فهرست مطالب
Archives of Breast Cancer
Volume:5 Issue: 4, Nov 2018
- تاریخ انتشار: 1397/09/03
- تعداد عناوین: 8
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Pages 150-158BackgroundAlthough iatrogenic displacement of epithelial cells after breast instrumentation is a well-documented phenomenon, it is usually underdiagnosed. Misinterpretation of this issue results in overtreatment of patients in some instances. Additionally, the hazard of tumor seeding and dissemination after needling is a concern to both clinicians and patients. Both issues are addressed in this narrative review.MethodsWe searched PubMed for abstracts of English-language publications using keywords “needle track/tract” and “displaced epithelium/epithelial displacement/iatrogenic displacement,” which resulted in 439 records restricted to human subjects. We read all the abstracts and selected 27 manuscripts with the most relevance.ResultsThere are some histopathologic features that can be useful in differentiating between epithelial displacement and real invasion/metastasis. The risk of seeding or metastasis after needling is shown to be trivial. Factors militating against the growth of dislodged cells are also discussed.ConclusionEpithelial displacement is an important issue in breast pathology that should be considered in every patient with a history of breast instrumentation.Keywords: Breast, Displaced epithelium, Iatrogenic, Histopathology
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Pages 159-162BackgroundFibroadenoma is a common benign breast disorder in young women which has a low risk of malignant transformation. Most fibroadenomas present as a single mass, but the presence of multiple fibroadenomas can be seen in 15–20% of patients, with average number of 3–4 masses in one breast. In different studies and reports, various treatment modalities-including observation and follow up, surgery, radiofrequency ablation, etc- have been proposed, though the best management for these patients are not determined yet.Case presentationWe present the case of 33-year-old female with history of multiple bilateral benign breast lesions with a presumptive diagnosis of fibroadenomas. She had three previous surgical excisions in the past 14 years. Her case was presented to a breast MDT meeting to obtain a recommendation on appropriate management. Question: The proposed a question in MDT concerned the best and most appropriate management plan for the patient; Does she require further surgical excisions? And if not, how should she be followed?ConclusionAfter reviewing past medical history, physical examination, and all documents regarding the patient, MDT members recommended that the patient should be managed with close follow up with physical examination and ultrasound every 6 months. The necessity of further surgical intervention would be determined according to any new findings.Keywords: Multiple fibroadenomas, Recurrent fibroadenomas, Benign breast masses, Management, Multidisciplinary team (MDT)
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Pages 163-167BackgroundBreast surgery for women newly diagnosed with breast cancer is associated with poor postoperative quality of life (QOL). The aim of this study was to determine the effectiveness of a programmed discharge planning in improving overall QOL and its physical, emotional, social, and spiritual domains.MethodIn this quasi-experimental study, we evaluated the newly diagnosed breast cancer women undergoing breast-conserving therapy in two groups, an experimental group (n = 35) and a control group (n = 34). The experimental group received programmed discharge planning at the time of hospital admission until six weeks after discharge. The control group received routine hospital care. Participants completed the QOL questionnaires before and after the intervention. The data were analyzed using the independent-samples t test, Fisher exact test, and Mann-Whitney U.ResultsBefore the intervention, there were no significant differences between the control and experimental groups in overall QOL or its physical, emotional, social, and spiritual domains. The data analysis after intervention showed significant improvement in QOL in the experimental group as compared with the control group. The changes in the scores of various domains of QOL were statistically significant (P < 0.01).ConclusionThis study emphasizes that programmed discharge planning is useful for improving QOL after breast-conserving surgery. Our finding could be applied to breast cancer patients with radiation therapy or chemotherapy.Keywords: Breast cancer, Discharge planning, Quality of life, Breast-conserving therapy
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Pages 168-172BackgroundThere are various factors affecting the effectiveness of the treatment of breast cancer patients. Although the disease pathology, along with surgery and other therapeutic modalities, plays the principal role in patient outcomes, anesthesia still plays an important role in the success of treatment. This study was designed to show the effects of anesthetic plans on risk classification and assessment in breast cancer surgeries.MethodsTwo hundred sixty patients receiving different types of breast cancer surgery for therapeutic and reconstructive purposes were enrolled in this study. They were divided into three groups according to the anesthesia risk assessment. Group 1 consisted of low-risk patients (ASA I) who received small surgeries such as lumpectomy. Patients with intermediate risk of anesthesia (ASA II) or those who underwent breast cancer and axillary surgery with overnight admission (ASA I or II) were considered as group 2. Group 3 comprised the patients with higher risk for anesthesia (ASA class III) regardless of the surgery type or those in any ASA class who were about to undergo advanced and prolonged surgeries such as breast reconstruction with free or pedicle flaps.ResultsTwo hundred sixty-eight surgical interventions were done in 260 patients. There were 106, 107, and 47 patients in groups 1, 2, and 3, respectively. In group 1, five patients out of 106 were admitted in the hospital for 24 hours after surgery and the remaining 101 patients were discharged from the hospital in a few hours after the operation when they were fully conscious and could tolerate the diet completely. All 107 patients in group 2 were admitted in the hospital for a few days after the operation, though the vast majority of them (98 patients) discharged from the hospital the day after surgery. In the last group, 6 out of 47 patients showed the signs of surgical complications such as partial flap ischemia in the postoperative period, mostly after TRAM or DIEP flap breast reconstruction surgery.ConclusionThe findings of this study support the idea that breast surgeries can be done in an ambulatory situation with no considerable risk. In contrast, all medical and anesthetic considerations should be taken into account in more complex surgeries, especially when they are applied in high-risk patients.Keywords: ASA classification, Breast Cancer, Risk Assessment
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Pages 173-182BackgroundBreast cancer is considered a chronic disease owing to the increases in survival rate. Thus, better body image and patient satisfaction with the surgery have become more important factors to be considered when choosing the surgical approach. The aim of this study was to compare body image and patient satisfaction following three different approaches.MethodsWe evaluated 183 consecutive patients who had undergone three different surgeries including breast-conserving surgery (BCS), mastectomy, or mastectomy followed by reconstruction (M-R). Body image was evaluated using the BICI questionnaire, and patient satisfaction was rated using a multiple-choice question and a scale ranging from 1 to 10.ResultsA significantly better body image was observed in the M-R and BCS groups compared with mastectomy (P = 0.02). In body image subscale analysis, social functioning scores were higher in the M-R and BCS groups than in the mastectomy group (P = 0.01), but no differences were obtained between surgery groups in appearance dissatisfaction subscale. Patients were more satisfied with BCS than the other two surgeries (P = 0.008).ConclusionBased on the results of this study, it could be proposed that both oncoplastic BCS and implant reconstruction could provide patients with acceptable body image, while BCS could bring about better satisfaction with the surgery. Reconstruction may be an alternative for the patients to improve body image and satisfaction when BCS is not applicable.Keywords: Breast cancer, Satisfaction, Body image, Breast-conserving surgery, Reconstruction
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Pages 183-188BackgroundPatient participation in medical decisions is essential and requires sufficient knowledge and awareness. Thus, the aim of this study was to investigate the relationship between health literacy and the participation of breast cancer patients in their medical decisions in Shiraz, Iran.MethodsThis was a descriptive-analytical study conducted on 196 women with breast cancer in 2016-2017. Data were collected using the standardized Health Literacy for Iranian Adults (HELIA) and the Decisional Conflict Scale. The data were analyzed using descriptive statistics and inferential methods (t test, Pearson correlation, ANOVA, and Kruskal-Wallis) on SPSS 21.ResultsThe mean age of participants was 46.7 years. Their health literacy was inadequate (18.7) and their decisional conflict was average (51.79). There was also an inverse and significant relationship between health literacy and decisional conflict (P < 0.001, r = -0.81)ConclusionIncreasing health literacy could reduce decisional conflict. It requires training individuals be able to access credible and reliable sources of information. This training can be provided through doctors, treatment staff, and public and social media.Keywords: Health literacy, Patient participation, Breast cancer
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Pages 189-191BackgroundWarfarin induced breast necrosis is a rare complication of oral anticoagulant therapy. Although it can be related to protein C, S, and antithrombin III deficiency; the pathogenesis of necrosis is still unknown.Case presentationWe report a case of a 38-year-old woman with extensive left breast necrosis after receiving warfarin for treatment of deep vein thrombosis. Simple mastectomy was performed and the wound was closed secondarily with an abdominal advancement flap. Rivaroxaban was prescribed after discontinuation of warfarin.ConclusionAlthough breast necrosis following warfarin usage is uncommon, it should be considered in women presenting with breast symptoms after initiation of warfarin. Early diagnosis and appropriate management are essential to prevent extensive loss of breast tissue.Keywords: Warfarin, Breast necrosis, Breast gangrene, Oral anticoagulant therapy