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Fulltext Diagnostic accuracy of tomosynthesis-guided vacuum assisted breast biopsy of ultrasound occult lesions

Bohan S, Ramli Hamid MT, Chan WY, Vijayananthan A, Ramli N, Kaur S, et al.

Sci Rep, 2021 01 08;11(1):129.
PMID: 33420200 DOI: 10.1038/s41598-020-80124-4

This study aims to evaluate the diagnostic accuracy of digital breast tomosynthesis-guided vacuum assisted breast biopsy (DBT-VABB) of screening detected suspicious mammographic abnormalities comprising of calcifications, asymmetric densities, architectural distortions and spiculated masses. In this institutionally approved study, a total of 170 (n = 170) DBT-VABB were performed, 153 (90%) were for calcifications, 8 (4.7%) for spiculated mass, 5 (2.9%) for asymmetric density and 4 (2.4%) for architectural distortion. All these lesions were not detected on the corresponding ultrasound. Histopathology results revealed 140 (82.4%) benign, 9 (5.3%) borderline and 21 (12.4%) malignant lesions. The total upgrade rate at surgery was 40% for atypical ductal hyperplasia and 5.9% for ductal carcinoma in-situ. 3.6% discordant benign lesions showed no upgrade. DBT-VABB showed 100% specificity, 91.3% sensitivity and 100% positive predictive value (PPV) for detecting malignant lesions. The negative predictive value (NPV) was 80%. 2 (1.2%) patients had mild complications and 1 (0.6%) had severe pain. Our study showed that DBT-VABB was a safe and reliable method, with high sensitivity, specificity, PPV and NPV in the diagnosis of non-palpable benign and malignant breast lesions. Our data also confirmed the accuracy of DBT-VABB in detecting malignant lesions and we suggest further surgical excision in borderline lesions for a more accurate diagnostic evaluation.

Matched MeSH terms: Breast/pathology; Breast/surgery; Breast Neoplasms/pathology; Breast Neoplasms/surgery
The Will Rogers phenomenon in the staging of breast cancer - does it matter?

Tan GH, Bhoo-Pathy N, Taib NA, See MH, Jamaris S, Yip CH

Cancer Epidemiol, 2015 Feb;39(1):115-7.
PMID: 25475062 DOI: 10.1016/j.canep.2014.11.005

Changes in the American Joint Commission on Cancer staging for breast cancer occurred when the 5th Edition was updated to the 6th Edition.

Matched MeSH terms: Breast Neoplasms/pathology*
Do clinical features and survival of single hormone receptor positive breast cancers differ from double hormone receptor positive breast cancers?

Ng CH, Pathy NB, Taib NA, Ho GF, Mun KS, Rhodes A, et al.

Asian Pac J Cancer Prev, 2014;15(18):7959-64.
PMID: 25292095

The significance of the single hormone receptor positive phenotype of breast cancer is still poorly understood. The use of hormone therapy has been found to be less effective for this type, which has a survival outcome midway between double positive and double negative phenotypes. The aim of this study was to investigate differences in patient and tumor characteristics and survival between double-receptor positive (ER+PR+), double receptor negative (ER-PR-) and single receptor positive (ER+PR- and ER-PR+) breast cancer in an Asian setting. A total of 1,992 patients with newly diagnosed stage I to IV breast cancer between 2003 and 2008, and where information on ER and PR were available, were included in this study. The majority of patients had ER+PR+ tumors (n=903: 45.3%), followed by 741 (37.2%) ER-PR-, 247 (12.4%) ER+PR-, and 101 (5.1%) ER-PR+ tumors. Using multivariate analysis, ER+PR- tumors were 2.4 times more likely to be grade 3 compared to ER+PR+ tumors. ER+PR- and ER-PR+ tumors were 82% and 86% respectively less likely to be grade 3 compared with ER-PR- tumors. ER-PR+ tumours were associated with younger age. There were no survival differences between patients with ER+PR+ and ER-PR+ tumors. However, ER+PR- tumors have poorer survival compared with ER+PR+ tumours. ER-PR- tumours had the worst survival. Adjuvant hormonal therapy with tamoxifen was found to have identical survival advantage in patients with ER+PR+ and ER-PR+ tumors whereas impact was slightly lower in patients with ER+PR- tumors. In conclusion, we found ER+PR- tumors to be more aggressive and have poorer survival when compared to ER+PR+ tumors, while patients with ER-PR+ tumours were younger, but had a similar survival to their counterparts with ER+PR+ tumours.

Matched MeSH terms: Breast Neoplasms/metabolism; Breast Neoplasms/mortality*; Breast Neoplasms/pathology; Carcinoma, Ductal, Breast/metabolism; Carcinoma, Ductal, Breast/mortality*; Carcinoma, Ductal, Breast/secondary
Fulltext Colonic and small bowel metastasis from ductal carcinoma of the breast : a case report

Visalini S, Daphne A, Mohamed Yusof AW

Med J Malaysia, 2013 Dec;68(6):477-8.
PMID: 24632919 MyJurnal
Matched MeSH terms: Breast Neoplasms*
Fulltext Pacifier Use and its Association with Breastfeeding and Acute Respiratory Infection (ARI) in Children Below 2 Years Old

Mahmud SZ, Joanita S, Khairun Nisa J, Balkish MN, Tahir A

Med J Malaysia, 2013 Apr;68(2):125-8.
PMID: 23629557 MyJurnal

Extensive literature reviews showed that pacifier usage is associated with early cessation of breast feeding, as well as respiratory infection. This cross sectional study was a part of the bigger study of The Third National Health Morbidity Survey conducted throughout Malaysia in 2006. Survival and pearson cox regression was done to find association between pacifier user and breast feeding duration. Logistic Regression was done to find association between variables of interest. The prevalence of pacifier use was 32.9%. Chinese children reported significantly higher usage of pacifier (95% CI; 47.5, 58.7) as well as those resided in urban area (95% CI;32.5,37.7). One third of pacifier user had stopped breastfeeding at 6 months of age. Those with pacifier users were significantly shorter in breast feeding duration and significantly associated with non exclusivity in breastfeeding. Those without pacifier user were significantly associated with ever breast fed.(p value=0.001). There was no significant association between pacifier use with acute respiratory infection. Factors such as ethnicity and residential are non modifiable whereas modifiable factor such as pacifier use is certainly needed to be addressed at maternal and child health care level.
Study name: National Health and Morbidity Survey (NHMS-2006)

Matched MeSH terms: Breast Feeding*
Fulltext Herbal Ingestion During Pregnancy and Post-Partum Period is A Cause For Concern

Teoh CS, Aizul MHI, Wan Fatimah Suriyani WM, Ang SH, Nurul Huda MZ, Nor Azlini MI, et al.

Med J Malaysia, 2013 Apr;68(2):157-60.
PMID: 23629564 MyJurnal

The potential harms of herbs to the pregnant mothers and their foetuses as well as the effect of herbs taken by nursing mothers on their babies remain largely unknown. Common perception is that herbal medicines ingestion during pregnancy and confinement period is a common practice among multi-racial Malaysian mothers. The purpose of this study was to explore the usage of herbal medicines during pregnancy and post-partum period among mothers who gave birth at a tertiary hospital in a metropolitan city of Malaysia. This cross sectional study was conducted between October and December 2010. The subjects were interviewed twice after giving birth: before hospital discharge and 6 to 8 weeks later. A total of 323 mothers were recruited for this study. The prevalence of herbs ingestion during pregnancy was 13.9%, with half of the users consuming it during the first trimester. A total of 163 (52.9%) mothers ingested herbs during the post-partum period. Significantly more Chinese (p=0.01) and Malay (p=0.04) mothers ingested herbs during pregnancy and post-partum period, respectively. Infants of mothers who ingested herbs had a higher rate of neonatal jaundice compared to infants of mothers who did not ingest herbs during the post-partum period (P=0.001).

Matched MeSH terms: Breast Feeding*
Who are the breast cancer survivors in Malaysia?

Ibrahim NI, Dahlui M, Aina EN, Al-Sadat N

Asian Pac J Cancer Prev, 2012;13(5):2213-8.
PMID: 22901196

INTRODUCTION: Worldwide, breast cancer is the commonest cause of cancer death in women. However, the survival rate varies across regions at averages of 73%and 57% in the developed and developing countries, respectively.
OBJECTIVE: This study aimed to determine the survival rate of breast cancer among the women of Malaysia and characteristics of the survivors.
METHOD: A retrospective cohort study was conducted on secondary data obtained from the Breast Cancer Registry and medical records of breast cancer patients admitted to Hospital Kuala Lumpur from 2005 to 2009. Survival data were validated with National Birth and Death Registry. Statistical analysis applied logistic regression, the Cox proportional hazard model, the Kaplan-Meier method and log rank test.
RESULTS: A total of 868 women were diagnosed with breast cancer between January 2005 and December 2009, comprising 58%, 25% and 17% Malays, Chinese and Indians, respectively. The overall survival rate was 43.5% (CI 0.573-0.597), with Chinese, Indians and Malays having 5 year survival rates of 48.2% (CI 0.444-0.520), 47.2% (CI 0.432-0.512) and 39.7% (CI 0.373-0.421), respectively (p<0.05). The survival rate was lower as the stages increased, with the late stages were mostly seen among the Malays (46%), followed by Chinese (36%) and Indians (34%). Size of tumor>3.0cm; lymph node involvement, ERPR, and HER 2 status, delayed presentation and involvement of both breasts were among other factors that were associated with poor survival.
CONCLUSIONS: The overall survival rate of Malaysian women with breast cancer was lower than the western figures with Malays having the lowest because they presented at late stage, after a long duration of symptoms, had larger tumor size, and had more lymph nodes affected. There is an urgent need to conduct studies on why there is delay in diagnosis and treatment of breast cancer women in Malaysia.

Matched MeSH terms: Breast Neoplasms/mortality*; Breast Neoplasms/epidemiology; Breast Neoplasms/therapy; Carcinoma, Ductal, Breast/mortality*; Carcinoma, Ductal, Breast/epidemiology; Carcinoma, Ductal, Breast/therapy
Fulltext Medullary carcinoma of the breast: Role of contrast-enhanced MRI in the diagnosis of multiple breast lesions

Abdul Rashid S, Rahmat K, Jayaprasagam K, Alli K, Moosa F

Biomed Imaging Interv J, 2009 Oct;5(4):e27.
PMID: 21610994 MyJurnal DOI: 10.2349/biij.5.4.e27

Medullary carcinoma is a rare breast carcinoma with a syncytial growth pattern and high-grade cytology. It can be difficult to diagnose and may be missed on conventional imaging as the findings may overlap with benign lesions i.e. fibroadenomas. The authors report a case of a 25-year-old female who presented with multifocal breast lumps diagnosed with medullary carcinoma and fibroadenomas. Imaging and pathological correlation with contrast-enhanced MRI are presented in the diagnosis of these lesions.

Matched MeSH terms: Breast; Breast Neoplasms
Fulltext Isolation, identification and quantification of differentially expressed proteins from cancerous and normal breast tissues

Othman MI, Majid MI, Singh M, Man CN, Lay-Harn G

Ann. Clin. Biochem., 2008 May;45(Pt 3):299-306.
PMID: 18482919 DOI: 10.1258/acb.2007.007104

Infiltrating ductal carcinoma (IDCA) is the most common type of breast cancer accounting for 85% of all invasive breast cancers.

Matched MeSH terms: Breast/metabolism*; Breast Neoplasms/diagnosis*; Breast Neoplasms/metabolism; Carcinoma, Ductal, Breast/diagnosis*; Carcinoma, Ductal, Breast/metabolism
Fulltext CD44 expression and axillary lymph node metastasis in infiltrating ductal carcinoma of the breast

Looi LM, Cheah PL, Zhao W, Ng MH, Yip CH

Malays J Pathol, 2006 Dec;28(2):83-6.
PMID: 18376796 MyJurnal

Metastasising ability connotes one of the most important life-threatening properties of malignant neoplasms. Recent studies indicate that CD44 proteins, multifunctional cell adhesion molecules which contribute to "homing" of lymphocytes to lymph nodes as well as cell-cell and cell-matrix interactions, are potential markers of tumour progression. However, whether CD44 expression by human tumours contribute to increased metastatic risk remains controversial. In an attempt to clarify its role in breast cancer, we have investigated the correlation between CD44 expression by breast carcinoma and the presence of axillary lymph node metastases. CD44 expression was detected using a standard immunoperoxidase method on formalin-fixed, paraffin-embedded, primary infiltrating ductal breast carcinoma tissues taken from 60 female patients who underwent mastectomy with axillary node clearance. Tumours were graded according to the modified Bloom and Richardson criteria. 62% of patients had histologically-proven lymph node metastasis. 40% of primary cancers exhibited cytoplasmic membrane immunopositivity for CD44. 46% of primary tumours which have metastasied to axillary lymph nodes were CD44 positive whereas 30% of tumours which have not metastasised expressed CD44. CD44 positivity was expressed by 20% of grade 1, 31% grade 2 and 58% grade 3 tumours. Our results suggest that CD44 may have a role in the progression of breast cancer and emphasise the need to investigate its interaction with other mechanisms of cancer advancement.

Matched MeSH terms: Breast Neoplasms/metabolism*; Breast Neoplasms/pathology; Breast Neoplasms/surgery; Carcinoma, Ductal, Breast/metabolism*; Carcinoma, Ductal, Breast/secondary; Carcinoma, Ductal, Breast/surgery
Correlations in survivin expression with the expression of p53 and bcl-2 in invasive ductal carcinoma of the breast

Al-Joudi FS, Iskandar ZA, Imran AK

Southeast Asian J. Trop. Med. Public Health, 2007 Sep;38(5):904-10.
PMID: 18041310

This work studied the correlations between survivin, bcl-2 and p53 in infiltrating ductal carcinoma of the breast. A total number of 382 cases were collected from 3 hospitals in northeastern Malaysia. Survivin, bcl-2 and p53 were detected by immunohistochemistry on samples prepared from tissue blocks. Significant correlations were found between tumor histological grades and tumor size and lymph node involvement. Highly significant statistical correlations (p<0.001) were found in expression of the markers under study. It is concluded that such significant correlations may imply that the alterations in the expression take place in a concerted fashion, implying that many of these cases may share common abnormalities.

Matched MeSH terms: Breast Neoplasms/genetics; Breast Neoplasms/metabolism*; Breast Neoplasms/pathology; Carcinoma, Ductal, Breast/genetics; Carcinoma, Ductal, Breast/metabolism*; Carcinoma, Ductal, Breast/pathology
Fulltext Skin-sparing mastectomy

Chan KY, Azlan NMN, Lo HL, Naqiyah I, Norlia A

Med J Malaysia, 2004 Oct;59(4):538-40.
PMID: 15779590 MyJurnal

Skin-sparing mastectomy is still in its infancy in Malaysia. The option of skin-sparing mastectomy is rarely given to patients as many general surgeons perform the conventional mastectomy. This could also be compounded by the lack of awareness amongst the local surgeons on the safety, surgical technique and treatment outcome of this relatively new procedure. This case report demonstrates the feasibility of this procedure performed on a Malaysian patient with a comparable outcome of those reported in the Western countries.

Matched MeSH terms: Breast Neoplasms/surgery
Predictors affecting breast self-examination practice among undergraduate female students in Klang Valley, Malaysia

Akhtari-Zavare M, Lattif LA, Juni MH, Md Said S, Ismail IZ

J Obstet Gynaecol Res, 2015 Dec;41(12):1982-7.
PMID: 26554636 DOI: 10.1111/jog.12819

Abstract
AIM:
Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia.

MATERIAL AND METHODS:
A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study.

RESULTS:
The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03).

CONCLUSION:
The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women.

KEYWORDS:
Malaysia; breast self-examination; predictors

Matched MeSH terms: Breast Neoplasms; Breast Self-Examination
A novel approach of dose mapping using a humanoid breast phantom in radiotherapy

Banjade DP, Ng BS, Zakir M, Tajuddin AA, Shukri A

Br J Radiol, 2002 Oct;75(898):812-8.
PMID: 12381690

A study of dose mapping techniques to investigate the dose distribution throughout a planned target volume (PTV) in a humanoid breast phantom exposed to a 6 MV photon beam similar to that of treatment conditions is described. For tangential breast irradiation using a 6 MV accelerator beam, the dose is mapped at various locations within the PTV using thermoluminescent dosemeters (TLDs) and radiographic films. An average size perspex breast phantom with the ability to hold the dosemeters was made. TLDs were exposed after packing them in various locations in a particular slice, as planned by the treatment planning system (TPS). To map the dose relative to the isocenter, films were exposed after tightly packing them in between phantom slices, parallel to the central axis of the beam. The dose received at every location was compared with the given dose as generated by the TPS. The mapped dose in each location in the isocentric slice from superficial to deep region was found to be in close agreement with the TPS generated dose to within +/-2%. Doses at greater depths and distant medial and lateral ends, however, were found to be lower by as much as 9.4% at some points. The mapped dose towards the superior region and closest inferior region from the isocenter was found to agree with those for TPS. Conversely, results for the farthest inferior region were found to be significantly different with a variance as much as 17.4% at some points, which is believed to be owing to the variation in size and shape of the contour. Results obtained from films confirmed this, showing similar trends in dose mapping. Considering the importance of accurate doses in radiotherapy, evaluating dose distribution using this technique and tool was found to be useful. This provides the opportunity to choose a technique and plan to provide optimum dose delivery for radiotherapy to the breast.

Matched MeSH terms: Breast*
Fulltext The experience with fine needle aspiration cytology in the management of palpable breast lumps in the University Hospital Kuala Lumpur

Yip CH, Jayaram G, Alhady SF

Med J Malaysia, 2000 Sep;55(3):363-7.
PMID: 11200718

A total of 676 palpable breast lumps seen in the Breast Clinic, University Hospital, Kuala Lumpur from August 1993 to August 1994 were subjected to fine needle aspiration cytology. Fifty-four were reported as inadequate, 501 benign, 95 malignant and 26 suspicious. One hundred and eighty-seven aspirates had histological correlation, while 34 of the malignant aspirates had clinical correlation. The majority of the other 455 patients were followed up for a period of 60 to 72 months without any malignancies becoming apparent. For analysis, only the 221 cases with histological or clinical correlation were included, (the suspicious category was included into the positive group and the inadequate cases were excluded), giving a sensitivity of 91.7%, a specificity of 91.7% and a diagnostic accuracy of 91.7%. Breast cytology was an accurate and rapid method of diagnosis of breast diseases, and in a busy surgical unit with limited operating time, it allowed for the triage of patients with breast complaints in deciding which cases needed early open biopsy. A negative cytology does not exclude the possibility of cancer, as there was a false negative rate of 11%. However by utilising a diagnostic triad of clinical examination, radiological assessment and fine needle aspiration cytology, the risk of missing a malignancy is small.

Matched MeSH terms: Breast Neoplasms/pathology*
Immunohistochemical analysis of p53 expression in primary breast carcinomas

Naidu R, Yadav M, Nair S, Kutty KK

Anticancer Res, 1998 Jan-Feb;18(1A):65-70.
PMID: 9568057

Expression of p53 protein was investigated by immunohistochemical techniques in archival cases of 134 primary breast carcinomas comprising 13 comedo ductal carcinoma in situ (DCIS), 105 invasive ductal carcinomas, 7 contained the comedo DCIS component adjacent to the invasive ductal component, 5 invasive lobular carcinomas, three colloid carcinomas and one medullary carcinoma. Overexpression of p53 gene product was studied to determine the association with clinico-pathological parameters and also its relationship to c-erbB2. Overexpression of p53 protein was observed in 31% (4/13) of comedo DCIS, 37% (39/105) of invasive ductal carcinomas, 57% (4/7) of carcinomas containing both the in situ and invasive lesions and all medullary carcinomas. A significant relationship (p < 0.05) was observed between strong immunoreactivity of p53 protein and absence of estrogen receptor, histological grade and c-erbB2 but not with lymph node metastases or age of patient. These observations suggest that overexpression of p53 protein may play an important role in tumor progression from noninvasive to invasive in some breast carcinomas and may have potential as an indicator for poorer prognosis.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/immunology; Breast Neoplasms/metabolism*; Carcinoma, Ductal, Breast/diagnosis; Carcinoma, Ductal, Breast/immunology; Carcinoma, Ductal, Breast/metabolism
Bilateral plasma cell granuloma (inflammatory pseudotumour) of the breast

Yip CH, Wong KT, Samuel D

Aust N Z J Surg, 1997 May;67(5):300-2.
PMID: 9152166

Plasma cell granuloma of the breast is an extremely rare condition. Only one other case has been reported in the literature. We report here the second case of plasma cell granuloma of the breast. After the initial excision, the lesion recurred in both breasts after 5 months.

Matched MeSH terms: Breast Diseases/pathology*
Fine needle aspiration cytology of the breast: an analysis of 1,094 aspirates

Sharifah NA, Hayati AR, Meah F, al-Rashid Z

Malays J Pathol, 1993 Jun;15(1):53-8.
PMID: 8277791

Our experience with 1,094 consecutive fine needle aspirations (FNAs) of the breast in 918 cases is presented. Correlation between the FNA cytology and subsequent histology of the lesions was available in 211 cases. FNA had a sensitivity rate of 87.3%, a specificity rate of 99.3% and a positive predictive value of 98.2%. A false negative diagnosis rate of 5.1% occurred. The overall diagnostic accuracy rate was 95.7%.

Matched MeSH terms: Breast/pathology*
Fulltext Oestrogen receptor status of breast tumour biopsies in Malaysian patients

Aziz S

Med J Malaysia, 1983 Jun;38(2):153-7.
PMID: 6621447

This communication describes the quantitative and qualitative analysis of oestrogen receptors in breast tumour biopsies of Malaysian patients. This preliminary investigation establishes certain rigid criteria that makes possible the classification of patients most likely to respond to hormonal therapy. 20 percent of the patients had oestrogen receptor positive tumours while 60 percent were oestrogen receptor negative.

Matched MeSH terms: Breast Neoplasms/drug therapy
Fulltext Primary carcinoma and benign tumours of the female breast in Malaysian women

Chan KE

Med J Malaysia, 1982 Sep;37(3):217-20.
PMID: 7177001

In a 10 year period 1971-1980, the records of 944 individual women with benign breast lumps and 228 with primary carcinomata are reviewed. This study describes the age, ethnic distribution of benign and malignant breast tumours in women in Peninsular Malaysia and compares the pattern with Western experience. There are important variations in the incidence pattern between the different races in Peninsular Malaysia and between them and women in Britain and the United States.

Matched MeSH terms: Breast Neoplasms/epidemiology*

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