OBJECTIVES: The study aimed to describe the demographic profile and determine the cause of delayed consultation among breast cancer patients seen at the Vicente Sotto Memorial Medical Center (VSMMC) Breast Center. The differences between these delayed consultations compared with those who consulted promptly, in terms of clinical, demographic, knowledge and cultural factors were determined.

METHODS: A survey of all female patients with breast cancer seen at the Breast Center of the VSMMC from September 2007 to February 2008, analyzing demographic, clinical, knowledge and cultural factors was conducted. Statistical analysis was done using chi square to determine factors significantly associated with delayed consultation.

RESULTS: Sixty-six (65.4%) out of 101 subjects had consulted late. Most of the delays were due to financial constraints. Delayed consultation was significantly associated with patient's low educational attainment up to elementary level only, and the patient's negative perceptions regarding the cause and possible cure of their cancer. During this time period, most breast cancer patients consulted late for their condition, primarily because of financial reasons.

CONCLUSIONS: In summary, this study showed that financial factors, and inadequate education were major causes of delayed consultations. Inappropriate cultural beliefs may have also contributed to this delay. Modification of current advocacies in the community served by VSMMC is needed to address this problem. Financial support through the community, in whatever form, may be significant in decreasing the incidence of delayed consultation for breast cancer.

Human ; Female ; Breast ; Breast Neoplasms ; Financial Support

This is a case of a 44- year old female presenting with an 18cm x 17cm soft, movable, non-tender mass at the right axilla extending to the lateral aspect of the right breast. Computerized tomographic scan of the chest revealed a lobulated, multi-septated hypodense mass. The patient underwent excision of the right axillary mass and final histopathology revealed cystic lymphangioma. Adult-onset cystic hygroma of the axilla is a rare case, with less than 10 studies documented in PubMed. Total surgical excision remains to be its primary treatment.
Lymphangioma ; Axilla

OBJECTIVES: 1) To determine the accuracy rate of sentinel lymph node? biopsy? (SLNB)? by? comparing? frozen? section? (FS)? with permanent formalin processed specimen by hematoxylin and eosin (H&E) staining; 2) To correlate with axillary lymph node dissection (ALND) histopathology results for those with positive SLNB.
METHODS: This? was? a? retrospective? study? on? all? breast? cancer patients? who? underwent? SLNB? using? methylene? blue? dye.? The number of SLN harvested, number of lymph nodes confirmed on frozen section, frozen section result, number of SLN confirmed on paraffin block H&E, result of H&E. If frozen section of SLN was positive for metastasis, further data on the axillary lymph nodes harvested and its final H&E result were noted. The accuracy rate was determined.? Whenever a discordance of FS and H&E findings occurred, the interpreting pathologists were interviewed for the cause.
RESULTS: A total of 34 SLNB procedures were performed. There were 24 SLNBs that turned out negative on frozen section while 10 were positive for metastasis and underwent further ALND. Three of the 24 negative SLNBs turned out to be positive (false negative rate of 12.5%). Out of the 10 positive SLNBs, 1 turned out to be negative (false positive rate of 10%). Only 6 of the 10 patients with (+) SLNB had? more? positive? nodes? harvested? upon? further? ALND.The accuracy rate of SLNB on frozen section was 88%, with sensitivity and? specificity? of? 90%? and? 87.5%? respectively.? There? were? 5 pathologists involved in the interpretations of the SLNB, and in 76% the? pathologist? interpreting? the? FS? was? different? from? the? one interpreting? the? permanent? specimen? H&E.? The? reasons? for discordance between frozen section and final H&E reading were inter-reader variability and tissue sampling limitation during frozen section.
CONCLUSION:?The accuracy of frozen section in SLNB procedure is 88%.

Human ; Sentinel Lymph Node Biopsy ; Hematoxylin ; Methylene Blue ; Formaldehyde ; Lymph Nodes ; Axilla ; Lymph Node Excision ; Breast Neoplasms

Background: This study was conducted to determine the factors which may affect the incidence and recurrence of breast cancer in patients treated at the Vicente Sotto Memorial Medical Center (VSMMC). Methods: Utilizing hospital records, a case-control study was done on all breast cancer patients, treated at the VSMMC from January 200 to December 2007, comparing those who developed recurrence and those who did not. Results and Conclusions: Of the total of 404 patients treated at VSMMC during this period, only 370 patients (91.6%) with complete records were retrieved and included in the study. Overall recurrence rate was 17.8%. Age, parity, menopausal status nor family history of breast cancer, tumor characteristics, nor adjuvant therapy compliance, were the same for the two groups. More patients without recurrence underwent hormonal therapy (P=0.113). Those patients with recurrent breast cancer more often had positive lymph nodes (P=0.007). Key words: recurrent breast cancer
NOT IDENTIFIED

INTRODUCTION: Palpable breast tissue is so prevalent in studies of men and boys that some authors suggest differentiating it from clinically important gynecomastia. Understanding male breast problems present a great challenge to many physicians especially when there is no specific guidelines developed for men.

OBJECTIVES: This study aims to determine the demographic and clinical profile of male patients with breast problems consulting at Vicente Sotto Memorial Medical Center.

METHODOLOGY: This study is a review of 77 male patients seen at the breast center of Vicente Sotto Memorial Medical Center from April 1, 2001 to March 31, 2004. The clinical profile included the age, geographic origin, chief complaint, family history of breast cancer, clinical breast examination findings, attributes of the clinically palpable breast mass like number, size, consistency, laterality, location, associated breast pain and pain score, clinical diagnosis and final histopathologic report.

RESULTS: Within this time period, there were 2,669 consultations seen at the breast clinic. A total of 77 male patients, comprising 2.9 percent were seen at the clinic. The mean age of occurrence was 36.2 years old. The frequency distribution of breast problem is highest between the ages of 20 to 29 years old at 40.3 percent. In all of the 69 patients (89.61 percent) with clinically palpable mass, 66 patients (95.65 percent) only had a solitary mass while 3 patients (4.35 percent) had two masses. Forty-three (59.7 percent) of the masses were less than 2 centimeters in diameter. Only 1 (1.4 percent) of the 72 masses was fixed to the chest wall which turned out to be a soft tissue sarcoma while the rest (98.6 percent) were freely movable. Based on the final histopathologic results, gynecomastia was the most common diagnosis among patients subjected to fine needle aspiration biopsy and excisional biopsy.

CONCLUSION: Male breast problems are common in the third decade of life and among patients living the urban area like Metro Cebu. Male patients sought consultation due to problems of unilateral firm breast mass less than 2 centimeters in diameter located in the nipple-areola complex. The most common clinical diagnosis is that of gynecomastia which is supported by the final histopathologic result of the same condition.

Human ; Male ; Mastodynia ; Nipples ; Gynecomastia ; Thoracic Wall ; Breast Diseases ; Breast Neoplasms ; Sarcoma

To determine the clinical profile of benign and malignant mastalgia in terms of age distribution, geographic location, laterality, pain severity and pattern.

METHOD: This is a 3-year (April 1,2001 until March 31, 2004) retrospective chart review of female patients presenting with mastalgia in a hospital-based government breast center at Vicente Sotto Memorial Medical Center, Cebu City. Malignant mastalgia was diagnosed based on histopathologic findings. Pain severity assessment was based on a numeric scale of 0 to 10. Exclusion criteria include patients without mastalgia as chief complaint, no histopathologic confirmation of malignancy and males. All statistical computations were done using Chi square test with a = 0.05.

RESULTS: A total of 1237 patients (89 percent) had benign mastalgia with an average age of 29.72 +/- 10.96 years and 156 (11 percent) had malignant mastalgia with an average of 48.92 +/- 11.96 years. Patients less than 60 years of age had a statistically significant probability that their mastalgia is due to benign pathology (p < 0.001 at a 0.05). However, for 60 years of age. there is a significant probability that the cause of mastalgia is malignant (p < 0.001). Right-sided mastalgia showed a significant probability for a benign cause (p value of 0.0132). Further, non-cyclical pain pattern significantly connotes malignant mastalgia with p < 0.001. No significant differences were found for geographic location and pain severity.

CONCLUSION: Age above 60 years, right-sidedness and non-cyclical pain pattern are the only significant factors for differentiating whether the mastalgia is due to a benign or malignant etiology.

Human ; Female ; Mastodynia ; Age Distribution ; Philippines ; Breast ; Probability ; Neoplasms

BACKGROUND: Educating physicians on the proper utilization of mammography is vital to effective implementation of the breast cancer control program.
OBJECTIVE: The general objective of this study was to determine the patterns of mammogram utilization and clinical profile of patients who underwent mammography at Cebu (Velez) General Hospital from January 1997 to February 2001.
METHODS: Checklists embodying important breast health information, clinical data (age, sex, address, menstrual and obstetrical history, personal and family history of breast cancer, presenting breast signs and symptoms), referring physicians, and mammography reports over the last four years were reviewed.
RESULTS: There were 468 mammograms done of which 279 (60 percent) were for diagnostics purposes and 189 (40 percent) for screening. The highest number of women who underwent screening mammography belonged to the 50-59 year age group. Gynecologists were the most frequent referring physicians for mammographic examination at 186 (40 percent) followed by 134 (29 percent) referrals from the general surgeons. There was an increasing trend of mammogram utilization noted over the past four years. Palpable mass in 172 (53 percent) patients was followed by mastodynia in 104 (33 percent) patients accounting for the most common indications for diagnostic mammography. Three hundred seventy-three (80 percent) mammogram results were negative and only 23 (5 percent) showed suspicious abnormalities warranting biopsy. Three hundred twenty-five (69.4 percent) of the mammograms showed extremely dense breasts which lowered sensitivity. There was a trend towards decreasing Grade IV radiographic density of the breast as the patients were older. Proper mammogram utilization at Cebu Velez General Hospital has increased over the last 4 years.

Human ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Child ; Mastodynia ; Checklist ; Mammography ; Breast ; Breast Neoplasms

Objectives: To determine if ultrasound can increase the accuracy of fine needle aspiration biopsy in confirming malignancy in clinically malignant breast masses. Methods: Clinically malignant breast masses underwent ultrasound, fine needle aspiration biopsy/cytology, and tissue biopsy. Accuracy of each test and in combination were calculated using histopathology as gold standard. Results: The accuracy of ultrasound alone was only 67.5% sensitivity of 90.0%, specificity of 33.3%, positive predictive value of 67.2% and negative predictive value of 68.8%, while FNAB alone has an accuracy of 89.2%, sensitivity of 90.0%, specificity of 87.9%, postive predictive value of 91.8%, and negative predictive value of 85.3%. With concordant findings in ultrasound and FNAB, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value are 94.3%, 97.6%, 81.8%, 95.3%, and 90%, respectively. Conclusion: With concordant findings in ultrasound and FNAB, accuracy in confirming malignancy is 94.3%. Key words: breast cancer, breast ultrasonography, fine needle aspiration biopsy/cytology
NOT IDENTIFIED

Objectives: To determine the accuracy of SLNB using methylene blue dye. Methods: Breast cancer patients consulting at the VSMMC Breast Center with biopsy proven adenocarcinoma of the breast, a Tis, T1, T2 or T3 primary breast tumor and clinically negative ipsilateral axilla by palpation and ultrasound, were included in the study. The subjects underwent either modified radical mastectomy or breast conservation theraphy. Subareolar injection of 5 ml 1% methylene blue dye 5 minutes prior to sentinel lymph node biopsy. Three blue staining axillary lymph nodes were taken and sent to pathology for frozen section evaluation and after surgery, H & E staining. A completion axillary lymph node dissection was done in all patients. Accuracy of SLNB using methylene blue was calculated using final histopathology results as gold standard. Results: Twent patients were included in this study. SLNB in this group had an accuracy, sensitivity, specificity, PPV, and NPV of 95.0% 83.3%, 100%, 100%, and 93.3%, respectively. The false negative rate is 6.7%. On the average, the SLN's were identified in 14 minutes. Conclusion: Sentinel lymph node dissection with methylene blue has an accuracy of 95% in the VSMMC Breast Center. Key words: sentinel lymph node biopsy, methylene blue dye, breast cancer
Human ; Female ; SENTINEL LYMPH NODE BIOPSY

Objective: To determine if early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Methods: This is a review of breast cancer patients who were discharged early after mastectomy consulting at the breast center at the Vicente Sotto Memorial Medical Center from May 2007-May 2010. The following variables were recorded: date of surgery, date of discharge, presence of surgical site morbidities such as infection, dehiscence, necrosis and significant pain, date of 1st drain removal, date of 2nd drain removal, presence of seroma, application of elastic bandage. Results: Of the 60 patients: 43 (71.7%) were from CVGH Breast Specialty Clinic and 17 (28.3%) from VSMMC Breast Clinic. There were 9 patients (15%) who developed surgical site morbidities, namely: infection -3 (5.0%), minimal partial wound dehiscence -4 (6.7%), superficial skin necrosis -2 (3.3%). No patient complained of significant pain on follow-up. The first drain was removed within a mean of 6 days. The second drain was removed a mean of 7 days. Fifteen patients (25%) developed seroma. There was no readmission due to morbidities. Conclusion: Early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Key words: mastectomy, postoperative pain
Human ; MASTECTOMY ; PAIN, POSTOPERATIVE