Archives of Breast Cancer
Volume:2 Issue: 2, May 2015

Fat necrosis is a benign inflammatory process which can involve adipose tissue anywhere in the body. A previous history of trauma or surgery may or may not be present. Information about the clinical and radiological appearance of this lesion is very important because it can mimic breast cancer.In this article, we review the features of fat necrosis in different imaging modalities including mammography, ultrasound, and magnetic resonance imaging (MRI), and compare them with histopathologic findings; then, we try to provide a logical approach for fat necrosis management.The appearance of fat necrosis at imaging is variable from definitely benign type to highly suspicious for malignancy. The specificity of mammography is higher than that of ultrasonography; therefore, for a definite diagnosis of fat necrosis, emphasis should be mainly based on mammography rather than ultrasonography.Finally, fat necrosis is not a common disease; however, regarding unusual and atypical findings in different imaging modalities, differentiation from a cancer may be difficult, especially in patients with a previous history of malignancy. Therefore, a multimodality approach is required for a definite diagnosis.

Quality of life (QOL) is becoming an important indicator of treatment efficacy in patients with breast cancer. Most previous studies have compared patients'' QOL following breast conserving surgery (BCS) and mastectomy with or without reconstruction. Our aim was to assess the impact of BCS versus oncoplastic breast surgery (OBS). Selection of patients for BCS or OBS was performed according to standard criteria e.g the breast and tumor size. The QOL was assessed by employing EORTC QLQ-C3 and QLQ-BR23 questionnaires concurrently and one year after the surgery. The QOL scores one year after the surgery were compared between two groups using analysis of covariance, after adjusting for the baseline values. A total of 120 patients with a mean age of 46.16±1.4 years were enrolled in the study. BCS and OBS were the main surgical treatment techniques in 57(47.5%) and 63(52.5%) patients, respectively. At the time of the last follow-up visit, there were no differences between the two groups regarding functional scales such as physical (P = 0.761), role (P = 0.356), emotional (P = 0.107), cognitive (P = 0.051), and social functioning (P = 0.659). No differences were observed between the two groups regarding nine symptom scales. Based on the results of breast cancer specific module of the questionnaire, no differences were observed in functional scales and symptoms with the exception of arm symptoms which were less common in OBS group (P = 0.023) Based on the results of the current study, it could be suggested that there are no significant differences in the in scores of QOL components between patients who received BCS or OBS.

The purpose of this study was to compare patient delay, diagnosis delay and treatment delay in breast cancer patients of selected public and private health centers in Tehran, Iran. In this cross-sectional study, female patients with newly diagnosed breast cancer in a public medical complex and a private breast clinic within one year were included. Patient delay was considered positive, if the interval between the detection of the first symptom by the patient and the first visit to a health care provider took longer than one month. Delay in diagnosis was defined as the period of more than one week between the first medical visit for the symptoms and the diagnosis of breast cancer. Following the confirmed diagnosis of breast malignancy, if the medical treatment was initiated later than one week, treatment delay had occurred. The potential reasons for patient, diagnosis and treatment delay according to the patients’ reports were also recorded. Overall, 385 patients were included of whom 52.7% were recruited from the public hospitals and 47.3% from a private clinic. The prevalence of patient delay, diagnosis delay and treatment delay were 31.7%, 17.9% and 28.3%, respectively. Patient delay was significantly more common among patients with lower socio-economic status and those recruited from the public hospitals. All the patients with diagnosis delay were in the group recruited from the public hospitals. Gaps between women of different socio-economic levels of the society need to be addressed in order to decrease patient, diagnosis and treatment delay.

The purpose of this study was to assess Iranian surgeons'' perceptions toward mastectomy and breast conserving therapy (BCT) and determine the contributing factor. In this cross-sectional study, a structured questionnaire was devised and hosted on survey.tums.ac.ir and a link to the questionnaire was emailed to surgeons registered in Iranian Medical Council, branch of Tehran. The results of the current study were compared to a similar study which was performed in 2004 on a comparable sample of surgeons in Tehran, Iran. A total 166 surgeons filled out the study questionnaire. Only 24 surgeons declared that they have not performed BCT before. Variables that showed a significant association with performing BCT were attending a breast surgery or surgical oncology fellowship (P = 0.010) and breast surgery workshop (P = 0.042). No associations were observed between performance of BCT and age category (P = 0.951), gender (P = 0.416), duration of practice (P = 0.821), number of breast cancer patients per year (P = 0.083), and setting of practice categorized as teaching – nonteaching hospitals (P = 0.417). Comparing the results of the current study with the study performed in 2004 revealed a significant increase in the frequency of surgeons who perform BCT (85.5% vs 19.3%, respectively) (P < 0.001). Participants of the current study were more likely to mention «lack of experience» as the reason for not performing BCT compared to the previous study (P = 0.004). Our results delineated that there was a significant increase in the percentage of surgeons performing BCT compared to the previous study. Factors significantly associated with performing BCT were participating in a surgical oncology or breast surgery fellowship or short courses in breast surgery.

Our study aims to determine the correlation between breast cancer tumor size according to imaging (ultrasonography and mammography) with final pathologic report as a gold standard. We included 132 women with pathologically proven invasive breast cancer between April 2011 and December 2013. Study variables included tumor size according to pathology (as a gold standard), ultrasonography and mammography. Pearson correlation coefficient was used to show correlations. A total of 132 patients were included in the final analysis. The correlation coefficient between tumor size in mammography and pathology was 0.74 (P < 0.001) and between ultrasonography and pathology was 0.67 (P < 0.001). Age had a modifying effect on the correlation between mammography and pathology; the correlation coefficient in women who aged 40 years or above was 0.92 (P < 0.001) and in women younger than 40 years was 0.74 (P < 0.001). Similarly, regarding the association between ultrasonography and pathologic tumor size, higher correlation coefficient was observed for women aging 40 years or above compared with their younger counterparts (0.74 versus 0.62, respectively). measuring tumor size in mammography whenever possible would be recommended considering the higher and significant observed correlation with the pathologic tumor size compared to ultrasonography. Both associations were stronger in women aging 40 years and above.

A hemangioma is a rather common benign soft tissue tumor that rarely originates from both the pectoralis muscle and the breast. Vascular tumors of the breast, such as benign hemangiomas, are rarely seen in men. A 40-year-old man presented with a non-tender palpable right breast mass since 6 months ago. On physical examination, a hard lump was detected in the central part of his right breast with normal intact skin without discoloration. No nipple discharge or axillary mass was detected.Mammography revealed a well-defined heterogeneous mass with a few macro-calcifications. Surgical excision was performed and Microscopic examination revealed multiple vascular spaces covered by one layer of endothelial cells without any remarkable atypia or mitotic activity proved to be benign hemangioma. A hemangioma should also be considered in the differential diagnosis of uncommon breast tumors in men. The imaging features of the male breast hemangioma seem to be similar to those described in female patients.