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Wahlström E, Audisio RA, Selvaggi G. Aspects to consider regarding breast cancer risk in trans men: A systematic review and risk management approach. PLoS One 2024; 19:e0299333. [PMID: 38451995 PMCID: PMC10919728 DOI: 10.1371/journal.pone.0299333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The risk of breast cancer in trans men is currently a poorly understood subject and trans men likely carries a different level of risk from that of cis women. AIM This review aims to review several aspects that affects breast cancer risk in trans men and to apply the Swiss cheese model to highlight these risks. The study takes its cue from a systematic review of all described breast cancer cases in trans men following medical or surgical intervention because of gender dysphoria. METHODS PubMed was systematically searched on the 14th of March 2023 to find all published cases of breast cancer following chest contouring surgery in trans men. Included articles had to involve trans men, the diagnosis of breast cancer had to be preceded by either a medical or surgical intervention related to gender dysphoria, and cases needed to involve invasive breast cancer or ductal carcinoma in situ. Articles were excluded if gender identity in the case subject was unclear and/or a full English version of the report was unavailable. Quality and risk of bias was evaluated using the GRADE protocol. A literature review of specific risk altering aspects in this population followed. The Swiss cheese model was employed to present a risk analysis and to propose ways of managing this risk. RESULTS 28 cases of breast cancer in trans men have been published. The Swiss cheese model identified several weaknesses associated with methods of preventing breast cancer in trans men. CLINICAL IMPLICATIONS This study may highlight the difficulties with managing risk factors concerning breast cancer in trans men to clinicians not encountering this patient group frequently. CONCLUSION This review finds that evidence for most aspects concerning breast cancer in trans men are inadequate, which supports the establishment of a risk-management approach to breast cancer in trans men.
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Affiliation(s)
- Edvin Wahlström
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Riccardo A. Audisio
- Department of General Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gennaro Selvaggi
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Ojala K, Saarinen M, Suominen S, Schantz PMV. Preoperative breast imaging and histopathological findings in chest contouring surgery on transmen. J Plast Reconstr Aesthet Surg 2023; 85:114-119. [PMID: 37480681 DOI: 10.1016/j.bjps.2023.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Chest contouring is the most common surgical procedure transmen receive. Only a few articles discuss the importance of preoperative imaging and postoperative histopathological analysis of excised breast tissue. We studied the findings of preoperative breast imaging and the results of postoperative histopathological analysis in a clinical setting. MATERIALS AND METHODS Data from 220 patients were collected retrospectively from 2005 to 2018. Preoperative imaging modalities and their findings were recorded and classified according to the American College of Radiology Breast Imaging Reporting and Data System. The histopathological findings in breast specimens were categorized based on the World Health Organization Classification of Breast Tumors (5th edition). RESULTS Preoperative imaging was performed in 133 (60.5%) patients. Patients in the ultrasound-only group were younger (mean age 22.8) than the other groups (mammogram (MGR) 37 years and MGR+US 35.5 years). Preoperative imaging results were normal in 131 (98.5%) patients. Two patients needed further evaluation. Histopathological results were available on 206 (93.6%) patients. The most common histopathological findings were fibrosis (67.5%), atrophy (34.3%), and chronic mastopathy (14.5%). There were no high-risk or malignant findings. CONCLUSIONS The need for further examinations based on routine preoperative imaging was low (1.5%). Therefore, more individualized patient selection for preoperative imaging is justified. There were no high-risk or malignant findings in histopathological analysis, and the occurrence of benign findings was similar to that reported in previous studies. Despite our findings, based on current knowledge, histopathological examination of excised breast tissue can still be recommended. Therefore, future studies are needed to define clear guidelines.
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Affiliation(s)
- Kaisu Ojala
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Stenbackinkatu 11, P.O. Box 281, 00029, Finland.
| | - Mirjam Saarinen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Stenbackinkatu 11, P.O. Box 281, 00029, Finland
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Stenbackinkatu 11, P.O. Box 281, 00029, Finland
| | - Päivi Merkkola-von Schantz
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Stenbackinkatu 11, P.O. Box 281, 00029, Finland
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Hajebian HH, Puyana S, Mejia N, Van Wert MK, Babycos CR, Friel MT. Routine Pathology Examination of Breast Tissue in Adolescent Reduction Mammaplasty: Not Cost Effective in a 7-Year Review. Ann Plast Surg 2023; 90:S416-S419. [PMID: 36975135 DOI: 10.1097/sap.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Routine pathology examination of breast tissue in reduction mammaplasty (RM) is performed with aims of detecting incidental malignancy or risk-increasing lesions. In adolescent patients, the reported incidence ranges between 0% to 0.01%, and costs of pathology claims range between $23 and $614 per analysis. We aim to investigate the rate of incidental findings and the cost-effectiveness of routine pathology examination in adolescent RM. METHODS A single-center retrospective review of the pathology results for 132 breast specimens from 66 consecutive RM patients was performed. Data collected for analysis included breast cancer risk factors, demographic information, and operative variables. RESULTS Zero cases of incidental malignant or risk-increasing lesions were found among the 132 breast specimens from 66 patients aged between 10 and 24 years. Of the 132 specimens, 34 (26%) contained benign fibrocystic disease, which was significantly associated a body mass index greater than 30 kg/m 2 and tissue resection weight greater than 1000 g per breast ( P = 0.003, P = 0.007) respectively. CONCLUSIONS Based on the available data, the use of routine specimen analysis costs more than US $150 million for one breast cancer diagnosis during RM in this age group. In our study, zero atypical, precancerous, or cancerous lesions were detected in a 7-year analysis. The results of this study support the current literature, which reports no occurrence of incidental findings in young women and may promote a greater understanding of evidence-based healthcare spending while concomitantly decreasing the strain placed on histopathology services.
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Affiliation(s)
| | - Salomon Puyana
- Division of Plastic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Natalia Mejia
- From the Department of Plastic and Reconstructive Surgery, Ochsner Clinic Foundation
| | - Mary K Van Wert
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
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Incidence of Cancer and Premalignant Lesions in Surgical Specimens of Transgender Patients. Plast Reconstr Surg 2021; 147:194-198. [PMID: 33370065 DOI: 10.1097/prs.0000000000007452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gender-affirming surgery is becoming increasingly more common. Procedures including chest masculinization, breast augmentation, vaginoplasty, metoidioplasty, and phalloplasty routinely generate discarded tissue. The incidence of finding an occult malignancy or premalignant lesion in specimens from gender-affirming surgery is unknown. The authors therefore conducted a retrospective review of all transgender patients at their institution who underwent gender-affirming surgery to determine the incidence of precancerous and malignant lesions found incidentally. METHODS A retrospective review of transgender patients who underwent gender-affirming surgery at the authors' institution between 2017 and 2018 performed by a single plastic surgeon and a single reconstructive urologic surgeon was conducted. Only transgender patients who underwent gender-affirming surgery that led to routine pathologic review of discarded tissue (mastectomy, vaginoplasty, vaginectomy as part of phalloplasty) were included. Charts were reviewed and patient demographics, duration of hormonal therapy, medical comorbidities, genetic risk factors for cancer, medications (including steroids or other immunosuppressants), pathology reports, and cancer management were recorded. RESULTS Between 2017 and 2018, 295 transgender patients underwent gender-affirming surgery that generated discarded tissue sent for pathologic evaluation. During this period, 193 bilateral mastectomies, 94 vaginoplasties with orchiectomies, and eight vaginectomies were performed; 6.4 percent of all patients had an atypical lesion found on routine pathologic evaluation. CONCLUSIONS Gender-affirming surgery is increasingly more common given the increase in access to care. The authors' review of routine pathologic specimens generated from gender-affirming surgery yielded a 6.4 percent rate of finding atypical lesions requiring further evaluation. The authors advocate that all specimens be sent for pathologic evaluation.
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Fitzpatrick SE, Lam TC. Occult Breast Carcinoma Is More Common in Women Undergoing Breast Reduction after Contralateral Cancer: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 146:117e-126e. [PMID: 32740565 DOI: 10.1097/prs.0000000000006965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens. METHODS The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer. RESULTS Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001). CONCLUSIONS Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.
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Affiliation(s)
| | - Thomas C Lam
- From the Plastic and Reconstructive Surgery Department, Westmead Private Hospital
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Genco IS, Steinberg J, Caraballo Bordon B, Tugertimur B, Dec W, Hajiyeva S. The rate of incidental atypical and malignant breast lesions in reduction mammoplasty specimens. Histopathology 2020; 76:988-996. [PMID: 32043273 DOI: 10.1111/his.14089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
AIMS Reduction mammoplasty (RM) is one of the most common plastic surgeries in the United States. We aimed to demonstrate the rate of incidental atypical and malignant breast lesions (AMBL) found in RM specimens and the impact of the number of submitted tissue sections on the rate of AMBL. METHODS AND RESULTS We analysed our database for patients who had undergone reduction mammoplasty between 2000 and 2018. Patients with a history of breast cancer were excluded from the study. All pathology reports were analysed for AMBL (ALH, LCIS, FEA, ADH, DCIS, invasive carcinoma). The grossing protocol was to submit 10 sections from each breast between 2000 and 2013 and six sections between 2014 and 2018. One hundred and sixty-nine of 5208 patients (3.3%) and 216 of 10 340 RM specimens (2.1%) showed at least one AMBL. Nineteen (0.36%) patients had incidental cancer. The median age of patients with AMBL was significantly higher than patients without ABL (aged 59 years versus 45 years). There was no cancer in patients aged <30 years. The age-controlled rate of overall AMBL as well as atypia and cancer only did not decrease by submitting fewer sections during the 2014-18 period compared to the 2010-13 period. CONCLUSIONS Decreasing the number of tissue sections from 10 to six did not lead to a significant decrease in the rate of overall AMBL or cancer. Our data suggest that submitting six tissue sections from each breast for patients aged >30 years and two sections from each breast for patients aged <30 years would be sufficient.
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Affiliation(s)
- Iskender S Genco
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Jordan Steinberg
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Beatriz Caraballo Bordon
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Bugra Tugertimur
- Department of Surgery, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Wojciech Dec
- Department of Plastic Surgery, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Sabina Hajiyeva
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY, USA
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Sears ED, Lu YT, Chung TT, Momoh AO, Chung KC. Pathology Evaluation of Reduction Mammaplasty Specimens and Subsequent Diagnosis of Malignant Breast Disease: A Claims-Based Analysis. World J Surg 2019; 43:1546-1553. [PMID: 30719555 DOI: 10.1007/s00268-019-04931-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to measure the use of pathology evaluation of breast specimens among patients undergoing reduction mammaplasty and assess rates of new diagnoses of breast disease and associated cost. METHODS We analyzed the Truven MarketScan Databases from 2009 to 2015 to identify adult female patients undergoing reduction mammaplasty for macromastia. We recorded patient age, rates of obtaining pathology evaluation, new diagnoses of benign or malignant breast disease after pathology evaluation, and total cost for the surgery encounter. RESULTS Among 17,738 macromastia patients undergoing reduction mammaplasty, 91.3% (n = 16,193) received pathology evaluation. Pathology evaluation rates were clinically similar across age groups <70 years (90.8-92.1%) and slightly lower for patients ≥70 (85.0%). Among 6987 patients less than 40 years who received pathology evaluation, 0.06% (n = 4) were subsequently diagnosed with malignant breast disease within 3 months, compared to 0.23% in the entire cohort (n = 37/16,193). Pathology claims resulted in an added $307 (SD 251) on average for the breast reduction surgery encounters. CONCLUSIONS Breast tissue after reduction mammaplasty is routinely submitted for pathology evaluation, without consideration of age-based risk for breast cancer. Routine pathology evaluation of breast tissue in patients in lower risk age groups (less than 40 years) required an additional $536,000 on average to detect a single occult breast cancer compared to an added $85,600 to detect a new malignancy in patients 40 years and older. Clinicians and policy makers should consider whether routine pathology evaluation of breast tissue should be individualized based on risk factors for breast cancer.
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Affiliation(s)
- Erika D Sears
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA. .,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Yu-Ting Lu
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA
| | - Ting-Ting Chung
- Center for Big Data Analytics and Statistics and Division of Rheumatology, Allergy and Immunology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Adeyiza O Momoh
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Abstract
BACKGROUND Reduction mammoplasty is indicated for symptomatic macromastia or breast asymmetry after contralateral cancer surgery. Previous studies compared the incidence of high-risk lesions in resection specimens between these 2 groups. However, no studies have compared incidental findings in breast reduction specimens based on relative risk of cancer. Our study stratifies lesions by relative risk of malignant progression and compares the frequency of these findings in bilateral versus unilateral reduction mammoplasties. METHODS Charts were reviewed from 422 patients undergoing breast reductions by a single surgeon over a 10-year period. Age, procedure, specimen weight, and histologic findings were recorded. Pathologic data were stratified by relative risk of malignant progression and compared between patients with and without cancer histories. RESULTS Three hundred five patients underwent bilateral reduction mammoplasty and 117 patients underwent unilateral reduction mammoplasty over the 10-year period. Bilateral patients had a higher incidence of benign lesions (P = 0.02). Both groups had similar incidences of proliferative lesions (P = 0.48). Unilateral patients had a higher incidence of atypia (P = 0.05) and carcinoma in situ (P < 0.01). One unilateral patient had an incidentally found invasive carcinoma. CONCLUSIONS Patients undergoing unilateral reduction after oncologic resection have a higher incidence of high-risk lesions compared with those undergoing bilateral reductions for macromastia. Although others have compared incidental findings between these cohorts, no group has compared these incidental findings stratified by risk. Our data underscore the importance of pathologic analysis of reduction specimens for early detection of high-risk lesions and will prove valuable for preoperative counseling before reduction mammoplasty for either of these indications.
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Nomikos A, Husain EA, Graham AD. Occult disease in reduction mammoplasties and prophylactic mastectomies. Breast J 2019; 26:691-696. [PMID: 31448509 DOI: 10.1111/tbj.13512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
Abstract
The aim of this study was to determine the incidence of occult breast carcinoma and significant breast disease in clinically and radiologically unremarkable breast reduction specimens and prophylactic mastectomies. A retrospective search using specimen type codes was performed in the computerized histopathology archive from April 2007 to April 2016. The pathology results of 505 patients were analyzed (782 specimens). A total of 267 patients underwent simple reduction mammoplasties (10 unilateral), 20 had bilateral prophylactic mastectomies and 218 undertook contralateral symmetrizing or prophylactic mastectomy surgery following a history of breast cancer. Overall, normal (unremarkable) breast tissue was found in 42.6% of patients (n = 215), benign tissue (nonproliferative/proliferative disease without atypia) in 51.1% (n = 258), significant disease (LCIS/proliferative disease with atypia) in 5.5% (n = 28), and malignant disease (invasive/ductal carcinoma in situ) in 0.8% (n = 4). The incidence of significant breast pathology was statistically higher (P value < .0001) in prophylactic mastectomies (12.4%) compared to reduction mammoplasties (2.3%). There was however no significant increase in the incidence of malignancy between prophylactic mastectomies (1.2%) and reduction mammoplasties (0.6%). Even though the clear majority of resected tissue in reduction mammoplasties and prophylactic mastectomies is benign, our findings support the continued need for histological examination of these specimens for occult carcinoma and precursor lesions.
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Affiliation(s)
| | - Ehab A Husain
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ashley D Graham
- Department of Pathology, Western General Hospital, Edinburgh, UK
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Zambacos GJ. Commentary on: Is Histological Evaluation of Reduction Mammaplasty Specimens Worthwhile? Aesthet Surg J 2019; 39:NP185-NP188. [PMID: 30649210 DOI: 10.1093/asj/sjy314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Demirdover C, Geyik A, Vayvada H, Menderes A. Is Histological Evaluation of Reduction Mammaplasty Specimens Worthwhile? Aesthet Surg J 2019; 39:NP178-NP184. [PMID: 30371739 DOI: 10.1093/asj/sjy295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reduction mammaplasty (RM) is one of the most common plastic surgery procedures. Despite its cost, the total number of RM procedures continues to increase every year. OBJECTIVES The purpose of this study is to review the prevalence of benign and malignant breast lesions among women who live in the Aegean region of Turkey, based on our university hospital's records and to compare our results with those in the literature. METHODS Seven hundred and thirty-three consecutive female patients who underwent RM between January 2003 and January 2017 in the Department of Plastic, Reconstructive, and Aesthetic Surgery were included in this study. RESULTS One hundred and sixty-five patients (23.4%) had preoperative breast imaging results. According to the Breast Imaging Reporting and Data System (BIRADS), most of these patients had BI-RADS-2 and BIRADS-1 findings (41.21% and 40%, respectively). Fibrocystic changes were the most common lesions (81.3%). Sixty-eight patients (9.6%) had normal breast tissue on the right side and 34 patients (4.8%) had the same on the left side. Five patients (0.71%) had atypical ductal hyperplasia and no atypical lobular carcinoma. Four patients (0.56%) had occult breast cancer and one patient (0.14%) had benign phyllodes tumor. CONCLUSIONS RM is a good opportunity to detect proliferative lesions and occult breast cancer. While meeting the patient's aesthetic desires, the plastic surgeon should consider for histopathological evaluation. We suggest that every part of the breast tissue should be sent to pathological examination regardless of the weight of the specimen. Even if health insurance does not cover its cost, patients should be informed about the importance of this process. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Cenk Demirdover
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Alper Geyik
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Haluk Vayvada
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Adnan Menderes
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dokuz Eylul University, Izmir, Turkey
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Lowes S, MacNeill F, Martin L, O'Donoghue JM, Pennick MO, Redman A, Wilson R. Breast imaging for aesthetic surgery: British Society of Breast Radiology (BSBR), Association of Breast Surgery Great Britain & Ireland (ABS), British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). J Plast Reconstr Aesthet Surg 2018; 71:1521-1531. [PMID: 30213745 DOI: 10.1016/j.bjps.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/16/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
This is an overview of the guidelines for breast imaging before and after aesthetic (cosmetic) breast surgery, which includes but is not limited to implants, lipomodelling and mammoplasty procedures. The guidelines are based on a review of the literature and consensus of breast imaging and aesthetic breast surgery specialists. 1. Pre-aesthetic surgery 2. Post-aesthetic surgery If breast imaging or breast assessment is required, it should be performed in a designated breast facility with access to specialist breast imaging and a complete breast multidisciplinary team in accordance with national guidelines and recommendations.
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Affiliation(s)
- Simon Lowes
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, NE9 6SX, United Kingdom.
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom
| | - Lee Martin
- Breast Unit, Aintree University Hospital, Lower Lane, Liverpool, Merseyside, L9 7AL, United Kingdom
| | - Joe M O'Donoghue
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom
| | - Mandana O Pennick
- Department of Breast Surgery, Glan Clwyd Hospital, Rhuddlan Road, Rhyl, Denbighshire, LL18 5UJ, North Wales, United Kingdom
| | - Alan Redman
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, NE9 6SX, United Kingdom
| | - Robin Wilson
- Department of Clinical Radiology, The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom
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Stone JP, Hartley RL, Temple-Oberle C. Breast cancer in transgender patients: A systematic review. Part 2: Female to Male. Eur J Surg Oncol 2018; 44:1463-1468. [DOI: 10.1016/j.ejso.2018.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/27/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022] Open
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Waldner M, Klein HJ, Künzi W, Guggenheim M, Plock JA, Giovanoli P. Occurrence of Occult Malignancies in Reduction Mammoplasties. Front Surg 2018; 5:17. [PMID: 29564332 PMCID: PMC5850823 DOI: 10.3389/fsurg.2018.00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Patients undergoing reduction mammoplasty (RM) bear the risk of having occult breast cancer nests. The detection rate of malignant neoplasms in the resected specimens, varies greatly in the literature. The aim of our present study was to analyze risk factors and evaluate histopathological findings in our cohort of patients who underwent RM towards our center. Material and methods In this retrospective single center study we analyzed 559 female patients [median age 35.99 (±13.34)] who underwent RM between 2000 and 2010. The presence of carcinoma and ductal- (DCIS) or lobular carcinoma in situ (LCIS) were considered as pathological findings. Body mass index (BMI), age, surgical technique and mass of resected tissue were included into the analysis. Results There were 6 cases of occult neoplasia (1.08 %) including 2 cases of breast cancer, one multicentric DCIS and 3 cases of LCIS (0.54 %) in 559 patients. Patients with breast cancer showed a significant increased median age: 49y median (IQR ± 18) vs. 35y (IQR ± 21) (p = 0.004) and a trend towards increased BMI: 25.88 median (IQR ± 7.3) vs. 24.50 (IQR ± 4.09) (p = 0.219), compared to patients without pathological results. One patient with occult carcinoma had a negative preoperative mammography, a patient with LCIS a negative preoperative breast ultrasound. Conclusions In our study the occurrence of occult neoplasia was associated with increased age and showed a trend towards increased BMI when compared to patients without pathological findings. The study demonstrates the necessity of thorough medical history, preoperative diagnostic screening and histopathological analysis of all resected specimens.
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Affiliation(s)
- Matthias Waldner
- Division of Plastic Surgery and Hand Surgery, Universitäts Spital Zürich, Zurich, Switzerland
| | - Holger J Klein
- Division of Plastic Surgery and Hand Surgery, Universitäts Spital Zürich, Zurich, Switzerland
| | - Walter Künzi
- Euro-Policlinic Switzerland, Zurich, Switzerland
| | | | - Jan A Plock
- Division of Plastic Surgery and Hand Surgery, Universitäts Spital Zürich, Zurich, Switzerland
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery, Universitäts Spital Zürich, Zurich, Switzerland
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Meyer L, Bille C, Foged T, Jylling AMB. Occult breast cancer in breast reduction specimens. Acta Oncol 2018; 57:170-173. [PMID: 29202610 DOI: 10.1080/0284186x.2017.1400178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lotte Meyer
- a Department of Pathology, Odense University Hospital , University of Southern Denmark , Odense , Denmark
| | - Camilla Bille
- b Department of Plastic Surgery Z , Odense University Hospital , Odense , Denmark
| | - Thomas Foged
- c Department of Plastic Surgery , Aarhus University Hospital , Aarhus , Denmark
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Huysmans M, Bronckaers M, Schillebeeckx C, Servaes D. Incidental breast carcinoma in reduction mammoplasty. Acta Chir Belg 2017; 117:308-311. [PMID: 28610472 DOI: 10.1080/00015458.2017.1328767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed. METHODS We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented. RESULTS A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2-73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%). CONCLUSIONS Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.
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Affiliation(s)
| | - Marc Bronckaers
- Department of General Surgery, AZ Turnhout, Turnhout, Belgium
| | | | - Dirk Servaes
- Department of General Surgery, AZ Turnhout, Turnhout, Belgium
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Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SM. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Breast 2017; 35:157-161. [DOI: 10.1016/j.breast.2017.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022] Open
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Ambaye AB, Goodwin AJ, MacLennan SE, Naud S, Weaver DL. Recommendations for Pathologic Evaluation of Reduction Mammoplasty Specimens: A Prospective Study With Systematic Tissue Sampling. Arch Pathol Lab Med 2017; 141:1523-1528. [PMID: 28795842 DOI: 10.5858/arpa.2016-0492-oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Breast reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed in more than 100 000 patients per year in the United States. The reported incidence of significant pathologic findings (SPF), that is, carcinoma and atypical hyperplasia, ranges from 0.06% to 12.8%. No standard pathology assessment for RMP exists. OBJECTIVES - To propose standard sampling for microscopic evaluation in RMP specimens, to evaluate the incidence of occult carcinoma and atypical hyperplasia, and to identify clinical risk factors for SPF in patients undergoing RMP. DESIGN - All RMP specimens from 2006 to 2013 at a single institution were prospectively examined. After baseline gross and microscopic evaluations, each specimen was subjected to systematic additional sampling. The incidence of SPF was tabulated, and variables such as age, specimen weight, previous history of SPF, and results of preoperative mammogram were examined. Clinical follow-up review was also subsequently undertaken. RESULTS - A total of 595 patients were evaluated. Significant pathologic findings were present in 9.8% (58 of 595) of patients. No cancer was identified in patients younger than 40 years; the rates of carcinoma were 2.4% (14 of 595) in all patients, 3.6% (14 of 392) in patients aged 40 years or older, and 4.3% (10 of 233) in patients aged 50 years or older. No carcinoma or atypical hyperplasia was identified on preoperative mammogram. Increased sampling was associated with a significantly greater frequency of SPF only in patients aged 40 years or older. CONCLUSIONS - In patients younger than 35 years, gross-only evaluation is sufficient. However, increased sampling may be necessary in patients older than 40 years.
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Affiliation(s)
- Abiy B Ambaye
- From the Departments of Pathology and Laboratory Medicine (Drs Ambaye, Goodwin, and Weaver) and Surgery (Dr MacLennan), University of Vermont Medical Center, Burlington; and the Department of Medical Biostatistics, University of Vermont, Burlington (Dr Naud)
| | - Andrew J Goodwin
- From the Departments of Pathology and Laboratory Medicine (Drs Ambaye, Goodwin, and Weaver) and Surgery (Dr MacLennan), University of Vermont Medical Center, Burlington; and the Department of Medical Biostatistics, University of Vermont, Burlington (Dr Naud)
| | - Susan E MacLennan
- From the Departments of Pathology and Laboratory Medicine (Drs Ambaye, Goodwin, and Weaver) and Surgery (Dr MacLennan), University of Vermont Medical Center, Burlington; and the Department of Medical Biostatistics, University of Vermont, Burlington (Dr Naud)
| | - Shelly Naud
- From the Departments of Pathology and Laboratory Medicine (Drs Ambaye, Goodwin, and Weaver) and Surgery (Dr MacLennan), University of Vermont Medical Center, Burlington; and the Department of Medical Biostatistics, University of Vermont, Burlington (Dr Naud)
| | - Donald L Weaver
- From the Departments of Pathology and Laboratory Medicine (Drs Ambaye, Goodwin, and Weaver) and Surgery (Dr MacLennan), University of Vermont Medical Center, Burlington; and the Department of Medical Biostatistics, University of Vermont, Burlington (Dr Naud)
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Breast Cancer Detection by Preoperative Imaging in Reduction Mammaplasty Patients: A Single Center Study of 918 Patients. World J Surg 2017; 41:2013-2019. [PMID: 28255630 DOI: 10.1007/s00268-017-3920-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of preoperative imaging and the usability of different imaging modalities is highly variable and controversial in reduction mammaplasty patients. Our study describes the imaging process in a single center in regard to modality selection, age and timing, and of the association between imaging and histopathological findings in reduction mammaplasty specimens. METHODS Nine hundred eighteen women, who underwent reduction mammaplasty during 1.1.2007-31.12.2011, were retrospectively reviewed for demographics, preoperative imaging, further preoperative examinations, and pathology reports. RESULTS Preoperative imaging had been conducted for 89.2% (n = 819) of the patients. In 49 (6.0%) patients, suspicious preoperative imaging led to further examinations revealing 2 high-risk lesions (atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS)), and 2 cancers preoperatively. Postoperatively abnormal histopathology specimens were revealed in 88 (10.4%) patients. The incidence of high-risk lesions was 5.5% (n = 47), and the incidence of cancer was 1.2% (n = 10). Preoperative imaging was normal (BI-RADS 1 and BI-RADS 2) in 80.8% of these patients. The sensitivity of the preoperative imaging for cancer detection was 20.0%, and the specificity was 100.0%. CONCLUSIONS Preoperative imaging and further examinations do not sufficiently detect malignant or cancer risk-increasing findings. Therefore, histopathological analysis of reduction mammaplasty specimens seems mandatory.
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Should we routinely analyze reduction mammaplasty specimens? J Plast Reconstr Aesthet Surg 2016; 70:196-202. [PMID: 27908767 DOI: 10.1016/j.bjps.2016.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/05/2016] [Accepted: 10/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reduction mammaplasty is one of the most common plastic surgery procedures. Preoperative imaging and histopathology protocols vary among countries and institutions. We aimed to analyze the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens. We also analyzed whether patients with abnormal histopathology differed from the study population in terms of demographics. PATIENTS AND METHODS In total, 918 women who underwent reduction mammaplasty from January 2007 to December 2011 were retrospectively reviewed for demographics, preoperative imaging, further preoperative examinations, pathology reports, and postoperative follow-up. RESULTS Abnormal histopathological findings were revealed in 88 (10%) patients with a mean age of 49.5 ± 10.2 years. The incidence of breast cancer was 1.2%, and the incidence of high-risk lesions (atypical ductal and lobular hyperplasia and lobular carcinoma in situ) was 5.5%. Age and specimen weights were significantly higher in patients with abnormal histopathology. Eighty-one percent of patients with abnormal histopathology had normal preoperative imaging revealing two high-risk and two cancer findings. Two patients developed breast cancer in the same breast in which the high-risk lesion was originally detected. CONCLUSION Women with abnormal histopathology cannot be sufficiently detected preoperatively. Therefore, histopathological analysis of reduction mammaplasty specimens seems mandatory. Reduction mammaplasty combined with subsequent histopathological examination offers a sufficient chance of detecting cancer and risk-increasing lesions that merits the cost of histopathology.
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21
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Radial Scar at Percutaneous Breast Biopsy That Does Not Require Surgery. J Am Coll Surg 2016; 223:712-716. [DOI: 10.1016/j.jamcollsurg.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 11/20/2022]
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Theophilou G, Fogarty SW, Trevisan J, Strong RJ, Heys KA, Patel II, Stringfellow HF, Martin-Hirsch PL, Martin FL. Spatial and temporal age-related spectral alterations in benign human breast tissue. J Mol Struct 2016. [DOI: 10.1016/j.molstruc.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The incidence of occult breast cancer detected by reduction mammoplasty is 0.06% to 5.45%. Preoperative screening mammography is indicated in all women 40 years and older and in women age 35 with a positive family or personal history of breast cancer before reduction mammoplasty. Breast MRI is considered in women with dense breasts and those with hereditary breast cancer syndromes. Management of occult breast cancer is impacted by specimens being typically removed in pieces and not oriented before submission to pathology. Total mastectomy is the most common treatment because of the uncertainties regarding margin status and disease extent.
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Affiliation(s)
- Grant W Carlson
- Department of Surgery, School of Medicine, Emory University, 1365C Clifton Road, Atlanta, GA 30322, USA.
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24
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Sorin T, Fyad J, Delay E, Rouanet P, Rimareix F, Houpeau J, Classe J, Garrido I, Tunon De Lara C, Dauplat J, Bendavid C, Houvenaeghel G, Clough K, Sarfati I, Leymarie N, Trudel M, Salleron J, Guillemin F, Oldrini G, Brix M, Dolivet G, Simon E, Verhaeghe J, Marchal F. Occult cancer in specimens of reduction mammaplasty aimed at symmetrization. A multicentric study of 2718 patients. Breast 2015; 24:272-7. [DOI: 10.1016/j.breast.2015.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 01/01/2023] Open
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Merkkola-von Schantz P, Jahkola T, Carpelan A, Krogerus L, Hukkinen K, Kauhanen S. Adverse Histopathology and Imaging Findings in Reduction Mammaplasty Day-surgery Patients. Scand J Surg 2014; 103:209-214. [DOI: 10.1177/1457496913512828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Reduction mammaplasty is a popular procedure in plastic surgery. Occasionally, occult invasive breast carcinoma or findings demonstrating increased risk of breast cancer occur in reduction mammaplasty specimens. The incidences have been studied elsewhere, but in Finland, the data on this subject are lacking. Our aim was to analyze the incidence of occult invasive and in situ carcinoma and benign breast disease causing increased risk of breast cancer in reduction mammaplasty specimens. We also analyzed preoperative mammograms and ultrasound images and compared findings with reduction mammaplasty specimens. Material and Methods: We performed a retrospective study of 100 women who underwent reduction mammaplasty during 1 January 2007 to 30 April 2009 in Jorvi Hospital day-surgery unit. Demographic data, findings in preoperative imaging, pathology reports, postoperative follow-up, and retrospective reanalysis of preoperative imaging were recorded. Results: Histological abnormality occurred in 14.6% of the patients. In situ carcinoma was diagnosed in 4.5% of the patients, and findings demonstrating increased risk of breast cancer were diagnosed in 13.5% of the patients. More than one lesion demonstrating increased risk of breast cancer was diagnosed in 4.5% of the patients. No invasive carcinoma occurred. Preoperative mammogram was performed for the majority (94.0%) of the patients. Conclusions: We detected a considerable amount of findings in reduction mammaplasty specimens with prognostic value with regard to future breast cancer risk. We recommend histological analysis for reduction mammaplasty specimens and focus attention on systematically performed preoperative imaging.
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Affiliation(s)
| | - T. Jahkola
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - A. Carpelan
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - L. Krogerus
- Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland
| | - K. Hukkinen
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - S. Kauhanen
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Sorin T, Fyad JP, Pujo J, Colson T, Bordes V, Leroux A, Marchal F, Brix M, Simon E, Verhaeghe JL, Classe JM, Dolivet G. Incidence of occult contralateral carcinomas of the breast following mastoplasty aimed at symmetrization. ANN CHIR PLAST ESTH 2014; 59:e21-8. [PMID: 24530086 DOI: 10.1016/j.anplas.2013.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/22/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Breast carcinomas are the most frequent form of cancer in French women. Following a total mastectomy, only an estimated 25% of patients wish to undergo breast reconstruction. After mammary volume reconstitution, the plastic surgeon often attempts to harmonize the two breasts by carrying out contralateral reduction mammaplasty (CRM). In the literature, the incidence of occult contralateral carcinomas incidentally discovered in surgical specimens ranges from 1.12 to 4.5%. The main objective of this study was to evaluate occurrence of carcinoma in the CRM specimens in the framework of a breast reconstruction operation. The secondary objective was to determine the consequences of the incidentally discovered carcinoma in the contralateral breast. MATERIAL AND METHODS This was a 6-year, bicentric, retrospective study involving women having undergone breast cancer surgery who later underwent contralateral reduction mammaplasty (CRM), that is to say reconstruction aimed at harmonization of the two breasts. RESULTS Three hundred and nineteen patients were included in the study. Mean age during the CRM was 55years (29-79). Mean weight of the surgical specimens was 323grams (12-2500). Incidence of occult carcinomas found in the specimens was 0.94% (3 patients). The mean age for these 3 cases was 58years (47-64). All 3 patients had superior pedicle mammaplasty. One of the patients benefited from monobloc resection with orientation of the surgical specimen. In the other 2 cases, there existed 3 surgical resection specimens; in one case, they were oriented; in the other, they were not. In all 3 cases, the histological findings were unifocal ductal carcinomas in situ (DCIS). Mean tumor size was 5.7mm (3-9). Only the patient having had monobloc resection with orientation of the specimen underwent salvage surgery, which consisted in partial mastectomy, otherwise known as secondary lumpectomy. Adjuvant radiotherapy was administered to all of the patients. After 17months of mean follow-up (12-22), no recurrence was found in any of the three cases. CONCLUSION Incidence of occult contralateral breast carcinomas after symmetrization CRM approximates 1%. Our observations are in agreement with the data in the literature. Incidence is greater than in mammaplasty carried out for esthetic or functional reasons; this is probably due to the higher age and the previous breast cancer history of the breast reconstruction population. Monobloc resection and orientation of the surgical specimens with surgeon's knots facilitate precise pinpointing of the occult carcinoma. A secondary lumpectomy may take place when margins of excision are invaded or inadequate.
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Affiliation(s)
- T Sorin
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - J-P Fyad
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - J Pujo
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - T Colson
- Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - V Bordes
- Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - A Leroux
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - F Marchal
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - M Brix
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - E Simon
- Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - J-L Verhaeghe
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - J-M Classe
- Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Dolivet
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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Patel II, Shearer DA, Fogarty SW, Fullwood NJ, Quaroni L, Martin FL, Weisz J. Infrared microspectroscopy identifies biomolecular changes associated with chronic oxidative stress in mammary epithelium and stroma of breast tissues from healthy young women: implications for latent stages of breast carcinogenesis. Cancer Biol Ther 2013; 15:225-35. [PMID: 24107651 DOI: 10.4161/cbt.26748] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Studies of the decades-long latent stages of breast carcinogenesis have been limited to when hyperplastic lesions are already present. Investigations of earlier stages of breast cancer (BC) latency have been stymied by the lack of fiducial biomarkers needed to identify where in histologically normal tissues progression toward a BC might be taking place. Recent evidence suggests that a marker of chronic oxidative stress (OxS), protein adducts of 4-hydroxy-2-nonenal (4HNE), can meet this need. Specifically: (1) 4HNE immunopositive (4HNE+) mammary epithelial (ME) cells were found to be prevalent in normal (reduction mammoplasty) tissues of most women (including many teenagers) studied, representative of those living in the United States' high risk-posing environment and: (2) marked (> 1.5-fold) differences were identified between tissues of healthy young women with many vs. few 4HNE+ ME cells in the relative levels of transcripts for 42 of the 84 OxS-associated genes represented in SABioscience Oxidative-Stress/Oxidative-Defense PCR array. Herein we used synchrotron radiation-based Fourier-transform infrared (SR-FTIR) microspectroscopy to identify molecular changes associated with 4HNE adducts in basal and luminal ME cells in terminal ductal units (TDLU), which are the cells of origin of BC, and associated intralobular and interlobular stroma, known contributors to carcinogenesis. Multivariate analysis-derived wavenumbers differentiated 4HNE+ and 4HNE- cells in each of the anatomical compartments. Specifically, principal component and linear discriminant analyses of mid-infrared spectra obtained from these cells revealed unambiguous, statistically highly significant differences in the "biochemical fingerprint" of 4HNE+ vs. 4HNE- luminal and basal ME cells, as well as between associated intralobular and interlobular stroma. These findings demonstrate further SR-FTIR microspectroscopy's ability to identify molecular changes associated with altered physiological and/or pathophysiological states, in this case with a state of chronic OxS that provides a pro-carcinogenic microenvironment.
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Affiliation(s)
- Imran I Patel
- Center for Biophotonics; Lancaster Environment Centre; Lancaster University; Lancaster, UK
| | - Debra A Shearer
- Department of Obstetrics and Gynecology; College of Medicine; Pennsylvania State University; Hershey, PA USA
| | - Simon W Fogarty
- Division of Biomedical and Life Sciences; Faculty of Health and Medicine; Lancaster University; Lancaster, UK
| | - Nigel J Fullwood
- Division of Biomedical and Life Sciences; Faculty of Health and Medicine; Lancaster University; Lancaster, UK
| | | | - Francis L Martin
- Center for Biophotonics; Lancaster Environment Centre; Lancaster University; Lancaster, UK
| | - Judith Weisz
- Department of Obstetrics and Gynecology; College of Medicine; Pennsylvania State University; Hershey, PA USA; Department of Pathology; College of Medicine; Pennsylvania State University; Hershey, PA USA
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Kececi Y, Tasli FA, Yagcı A, Sır E, Canpolat S, Vardar E. Histopathologic findings in breast reduction specimens. J Plast Surg Hand Surg 2013; 48:122-5. [PMID: 23879776 DOI: 10.3109/2000656x.2013.823093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reduction mammaplasty is a commonly performed operation for treatment of breast hypertrophy. It allows examination of specimens from a seemingly healthy population. Although there are many publications reporting the incidence of occult breast carcinomas, only a few studies have specifically examined the incidence of other breast lesions in reduction mammaplasty specimens. The authors conducted a single-centre retrospective chart review examining the incidence of benign and precancerous lesions in breast reduction specimens. Both age and the number of tissue sections were evaluated for the association with important pathologic findings. Of the 95 patients who underwent reduction mammaplasty, eight patients (8.4%) had atypical lesions. Fourteen patients (15%) had proliferative and 54 patients (57%) had non-proliferative breast lesions. No occult invasive breast cancer was identified in the breast reduction specimens. The existence of significant pathologic findings was not associated with age (p = 0.231, student t-test). On the other hand, it was found to be associated with the number of tissue sections (p = 0.046, Mann-Whitney U-test). This study reveals that breast reduction specimens should be analyzed histologically since a considerable amount of patients have breast lesions with increased cancer risk. Therefore, this analysis would guide the management of these patients in the follow-up period.
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