Archives of Breast Cancer
Volume:3 Issue: 3, Aug 2016

Despite developments in surgical treatment, radiation therapy, and chemotherapy protocols, tumor recurrence and metastasis are still major problems in breast cancer management. The aim of the present report was to review and compare the performance of PET/CT with some of the conventional imaging modalities in detection of breast cancer recurrence.
A literature search was performed in PubMed, Europe PMC and ScienceDirect databases with no search restriction for the date of publication but the search was limited to papers published in English.
Twenty-two studies including a total of 1378 patients with prior breast cancer and clinical suspicion of recurrence that assessed the sensitivity, specificity, and accuracy of PET/CT and other conventional imaging methods in followed up by treated breast cancer and presented the results in systematic review format. The information extracted from each article included the first author, publication year, number of patients and their characteristics, index test(s), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.
According to the literature, PET/CT seems to be a more useful modality than current techniques to assess the patients with suspected recurrent and metastatic breast cancer. If PET/CT is not applicable, MRI and also bone scintigraphy could also be performed as alternatives.

In an attempt to reduce the risk of developing lymphedema following breast cancer surgery, some researchers suggested that by identifying and preserving the lymphatic plexus which drains ipsilateral arm we can minimize the risk of lymphedema. The procedure is known as axillary reverse mapping (ARM). In the current study, we investigated the oncological safety of this technique.
A total of 60 patients who were undergoing axillary lymph node dissection were involved. The indications for axillary dissection were whether clinically node-positive axilla or positive sentinel lymph node biopsy. ARM was performed by injecting 2 ml of methylene blue subcutaneously in the upper and medial part of ipsilateral patients’ arm along the intermuscular groove.
ARM nodes were identified by means of methylene blue injection in 51(85%) patients (identification rate = 85%). For the subgroup of clinically positive axillary lymph nodes, identification rate was 93.1%, and the corresponding figure was 77.4% for positive SLNB group (P = 0.148). Pathological evaluation of harvested ARM nodes demonstrated metastatic involvement in 8(27.5%) and 1(3.2%) patients in clinically positive and SLNB positive groups respectively (P = 0.026).
Based on the findings of this study it seems that ARM could be considered as a safe procedure in patients who are a candidate for ALND when SLNB is positive. In contrast, in patients with clinically positive axillary nodes, there is a considerable risk of tumoral metastasis in ARM nodes.

Keeping the patient in a sitting or semi-sitting position for time-consuming oncoplastic breast surgery is a major challenge for anesthesiologists due to several considerations. This cohort study was conducted on two groups of patients undergoing breast surgery.
Study participants were categorized into two groups: one group was composed of normotensive women (group A) and the other group comprised women with controlled hypertension (group B). After the induction of anesthesia in the supine position, the position was changed to sitting and the surgery was done in the sitting position. Hemodynamic monitoring included ECG, heart rate, non-invasive blood pressure (NIBP), invasive blood pressure (IBP), cardiac output (CO), arterial O2 saturation (SPO2), end-tidal CO2 (EtCO2), and bispectral index (BIS). The amount of administrated fluid and vasopressor was recorded for each patient. Any episode of hemodynamic instability was recorded, too.
Hemodynamic variation occurred in both groups, but the changes were more significant in group B and the amount of fluid and vasopressor administration was more prominent in group B. Changing the position caused no significant variation in BIS, SPO2, and EtCO2 in the two groups.
The sitting position can be safe for time-consuming oncoplastic breast surgery using adequate hemodynamic monitoring. Hemodynamic changes are more significant in patients with controlled hypertension, and more medical interference is needed for these patients.

When a couple confronts cancer, there is a major impact on their psychosocial life. Marital life and satisfaction with that are important factors in the quality of life of breast cancer patient. The aim of this research was to predict marital satisfaction based on hardiness in women with breast cancer
A total of 100 women with breast cancer participated in this study and completed the Kobasa Personal View Survey and ENRICH (evaluation and
nurturing relationship issues, communication, and happiness) Marital Satisfaction Scale. The study was conducted in Rasol Akrm Hospital, Tehran, Iran. Descriptive statistics, correlation, and linear regression were used for data analysis.
The results showed a significant relationship between hardiness and marital satisfaction. Moreover, hardiness determined 13% of the variance of marital satisfaction.
Hardiness as an efficient coping style in breast cancer is an important factor to increase perceived marital satisfaction in breast cancer. Therefore, healthcare professionals such as psycho-oncologists can promote resiliency in breast cancer patients by improving cognitive hardiness in their patients.

Contralateral axillary metastasis (CAM) is a rare entity in patients with breast cancer which can occur during the primary breast cancer or its follow-up. Different treatment modalities include surgery, radiotherapy, and chemotherapy, but there is no agreement on them. In our review, we found 12 series with available data, 82 patients with synchronous or metachronous contralateral axillary node involvement with no primary cancer in the contralateral breast.
Our patient was a 50-year-old woman who presented with locally advanced right breast cancer with no distant metastasis. After treatment including neoadjuvant chemotherapy, MRM, and radiotherapy, her contralateral axillary lymph node was involved with metastatic carcinoma compatible with ductal carcinoma of the breast with similar IHC results. Evaluation of the contralateral breast was negative for occult lesions and metastatic workups were negative for malignancy. We assumed this presentation as a CAM and planned the treatment accordingly.
CAM without systemic metastasis might be considered a regional disease because in many cases the spread is lymphatic and not hematogenous. The new concept of lymphatic invasion instead of hematogenous spread has changed the intent of palliative to curative treatment. According to our study, CAM patients were mostly managed with chemotherapy (96%), ALND (45%), contralateral breast and axillary radiation (35%). The prognosis of CAM is usually poor with a high relapse rate (>60%) and a mortality rate of 15% in our review after 14-43 months follow-up, but it is better than the prognosis of the patients with systemic metastasis.