PURPOSE: Absorbable retaining thread (ART) needle localization utilizes a guiding needle with a thread; this technique was invented to reduce patient discomfort and wire migration. We investigated the feasibility of ultrasound (US)-guided ART needle localization for nonpalpable breast lesions. METHODS: ART needle localization was performed for 26 nonpalpable breast lesions in 26 patients who were scheduled to undergo surgical excision the day after localization. Seventeen breast lesions were initially diagnosed as invasive ductal carcinoma, six as ductal carcinomas in situ, and one as fibrocystic change. The other two cases without an initial pathologic diagnosis had suspicious US features, and excision was planned concomitantly with contralateral breast cancer surgery. The primary outcome was the technical success rate of ART needle localization confirmed by US immediately after the procedure, and the secondary outcomes were the percentage of clear margins on pathology and the complication rate of ART needle localization. RESULTS: The technical success rate of ART needle localization was 96.2% (25 of 26 patients), and the ART was located 1 cm away from the mass in one patient (3.8%). The lesions were successfully removed with clear margins in all 26 patients. No significant complications related to ART needle localization were observed. CONCLUSION: ART needle localization can be an alternative to wire needle localization for nonpalpable breast lesions.
Breast Neoplasms ; Breast ; Carcinoma, Ductal ; Diagnosis ; Humans ; Needles ; Pathology ; Surgery, Computer-Assisted ; Ultrasonography

Adult ; Breast Neoplasms ; diagnosis ; metabolism ; surgery ; Female ; Humans ; Nipples ; pathology ; surgery ; Ultrasonography ; methods

OBJECTIVETo evaluate the prognostic value of lymph node ratio (LNR) as compared with the number of pN staging in patients with axillary lymph node-positive breast cancer treated by breast conserving surgery.

METHODSWe performed a retrospective analysis of the clinical data of patients who received breast conserving surgery and with positive lymph nodes (n = 152) between 1998 and 2007. The disease-free survival (DFS) and overall survival (OS) were compared based on the LNR and pN staging.

RESULTSA total of 152 patients were classified as pN1 in 114, pN2 in 23, and pN3 in 15 cases. Among the 152 cases, 114 cases had a LNR ≤ 0.20, 26 cases had 0.21-0.65, and 12 cases had a LNR>0.65. Univariate analysis showed that number of dissected lymph nodes, LNR, pN stage, ER/PR status and radiotherapy were significant prognostic factors for DFS and OS (P < 0.05 for all). Age and chemotherapy were prognostic factors only for OS (P < 0.05). Multivariate analysis indicated that LNR was an independent prognostic factor for DFS and OS (P < 0.05 for both). pN stage had no significant effect on DFS or OS (P > 0.05 for both). In the pN subgroup analysis, LNR was also showed to be significantly correlated with the prognosis of patients.

CONCLUSIONSLNR is superior to pN staging as a prognostic factor in axillary lymph node-positive breast cancer patients treated by breast conservation surgery, and can be used as one of independent prognostic predictors for the patients.

Axilla ; Breast Neoplasms ; diagnosis ; surgery ; Disease-Free Survival ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Mastectomy, Segmental ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Retrospective Studies

Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.
Breast Neoplasms/pathology/surgery/therapy ; Carcinoma/*pathology/surgery/therapy ; Cervix Uteri/pathology/ultrasonography ; Charcoal/toxicity ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Granuloma/*diagnosis/pathology ; Humans ; Lymph Nodes/*surgery/ultrasonography ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

INTRODUCTIONWhilst only 5.5% to 7% of breast cancer occurs in women less than 40 years of age in the West, the incidence has been reported in up to 18% in Asian population. This study seeks to evaluate our unit's experience in breast cancer in young women.

MATERIALS AND METHODSA retrospective review of our database identified women with newly diagnosed breast cancer from January 2006 to February 2011. Patient demographics, clinical presentation, imaging and pathological findings and treatment received were determined.

RESULTSOut of a total of 1160 women with breast cancer, 135 (11.6%) were under 40 years of age and made up our study population. The most common presentation was a self-detected breast lump. Most patients did not have a positive family history. Mammography demonstrated abnormal findings in 78% of patients. Ultrasound was very sensitive in the evaluation of a breast lump and demonstrated abnormal findings in 95%. Out of 129 women, 40 (31%) underwent breast-conserving surgery of which 5 (12.5%) proceeded to mastectomy due to involved margins. Also, 89 out of 129 women (69%) underwent mastectomy of which 19 (21.3%) had immediate reconstruction. Of a total of 121 primary resections, 94% were invasive ductal carcinoma while 15.5% were pure ductal in-situ carcinomas. The majority (61.2%) showed high grade disease.

CONCLUSIONMost young breast cancer patients present with a self-detected breast lump and do not have a positive family history. A strong clinical index of suspicion and appropriate breast imaging workup are useful for the early and accurate diagnosis of breast cancer in young women.

Adolescent ; Adult ; Age Factors ; Breast Neoplasms ; diagnosis ; epidemiology ; surgery ; Female ; Hospital Units ; Humans ; Retrospective Studies ; Singapore ; Young Adult

Breast Neoplasms ; diagnosis ; drug therapy ; surgery ; Female ; Humans ; Lymph Node Excision

PURPOSE: A newly isolated mediastinal lymph node (LN) or a small pulmonary nodule, which appears during breast cancer surveillance, may pose a diagnostic dilemma with regard to malignancy. We conducted this study to determine which clinical factors were useful for the differentiation of malignant lesions from benign lesions under these circumstances. MATERIALS AND METHODS: We enrolled breast cancer patients who were presented with a new isolated mediastinal LN or small pulmonary nodule that arose during surveillance, and whose lesions were pathologically confirmed. Tissue diagnosis was made by mediastinoscopy, video-assisted thoracic surgery or thoracotomy. RESULTS: A total of 43 patients were enrolled (mediastinal LN, 13 patients; pulmonary nodule, 30 patients). Eighteen patients (41.9%) were pathologically confirmed to have a benign lesion (benign group), and 25 patients (58.1%) were confirmed to have malignant lesion (malignant group). Between the two groups, the initial tumor size (p=0.096) and N stage (p=0.749) were similar. Hormone receptor negativity was more prevalent in the malignant group (59.1% vs. 40.9%, p=0.048). The mean lesion size was larger in the malignant group than in the benign group (20.8 mm vs. 14.4 mm, p=0.024). Metastatic lesions had a significantly higher value of maximal standardized uptake (mSUV) than that of benign lesions (6.4 vs. 3.4, p=0.021). CONCLUSION: Hormone receptor status, lesion size, and mSUV on positron emission tomography are helpful in the differentiation of malignant lesions from benign lesions in breast cancer patients who were presented with a new isolated mediastinal LN or small pulmonary nodule during surveillance.
Breast Neoplasms* ; Diagnosis ; Humans ; Lymph Nodes* ; Mediastinoscopy ; Neoplasm Metastasis ; Positron-Emission Tomography ; Thoracic Surgery, Video-Assisted ; Thoracotomy

OBJECTIVETo study the pathology, diagnosis and differential diagnosis of papillary carcinoma of the breast featuring expansile invasion.

METHODSMorphologic analysis and immunohistochemical study using MaxVision method were carried out in 25 cases of papillary carcinoma of the breast featuring expansile type of invasion.

RESULTSAll the 25 cases were female, and ranged from 26 to 84 years old in age with median of 69. The diameters of the neoplasms were from 1 cm to 5 cm, among which those of two cases were 4 cm and 5 cm respectively and the others were less than 2.5 cm. The tumor appeared solid and well-demarcated on gross examination. Histologically, the tumor was non-encapsulated. In some cases, the tumor tissue was separated by fibrous septa or intervening native breast tissue. The tumor was composed of arborizing papillae with fibrovascular cores, associated glandular fusion and cribriform pattern. The fibrovascular cores were covered by cuboidal to columnar cells. In 3 of the cases studied, focal transition with micropapillary ductal carcinoma-in-situ was demonstrated. The tumor cells showed mild or moderate degree of nuclear pleomorphism and contained amphophilic to eosinophilic cytoplasm. Mitotic figures were not frequently seen. One case displayed squamous metaplasia and 4 cases showed apocrine metaplasia. Dimorphic features were identified in 2 cases. The stromal tissue within the tumor was often scanty and sometimes sclerotic, associated with various degrees of inflammatory infiltrate and hemosiderin deposition. Immunohistochemical study for smooth muscle actin, p63, CD10 and CK5/6 showed negative staining in all of the 25 cases studied, including the 2 cases with dimorphic features. Seven cases had breast cancer marker study performed. Six cases were positive for estrogen receptor and progesterone receptor. HER2 oncoprotein was not over-expressed in 6 cases. Nine patients underwent axillary dissection and 2 of them showed axillary nodal metastasis.

CONCLUSIONSDiagnosis of papillary carcinoma of the breast is one of the most difficult areas in breast pathology. Demonstration of expansile type of invasion, when coupled with complex papillary fusion, cribriform pattern and absence of myoepithelial cells on immunohistochemistry, is helpful in arriving at a correct diagnosis.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Carcinoma, Papillary ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Mastectomy, Modified Radical ; Middle Aged ; Mucin-1 ; metabolism ; Neoplasm Invasiveness ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism

Adenocarcinoma, Mucinous ; pathology ; Adenoma ; pathology ; Adolescent ; Breast Neoplasms, Male ; metabolism ; pathology ; secretion ; surgery ; Carcinoma ; metabolism ; pathology ; secretion ; surgery ; Diagnosis, Differential ; Humans ; Keratin-18 ; metabolism ; Keratin-8 ; metabolism ; Male ; Mastectomy, Modified Radical ; Proto-Oncogene Proteins c-kit ; metabolism ; S100 Proteins ; metabolism

Actins ; metabolism ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; Calcium-Binding Proteins ; metabolism ; Carcinoma ; metabolism ; pathology ; Cyclophosphamide ; therapeutic use ; Desmin ; metabolism ; Diagnosis, Differential ; Female ; Fibrosarcoma ; metabolism ; pathology ; Fluorouracil ; therapeutic use ; Follow-Up Studies ; Humans ; Leiomyosarcoma ; drug therapy ; metabolism ; pathology ; surgery ; Mastectomy, Segmental ; Methotrexate ; therapeutic use ; Microfilament Proteins ; metabolism ; Neurilemmoma ; metabolism ; pathology ; Phyllodes Tumor ; metabolism ; pathology ; Postoperative Period ; Vimentin ; metabolism