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Freitas V, Li X, Amitai Y, Au F, Kulkarni S, Ghai S, Mulligan AM, Bromley M, Siepmann T. Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer. Radiology 2022; 304:297-307. [PMID: 35471109 DOI: 10.1148/radiol.212361] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The diagnostic value of screening the contralateral breast with MRI in patients with newly diagnosed breast cancer is poorly understood. Purpose To assess the impact of MRI for screening the contralateral breast on long-term outcomes in patients with newly diagnosed breast cancer and to determine whether subgroups with unfavorable prognoses would benefit from MRI in terms of survival. Materials and Methods Data on consecutive patients with newly diagnosed breast cancer seen from January 2008 to December 2010 were reviewed retrospectively. Patients with neoadjuvant chemotherapy, previous breast cancer, distant metastasis, absence of contralateral mammography at diagnosis, and no planned surgical treatment were excluded. Groups that did and did not undergo preoperative MRI were compared. Survival analysis was performed using the Kaplan-Meier method for propensity score-matched groups to estimate cause-specific survival (CSS) and overall survival (OS). A marginal Cox proportional hazards model was used to evaluate association of MRI and clinicopathologic variables with OS. Results Of 1846 patients, 1199 fulfilled the inclusion criteria. Median follow-up time was 10 years (range, 0-14 years). The 2:1 matched sample comprised 705 patients (470 in the MRI group and 235 in the no-MRI group); median ages at surgery were 59 years (range, 31-87 years) and 64 years (range, 37-92 years), respectively. MRI depicted contralateral synchronous disease more frequently (27 of 470 patients [5.7%] vs five of 235 patients [2.1%]; P = .047) and was associated with a higher OS (hazard ratio [HR], 2.51; 95% CI: 1.25, 5.06; P = .01). No differences were observed between groups in metachronous disease rate (MRI group: 21 of 470 patients [4.5%]; no-MRI group: 10 of 235 patients [4.3%]; P > .99) or CSS (HR, 1.34; 95% CI: 0.56, 3.21; P = .51). MRI benefit was greater in patients with larger tumor sizes (>2 cm) (HR, 2.58; 95% CI: 1.11, 5.99; P = .03) and histologic grade III tumors (HR, 2.94; 95% CI: 1.18, 7.32; P = .02). Conclusion Routine MRI screening of the contralateral breast after first diagnosis of breast cancer improved overall survival; the most pronounced benefit was found in patients with larger primary tumor size and primary tumors of histologic grade III. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Taourel in this issue.
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Affiliation(s)
- Vivianne Freitas
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Xuan Li
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Yoav Amitai
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Frederick Au
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Supriya Kulkarni
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Sandeep Ghai
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Anna Marie Mulligan
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Miluska Bromley
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Timo Siepmann
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
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2
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Maxillary Sinus Vascular Malformation or Metastatic Renal Cell Carcinoma: The Importance of Differential Diagnosis. Indian J Otolaryngol Head Neck Surg 2021; 74:1562-1565. [PMID: 34226868 PMCID: PMC8244670 DOI: 10.1007/s12070-021-02478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/16/2021] [Indexed: 11/11/2022] Open
Abstract
Epistaxis is a common presenting complain with varied differentials. Our case is of epistaxis due to maxillary sinus vascular malformation which could be managed with embolization and endoscopic excision. Histopathologically, the lesion had features of metastatic renal cell carcinoma (RCC). A RCC metastatic lesion masquerading as a maxillary sinus vascular malformation (VM) has been extremely rare in published literature. We present this interesting case of maxillary sinus VM and also briefly review the relevant literature.
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3
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Lameijer JRC, Nederend J, Voogd AC, Tjan-Heijnen VCG, Duijm LEM. Frequency and diagnostic outcome of bilateral recall at screening mammography. Int J Cancer 2020; 148:48-56. [PMID: 32621785 PMCID: PMC7689830 DOI: 10.1002/ijc.33187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
Our study was performed to determine the frequency of recall for bilateral breast lesions at screening mammography and compare its outcome with respect to unilateral recall. We included 329 132 screening mammograms (34 889 initial screens and 294 243 subsequent screens) from a Dutch screening mammography program between January 2013 and January 2018. During a 2‐year follow‐up, we collected radiological data, pathology reports and surgical reports of all recalled women. At bilateral recall, the lesion with the highest Breast Imaging Reporting and Data System score was used as the index lesion when comparing screening mammography characteristics at bilateral vs unilateral recall. A total of 9806 women were recalled at screening (recall rate, 3.0%). Bilateral recall comprised 2.8% (271/9806) of all recalls. Biopsy was more frequently performed after bilateral recall than unilateral recall (54.6% [148/271] vs 44.1% [4201/9535], P < .001), yielding a lower positive predictive value (PPV) of biopsy after bilateral recall (42.6% vs 51.7%, P = .029). The PPV of recall was comparable for both groups (23.2% [63/271] vs 22.8% [2173/9535], P = .85). Invasive cancers after bilateral recall were larger than those diagnosed after unilateral recall (P = .02), but histological subtype, histologic grading, receptor status and proportions of lymph node positive cancers were comparable. Bilateral recall infrequently occurs at screening mammography. Biopsy is more frequently performed following bilateral recall, but the PPV of recall is similar for unilateral and bilateral recall. Invasive cancers of both groups show comparable pathological features except of a larger tumor size after bilateral recall. What's new? Data on bilateral breast cancer in a screened population is sparse, and information on bilateral recall is lacking. Based on more than 329,000 screening mammograms, our study shows that bilateral recall occurs infrequently at screening mammography, and that the majority of these recalls are false positives. Invasive cancer has comparable pathological features in bilateral and unilateral breast cancer patients, except larger tumour size after bilateral recall. Altogether, the results highlight the need for screening radiologists to pay vigorous attention to the contralateral breast after detecting a screening mammographic abnormality in order to facilitate a timely diagnosis of bilateral breast cancer.
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Affiliation(s)
- Joost R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Breast Cancer Screening, Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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4
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Mejdahl MK, Wohlfahrt J, Holm M, Knoop AS, Tjønneland A, Melbye M, Kroman N, Balslev E. Synchronous bilateral breast cancer: a nationwide study on histopathology and etiology. Breast Cancer Res Treat 2020; 182:229-238. [PMID: 32441019 DOI: 10.1007/s10549-020-05689-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to describe histopathologic characteristics of synchronous bilateral breast cancer (SBBC), and by comparing SBBC to unilateral breast cancer (UBC), identify possible etiological mechanisms of SBBC. METHODS Patients with primary SBBC (diagnosed within 4 months) and UBC diagnosed in Denmark between 1999 and 2015 were included. Detailed data on histopathology were retrieved from the Danish Breast Cancer Group database and the Danish Pathology Register. Associations between bilateral disease and the different histopathologic characteristics were evaluated by odds ratios and estimated by multinomial regression models. RESULTS 1214 patients with SBBC and 59,221 with UBC were included. Patients with SBBC more often had invasive lobular carcinomas (OR 1.29; 95% CI 1.13-1.47), a clinically distinct subtype of breast cancer, than UBC patients. Further, they were older than UBC patients, more often had multifocal cancer (OR 1.13; 95% CI 1.01-1.26), and a less aggressive subtype than UBC patients. Invasive lobular carcinoma was associated with having multiple tumors in breast tissue-both in the form of bilateral disease and multifocal disease, and this association was independent of laterality. No similar pattern was observed for other tumor characteristics. CONCLUSION We identified two etiological mechanisms that could explain some of the occurrence of SBBC. The high proportion of less aggressive carcinomas and higher age of SBBC compared to UBC patients suggests that many are diagnosed at a subclinical stage as slow-growing tumors have a higher probability of simultaneous diagnosis. The high proportion of invasive lobular carcinoma observed in bilateral and multifocal disease, being independent of laterality, suggests that these patients have an increased propensity to malignant tumor formation in breast tissue.
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Affiliation(s)
- Mathias Kvist Mejdahl
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, 2730, Herlev, Denmark. .,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marianne Holm
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ann Søegaard Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Niels Kroman
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, 2730, Herlev, Denmark.,Danish Cancer Society, Copenhagen, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
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5
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Pan B, Xu Y, Zhou YD, Yao R, Wu HW, Zhu QL, Wang CJ, Mao F, Lin Y, Shen SJ, Sun Q. The prognostic comparison among unilateral, bilateral, synchronous bilateral, and metachronous bilateral breast cancer: A meta-analysis of studies from recent decade (2008-2018). Cancer Med 2019; 8:2908-2918. [PMID: 31038845 PMCID: PMC6558468 DOI: 10.1002/cam4.2198] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 01/04/2023] Open
Abstract
Background The incidence of bilateral breast cancer (BBC) is increasing nowadays comprising 2%‐11% of all breast cancer (BC). According to the interval time between the first and second cancer, BBC could be divided into synchronous (SBBC) and metachronous (MBBC). However, this interval time is quite different across studies. It remains controversial whether the survival of BBC, SBBC, and MBBC is similar or worse compared to that of unilateral breast cancer (UBC), and whether the survival of SBBC is similar or worse compared to MBBC. To better understand the survival of UBC, BBC, SBBC, and MBBC and how the interval time would influence the prognosis of SBBC and MBBC, we performed this meta‐analysis on studies from recent 10 years (2008‐2018). Methods Databases of PubMed, Embase, and Web of Science were searched for relevant studies within recent 10 years. Hazard ratio (HR) was adopted to evaluate the difference of overall survival (OS) of UBC, BBC, SBBC, and MBBC. HR of OS comparisons were performed between BBC vs UBC, SBBC vs UBC, MBBC vs UBC, and SBBC vs MBBC with 3, 6, 12 months as the interval time, respectively. Results There were 15 studies of 72 302 UBC and 2912 BBC included in the meta‐analysis. The summary HR of OS comparison between BBC vs UBC was 1.68 (95% CI: 1.28‐2.20), SBBC vs UBC was 2.01 (95% CI: 1.14‐3.55), MBBC vs UBC was 3.22 (95% CI: 0.75‐13.78). When 3, 6, 12 months were used as the interval time, the summary HR of the OS comparison between of SBBC vs MBBC were 0.64 (95% CI: 0.44‐0.94), 1.17 (95% CI: 0.84‐1.63) and 1.45 (95% CI: 1.10‐1.92), respectively. Conclusion BBC and SBBC showed worse prognosis in terms of OS compared to UBC while MBBC manifested similar or non‐superior survival as UBC. The OS comparison between SBBC and MBBC changed with different interval time used. The longer the interval time used, the worse the survival of SBBC. SBBC with interval of 3‐12 months between the two cancers had the worst prognosis. When 6 months was used to differentiate SBBC from MBBC, these two clinical entities showed similar OS.
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Affiliation(s)
- Bo Pan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Ying Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Yi-Dong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Ru Yao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Huan-Wen Wu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Qing-Li Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Chang-Jun Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Song-Jie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
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6
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Mejdahl MK, Wohlfahrt J, Holm M, Balslev E, Knoop AS, Tjønneland A, Melbye M, Kroman N. Breast cancer mortality in synchronous bilateral breast cancer patients. Br J Cancer 2019; 120:761-767. [PMID: 30804429 PMCID: PMC6461871 DOI: 10.1038/s41416-019-0403-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background Evidence suggests that patients with synchronous bilateral breast cancer (SBBC), diagnosed within 4 months, have an inferior prognosis compared to unilateral breast cancer (UBC) patients. Using data from nationwide Danish clinical databases, this cohort study investigated whether the inferior prognosis could be explained by SBBC patients having a more aggressive disease, or whether the prognosis could be explained by the fact that they have two simultaneous cancers. Methods Patients were diagnosed from 1999–2015. The main outcome was excess mortality, subtracting background population mortality from observed mortality. Differences between SBBC and UBC patients were evaluated by rate ratios (RR) and estimated by Poisson regression. Results In total, 1214 SBBC and 59 177 UBC patients were included. SBBC patients had a significantly higher excess mortality than UBC patients after adjustment for age and period (RR = 1.73; 95% CI:1.44–2.08; p < 0.01) and after adjusting for characteristics of the worst tumour as traditionally done (RR = 1.31; 95% CI:1.08–1.57; p = 0.01). However, adjusting for characteristics of both tumours, using a more advanced competing risks model, no difference was observed (RR = 1.01; 95% CI:0.83–1.22; p = 0.93). Conclusions Our study does not support that the inferior prognosis in SBBC patients is due to having more aggressive tumours per se, but rather the combined effect of having two simultaneous cancers.
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Affiliation(s)
- Mathias Kvist Mejdahl
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark. .,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marianne Holm
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Ann Søegaard Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Niels Kroman
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Danish Cancer Society, Copenhagen, Denmark
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7
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Jacob LA, Anand A, Lakshmaiah KC, Babu GK, Lokanatha D, Suresh Babu MS, Lokesh KN, Rudresha AH, Rajeev LK, Koppaka D. Clinicopathological Profile and Treatment Outcomes of Bilateral Breast Cancer: A Study from Tertiary Cancer Center in South India. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_56_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Bilateral breast cancer (BBC) is a rare clinical entity with limited data regarding clinicopathological aspects and treatment guidelines. Materials and Methods: This was an observational study of patients diagnosed with BBC from August 2012 to July 2014. Synchronous breast cancers (SBCs) was defined as two tumors diagnosed within an interval of 6 months and metachronous breast cancer (MBC) as second cancer diagnosed after 6 months. Results: Out of 750 breast cancer patients seen during a 2-year period, 35 had BBC. Ten patients were diagnosed as SBC whereas 25 patients as MBC. Among patients with MBC, the average time for development of contralateral breast cancer was 5 years. In 8 patients, the contralateral breast cancer was detected mammography whereas rest 27 patients were detected by clinical breast examination. At a median follow-up of 24 months, 23 (66%) patients were disease free, 9 (26%) patients had disease relapse, and 3 (8%) patients succumbed to the progressive disease. Conclusions: Every patient with breast cancer should be regularly followed up with clinical breast examination at a more frequent interval. The role of frequent clinical breast examination appears more than mammography especially beyond 5 years for early detection of contralateral breast cancer.
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Affiliation(s)
- Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Abhishek Anand
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Govind K. Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Dasappa Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - M.C. Suresh Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Kadabur N. Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - L K. Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Deepak Koppaka
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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8
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Lee SM, Kim YM, Kim BM. Epistaxis as the First Manifestation of Silent Renal Cell Carcinoma: A Case Report with Relevant Literature Review. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e31208. [PMID: 27110343 PMCID: PMC4835635 DOI: 10.5812/iranjradiol.31208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/21/2015] [Indexed: 11/16/2022]
Abstract
The paranasal sinuses are known to be a rare location for metastasis. Renal cell carcinoma (RCC) is the most frequent primary tumor to metastasize to the sinonasal region, followed by lung and breast cancer. In particular, clear cell type RCC, which represents approximately 85% of RCCs, is characterized by early metastasis, and it sometimes spreads to unusual sites (1, 2). Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency. Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor. The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%. The purpose of this case report is to document a rare case of silent RCC that first presented as epistaxis due to nasal cavity and ethmoid sinus metastasis.
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Affiliation(s)
- Seung Min Lee
- Department of Radiology, Dankook University Hospital, Choenan, South Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, Choenan, South Korea
| | - Bong Man Kim
- Department of Radiology, Dankook University Hospital, Choenan, South Korea
- Corresponding author: Bong Man Kim, Department of Radiology, Dankook University Hospital, Choenan, South Korea. Tel: +82-1056908768, Fax: +82-415509674, E-mail:
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Padmanabhan N, Subramanyan A, Radhakrishna S. Synchronous Bilateral Breast Cancers. J Clin Diagn Res 2015; 9:XC05-XC08. [PMID: 26500995 DOI: 10.7860/jcdr/2015/14880.6511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bilateral breast cancer (BBC) is not an uncommon entity in contemporary breast clinics. Improved life expectancy after breast cancer treatment and routine use of contra-lateral breast mammography has led to increased incidence of BBC. Our study objective was to define the epidemiological and tumour characteristics of BBC in India. MATERIALS AND METHODS A total of 1251 breast cancer patients were treated during the period January 2007 to March 2015 and 30 patients were found to have BBC who constituted the study population (60 tumour samples). Synchronous bilateral breast cancers (SBC) was defined as two tumours diagnosed within an interval of 6 months and a second cancer diagnosed after 6 months was labelled as metachronous breast cancer (MBC). Analyses of patient and tumour characteristics were done in this prospective data base of BBC patients. RESULTS Median patient age was 66 years (range 39-85). Majority of the patients had SBC (n=28) and in 12 patients the second tumour was clinically occult and detected only by mammography of the contra-lateral breast. The second tumour was found at lower tumour size compared to the first in 73% of cases and was negative for axillary metastasis in 80% of cases (24/30). Infiltrating ductal carcinoma was the commonest histological type (n=51) and majority of the tumours were ER/PR positive (50/60). Her2 was overexpressed in 13 tumours (21%). Over 70% (22/30) of patients had similar histology in both breasts and amongst them grade concordance was present in about 69% (15/22) of patients. Concordance rates of ER, PR and Her2 statuses were 83%, 80% and 90% respectively. Bilateral mastectomy was the commonest surgery performed in 80% of the patients followed by bilateral breast conservation in 13%. At the end of study period, 26 patients were alive and disease free. Median survival was 29 months (range 3-86 months). CONCLUSION In most patients with BBC, the second tumour is identified at an early stage than index tumours supporting the importance of contralateral breast cancer screening at the time of primary diagnosis and during follow-up. BBC occurs more frequently in old age group and majority of these tumours are estrogen dependent. There is good pathological concordance between the index tumour and the contralateral breast cancer.
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Affiliation(s)
- Naveen Padmanabhan
- Registrar, Department of Surgical Oncology, Apollo Speciality Hospitals , Chennai-35, India
| | - Annapurneswari Subramanyan
- Chief of Surgical Pathology, Department of Surgical Pathology, Apollo Speciality Hospitals , Chennai-35, India
| | - Selvi Radhakrishna
- Senior Consultant, Department of Breast surgery and Oncoplastic Breast surgeon, Apollo Speciality Hospitals , Chennai-35, India
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Kadioğlu H, Özbaş S, Akcan A, Soyder A, Soylu L, Koçak S, Cantürk NZ, Tükenmez M, Müslümanoğlu M. Comparison of the histopathology and prognosis of bilateral versus unilateral multifocal multicentric breast cancers. World J Surg Oncol 2014; 12:266. [PMID: 25143016 PMCID: PMC4247688 DOI: 10.1186/1477-7819-12-266] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 08/06/2014] [Indexed: 11/30/2022] Open
Abstract
Background Multiple breast cancers may present with different clinical and biological characteristics. The data indicate that multifocal (MF), multicentric (MC), and bilateral synchronous (BS) breast cancers (BC) are more aggressive and have an equivalent or moderately poorer survival rate compared with unilateral cases. However, a comparison of these multiple breast cancers has not been covered in the literature. The aim of this study was to describe the histopathological characteristics of patients suffering from MF, MC, and BS breast carcinoma and to compare their prognoses. Methods Retrospective data for MF, MC, and BS breast carcinoma patients treated in five different breast cancer units in Turkey between 2003 and 2012 were collected. MF and MC cancers were defined as more than one lesion in the same quadrant or in separate quadrants, respectively. Results There were 507 patients (271 MF, 147 MC, and 89 BS) treated in this time period. BS breast carcinoma patients were younger than the other groups (44.83 ± 9.6, 47.27 ± 11.6, and 51.11 ± 11.8 years for BS, MF, and MC breast carcinoma patients, respectively). MFBC and MCBC patients in this study were younger than the ages reported in Western literature, but this result was similar to the ages reported in Eastern literature. The five-year survival rates and recurrence rates were not statistically different among groups (P = 0.996 and P = 0.263, respectively). According to univariate analyses, tumor size, histological grade, and lymph node status were statistically significant factors that affected survival. However, only lymph node involvement was significant for survival according to multivariate analyses. Conclusions The clinical significance of MF, MC, and BS breast cancers is still unclear and their influence on prognosis is controversial. Disease-free and overall survival rates of BS breast cancers might be similar to MF and MC breast cancers.
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Affiliation(s)
- Hüseyin Kadioğlu
- Department of General Surgery, Bezmialem Vakif University, Istanbul Adnan Menderes Bulvarı Vatan Caddesi, 34093 Fatih/İstanbul, Turkey.
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11
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Prognosis of synchronous bilateral breast cancer: a review and meta-analysis of observational studies. Breast Cancer Res Treat 2014; 146:461-75. [DOI: 10.1007/s10549-014-3045-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/23/2014] [Indexed: 12/20/2022]
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Beckmann KR, Roder DM, Hiller JE, Farshid G, Lynch JW. Influence of Mammographic Screening on Breast Cancer Incidence Trends in South Australia. Asian Pac J Cancer Prev 2014; 15:3105-12. [DOI: 10.7314/apjcp.2014.15.7.3105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lebris A, Vildé A, Marret H, Body G, Ouldamer L. [Role of imaging procedures in the diagnosis of synchronous bilateral breast cancer]. ACTA ACUST UNITED AC 2013; 42:14-9. [PMID: 24309024 DOI: 10.1016/j.gyobfe.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the role of imaging procedures in the diagnosis of synchronous bilateral breast cancer (SBBC) PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing managed for SBBC in our institution between January 2006 and July 2012. We defined SBBC as bilateral breast tumors diagnosed simultaneously or up to 3 months after initial diagnosis. Clinical data included comorbidities, BMI (kg/m(2)), preoperative breast imaging modalities used and their findings. RESULTS Of the 2322 patients with newly diagnosed breast cancer treated on the study period, 46 patients with the diagnosis of SBBC were enrolled to the study. A total of 41.3% patients had family history of breast cancer. A total of 56.52% had clinical symptoms. The most frequent situation of diagnosis (32.6%) was the association of a palpable tumor and a contralateral radiologic abnormality. MRI permitted the diagnosis of 19.6% occult contralateral lesions. DISCUSSION AND CONCLUSION Clinical examination and conventional imaging procedures (mammography and sonography) detects the majority (76%) of synchronous contralateral breast cancers. A family history of breast cancer, a multifocal breast tumor or the presence of an invasive lobular carcinoma should be arguments for the realization of a breat MRI to eliminate contralateral malignancy.
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Affiliation(s)
- A Lebris
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - A Vildé
- Département de radiologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France
| | - H Marret
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
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Neuburger J, MacNeill F, Jeevan R, van der Meulen JHP, Cromwell DA. Trends in the use of bilateral mastectomy in England from 2002 to 2011: retrospective analysis of hospital episode statistics. BMJ Open 2013; 3:bmjopen-2013-003179. [PMID: 23906951 PMCID: PMC3733300 DOI: 10.1136/bmjopen-2013-003179] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES For healthy women at high risk of developing breast cancer, a bilateral mastectomy can reduce future risk. For women who already have unilateral breast cancer, removing the contralateral healthy breast is more difficult to justify. We examined trends in the number of women who had a bilateral mastectomy in England between 2002 and 2011. DESIGN Retrospective cohort study using the Hospital Episode Statistics database. SETTING NHS hospital trusts in England. PARTICIPANTS Women aged between 18 and 80 years who had a bilateral mastectomy (or a contralateral mastectomy within 24 months of unilateral mastectomy) with or without a diagnosis of breast cancer. MAIN OUTCOME MEASURES Number and incidence of women without breast cancer who had a bilateral mastectomy; number and proportion who had a bilateral mastectomy as their first breast cancer operation, and the proportion of those undergoing bilateral mastectomy who had immediate breast reconstruction. RESULTS Among women without breast cancer, the number who had a bilateral mastectomy increased from 71 in 2002 to 255 in 2011 (annual incidence rate ratio 1.16, 95% CI 1.13 to 1.18). In women with breast cancer, the number rose from 529 to 931, an increase from 2% to 3.1% of first operations (OR for annual increase 1.07, 95% CI 1.05 to 1.08). Across both groups, rates of immediate breast reconstruction roughly doubled and reached 90% among women without breast cancer in 2011. CONCLUSIONS The number of women who had a bilateral mastectomy nearly doubled over the last decade, and more than tripled among women without breast cancer. This coincided with an increase in the use of immediate breast reconstruction.
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Affiliation(s)
- Jenny Neuburger
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Fiona MacNeill
- The Royal Marsden, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ranjeet Jeevan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Whiston Hospital, St Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Jan H P van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - David A Cromwell
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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