MyMedR

Spectrum of Multimodality Findings in Post-surgical Breast Cancer Imaging

Ramli Hamid MT, Rahmat K, Hamid SA, Kirat Singh SK, Hooi TG

Curr Med Imaging Rev, 2019;15(9):866-872.

PMID: 32008533 DOI: 10.2174/1573405614666180627101520

BACKGROUND: Breast cancer is the commonest cancer affecting Malaysian women, accounting for an estimated 30% of all new cancer diagnosed annually. Improvements in breast cancer management have increased the breast cancer survival rate in Malaysia. Clinical and radiological surveillance of the treated breast is vital, as early detection of recurrence improves patient's survival rate.

DISCUSSION: As surgery and radiotherapy alter the appearance of the breasts, distinguishing between recurrence and benign post-surgical changes can be challenging radiologically due to overlapping features. Despite this, differentiation between these two entities is usually possible by recognizing characteristic features of post-treatment sequelae and the evolution of the appearance of the conservatively treated breast by comparing interval findings on serial studies.

CONCLUSION: This pictorial review aims to describe the typical and unusual features of post-treated breasts in the multimodality imaging workup of an established breast care centre in a teaching hospital in Malaysia.

Matched MeSH terms: Breast Neoplasms/surgery*

Fulltext Trans-sphenoidal hypophysectomy in the treatment of advanced breast cancer

Tan J, Dale B

Med J Malaysia, 1988 Mar;43(1):44-8.

PMID: 3244319

Matched MeSH terms: Breast Neoplasms/surgery*

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

A Malaysian retrospective study of acupuncture-assisted anesthesia in breast lump excision

Ang JY, Bhojwani K, Chan HK, Chan AC

Acupunct Med, 2021 02;39(1):64-68.

PMID: 32539426 DOI: 10.1177/0964528420920307

INTRODUCTION: The objective of this retrospective study was to evaluate the effectiveness and safety of acupuncture-assisted anesthesia (AAA) in breast lump excision.

METHODS: The medical records of all patients who underwent breast lump excision under AAA in combination with electrical stimulation at traditional acupuncture points in 2016 were examined. All of them (n = 17) received electrostimulation (2-4 Hz) using single needles inserted at bilateral LI4 and PC6. They also underwent insertion of four acupuncture needles at the lump site, which were electrically stimulated at 30 Hz frequency.

RESULTS: All surgical procedures were successful with minimal use of analgesics and local anesthetic. The median pain score reported was 1/10 (interquartile range (IQR) = 2/10) at the first hour, and slightly increased to 2/10 (IQR = 2/10) between 24 and 48 h of the surgery. No major postoperative adverse events were documented, except for drowsiness in one case.

CONCLUSION: AAA was found to be generally safe and effective for anaesthesia and analgesia in breast lump excision. However, a large-scale randomized controlled study is required to verify the findings.

Matched MeSH terms: Breast Neoplasms/surgery*

Fulltext Omental transposition flap and split skin graft for locally advanced breast carcinoma

Lee SH, Cheah DS, Krishnan MM

Singapore Med J, 1990 Jun;31(3):217-20.

PMID: 2392698

Locally advanced or recurrent carcinoma of the breast poses difficult management problems. These fungating and discharging tumours severely impair the quality of life in these unfortunate patients. We report two cases successfully treated with omental transposition flaps and split skin grafts. The operation is described in detail and the results discussed. This technique was found to be safe, effective and rewarding.

Matched MeSH terms: Breast Neoplasms/surgery*

Difficulty of Achieving Clear Margins in Nonpalpable Ductal Carcinoma of the Breast

Yip CH

JAMA Surg, 2017 04 01;152(4):385.

PMID: 28002571 DOI: 10.1001/jamasurg.2016.4752

Matched MeSH terms: Breast Neoplasms/surgery

Fine-needle aspiration cytology of phyllodes tumors

Jayaram G, Sthaneshwar P

Diagn Cytopathol, 2002 Apr;26(4):222-7.

PMID: 11933267

Breast lesions with a significant spindle cell or mesenchymal component are not commonly encountered in fine-needle aspiration (FNA) cytologic material and include a heterologous variety of benign and malignant conditions, with phyllodes tumors (PTs) being the foremost differential diagnostic consideration. This study comprises 28 tumors diagnosed histologically as PT in which FNAC material was available for review. Histological sections and cytological smears from these cases were retrieved and subjected to detailed morphological review. Cytological parameters assessed included ratio of stroma to epithelium, pattern characteristics and cytological characteristics of the stromal, and epithelial components and the background cells. Large and hypercellular stroma fragments, dissociated spindle and plump stromal cells, often accompanied by large, folded sheets of epithelium were cytological features that characterized PT. Smears from malignant PT showed predominantly or solely mesenchymal components. FNAC was a highly reliable procedure for the diagnosis of PT, giving an accuracy rate of 92.8%.

Matched MeSH terms: Breast Neoplasms/surgery

Unusually large breast tumour in a middle-aged woman

Khajotia R, Poovaneswaran S, Pavadai T, Sabaratnam S, Khairan H

Can Fam Physician, 2014 Feb;60(2):142-6.

PMID: 24522677

Matched MeSH terms: Breast Neoplasms/surgery*

Fulltext Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women

Abdul Hamid S, Rahmat K, Ramli MT, Fadzli F, Jamaris S, See MH, et al.

Medicine (Baltimore), 2018 Aug;97(31):e11412.

PMID: 30075507 DOI: 10.1097/MD.0000000000011412

Phyllodes tumor or cystosarcoma phyllodes is a rare fibroepithelial neoplasm which arises from the periductal stroma of the breast. They are classified as benign, borderline, and malignant based on the histologic features. However, all phyllodes tumor (PT) subtypes are regarded as having malignant potential and correct diagnosis is important for surgical management and optimal care. This study is a retrospective review of 76 women diagnosed as PT with highlights on the imaging characteristics, pathology, and surgical treatment over a 7-year period in a tertiary medical center of urban population in Malaysia. There were 45 benign, 16 borderline, and 15 malignant PT. The median age for benign PT was 43, borderline 48.5, and malignant 42 years. The Malay ethnic group constitute 52.6% of cases, with 27.6% and 18.4% in Chinese and Indian ethnic groups, respectively. On mammograms, most benign (64.3%) and 33.3% of malignant PT showed high-density lesions. Calcifications were only seen in 2 benign PT. On ultrasound, 86% of benign PT was well-circumscribed whilst 50.0% of malignant PT had irregular outline. Cystic spaces were seen in 40.0% of malignant and 9.5% of benign PT. 80% of malignant PT lesions were heterogenous. Malignant PT demonstrates tumor heterogeneity, cystic spaces, and posterior acoustic enhancement on ultrasound. Half of malignant PT showed regular borders on ultrasound and appear well circumscribed on mammogram. A total of 46 patients had wide local excision or excision biopsy whilst 30 underwent mastectomy as primary treatment. The majority of the borderline and malignant PTs in our study (75.0% and 85.7% respectively) and only 5 out of the 43 (11.6%) benign PT underwent mastectomy. There were 2 tumor recurrence in the benign PT group and 1 case in the borderline and malignant group respectively.

Matched MeSH terms: Breast Neoplasms/surgery*

Cytologic appearances in invasive lobular carcinoma of the breast. A study of 21 cases

Jayaram G, Swain M, Chew MT, Yip CH

Acta Cytol., 2000 Mar-Apr;44(2):169-74.

PMID: 10740602

OBJECTIVE: To examine the fine needle aspiration cytologic features of invasive lobular carcinoma of breast and to discuss problems that may occur in cytodiagnosis.

STUDY DESIGN: Fine needle aspiration cytologic smears from 21 cases of invasive lobular carcinoma (ILC) of breast were subjected to detailed cytomorphologic analysis. Features studied included pattern of cells, size of cells, nuclear placement, pleomorphism, presence of intracytoplasmic lumina (ICL) and signet ring cells.

RESULTS: Cellularity was generally moderate or high, and the pattern was predominantly or partly dissociated in 86% of cases. Rosettelike pattern was discerned in alveolar-type ILC. Cell size was usually small or intermediate, with nuclei placed eccentrically in most cases. ICLs with or without signet ring cells were present in 12 cases (57%).

CONCLUSION: A cytologic picture consisting of predominantly dissociated small or intermediate-sized tumor cells with eccentric nuclei, with some of the cells showing ICLs, is highly suggestive of ILC. Indian file pattern, another characteristic feature of ILC, is, however, focal and inconsistent. Variant patterns of ILC may show other cytologic features, such as rosettelike pattern (alveolar variant of ILC) or large cell pattern (pleomorphic variant of ILC) and may consequently be difficult to categorize on cytologic smears.

Matched MeSH terms: Breast Neoplasms/surgery

Fulltext Breast cancer in pregnancy--our experience with six patients in the University Hospital, Kuala Lumpur

Yip CH, Taib NA, Abdullah MM, Wahid I

Med J Malaysia, 2000 Sep;55(3):308-10.

PMID: 11200709

Presentation of breast cancer during pregnancy is a rare situation and one that requires a multidisciplinary approach involving an obstetrician, surgeon and oncologist. Management should be along the same principles as in non-pregnant patients and delay is not justifiable. Mastectomy and axillary clearance is the best option, followed by chemotherapy, which is safe after the first trimester. Radiation if required should be delayed until after delivery of the baby. We present here our experience with 6 patients who presented with breast cancer during pregnancy. Five patients refused any treatment until after delivery, while one underwent only a mastectomy and axillary clearance. The outcome was poor; all of them died between 14 months and 52 months. The poor outcome probably reflects the late stage at presentation in four of the patients (State 3 and 4) rather than the delay in treatment, while delay in treatment in the two who presented with early cancer (Stage 1 and 2) led to a more advanced stage after delivery.

Matched MeSH terms: Breast Neoplasms/surgery*

Cytological analysis of breast lesions: a review of 780 cases

Jayaram G, Alhady SF, Yip CH

Malays J Pathol, 1996 Dec;18(2):81-7.

PMID: 10879227

780 breast cytology samples obtained over a one year period at the Breast Clinic of the University Hospital, Kuala Lumpur were reviewed. These included 745 fine needle aspirates (FNA's) and 35 nipple smears. The broad categories of cytodiagnoses were as follows: malignant: 95, suspicious or equivocal: 26, benign: 543, no proliferative lesion: 58 and inadequate: 58. The benign and malignant lesions were also subcategorized on cytological basis. The suspicious or equivocal lesions were subjected to biopsy and 17 of these proved to be malignant. 194 cases that were subjected to histological confirmation and 34 cases that were considered to be undisputably malignant (on the basis of clinical features, recurrences, metastases, etc.) were subjected to statistical analysis (total 228 cases). If the cytologically suspicious/equivocal category was considered as "test positive" the sensitivity of cytodiagnosis was 97.4% and the specificity 92%. The high degree of cytodiagnostic sensitivity and specificity make breast cytology a valuable adjunct in the evaluation of breast lesions.

Matched MeSH terms: Breast Neoplasms/surgery

Angiosarcoma of the breast complicating pregnancy

Kaur G

Malays J Pathol, 1998 Jun;20(1):41-4.

PMID: 10879263

A 32-year-old pregnant lady presented with a rapidly enlarging right breast mass. A fine needle aspiration was suggestive of a malignant phylloides tumour. However histopathological examination after mastectomy revealed a moderately differentiated angiosarcoma. The histopathological and cytological features of this rare tumour together with the diagnostic pitfalls are discussed.

Matched MeSH terms: Breast Neoplasms/surgery

Fulltext Breast cancer--a comparative study between Malaysian and Singaporean women

Yip CH, Ng EH

Singapore Med J, 1996 Jun;37(3):264-7.

PMID: 8942224

Breast cancer is the leading cause of cancer deaths in Malaysian and Singaporean women. A study done to compare the epidemiology of the disease, as well as to compare the rate of conservative surgery between Malaysian and Singaporean women was carried out. The results show that the median age at presentation was the same in both countries, and the incidence was lower among the Malays. However, there was a significant difference in the stage at presentation and the tumour size; Singaporean women presented at earlier stages and with smaller tumours compared to Malaysian women. This led to a lower rate of conservation surgery in Malaysian women.

Matched MeSH terms: Breast Neoplasms/surgery

Fulltext Breast Surgery International--breast cancer in developing countries

Sandelin K, Apffelstaedt JP, Abdullah H, Murray EM, Ajuluchuku EU

Scand J Surg, 2002;91(3):222-6.

PMID: 12449462

Breast Surgery International (BSI) was formed in 1999 as an integrated society within the International Surgical Society ISS/SIC. One goal is to promote breast surgery world wide and focus on the situation in the developing countries. An edited summary of a symposium on locally advanced breast cancer (LABC) and the current situation in two African countries and in Malaysia is reported. Diagnosis, management and treatment options differ from recommendations that prevail due to lack of resources, lack of access to facilities and cultural and socioeconomic barriers. Younger age at onset, more men are affected and locally advanced breast cancer dominates the clinical panorama. A rational treatment plan for LABC should have chemotherapy, surgery, radiotherapy and hormonal therapy as armaments. A unique opportunity exists for international interchange within a professional organization such as BSI, for providing training opportunities, for clinical and experimental studies of the world' s most common female malignancy.

Matched MeSH terms: Breast Neoplasms/surgery*

Palliation and breast cancer

Yip CH

J Surg Oncol, 2017 Apr;115(5):538-543.

PMID: 28097656 DOI: 10.1002/jso.24560

Metastatic breast cancer is an incurable disease. With improvement in systemic therapy, survival has improved over the past few years. Removing the primary tumor has shown improved survival in retrospective studies, but this may be due to selection bias. The first reported randomized controlled trial (RCT) from India showed no difference in survival with surgery. However another RCT from Turkey showed that a select group of patient with bone-only metastases have a survival benefit.

Matched MeSH terms: Breast Neoplasms/surgery*

Fulltext Psychometric properties of the Malay version of the Breast Module (BR23)

Yusoff N, Low WY, Yip CH

Singapore Med J, 2012 Jan;53(1):36-9.

PMID: 22252181

The Breast Module (BR23) is increasingly being used worldwide in breast cancer research. This study evaluates the appropriateness of the translated version (i.e. BR23-Malay version) as a useful tool for the Malaysian population who could understand Malay, and examines the reliability and validity of the BR23-Malay version.

Matched MeSH terms: Breast Neoplasms/surgery

Fulltext Isolated late chest wall recurrence after mastectomy for breast cancer

Azrif M, Saladina JJ, Nani ML, Shahrunniza AS, Norlia A, Rohaizak M

Med J Malaysia, 2011 Aug;66(3):255-6.

PMID: 22111452 MyJurnal

An isolated late chest wall recurrence after mastectomy for breast cancer is rare. We present a case of a lady with a T2N1M0 right breast cancer who developed an isolated local recurrence on the chest wall 11 years after mastectomy. Staging investigations excluded distant metastases. She underwent an excisional biopsy and was started on an aromatase inhibitor. Radiotherapy was given to the chest wall followed by a boost to the site of excision. Although most chest wall recurrences fare poorly, a favourable subgroup can be identified and should be treated aggressively in a multidisciplinary approach.

Matched MeSH terms: Breast Neoplasms/surgery

Fulltext The health seeking trajectories of Malaysian women and their husbands in delay cases of breast cancer: a qualitative study

Yusoff N, Taib NA, Ahmad A

Asian Pac J Cancer Prev, 2011;12(10):2563-70.

PMID: 22320956

The aim of this study was to assess why women delay in getting treatment (i.e. surgery) for breast cancer, as well as to explore on what type of issues are involved in such delay cases. Basic interpretative of qualitative methodology was applied to construct the reality of delay phenomena, and its interaction with social worlds. Six themes were identified: new conception of breast cancer treatment, psychological defenses, health support system, symtomatology experience, model and barriers. The delay issue in breast cancer requires attention as a multidimensional problem as this will facilitate more comprehensive and effective intervention to reduce delay.

Matched MeSH terms: Breast Neoplasms/surgery

Determinants of choice of surgery in Asian patients with early breast cancer in a middle income country

Teh YC, Shaari NE, Taib NA, Ng CH, See MH, Tan GH, et al.

Asian Pac J Cancer Prev, 2014;15(7):3163-7.

PMID: 24815464

BACKGROUND: Breast-conserving surgery (BCS) plus radiotherapy is equivalent to modified radical mastectomy (MRM) in terms of outcome. However there is wide variation in mastectomy rates dependent both on tumour and patient characteristics.

OBJECTIVE: This study aimed to assess the determinants of surgery choice in Asian patients with early breast cancer in a middle-income country.

MATERIALS AND METHODS: 184 patients with early breast cancer treated between Jan 2008 and Dec 2010 were recruited to complete a questionnaire. Chi-square test was used to analyze the association between surgery choice and demographic and tumour factors, surgeon recommendation, family member and partner opinions, fear of recurrence, avoidance of second surgery, fear of disfigurement, interference with sex life, fear of radiation and loss of femininity.

RESULTS: 85 (46%) had BCS while 99 (54%) had mastectomy. Age >60, Chinese ethnicity, lower education level, and larger tumour size were significantly associated with mastectomy. Surgeon recommendation was important in surgery choice. Although both groups did not place much importance on interference with sex life, 14.1% of the BCS group felt it was very important compared to 5.1% in the mastectomy group and this was statistically significant. There was no statistical difference between the two groups in terms of the other factors. When analyzed by ethnicity, significantly more Malay and Indian women considered partner and family member opinions very important and were more concerned about loss of femininity compared to Chinese women. There were no statistical differences between the three ethnic groups in terms of the other factors.

CONCLUSIONS: When counseling on surgical options, the surgeon has to take into account the ethnicity, social background and education level, age and reliance on partner and family members. Decision-making is usually a collective effort rather than just between the patient and surgeon, and involving the whole family into the process early is important.

Matched MeSH terms: Breast Neoplasms/surgery*

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