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Yu M, Shi G, Gao Z, Wu K, Wei C, Li X, Miao X. A case report and a literature review of double mammary pseudoangiomatous stromal hyperplasia associated with galactoma during pregnancy. Front Oncol 2024; 14:1359886. [PMID: 38601752 PMCID: PMC11004339 DOI: 10.3389/fonc.2024.1359886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign interstitial hyperplasia of the breast that usually occurs in premenopausal or perimenopausal women. It is usually characterized by localized lesions or clear boundary masses, and diffuse double breast enlargement is rare. PASH is considered a hormone-dependent disease that is commonly progesterone related. There are no imaging characteristics, and both benign and suspicious malignant signs can be seen. The definitive diagnosis of PASH depends on a pathological diagnosis, and it is necessary to be vigilant in distinguishing between benign and malignant tumors with similar breast histopathology. Here, we report the case of a 23-year-old multipara patient with bilateral diffuse pseudoangiomatous stromal hyperplasia of the breast during pregnancy who presented with macromastia and reviewed the literature to further understand the clinical features, pathological diagnosis, differential diagnosis, treatment and prognosis of pseudoangiomatous stromal hyperplasia of the breast.
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Affiliation(s)
- Minmin Yu
- Pathology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangxi Shi
- Breast and Thyroid Surgery Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zong Gao
- Neurosurgery Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kai Wu
- Pathology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Cuilei Wei
- Pathology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaohong Li
- First Clinical School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiuming Miao
- Pathology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Ammann AM, Pratt CG, Lewis JD, Ahmad SA, Shaughnessy E, Heelan AA. Breast infections: A review of current literature. Am J Surg 2024; 228:78-82. [PMID: 37949727 DOI: 10.1016/j.amjsurg.2023.10.040] [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: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Breast infections are common, affect women of all ages, and are associated with significant morbidity. Despite overall prevalence, treatment varies significantly based on provider or institution and no central treatment guidelines exist to direct the management of breast infections. This article provides a summary of the current trends in management of breast infections. The etiology, epidemiology, risk factors, presentation, diagnosis, and treatment of mastitis and breast abscesses (and their relative subdivisions) are explored based on the current literature. Trends in microbiology are reviewed and an approach to antibiotic coverage is proposed. Overall, there is a lack of randomized-controlled trials focused on the treatment of breast infections. This has resulted in an absence of clinical practice guidelines for the management of breast abscesses and variable practice patterns. The development of best-care protocols or pathways could provide more uniformity in care of breast infections.
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Affiliation(s)
- Allison M Ammann
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Catherine G Pratt
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Jaime D Lewis
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Elizabeth Shaughnessy
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Alicia A Heelan
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
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3
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Guan Y, Haardörfer R, McBride CM, Escoffery C, Lipscomb J. Testing Theory-Based Messages to Encourage Women at Average Risk for Breast Cancer to Consider Biennial Mammography Screening. Ann Behav Med 2023; 57:696-707. [PMID: 37155576 DOI: 10.1093/abm/kaad018] [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] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The US Preventive Services Task Force does not recommend routine annual mammography screening for women aged 40-49 at average risk. Little research has been done to develop theory-based communication interventions to facilitate informed decision-making about reducing potentially low-value mammography screening. PURPOSE Evaluate the effects of theory-based persuasive messages on women's willingness to consider delaying screening mammography until age 50 or have mammograms biennially. METHODS We conducted a randomized controlled communication experiment online with a population-based sample of U.S. women aged 40-49 (N = 383) who screened to be at average risk for breast cancer. Women were randomly assigned to the following messaging summaries: annual mammography risks in 40s (Arm 1, n = 124), mammography risks plus family history-based genetic risk (Arm 2, n = 120), and mammography risks, genetic risk, and behavioral alternatives (Arm 3, n = 139). Willingness to delay screening or reduce screening frequency was assessed post-experiment by a set of 5-point Likert scale items. RESULTS Women in Arm 3 reported significantly greater willingness to delay screening mammography until age 50 (mean = 0.23, SD = 1.26) compared with those in Arm 1 (mean = -0.17, SD = 1.20; p = .04). There were no significant arm differences in willingness to reduce screening frequency. Exposure to the communication messages significantly shifted women's breast cancer-related risk perceptions without increasing unwarranted cancer worry across all three arms. CONCLUSIONS Providing women with screening information and options may help initiate challenging discussions with providers about potentially low-value screening.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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4
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Azam R, Mrkonjic M, Gupta A, Gladdy R, Covelli AM. Mesenchymal Tumors of the Breast: Fibroblastic/Myofibroblastic Lesions and Other Lesions. Curr Oncol 2023; 30:4437-4482. [PMID: 37232796 DOI: 10.3390/curroncol30050338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 05/27/2023] Open
Abstract
Mesenchymal breast tumors are a rare and diverse group of tumors that present some of the most challenging cases for multidisciplinary breast cancer teams. As a result of overlapping morphologies and a lack of large-scale studies on these tumors, practices are often heterogeneous and slow to evolve. Herein, we present a non-systematic review that focuses on progress, or lack thereof, in the field of mesenchymal breast tumors. We focus on tumors originating from fibroblastic/myofibroblastic cells and tumors originating from less common cellular origins (smooth muscle, neural tissue, adipose tissue, vascular tissue, etc.).
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Affiliation(s)
- Riordan Azam
- Postgraduate Medical Education, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Miralem Mrkonjic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1X5, Canada
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Abha Gupta
- Department of Medical Oncology, University of Toronto, Toronto, ON M5G 1X8, Canada
- The Hospital for Sick Children and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rebecca Gladdy
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Andrea M Covelli
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
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Suga Y, Kuehn T, W/Ammanuel G, Knfe G, Teklewold B. Review of Breast Abscess Cases at a Tertiary Hospital in Addis Ababa, Ethiopia. Int J Womens Health 2023; 15:433-442. [PMID: 36999001 PMCID: PMC10046216 DOI: 10.2147/ijwh.s391686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Background Breast abscess is a prevalent cause of morbidity in women occurring in 0.4% to 11% of patients after mastitis. The majority are benign, but worrisome etiologies such as inflammatory cancer and concomitant immune-compromising diseases should be addressed when a non-lactating patient presents with a breast abscess. The problem is high among women in developing countries (1). The purpose of this study is to assess the magnitude, clinical presentation, and treatment of breast abscess patients at a tertiary hospital. Methodology A descriptive cross-sectional study was conducted on all patients treated for breast abscesses from September 2015 to August 2020. A retrospective review of the clinical records was performed to collect data on sociodemographic, clinical, and management data using a data extraction form. The collected data were then cleaned and entered into SPSS for analysis. Results Two hundred and nine patients were included in this study over 5 years and lactational breast abscess (LBA) is more prevalent,182 (87.1%) than non-lactational breast abscess (NLBA), 27 (12.9%). Bilateral breast abscesses occurred in 16 (7.7%) patients. Patients presented at a median duration of 11 days and had been breastfeeding for 2 or more months. A spontaneously ruptured abscess was detected in, 30 (14.4%) of the patients. Comorbidities identified include diabetes mellitus (DM) in, 24 (11.5%), Hypertension in, 7 (3.3%), HIV in, 5 (2.4%) of patients. All women were treated with Incision and Drainage and had a median volume of 60 mL of pus drained. Following surgery, all patients were given ceftriaxone in the immediate post-operative days and either cloxacillin,167 (80.3%), or Augmentin,41 (19.7%) antibiotics p on discharge. Follow-up data were available for 201 (96.1%) patients and the recurrence rate was 5.8%. Conclusions and Recommendations Lactational breast abscesses are more common than non-lactational breast abscesses, particularly in primiparas. DM is the most common comorbidity in non-lactational breast abscesses and health-seeking behavior should be improved given the delayed presentation.
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Affiliation(s)
- Yisihak Suga
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Correspondence: Yisihak Suga, Tel +251913470780, Email ;
| | - Thorsten Kuehn
- Department of Gynecological Oncology and Gynecologic Surgery, Klinikum Esslingen, Esslingen, Germany
| | - Gessesse W/Ammanuel
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goytom Knfe
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Berhanetsehay Teklewold
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Román M, Louro J, Posso M, Vidal C, Bargalló X, Vázquez I, Quintana MJ, Alcántara R, Saladié F, del Riego J, Peñalva L, Sala M, Castells X. Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052625. [PMID: 35270331 PMCID: PMC8909630 DOI: 10.3390/ijerph19052625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022]
Abstract
Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
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Affiliation(s)
- Marta Román
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | - Javier Louro
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain;
| | - Xavier Bargalló
- Department of Radiology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Ivonne Vázquez
- Pathology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Rodrigo Alcántara
- Radiology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - Francina Saladié
- Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain;
| | - Javier del Riego
- Department of Radiology, Parc Taulí University Hospital-UAB, 08208 Sabadell, Spain;
| | - Lupe Peñalva
- Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, 08402 Granollers, Spain;
| | - Maria Sala
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
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Chen M, Wu X, Zhang J, Dong E. Prediction of total hospital expenses of patients undergoing breast cancer surgery in Shanghai, China by comparing three models. BMC Health Serv Res 2021; 21:1334. [PMID: 34903242 PMCID: PMC8667393 DOI: 10.1186/s12913-021-07334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Breast cancer imposes a considerable burden on both the health care system and society, and becomes increasingly severe among women in China. To reduce the economic burden of this disease is crucial for patients undergoing the breast cancer surgery, hospital managers, and medical insurance providers. However, few studies have evidenced the prediction of the total hospital expenses (THE) for breast cancer surgery. The aim of the study is to predict THE for breast cancer surgery and identify the main influencing factors. METHODS Data were retrieved from the first page of medical records of 3699 patients undergoing breast cancer surgery in one tertiary hospital from 2017 to 2018. Multiple liner regression (MLR), artificial neural networks (ANNs), and classification and regression tree (CART) were constructed and compared. RESULTS The dataset from 3699 patients were randomly divided into training and test sets at a 70:30 ratio (2599 and 1100 records, respectively). The average total hospital expenses were 12520.54 ± 7844.88 ¥ (US$ 1929.20 ± 1208.11). MLR results revealed six factors to be significantly associated with THE: age, LOS, type of disease, having medical insurance, minimally invasive surgery, and receiving general anesthesia. After comparing three models, ANNs was the best model to predict THEs in patients undergoing breast cancer surgery, and its strong predictive performance was also validated. CONCLUSIONS To reduce the THEs, more attention should be paid to related factors of LOS, major and minimally invasive surgeries, and general anesthesia for these patient groups undergoing breast cancer surgery. This may reduce the information asymmetry between doctors and patients and provide more reliable cost, practical inpatient medical consumption standards and reimbursement standards reference for patients, hospital managers, and medical insurance providers ,respectively.
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Affiliation(s)
- Minjie Chen
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Xiaopin Wu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Jidong Zhang
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China.
| | - Enhong Dong
- School of Nursing and Health Management, Shanghai university of medicine and health sciences, No.279 Zhouzhu Road, Shanghai, 210318, China.
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Shah H, Surujballi J, Awan AA, Hutton B, Arnaout A, Shorr R, Vandermeer L, Alzahrani MJ, Clemons M. A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management. Breast Cancer Res Treat 2020; 185:533-547. [PMID: 33156490 DOI: 10.1007/s10549-020-06009-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Choosing Wisely (CW)® was created by the American Board of Internal Medicine (ABIM) to promote patient-physician conversations about unnecessary medical interventions. Similarly, other countries created their own panels of experts called "CW® campaigns" which review recommendations submitted by that country's oncology societies. We performed a scoping review to consolidate CW® recommendations from different groups with respect to breast cancer care. METHODS A systematic search of Medline and Embase was designed by an information specialist for publications presenting CW® recommendations for breast cancer care practices from 2011-2020. We also reviewed the websites of all CW® campaigns and reference sections of each CW® recommendation. Two reviewers independently screened studies for inclusion and performed data extraction. Findings were summarized narratively. RESULTS Review of ABIM CW® recommendations showed 19 breast cancer-related recommendations pertaining to; screening (n = 4), radiological staging (n = 2), treatment (n = 10), surveillance (n = 2), and miscellaneous (genetic testing; n = 1). Of 22 countries with CW® campaigns, 10 published recommendations for breast cancer. Over half (57%) of recommendations were supported by more than one country. No recommendations were refuted between campaigns. Two campaigns developed 3 novel recommendations on new topics, including chemotherapy in ductal carcinoma in situ (Italy) and comparison of screening imaging modalities (Portugal). CONCLUSIONS CW® recommendations focus on reducing overutilization of investigations and treatments. There was a high rate of consensus between different CW® campaigns. As health care systems globally move attention to reduce low-value care, further studies are required to address adherence to these current recommendations and develop new recommendations.
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Affiliation(s)
- Hely Shah
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Julian Surujballi
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Arif Ali Awan
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Brian Hutton
- The University of Ottawa, School of Epidemiology and Public Health, and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Angel Arnaout
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | - Mashari Jemaan Alzahrani
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Mark Clemons
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. .,Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada. .,The University of Ottawa, School of Epidemiology and Public Health, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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9
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Whitworth P, Hogan A, Ferko N, Son D, Wang F, Xiong Y, Suri H, Barclay B. Reduced Hospital Costs for Ultrasound-guided Vacuum-assisted Excision Compared with Open Surgery in Patients with Benign Breast Masses and High-risk Lesions. JOURNAL OF BREAST IMAGING 2020; 2:452-461. [PMID: 38424905 DOI: 10.1093/jbi/wbaa055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Benign breast masses represent a substantial proportion of breast cancer screening results and may require multiple follow-up visits and biopsy. Even with a preceding benign core biopsy, benign masses have been excised via open surgery for a variety of reasons. This study compared the procedural costs of US-guided vacuum-assisted excision (US-VAE) versus open surgical excisions for benign breast masses and high-risk lesions (HRL). METHODS In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective. RESULTS A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001). CONCLUSION Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.
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Affiliation(s)
| | | | | | | | - Faye Wang
- Becton, Dickinson and Company, Tempe, AZ
| | - Yan Xiong
- Becton, Dickinson and Company, Franklin Lakes, NJ
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10
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Naso JR, Chiu CG, Goecke ME, Chang D, Shiau CJ. Benign spindle cell lesions of the breast: a diagnostic approach to solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. J Clin Pathol 2019; 72:438-442. [PMID: 30739079 DOI: 10.1136/jclinpath-2018-205561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/12/2019] [Accepted: 01/19/2019] [Indexed: 01/20/2023]
Abstract
Benign spindle cell lesions of the breast include neoplastic and reactive entities that are diagnostically challenging given their rarity and similar histomorphology. Accurate diagnosis on percutaneous core biopsy within this category is essential as some lesions require excision and surveillance, whereas others may be observed. We present three cases of rare benign spindle cell lesions of the breast that reflect the diversity of this group: solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. Through these cases, we discuss the associated differential diagnosis and demonstrate how emerging ancillary studies can be integrated into a diagnostic approach. We highlight distinctive clinical and histopathological features and summarise recent updates to the clinical management of these lesions. An organised approach to the broad differential of spindle cell lesions is essential for appropriate diagnosis and treatment.
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Affiliation(s)
- Julia R Naso
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Connie G Chiu
- Department of Surgery, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Michelle E Goecke
- Department of Surgery, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Debra Chang
- Department of Radiology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Carolyn J Shiau
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada .,Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
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