Frequency of Metabolic Syndrome and its Associated Factors in Patients with Breast Carcinoma at Tertiary Care University Hospitals of Pakistan

Objective: To determine the frequency of metabolic syndrome and its associated factors in patients with biopsy proven breast cancer at tertiary care university hospitals of Karachi, Pakistan. Methods: This cross sectional study was conducted at the hospitals affiliated with Dow university of health sciences & Baqai medical university from January 2018 to September 2019.A total of 114women between 30 to 50 years of age presented to the out patients clinics and underwent triple assessment including detailed history &examination, radiological assessment and fine needle aspiration cytology for confirmation of breast cancer were included in the study after taking written informed consent. Along with the routine baseline investigations blood sugar for hyperglycemia&blood sample for lipid profile was taken in fasting from Dow Lab. Blood pressure of the patients was also checked along with the weight, height and waist measurements. The SPSS version 19 was applied to the data for description and analysis. Results: Mean age of the patients was 42.57 ±4.90 years. Stages of cancer showed that stage III was found in majority (n=50, 43.9%). Frequency of metabolic syndrome was observed in 44 (38.6%) of the patients. A significant association of metabolic syndrome with educational status (p-value <0.001), Hypertension (p-value <0.001), Central obesity (p-value <0.001), Fasting blood sugar levels (p-value <0.001), Triglyceride levels (p-value <0.001), High density lipoprotein levels (p-value <0.001), and different Stages of breast cancer (p-value 0.003) was observed. Conclusion: This study show that a significant number of patients with breast cancer are suffering from metabolic syndrome which is also correlates with the educational status of the patients.

Application of IAC Yokohama system for breast cytology – The experience at a tertiary care hospital

Breast malignancies are one of the commonest malignancies in Indian women. Increasing urbanization is attributed to raise of breast cancers and have surpassed cervix cancer in recent times and are now ranked top in some metros. FNA is used as an important diagnostic tool as a part of triple assessment. The application of the IAC Yokohama system in breast cytology improves the reporting and also allows the calculation of risk of malignancy (ROM). The main aim of the study is to; 1. Apply the IAC Yokohama system for the diagnostic; 2. assessment and subsequent categorization of FNA samples and correlate them with histopathology examination (HPE); 3. calculate ROM; 4. Calculate p-value.A total of 305 samples received were diagnosed and classified according to the IAC Yokohama system. The study was conducted over a period of 2 yrs retrospectively from June 2019 to May 2021. For the 305 FNA samples received, HPE correlation was made and statistical parameters, ROM , p-value were calculated.305 FNA samples were obtained and categorized according to the IAC Yokohama system. They were categorized and the percentage of incidence noted as 1. Insufficient - 6.89%, 2.Benign - 72.46%, 3.Atypical probably benign - 3.28%, 4. Suspicious - 3.28%, 5. Malignant - 14.09%. ROM was also calculated. The distribution of cases in percentage as per categories are: category 1 – 0%, category 2 - 2%, category 3 – 0%, category 4- , 42.86% category 5- 100%. For 305 FNA samples reported 95 cases received for HPE and subsequently cyto – histopathological correlation was made and statistical parameters were calculated. Compiled statistics showed sensitivity of 100%, specificity of 93.54%, NPV of 100%, PPV of 89.19% and diagnostic accuracy at 95.78%. The p-value for the present study is 0.0001 which is very significant.Application of the IAC Yokohama system of reporting breast cytopathology helps in better categorization of FNA samples and it improves the efficacy of cytopathologist. It gives better clarity to the clinicians in the management of the patient and can reduce unnecessary surgeries.

Male Breast Cancer Review. A Rare Case of Pure DCIS: Imaging Protocol, Radiomics and Management

Ductal carcinoma in situ (DCIS) of male breast is a rare lesion, often associated with invasive carcinoma. When the in situ component is present in pure form, histological grade is usually low or intermediate. Imaging is difficult as gynaecomastia is often present and can mask underlying findings. We report a rare case of pure high-grade DCIS in a young male patient, with associated intraductal papilloma and atypical ductal hyperplasia. Digital breast tomosynthesis (DBT) showed an area of architectural distortion at the union of outer quadrants of the left breast without gynaecomastia. Triple assessment suggested performing a nipple-sparing mastectomy, which revealed the presence of a focal area of high-grade DCIS of 2 mm. DCIS, even of high grade, is difficult to detect with mammography and even more rare, especially when associated with other proliferative lesions. DBT with 2D synthetic reconstruction is useful as the imaging step of a triple assessment and it should be performed in both symptomatic and asymptomatic high-risk men to differentiate between malignant and benign lesions. We propose a diagnostic model to early detect breast cancer in men, optimizing resources according to efficiency, effectiveness and economy, and look forward to radiomics as a powerful tool to help radiologists.

Breast surgery

This chapter outlines the surgical and medical treatment of breast cancer in females and males, breast cancer screening, benign breast conditions, breast pain and gynaecomastia. It describes the assessment of a breast lump with triple assessment and also how to perform a punch biopsy.

TP8.1.8 Blue flag clinics. A way to achieve a 2 week wait service in the age of plentiful referrals, radiological pressures and pension threat

Introduction In early 2019 increased referrals to the Breast 2WW Service, limited radiologist capacity and the pension crisis combined to cause the 2 week wait target to fail. A multidisciplinary solution was sought. Using the Nottingham Breast Institute triage criteria and decoupling clinical and radiological assessments, patients were referred along 2 pathways; red and blue flag. Methods Patients were clinically assessed by a trained breast surgeon within 2 weeks. Red flag patients underwent standard triple assessment. The aim for blue flag patients was to undergo any necessary imaging within 10 days. In both cohorts selected patients were given a patient satisfaction questionnaire. Data from red flag clinics were obtained from cancer services. Notes were reviewed for blue flag patients. Results Data on 858 blue flag patients seen were analysed. There was no difference between satisfaction scores. Conclusions The 2WW target was regained within a month of implementing change. As long as the standard operating procedure is maintained, the triage criteria adopted were successful and reduced pressure on radiology services. Patient safety and satisfaction were maintained.

376 Management of Breast Cancer in elderly patients

Aim To evaluate the care and outcomes for women with breast cancer over the age of 70 and to compare our performance at AUH against the national outcomes. Method Using the online database at AUH we gathered the following data: age, TNM status, surgical management, histology, adjuvant treatment (radiotherapy, chemotherapy, hormone therapy, targeted therapy) and reasons for alterations in planned therapy. Results We audited 176 patients between 2018 and 2019. Age varied between 70 and 95 years old. 10 patients suffered from DCIS, 152 from invasive breast cancer and 14 from de novo metastatic breast cancer. 40% of patients with DCIS with underwent WLE, 40% underwent mastectomy and 20% were not offered an operation as they were unfit. Invasive breast cancer accounted for the majority of cases. 86% were ER/PR positive and 12.2% were Her-2 positive. 35.7% underwent mastectomy, 64.4% underwent WLE and 0.8% VAB excision. 51.7% had Sentinel node biopsy, 15.3% underwent axillary clearance and 1.7 % had axillary sampling. 7.9% of patients presented with metastatic disease. 2.6% of those patients had palliative radiotherapy. Primary endocrine therapy was commenced on 21.1% of patients. Factors that lead to PET were that 47% of patients were unfit for an operation, 20.6% refused surgical intervention, 11.7% had concurrent aggressive malignancy and 8.8% were inoperable. Conclusions Overall, successful results were achieved for this group of patients compared to the national outcomes. 99.4% of patients in our centre had triple assessment prior to MDT. Further review of functional status and service outcomes will be required to be audited.

551 Patient Satisfaction with Telephone Consultations in A One-Stop Breast Clinic During COVID-19 Pandemic

Aim Telemedicine has gained an important role in medical practice lately, particularly in the outpatient setting. In our unit, virtual consultations were previously used for results clinics only. However, the first wave of COVID-19 pandemic necessitated change of practice to address issues of triage, infection control, cancer target times, and decreased capacity in the face of maintained demand. New patients underwent a telephone consultation followed by a clinic visit one week afterwards to complete triple assessment. We aimed to assess patient satisfaction with the phone consultation and subsequent care. Method Patients referred from general practice to the Breast Unit at West Middlesex University Hospital, who had a telephone appointment in the period 15/04/2020 to 15/07/2020, were included. The study was registered with the Clinical governance department. Patients received text messages with anonymised links to an online survey and were contacted over the telephone to explain the survey. Results 219 successful phone calls were made to eligible patients, and 126 patients responded to the survey (57.5%). 78% felt that they were able to express all or most of their concerns over the phone. 86% spent less than 2 hours in clinic. 87% felt social distancing and safety measures were adequate. More than 75% were overall satisfied with their care. Conclusions We further discuss responses to this survey. Patients were largely satisfied; however, areas of improvement were identified, and changes need to be made to ensure telemedicine is used to its full potential and is appropriately incorporated in the post COVID-19 practice.

A study on diagnostic accuracy of modified triple assessment in palpable breast lumps

Background: Breast (mammary gland) is a distinguishing feature of class Mammalia. Patients commonly present, complaining of a lump in the breast, pain, and nipple discharge. Although the most common cause of symptoms is benign breast diseases. But as the life expectancy is increasing incidence of carcinoma breast is also increasing. 1.To assess the individual component diagnostic accuracy of MTT.Methods: This was a cross-sectional study involving 50 female patients with palpable breast lumps attending the Surgical Out-Patient of the Department of General Surgery, Government Royapettah Hospital, Kilpauk medical college, Chennai between June 2020 and May 2021 over 12 months, who underwent clinical breast examination (CBE), ultrasonography (USG), and fine-needle aspiration cytology (FNAC). Results: In the study population, the breast tumor is common on the left side account for about overall 53%age of patients. The bilateral tumors are the least common. Fibroadenoma is the most common benign tumor. In our study also similar results were obtained. The next common benign tumor among the study group is a fibrocystic disease of the breast. Analysis of the above results shows that though FNAC has a sensitivity of 90%, it has a positive predictive value of 100%. The study shows that the combined results of the Modified Triple Test are comparable to the histopathological diagnosis of the biopsy specimen. Conclusions: Our study includes assessment of combined diagnostic accuracy of Modified Triple Test in women of more than 30 years of age with a palpable breast lump.

Breast fibroadenoma and its clinical perspectives: a prospective observational study

Background: To study the patterns of breast fibroadenoma in females and to co-relate them with the pathological findings.Methods: Sixty six females who attended the Surgery Department in Darbhanga Medical College, Bihar, a tertiary centre in rural area, with benign breast lump during the period Bihar during period of November 2009 to November 2011, were studied. Early diagnoses by doing a triple assessment like a clinical examination, FNAC or a core needle biopsy and imaging methods like ultrasonography or mammography. The clinical diagnoses were compared with the cytological or histological findings wherever possible and their accuracies were evaluated.Results: Out of the 66 confirmed fibroadenoma female patients who were studied, most patients presented as a painless lump which is need to be differentiated from carcinoma. Most of the patient (63%) presented within 6 months of development of breast lesion showing increasing awareness in females of rural India. The maximum number of patient presented (55%) is of 2nd to 3rd decade. It was found that maximum number of patients have upto three children due to early marriage in rural background.Conclusions: Fibroadenoma is a common cause for breast lump even in rural background. Triple assessment provided a quick diagnosis and it alleviated unnecessary anxiety from the patients about breast cancer. The clinical diagnosis of a breast lump, as confirmed by cytology and histology, was accurate in most of the cases.