting and data system (BI-RADS) ultrasound category were 0.6%, 3.4%, 34.8%, 66.2%, and 93.8% for category 3, 4a, 4b, 4c, and 5 lesions, respectively. The mean number of core specimens was 9.5±8.8; the mean procedure time was 3.4±2.7 min. No residual lesions were found in 94.4% of the 7,480 patients. CONCLUSION VABB could replace ultrasound-guided core biopsy and surgical excisional biopsy for the diagnosis of breast disease and the treatment of benign breast lesions.
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Affiliation(s)
- Hai-Lin Park
- Departments of Surgery, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Ka Young Kim
- Diagnostic Radiology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Jong Seob Park
- Departments of Surgery, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Ji-Eun Shin
- Diagnostic Radiology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Hye-Rin Kim
- Diagnostic Radiology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Bora Yang
- Diagnostic Radiology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Ji-Young Kim
- Diagnostic Pathology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Jeong Yun Shim
- Diagnostic Pathology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Eun-Ah Shin
- Diagnostic Pathology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
| | - Song-Mi Noh
- Diagnostic Pathology, Gangnam CHA Hospital, College of Medicine, CHA University, Seoul, Republic of Korea
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20
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Ashoor A, Monti S, Pezzella M. Fibromatosis, a benign breast disease mimicking carcinoma. A case report. Int J Surg Case Rep 2017; 41:392-397. [PMID: 29545999 PMCID: PMC5697995 DOI: 10.1016/j.ijscr.2017.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation. Case summary We present a clinical case in which a diagnosis and treatment dilemma existed, in terms of ultrasound findings that were not clear and suspicious, as well as results of Fine needle aspiration cytology. Our findings are compared with previous published cases. Also, literature review regarding fibromatosis presentation and diagnosis has been discussed, as well as treatment options. Conclusion Management of breast fibromatosis remains controversial because of the low incidence and further efforts needed to establish evidence-based treatment guidelines.
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Affiliation(s)
- Arwa Ashoor
- Breast Unit, Department of Surgery, King Fahd General Hospital, P. O. Box: 51652, Jeddah, 21553, Saudi Arabia.
| | - Simonetta Monti
- Senology Division, European Institute of Oncology, Milan, Italy
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21
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Bennett IC. The Changing Role of Vacuum-assisted Biopsy of the Breast: A New Prototype of Minimally Invasive Breast Surgery. Clin Breast Cancer 2017; 17:323-325. [PMID: 28359730 DOI: 10.1016/j.clbc.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/18/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Ian C Bennett
- University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.
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22
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CHEN Q, XIAO J, ZHANG P, CHEN L, CHEN X, WANG S. Lower Serum Levels of Uric Acid in Uterine Fibroids and Fibrocystic Breast Disease Patients in Dongying City, China. Iran J Public Health 2016; 45:596-605. [PMID: 27398332 PMCID: PMC4935703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increasing serum levels of uric acid (SUA) after menopause in women brought up a hypothesis that estrogenic effect may protectively regulate SUA. Estrogenic effect is a major etiology of uterine fibroids and fibrocystic breast disease. The study aimed to explore SUA among patients suffering from these diseases to enhance the hypothesis. METHODS Overall, 1349 female participants were selected into three cases: Case I having uterine fibroids (n=568), Case II having fibrocycstic breast disease (n=608) and Case III having uterine fibroids combining with fibrocycstic breast disease (n=173); 4206 participants without these diseases were selected as controls. Based on health check-up data from 2011 to 2012, in Dongying Shengli Oilfield Central Hospital, a cross-sectional study was conducted to examine the difference in SUA between the case and control. We adjusted covariates by generalized linear regression mode. RESULTS From 19 to 44 yr, SUA of Case I to Case III were lower than controls by 8.46 umol/L (P=0.011), 5.88umol/L (P=0.014) and 9.39 umol/L (P=0.059), respectively. From 45-54 yr, no significant differences were between three cases and controls. In Case I and its control: from 54-59 yr, differences were not significant; from 60 to 72 yr, SUA in Case I was lower than the control by 32.02umol/L (P=0.003). CONCLUSION Participants of uterine fibroids and fibrocystic breast disease had a lower SUA except the stage of menopause, which indirectly supported that estrogenic effect, may protectively decrease SUA.
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Affiliation(s)
- Qicai CHEN
- Dept. of Prevention and Health Care, Dongying Shengli Oilfield Central Hospital, Dongying, China
| | - Juan XIAO
- Dept. of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Pengpeng ZHANG
- Dept. of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China,Tianjin Entry-Exit Inspections and Quarantine Bureau, Tianjin, China
| | - Lili CHEN
- Dept. of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China,Dept. of Nutrition and Food Safety, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoxiao CHEN
- Dept. of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Shumei WANG
- Dept. of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China,Corresponding Author:
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23
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Arnaud A, Dumuids M, Mège A, de Rauglaudre G, Regis Arnaud A, Martin N, Dupuy Meurat F, Dolle S, Gallon E, Serin D. ["SOS SEIN 84" accelerated breast disease management: Patients satisfaction survey]. Bull Cancer 2016; 103:415-20. [PMID: 27040268 DOI: 10.1016/j.bulcan.2016.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/03/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
In case of a new breast symptom or an abnormal result of breast imaging, some women have a problem finding a quick answer to allay their anxiety. The Institut Sainte-Catherine in Avignon has set up a new form of accelerated disease management through the opening of a new dedicated consultation called SOS SEIN 84. We present the result of a prospective quality study of our first new patients.
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Affiliation(s)
- Antoine Arnaud
- Institut Sainte-Catherine, service de radiothérapie, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Magali Dumuids
- Institut Sainte-Catherine, service de radiothérapie, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Alice Mège
- Institut Sainte-Catherine, service de radiothérapie, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Gaëtan de Rauglaudre
- Institut Sainte-Catherine, service de radiothérapie, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Anne Regis Arnaud
- Institut Saint-Catherine, service d'imagerie médicale, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Nicole Martin
- Institut Saint-Catherine, service d'imagerie médicale, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Françoise Dupuy Meurat
- Institut Saint-Catherine, service d'imagerie médicale, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Sabine Dolle
- Institut Saint-Catherine, service d'imagerie médicale, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Elise Gallon
- Institut Sainte-Catherine, unité de psycho-oncologie, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - Daniel Serin
- Institut Sainte-Catherine, service de radiothérapie, 250, chemin de Baigne-Pieds, 84000 Avignon, France.
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Abstract
INTRODUCTION A palpable lesion in the breast is usually subjected to triple assessment (clinical examination [CE], imaging and core biopsy [CB] or fine needle aspiration [FNA]) to minimise the risk of missing breast cancer. However, breast cancer is rare in young women, and triple assessment (especially CB) is invasive and expensive. Our aim was to see whether CB/FNA could be avoided in young women with benign findings on CE and imaging. METHODS This study analysed data from a prospectively entered database on female patients aged under 25 years who attended a rapid diagnosis breast clinic over a 68-month period. RESULTS Among 10,301 patients seen, 955 females (9.3%) were aged <25 years. The most common presenting complaint was a lump, followed by pain and nipple discharge. CE was normal or revealed benign findings in all except 15 patients, in whom it was indeterminate. Ultrasonography was performed in 692 patients (72%) and was normal (n=289) or benign (n=382) in all except 21 patients, in whom it was indeterminate. In six patients, both were indeterminate. A total of 317 patients (35%) had triple assessment: FNA in 106, CB in 239 and both in 9 cases. No cancers were diagnosed. CONCLUSIONS It would appear safe to omit FNA/CB in patients aged under 25 years when clinical and ultrasonography findings are normal or benign. This approach would have avoided needle biopsies in all but 30 patients (3%) in the study.
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Affiliation(s)
- D Yue
- Luton and Dunstable University Hospital NHS Foundation Trust, UK
| | - C Swinson
- Luton and Dunstable University Hospital NHS Foundation Trust, UK
| | - D Ravichandran
- Luton and Dunstable University Hospital NHS Foundation Trust, UK
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25
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Abstract
BACKGROUND Breast diseases are rising in incidence especially in developing countries. However, most research focuses on breast cancer. Analysing the spectrum of breast disease will enable establishment of efficient breast clinics within an existing general surgery out-patient department with minimal additional investment or personnel whilst providing quality care. OBJECTIVES To study the spectrum of breast disease in an urban general surgical centre in India. To use a `Clinic-within-a-Clinic' model to provide affordable care and accurate early diagnosis to patients with breast disorders. MATERIALS & METHODS A prospective study was conducted over 1 year at M. S. Ramaiah Hospital, Bangalore by a single general surgical unit. 903 patients who presented to the OPD with a variety of breast-related symptoms were included in the study (896 women and 7 men). Relevant history was taken; the patients were then examined and investigated according to our protocol and patterns were recognized. RESULTS Benign breast disease formed the majority of the cases (640 patients, 70.87%). The 21-30 years age group had the most patients (272 patients, 30.12%). ANDI was the commonest diagnosis (522 patients, 57.8%). 92 patients (10.18%) were diagnosed with cancer. More than 50% of these were less than 50 years of age. Majority of the patients (511 patients, 56.58%) could be managed conservatively. The cost of diagnosis and treatment was found to be a small fraction of that in specialized breast units of western countries using our `Clinic-within-a-clinic' model. CONCLUSION Research on the demographic and clinical pattern of breast disease can help establish and efficient, effective and affordable diagnostic and therapeutic systems in developing nations.
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Bruno A, Pandolfo G, Scimeca G, Leonardi V, Cedro C, Racchiusa S, Zoccali RA, Muscatello MRA. Anger in health, benign breast disease and breast cancer: a prospective case-control study. In Vivo 2014; 28:973-977. [PMID: 25189916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The State-Trait Anger Expression Inventory 2 (STAXI-2) is a psychometric instrument measuring anger experience and expression. Associations between the STAXI-2 and risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS A total of 117 women with breast symptoms referred for breast examination were selected and assessed before any diagnostic procedures. RESULTS Twenty-four patients with BC, 44 with benign breast disease (BBD) and 49 healthy individuals (HHS) were included. Scores for parameters state anger/feel like expressing anger physically (SANGP) were significantly higher in the HHS group (HHS vs. BBD: p=0.027; HHS vs. BC: p=0.025). BC patients showed a trend to lower scores in almost all scales of STAXI-2, except for the scales trait anger/angry temperament (TANGT), anger expression-in (AX-I), and anger control-out (AC-O), that were higher than the two other groups' scores. CONCLUSION The results of this study do not support a specific link between STAXI-2 and breast cancer risk.
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Affiliation(s)
- Antonio Bruno
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Gianluca Pandolfo
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Giuseppe Scimeca
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Valentina Leonardi
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Clemente Cedro
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Sergio Racchiusa
- Department of Radiological Sciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Rocco Antonio Zoccali
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Maria Rosaria A Muscatello
- Section of Psychiatry, Department of Neurosciences, G. Martino Polyclinic, University of Messina, Messina, Italy
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Mobasheri MH, Johnston M, King D, Leff D, Thiruchelvam P, Darzi A. Smartphone breast applications - what's the evidence? Breast 2014; 23:683-9. [PMID: 25153432 DOI: 10.1016/j.breast.2014.07.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There are around 40,000 healthcare applications (apps) available for smartphones. Apps have been reviewed in many specialties. Breast cancer is the most common malignancy in females with almost 1.38 million new cases a year worldwide. Despite the high prevalence of breast disease, apps in this field have not been reviewed to date. We have evaluated apps relevant to breast disease with an emphasis on their evidence base (EB) and medical professional involvement (MPI). METHODS Searching the major app stores (apple iTunes, Google Play, BlackBerry World, Windows Phone) using the most common breast symptoms and diseases identified relevant apps. Extracted data for each app included target consumer, disease focus, app function, documentation of any EB, documentation of MPI in development, and potential safety concerns. RESULTS One-hundred-and-eighty-five apps were reviewed. The majority focused on breast cancer (n = 139, 75.1%). Educational (n = 94) and self-assessment tools (n = 30) were the most common functions demonstrated. EB and MPI was identified in 14.2% and 12.8% of apps respectively. Potential safety concerns were identified in 29 (15.7%) apps. CONCLUSIONS There is a lack of EB and MPI in the development of current breast apps. Safety concerns highlight the need for regulation, full authorship disclosure and clinical trials. A robust framework for identifying high quality applications is necessary. This will address the current barrier pertaining to a lack of consumer confidence in their use and further aid to promote their widespread implementation within healthcare.
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Affiliation(s)
| | | | - Dominic King
- Institute of Global Health Innovation, Imperial College London, UK.
| | - Daniel Leff
- Institute of Global Health Innovation, Imperial College London, UK.
| | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, UK.
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Abstract
Sonographic examination of the breast with state-of-the-art equipment has become an essential part of the clinical work-up of breast lesions and a valuable adjunct to mammographic screening and physical examination. Fine-needle aspiration (FNA) and core-needle biopsy (CNB) are well-established, valuable techniques that are still used in most cases, whereas vacuum-assisted breast biopsy (VABB) is a more recent technique. VABB has proven clinical value and can be used under sonographic, mammographic, and magnetic resonance imaging guidance. The main indication for the use of VABB is for biopsies of clustered microcalcifications, which are usually performed under stereotactic guidance. This method has been proven reliable and should replace surgical biopsies. The ultrasound-guided procedure is still more a matter of discussion, but it should also replace surgical biopsies for nodular lesions, and it should even replace surgery for the complete removal of benign lesions. This viewpoint is gradually gaining acceptance. Different authors have shown increased diagnostic accuracy of VABB compared to FNA and CNB. VABB particularly leads to less histological underestimation. The other indications for VABB are palpable or nonpalpable nodular lesions or American College of Radiology Breast Imaging Reporting and Data System 3 and 4A lesions. For masses that are likely benign or indeterminate, we attempt to completely remove the lesion to eliminate uncertainty on later follow-up images. VABB offers the best possible histological sampling and aids avoidance of unnecessary operations. VABB complications include bleeding or pain during the procedure, as well as postoperative pain, hemorrhaging, and hematomas. But, these hemorrhaging could be controlled by the post-procedural compression and bed resting. Overall, VABB is a reliable sampling technique with few complications, is relatively easy to use, and is well-tolerated by patients. The larger amount of extracted tissue reduces sampling error.
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Affiliation(s)
- Hai-Lin Park
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | - Jisun Hong
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
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Yu JH, Kim MJ, Cho H, Liu HJ, Han SJ, Ahn TG. Breast diseases during pregnancy and lactation. Obstet Gynecol Sci 2013; 56:143-59. [PMID: 24327995 DOI: 10.5468/ogs.2013.56.3.143] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022] Open
Abstract
Breast is a typical female sexual physiologic organ that is influenced by steroid hormone from menarche until menopause. Therefore various diseases can be developed by continuous action of estrogen and progesterone. Breast diseases are mainly categorized as benign and malignant. It is very important to distinguish the malignancy from breast diseases. However, it is very difficult to diagnose malignancy in pregnant and lactating women even though the same breast diseases took place. Therefore, we will review breast diseases such as breast carcinoma during pregnancy and lactation.
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Abstract
Until 20 or 30 years ago, the diagnosis and treatment of breast disease was managed exclusively by the surgeon. This situation has changed to some extent as a result of recent technological advances, and clinicians' contributions to the diagnostic work-up and/or treatment of these cases can begin at any time. If they are the first physician to see the patient after the examination and formulation of a diagnostic hypothesis, they will almost always have to order a panel of imaging/instrumental examinations that is appropriate for the type of lesion suspected, the patient's age, and other factors; if they intervene at the end of the diagnostic work-up, it will be their job to arrive at a conclusion based on all of the data collected. The clinical examination includes various steps - history taking and inspection and palpation of the breasts - each of which is essential and requires the use of appropriate methods and techniques. The diagnostic capacity of the examination will depend largely on the consistency of the breasts, but it is influenced even more strongly by the doctor-patient relationship. Physicians must know their patient well, listen to and understand what she is saying, explain their own findings and verify that the explanations have been understood, and they must be convincing. Clinicians must also be able to assess the results of imaging studies (rather than relying solely on the radiologist's report), and this requires interaction with other specialists. The days are over when a clinician or radiologist or sonographer worked alone, certain that his/her examination method was sufficient in itself: today, teamwork is essential. But this also means that each member of the team must be extremely competent in his/her own sector and be aware of the other team members' limitations and expectations. The clinical examination remains central to the process since it is the basis for selecting appropriate treatment. SOMMARIO: Da quando si conosce la patologia mammaria la diagnosi e la terapia di tale patologia sono state a totale appannaggio del chirurgo, situazione che è proseguita fino a qualche decennio fa. Il recente progresso tecnologico ha modificato, in parte, questa situazione e il clinico può entrare nel percorso diagnostico o terapeutico in qualsiasi momento. Se è il primo coinvolto, dopo l'esame e dopo un'ipotesi diagnostica, dovrà, quasi sempre, orientarsi verso indagini strumentali in relazione al sospetto, all'età della paziente ecc., se è l'ultimo anello deve arrivare a una conclusione mettendo insieme tutte le informazioni. L'esame clinico è composto di varie fasi: anamnesi, ispezione, palpazione, ognuna essenziale. Ogni singola fase va affrontata con metodo e tecnica appropriata. La capacità diagnostica dell'esame clinico è influenzata dalla costituzione della mammella, ma ancor di più è condizionata da uno stretto rapporto tra paziente e medico che deve conoscere molto la paziente che gli sta davanti e che non solo deve "visitare", ma capire, spiegare, accertarsi che si abbia capito, convincere. È inoltre indispensabile che il clinico sia in grado di esaminare le indagini strumentali e non limitarsi a leggere i referti, quindi interagire con gli altri specialisti. L'epoca del clinico o del radiologo o dell'ecografista che lavora da solo credendo che il proprio esame sia sufficiente o sganciato da altri contesti è finita da tempo, tutti hanno bisogno di tutti. È però vero che ciascuno deve essere estremamente competente nel suo settore e deve conoscere i limiti e le aspettative di chi collabora in altre specialità, come rimane valida la regola che la clinica resta comunque il momento centrale, non fosse altro perché poi deve affrontare la terapia.
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Affiliation(s)
- S Poma
- Istituto Clinico Città Studi Milano, Italy
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