Contrast enhanced spectral mammography (CESM) guided breast biopsy as an alternative to MRI guided biopsy

Objective: Contrast Enhanced Spectral Mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI guided biopsy. Methods and materials: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally this would have necessitated a MRI guided breast biopsy, but was performed under CESM guidance. Results: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. Conclusion: CESM guided breast biopsy is a new technique that can be successfully used as an alternative to MRI guided breast biopsy. Advances in knowledge: CESM guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.

Anti-breast carcinoma effects of green synthesized nickel nanoparticles from Alhagi ‎sparsifolia leaf aqueous extract: A pre-clinical trial study ‎

IntroductionMany nanoparticles have pharmacological and biochemical properties, including antioxidant and anti-‎inflammatory properties, which appear to be involved in anticarcinogenic and antimutagenic activities. In the recent study, nickel nanoparticles were green-synthesized using the Alhagi sparsifolia leaf aqueous ‎extract. ‎Material and methodsThe synthesized Ni nanoparticles‎ were characterized by analytical techniques including SEM, UV-Vis., and FT-‎IR. The nanoparticles were formed in a spherical shape in the average size of 16.19 nm. ‎ResultsIn the antioxidant test, the IC50 of Ni nanoparticles‎ and BHT against DPPH free radicals were 316 and 231 ‎‎µg/mL, respectively. In the cellular and molecular part of the recent study, the treated cells with Ni ‎nanoparticles‎ were assessed by MTT assay for 48h about the cytotoxicity and anti-human breast cancer ‎properties on normal (HUVEC) and breast cancer cell lines i.e. lobular carcinoma of breast (UACC-3133), ‎inflammatory carcinoma of the breast (UACC-732), and metastatic carcinoma (MDA-MB-453). The viability of ‎malignant breast cell line reduced dose-dependently in the presence of Ni nanoparticles‎. The IC50 of Ni ‎nanoparticles‎ were 477, 548, and 605 µg/mL against lobular carcinoma of breast (UACC-3133), inflammatory ‎carcinoma of the breast (UACC-732), and metastatic carcinoma (MDA-MB-453) cell lines, respectively. ‎ConclusionsAfter clinical study, nickel nanoparticles containing Alhagi sparsifolia leaf aqueous extract may be used to ‎formulate a new chemotherapeutic drug or supplement to treat the several types of human breast cancer. ‎

Primary Small Cell Malignancies of the Breast: Are They Rare Malignancies?

In contrast with the other organs such as the lung, small cell tumors have been less studied in the breast due to their relatively less frequency. Although rare, neuroendocrine neoplasms, some lymphomas, and some small cell sarcomas such as undifferentiated small round cell sarcoma and rhabdomyosarcoma can be seen in small cell morphology in the breast. Many cytological specimens such as fine-needle aspiration biopsies and touch imprint cytology are used for diagnosis and further prognostic/predictive marker determination in primary breast masses, sentinel and axillary lymph nodes, and metastatic masses. Lobular carcinoma deserves to be considered in the small cell tumor group because of its small, monomorphic, discohesive, scant cytoplasmic cytological features. Since so many different types of tumors in the breast can have small cell characteristics, they should be divided into small cell neuroendocrine tumors and small cell nonneuroendocrine tumors. When evaluating small cell breast tumors cytologically, wide tumor diversity should be kept in mind, and clinical, hematological, and radiological features should be taken into consideration.

Frequency of Malignancies in Surgical Subjects and Subjects with Mass in Breast in the Surgical Department of Pumhsw Nawabshah Pakistan

Objective: To conclude frequency for malignancies in subjects with mass in breast at the PUMHSW Nawabshah department of surgery Wards. Design of Study: This is an Observational research. Duration & Location of Study: Current research was carried out in surgery at Nawabshah People's Medical College Hospital (SBA) from November 20, 2018 to November 20, 2020. Methodology: This research comprised of 200 subjects. A comprehensive history was taken from total subjects with special consideration for breast nodules & axillary lymph nodes & recorded proforma to evaluate the affected area was specifically inspected. A systematic review was also conducted to identify comorbidities. Total subjects received baseline & specific tests, especially radiological & histopathological reports. The selection criterion was that total female subjects over the age of 15 associated with mass in breast were included in this research. Exclusion criteria were subjects with breast abscesses & those who were diagnosed & treated for breast cancer with recurrent lesions. Results: the range of age started from 15-65 years, 39+4.11 years was mean age. lesion of Benign nature on biopsy were were Fibroadenoma 22%, intraductal papilloma 9%, Phylloid Tumor Benign 6% & lactating adenoma 5%. Neoplastic nature was observed on biopsy invasive ductal carcinoma 19%, Invasive lobular carcinoma 11% & malignant phylloides tumor 9%. Conclusion: Study determined that frequency of breast malignancy in breast lumps was 58%.

The incidence of discordant clinical and genomic risk in patients with invasive lobular or ductal carcinoma of the breast: a National Cancer Database Study

When molecular testing classifies breast tumors as low risk but clinical risk is high, the optimal management strategy is unknown. One group of patients who may be more likely to have such discordant risk are those with invasive lobular carcinoma of the breast. We sought to examine whether patients with invasive lobular carcinoma are more likely to have clinical high/genomic low-risk tumors compared to those with invasive ductal carcinoma, and to evaluate the impact on receipt of chemotherapy and overall survival. We conducted a cohort study using the National Cancer Database from 2010–2016. Patients with hormone receptor positive, HER2 negative, stage I-III breast cancer who underwent 70-gene signature testing were included. We evaluated the proportion of patients with discordant clinical and genomic risk by histology using Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models with and without propensity score matching. A total of 7399 patients (1497 with invasive lobular carcinoma [20.2%]) were identified. Patients with invasive lobular carcinoma were significantly more likely to fall into a discordant risk category compared to those with invasive ductal carcinoma (46.8% versus 37.1%, p < 0.001), especially in the clinical high/genomic low risk subgroup (35.6% versus 19.2%, p < 0.001). In unadjusted analysis of the clinical high/genomic low-risk cohort who received chemotherapy, invasive ductal carcinoma patients had significantly improved overall survival compared to those with invasive lobular carcinoma (p = 0.02). These findings suggest that current tools for stratifying clinical and genomic risk could be improved for those with invasive lobular carcinoma to better tailor treatment selection.