1
|
Seyyedi MS, Zangouri V, Dehghani Z, Dehghanian A, Jahromi MG. A rare occurrence of breast, thyroid, and stomach tumors in a single patient: A case report. Int J Surg Case Rep 2024; 119:109670. [PMID: 38688151 PMCID: PMC11067463 DOI: 10.1016/j.ijscr.2024.109670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE There are only a few case reports to date that have described patients with three or more multiple primary tumors. However, they have been reported more in the last decade, so a precise screening in patients with or without risk factors could be helpful in early diagnosis and treatment. This work has been reported in line with the SCARE criteria. CASE PRESENTATION Here, we presented a 44-year-old female patient without any history of smoking, alcohol consumption, or cancer in her family. She had three metachronous primary tumors; breast, thyroid, and gastric cancer, which had metastasized to both her ovaries and colon. She died in January 2023 due to complex pneumonia and septic shock. To our knowledge, this article is the second case in which breast, thyroid, and stomach cancer are reported together. CLINICAL DISCUSSION When it comes to Multiple primary malignancies (MPMs), not only screening in patients with risk factors should be considered, but patients without any other risk factors except current or past history of tumors should be screened precisely for early diagnosis and treatment. In this study, we discuss prevalence and causes of MPMs, prevalence of breast, thyroid, and stomach cancer, and also their possible relations with each other that may affect their occurrence. CONCLUSION Reporting other cases with MPMs by physicians could lead to establish an evidence based approach to these patients.
Collapse
Affiliation(s)
- Mahdiyeh Sadat Seyyedi
- Breast Disease Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Disease Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Dehghani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Ghaderian Jahromi
- Medical Imaging Research Center, Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Bahrami MA, Tabari S, Tahmasebi S, Zangouri V, Ravangard R. Strategies to Promote Empowerment Status of Breast Cancer Women. Int J Breast Cancer 2024; 2024:3305399. [PMID: 38348180 PMCID: PMC10861285 DOI: 10.1155/2024/3305399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/01/2024] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background As the second leading cause of death in women in the world, breast cancer has several physical and psychological effects. Nowadays, nonclinical approaches such as patient empowerment have been considered by physicians along with clinical care. Given the increasing number of breast cancer women worldwide, promoting the empowerment of these patients is one of the key factors affecting their survival and quality of life. Therefore, because of no comprehensive research on the empowerment needs and related improvement strategies, this study is aimed at determining the empowerment status of breast cancer patients referred to the Shahid Motahari Breast Cancer Clinic in Iran, Shiraz, and at providing strategies to improve their empowerment in 2021. Methods This applied study was conducted in two phases. In the quantitative phase, 310 Cancer-Related Patient Empowerment Scale questionnaires (Persian format) were distributed among the studied patients selected through the random sampling method in the clinic, and the items with "unacceptable status" became the basis for determining the empowerment strategies through the scoping review and semistructured interviews with 22 medical staff and patients through the thematic analysis. The collected data were analyzed using the SPSS 20.0 and MAXQDA10 software. Results The mean score of the participants' empowerment strategies was 3.58. The results showed that trust in the physician, family support, and spiritual beliefs could affect the empowerment of the studied patients. Moreover, the participants needed empowerment strategies in 11 scale items with unacceptable status, for which 46 strategies were determined in the scoping review and interview phase. Conclusion The results of this study provided useful strategies for empowering breast cancer patients, the most important of which were classified into five categories of financial support, informational support, interaction with the physician, occupational support, and complementary therapies, the use of which by the stakeholders could help to improve the patients' quality of life while improving their empowerment.
Collapse
Affiliation(s)
- Mohammad Amin Bahrami
- Health Human Resources Research Center, Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrzad Tabari
- Student Research Committee, Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Zangouri V, Roshanshad A, Ranjbar A, Izadi M, Rajaeifar S, Goodarzi A, Nasrollahi H. Outcomes and complications of intraoperative radiotherapy versus external beam radiotherapy for early breast cancer. Cancer Rep (Hoboken) 2024; 7:e1950. [PMID: 38205671 PMCID: PMC10849931 DOI: 10.1002/cnr2.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/19/2023] [Accepted: 11/12/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) is an alternative for external beam radiotherapy (EBRT) for early stage breast cancer (BC). Herein, we compared outcomes, postoperative and post-radiation complications of IORT and EBRT. METHODS We conducted a cohort study to compare complications of IORT and EBRT in patients. A checklist of the complications of IORT and EBRT, was used to assess and post-radiation complications and outcomes. RESULTS Overall, 264 women (121 in IORT and 143 in EBRT group) with a mean (SD) age of 55 ± 8.6 years analyzed in this study. The IORT group (quadrantectomy + SLNB + IORT) had more severe post-operative pain compared to the EBRT group (quadrantectomy + SLNB) (OR = 1.929, 95% CI: 1.116-3.332). Other postoperative complications, including edema, erythema, seroma, hematoma, and wound complications were not significantly different between the IORT and EBRT groups. EBRT was associated with higher rates post-radiation complications, including erythema (95.8% vs. 21.5%), skin dryness (30.8% vs. 12.4%), pruritus (26.6% vs. 17.4%), hyperpigmentation (48.3% vs. 9.9%), and telangiectasia (1.4% vs. 0.8%). Multivariate analysis showed that erythema, skin dryness and pruritus, and hyperpigmentation were more severe in the EBRT group, while breast induration was higher in the IORT group (OR = 4.109, 95% CI: 2.242-7.531). Excellent, good, and fair cosmetic outcome was seen in 11.2%, 72%, and 16.8% of the patients in the EBRT group and 29.8%, 63.6%, and 6.6% in the IORT group, respectively, suggesting that the cosmetic outcome was significantly better in the IORT group (P < .001). There wasn't statistically significant difference in recurrence-free survival and overall survival rates between two groups of patients who received either IORT or EBRT (P = .953, P = .56). CONCLUSION IORT is considered to have lower post-radiation complications and better cosmetic outcomes in breast cancer patients. Therefore, IORT might be used as the treatment of choice in eligible patients.
Collapse
Affiliation(s)
- Vahid Zangouri
- Surgical Oncology Division, General Surgery DepartmentShiraz University of Medical SciencesShirazIran
- Breast Diseases Research CenterShiraz University of Medical SciencesShirazIran
| | - Amirhossein Roshanshad
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Poostchi Ophthalmology Research CenterShiraz University of Medical SciencesShirazIran
| | - Aliyeh Ranjbar
- Breast Diseases Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mahsa Izadi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Sara Rajaeifar
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ali Goodarzi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Hamid Nasrollahi
- Radiation Oncology, Radio‐Oncology Department, School of MedicineShiraz University of Medical SciencesShirazIran
| |
Collapse
|
4
|
Ranjbar A, Zangouri V, Shokripour M. Margin status impact on recurrence of phyllodes tumors in high-risk groups: a retrospective observational study. BMC Cancer 2024; 24:48. [PMID: 38195454 PMCID: PMC10775459 DOI: 10.1186/s12885-023-11805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Phyllodes tumor (PT) is an fibroepithelial tumor with potential for local recurrence. The optimal margin for surgical resection of PT is still debated, particularly in cases of positive margins. This study aimed to identify the risk factors for phyllodes tumor recurrence and the effect of a free margin on tumor recurrence by considering these risk factors. MATERIALS AND METHODS This is a retrospective observational study of patients diagnosed with PT who had undergone surgical management. The data were collected from medical records from 2001 to 2020 in the breast clinic of Shahid Motahhari Clinic of Shiraz. Patients were followed up for at least 3 years after the operation to be checked for local recurrence or distant metastasis at regular intervals. RESULTS This retrospective study included 319 patients with PT who underwent surgical management. Of these patients, 83.9% (n = 267), 7.6% (n = 24), and 8.5% (n = 27) were classified as benign, borderline, and malignant, respectively. 8.8% of all patients and 7.6% of non-malignant cases experienced local recurrence, and risk factors for recurrence included oral contraceptive use, smoking, size > 4 cm, stromal overgrowth, and stromal cell atypia. A negative surgical margin decreased the prevalence of recurrence in tumors > 4 cm and with stromal overgrowth significantly. CONCLUSION The study found that a negative margin in all patients did not reduce the recurrence rate in benign and borderline phyllodes tumors, suggesting close follow up as a reasonable alternative. However, a negative margin may be effective in reducing recurrence in certain high-risk groups.
Collapse
Affiliation(s)
- Aliyeh Ranjbar
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mansoureh Shokripour
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
5
|
Jalali FS, Seif M, Jafari A, Zangouri V, Keshavarz K, Ravangard R. Factors affecting the economic burden of breast cancer in southern Iran. BMC Health Serv Res 2023; 23:1332. [PMID: 38041035 PMCID: PMC10691120 DOI: 10.1186/s12913-023-10346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in the world, and is associated with significant economic costs for patients and communities. Therefore, the information on the costs of the disease and the identification of its underlying factors will provide insights into designing effective interventions and reducing the costs. Thus, the present study aimed to identify the factors affecting the economic burden of breast cancer from all medical centers providing diagnostic and treatment services in southern Iran. METHODS A list of factors affecting the economic burden of breast cancer was obtained based on the effective factors searched in the databases, including PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran, and the opinions of BC cancer specialists. Then, the data on 460 breast cancer patients was collected from March 2020 to March 2022. The relationship between the factors affecting Breast Cancer costs was analyzed using SPSS 13.0 software by the use of multiple regression analysis. RESULTS The results of the multiple regression analysis showed that stages (P-value < 0.001), being an extreme user (p = 0.025), type of treatment center (P-value < 0.001), income (P-value < 0.001), chemotherapy side effects (P-value < 0.001), and distance to the nearest health center (P-value < 0.001) were important factors affecting the costs of breast cancer patients. CONCLUSIONS According to the results, encouraging people to undergo annual screenings, increasing insurance coverage, assuring the patients about the desirability and adequacy of the provided medical services, deploying specialists in chemotherapy centers (especially nutritionists) to recommend special diets, and establishing cancer diagnostic and treatment centers in high-population cities could help reduce the costs of breast cancer patients.
Collapse
Affiliation(s)
- Faride Sadat Jalali
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-communicable Disease Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ramin Ravangard
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
6
|
Zangouri V, Ranjbar A, Homapour F, Seyyedy MS, Gooya S, Karami MY, Halimi E. Breast Cancer Survivors and COVID-19: Prevalence and Risk of Severe Disease in a Screening Study. Med J Islam Repub Iran 2023; 37:114. [PMID: 38145185 PMCID: PMC10744123 DOI: 10.47176/mjiri.37.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Indexed: 12/26/2023] Open
Abstract
Background Determining the risk of severe course coronavirus disease 2019 (COVID-19) and its related factors in survivors of common cancers such as breast cancer is important. This study has been designed to evaluate the prevalence of COVID-19 infection in breast cancer survivors and also estimate the risk of severe disease in this population. Methods Out of 6134 patients in the Shiraz Breast Cancer Registry (SBCR), A total of 292 patients who elapsed less than a year from their breast cancer diagnosis were excluded. We called 5842 patients. Finally, 4135 breast cancer survivors who agreed to cooperate were screened for COVID-19 symptoms by a symptom-based questionnaire in November 2020. COVID-19 in symptomatic participants was confirmed by a polymerase chain reaction (PCR) test. The clinical and paraclinical data of the COVID-19 course were collected for patients with a positive PCR test. Results A total of 247 (5.9%) participants had at least reported one of the COVID-19 symptoms. Also, 17% of symptomatic participants had a positive PCR test; 83.7% had mild disease, 9.5% moderate, and 16.7% had severe conditions. Chronic cardiovascular disease, hypertension, and diabetes were related to an increased risk of severe illness ( P = 0.018, P = 0.018, P = 0.002). Conclusion This study suggests that breast cancer intermediate and longtime survivors without other underlying diseases are considered at low risk for developing severe/critical COVID-19.
Collapse
Affiliation(s)
- Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
- Surgical Oncology Division, General Surgery Department, Shiraz University of
Medical Sciences, Shiraz, Iran
| | - Aliyeh Ranjbar
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
| | - Farhad Homapour
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
- Surgical Oncology Division, General Surgery Department, Shiraz University of
Medical Sciences, Shiraz, Iran
| | | | - Shakila Gooya
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
| | - Mohammad Yasin Karami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
- Surgical Oncology Division, General Surgery Department, Shiraz University of
Medical Sciences, Shiraz, Iran
| | - Elham Halimi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
| |
Collapse
|
7
|
Zangouri V, Niazkar HR, Nasrollahi H, Homapour F, Ranjbar A, Seyyedi MS. Benign or premalignant? Idiopathic granulomatous mastitis later diagnosed as ductal carcinoma breast cancer: Case report and review of literature. Clin Case Rep 2022; 10:e6323. [PMID: 36172329 PMCID: PMC9468569 DOI: 10.1002/ccr3.6323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vahid Zangouri
- Surgical Oncology Division, General Surgery Department Shiraz University of Medical Sciences Shiraz Iran
- Breast Diseases Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Hamid Reza Niazkar
- Breast Diseases Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Hamid Nasrollahi
- Radio‐Oncology Department, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | - Farhad Homapour
- Department of Surgery, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | - Aliyeh Ranjbar
- Breast Diseases Research Center Shiraz University of Medical Sciences Shiraz Iran
- Shiraz University of Medical Sciences Shiraz Iran
| | - Mahdiyeh Sadat Seyyedi
- Breast Diseases Research Center Shiraz University of Medical Sciences Shiraz Iran
- Shiraz University of Medical Sciences Shiraz Iran
| |
Collapse
|
8
|
Tahmasebi S, Khorsand Rahim Zadeh A, Zangouri V, Akrami M, Ghoddusi Johari M, Talei A. Pseudoangiomatous stromal hyperplasia of the breast: A case report. Clin Case Rep 2022; 10:e6221. [PMID: 35957783 PMCID: PMC9361800 DOI: 10.1002/ccr3.6221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022] Open
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast entity scarcely reported in the medical literature. Its pathogenesis, etiology, and optimal treatment are still unknown. PASH tumors have a broad spectrum of clinical presentations and might be mistaken for malignancies. The authors present six patients diagnosed with PASH.
Collapse
Affiliation(s)
- Sedigheh Tahmasebi
- Breast Diseases Research Center Shiraz University of Medical sciences Shiraz Iran
| | | | - Vahid Zangouri
- Department of Surgery, Division of surgical Oncology Shiraz University of Medical Sciences Shiraz Iran
| | - Majid Akrami
- Breast Diseases Research Center Shiraz University of Medical sciences Shiraz Iran
| | | | - Abdolrasoul Talei
- Breast Diseases Research Center Shiraz University of Medical sciences Shiraz Iran
| |
Collapse
|
9
|
Omidifar N, Chogani E, Zangouri V, Keshavarz K, Talei A. Cost-Effectiveness Analysis of Intraoperative Frozen Section in Women with Breast Cancer: Evidence from South of Iran. Iran J Med Sci 2022; 47:143-151. [PMID: 35291436 PMCID: PMC8919313 DOI: 10.30476/ijms.2021.88887.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/08/2021] [Accepted: 03/13/2021] [Indexed: 11/04/2022]
Abstract
Background Breast cancer is one of the most prevalent malignancies in women worldwide, and the rate of breast cancer is increasing among Iranian women. The purpose of this study is to determine the cost-effectiveness of intraoperative frozen section analysis in women with breast cancer. Methods This study was a cost-effectiveness analysis, which was implemented as a cross-sectional study from a societal perspective. In this case, total direct and indirect costs were calculated, and the study outcome was involved in preventing reoperation. A data collection form has been used to collect the cost and effectiveness data. The sample size was comprised of all the patients referred to the hospitals of Shiraz University of Medical Sciences for breast cancer surgery in 2019. The patients were studied in two different groups, including individuals who received frozen counseling during surgery, and individuals who did not receive it. A one-way sensitivity analysis was performed for this case. Moreover, the Tree Age and Microsoft Excel Software were employed for analyzing processes. Results The results demonstrated that the mean costs of frozen and non-frozen patients were 4168$ and 3843$ purchasing power parity (PPP), respectively. In addition, the effectivenesses were 0.996 for the former and 0.8 for the latter. Furthermore, the incremental cost-effectiveness ratio (ICER) was 1658.2 PPP$. This issue revealed that the frozen section procedure during surgery was more cost-effective than the other case. Because, the cost-effectiveness of this option was below the threshold. Besides, the one-way sensitivity analysis confirmed the robustness of the study results. Conclusion The results showed that performing frozen sections during surgery in women with breast cancer was more cost-effective than ignoring them. Indeed, the frozen section can prevent the costs of subsequent reoperations.
Collapse
Affiliation(s)
- Navid Omidifar
- Department of Pathology, School of Medicine, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Chogani
- Student Research Committee, Department of Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Department of Surgery, School of Medicine, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Department of Surgery, School of Medicine, Breast Diseases Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Zangouri V, Nasrollahi H, Taheri A, Akrami M, Arasteh P, Hamedi SH, Johari MG, Karimaghaee N, Ranjbar A, Karami MY, Tahmasebi S, Mosalaei A, Talei A. Intraoperative radiation therapy for early stage breast cancer. BMC Surg 2022; 22:26. [PMID: 35081942 PMCID: PMC8793207 DOI: 10.1186/s12893-021-01427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background and objective We report our experiences with Intraoperative radiation therapy (IORT) among breast cancer (BC) patients in our region. Methods All patients who received radical IORT from April 2014 on to March 2020 were included in the study. Patient selection criteria included: Age equal or older than 45 years old; All cases of invasive carcinomas (in cases of lobular carcinomas only with MRI and confirmation); Patients who were 45–50 years old with a tumor size of 0–2 cm, 50–55 years old with a tumor size of < 2.5 cm, and those who were ≥ 55 years old with a tumor size of < 3 cm; Invasive tumors only with a negative margin; Negative nodal status (exception in patients with micrometastasis); A positive estrogen receptor status. Primary endpoints included death and recurrence which were assessed using the Kaplan–Meier method. Results Overall, 252 patients entered the study. Mean (SD) age of patients was 56.43 ± 7.79 years. In total, 32.9% of patients had a family history of BC. Mean (SD) tumor size was 1.56 ± 0.55 cm. Mean (IQR) follow-up of patients was 36.3 ± 18.7 months. Overall, 8 patients (3.1%) experienced recurrence in follow-up visits (disease-free-survival of 96.1%), among which four (1.5%) were local recurrence, two (0.8%) were regional recurrence and two patients (0.8%) had metastasis. Median (IQR) time to recurrence was 46 (22, 53.7) months among the eight patient who had recurrence. Overall, one patient died due to metastasis in our series. Eleven patients (4.3%) with DCIS in our study received IORT. All these patients had free margins in histopathology examination and none experienced recurrence. Conclusion Inhere we reported our experience with the use of IORT in a region where facilities for IORT are limited using our modified criteria for patient selection. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01427-5.
Collapse
Affiliation(s)
- Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrollahi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Taheri
- Trauma Research Center, Rajaei Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hassan Hamedi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nazanin Karimaghaee
- Core Medical Trainee, Northumbria Healthcare NHS Foundation /Trust, Newcastle Upon Tyne, UK
| | - Aliye Ranjbar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Yasin Karami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ahmad Mosalaei
- Shiraz Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
11
|
Namdar ZM, Omidifar N, Arasteh P, Akrami M, Tahmasebi S, Nobandegani AS, Sedighi S, Zangouri V, Talei A. How accurate is frozen section pathology compared to permanent pathology in detecting involved margins and lymph nodes in breast cancer? World J Surg Oncol 2021; 19:261. [PMID: 34470649 PMCID: PMC8411544 DOI: 10.1186/s12957-021-02365-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Frozen section (FS) pathology has multiple limitations, and different institutions report variable experiences with the use of FS for diagnosis of tumor involvement. We aimed to compare the FS accuracy with that of permanent pathology (gold standard) regarding marginal involvement and lymph node status using data from the largest breast cancer registry in Iran. Methods In this retrospective study, women who had both FS and permanent pathology reports were included. The two pathology reports were cross compared with regard to the involvement of tumor margins and sentinel lymph nodes. Results Overall, 2786 patients entered the study. Mean age of patients was 48.96±11.44 years. A total of 1742 margins were analyzed. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FS pathology for detection of involvement of involved margins were 78.49%, 97.63%, 65.1%, and 98.7%, respectively. The accuracy and area under the curve (AUC) for FS pathology were 96.61% and 0.73 (95% CI: 0.64–0.831), respectively. A total of 1702 sentinel lymph node biopsies were assessed. Sensitivity, specificity, PPV, and NPV, of FS pathology for detection of lymph node involvement, were 87.1%, 98%, 95.5%, and 93.3%, respectively. Accuracy and AUC of FS for diagnosis of involved lymph nodes were 94.1% and 0.926 (95% CI: 0.909–0.942), respectively. Conclusion Frozen pathology is a suitable method for identifying involved sentinel lymph nodes in patients with breast cancer, but this method has a less than optimum efficacy for detecting and confirming marginal involvement.
Collapse
Affiliation(s)
| | - Navid Omidifar
- Clinical Education Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sogol Sedighi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abdolrasoul Talei
- Clinical Education Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
12
|
Akrami M, Hosseinpour H, Ghoddusi Johari M, Shariat M, Zangouri V, Tahmasebi S, Keumarsi Z, Hosseinpour A, Talei A. Occurrence of residual disease in specimens of re-excision surgery in patients with positive margins of primary quadrantectomy. Breast J 2021; 27:797-803. [PMID: 34402559 DOI: 10.1111/tbj.14281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
Performing a re-intervention following a positive margin after primary lumpectomy in patients with breast cancer entails several disadvantages such as additional costs and postponing the follow-up treatments. In the present study, we sought to measure the incidence rate of residual disease in specimens taken from breast cancer patients who had positive margins after quadrantectomy and also compare the clinical and pathological factors between patients with and without a residual disease after the secondary surgery. All of the medical records of patients undergoing quadrantectomy from December 1994 to December 2019 were collected from Shiraz Breast Cancer Registry (SBCR). Patients were divided into two subgroups of patients with and without residual disease from the secondary surgery and also with and without positive margin from the first operation. Two groups were compared in terms of all clinicopathological factors. The records of 4843 patients undergoing quadrantectomy were reviewed, of which 132 (2.3%) had involved margins. Of these, 112 patients underwent a secondary surgery and 28 had residual disease (25%). No clinicopathological factor was correlated with presence of residual cancer. Also, bigger tumor size (p < 0.001) and the presence of in situ component (p < 0.001) were associated with positive margin and hence the need for a re-excision surgery. These results revealed that the significant rate of residual disease in the specimens of the secondary surgery indicates that a re-operation (either re-excision or simple mastectomy) cannot be omitted after obtaining a positive margin from the primary quadrantectomy.
Collapse
Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Mehdi Shariat
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Keumarsi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Hosseinpour
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
13
|
Tahmasebi S, Almayali AMJ, Arasteh P, Akrami M, Zangouri V, Arasteh P, Hosseini SM, Salehi Nobandegani A, Asgari A, Sadeghi E, Zahiri L, Talei A. Determinants of Prognosis in Triple-Negative Breast Cancer: Report from a Large Breast Cancer Registry. Arch Iran Med 2021; 24:280-288. [PMID: 34196187 DOI: 10.34172/aim.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The outcome of patients with triple-negative breast cancer (TNBC) is highly dependent on demographic factors and ethnicity. We aimed to evaluate the clinicopathological determinants of prognosis among women with TNBC using data from one of the largest breast cancer (BC) registries. METHODS A total of 6145 patients with BC from our referral center were evaluated from 1995 to 2018, among whom 523 had TNBC. The baseline, menstrual and reproductive, treatment and pathology related characteristics were evaluated. RESULTS Among TNBC patients, the rate of stage 3 and 4 BC (29.9% vs. 14.4% and 7.8% vs. 0% for stage 3 and 4, respectively; P<0.001), invasive ductal carcinoma (90.7% vs. 75.6%; P=0.004), nodal involvement (46.7% vs. 33.4%; P=0.026), mastectomy (57.3% vs. 37.8%; P=0.001) and axillary node dissection (76.7% vs. 59.8%; P=0.019) was significantly higher in the group that developed recurrence. Disease-free-survival was 80.6% (157.76 ± 9.48 months) and overall-survival was 90.1% (182.73 ± 3.28 months). For death, stage 3 BC (compared to stages 0 and 1 as base) showed a higher risk of earlier death (adjusted HR: 4.191, 95% CI=1.392-12.621; P=0.011). For recurrence, stage 3 BC (adjusted HR: 1.044, 95% CI=1.209-6.673; P=0.017) (compared to stages 0 and 1 as base) showed significantly higher risk for developing earlier recurrence. Moreover, those who had invasive ductal carcinoma (compared to other types of BCs) had a higher risk for developing earlier recurrence (adjusted HR: 3.307, 95% CI=1.191-0.724; P=0.012). CONCLUSION BC stage plays a significant role in both earlier recurrence and earlier mortality among patients with TNBC.
Collapse
Affiliation(s)
- Sedigheh Tahmasebi
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Peyman Arasteh
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Arasteh
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Foreign Languages and Linguistics, Shiraz University, Shiraz, Fars, Iran
| | | | | | - Azam Asgari
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Sadeghi
- Non-communicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran.,Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Zahiri
- Department of Internal Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Abdolrasoul Talei
- MBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
14
|
Akrami M, Nasrollahi H, Vahabi M, Hamedi SH, Tahmasebi S, Karbasi S, Pashnesaz M, Zangouri V, Karami MY, Mosalaei A, Talei A. Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran. Med J Islam Repub Iran 2020. [DOI: 10.47176/mjiri.34.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
15
|
Akrami M, Nasrollahi H, Vahabi M, Hamedi SH, Tahmasebi S, Karbasi S, Pashnesaz M, Zangouri V, Karami MY, Mosallaei A, Talei A. Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran. Med J Islam Repub Iran 2020; 34:50. [PMID: 32884925 PMCID: PMC7456436 DOI: 10.34171/mjiri.34.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Intraoperative radiation therapy (IORT) is the delivery of radiation at the time of surgery. Whereas the dose delivered by external beam radiation therapy (EBRT) is limited by the tolerance of the surrounding normal tissues, IORT allows exclusion of a part or all of the dose-limiting sensitive structures by operative mobilization and/or direct shielding of these structures. The aim of the present study was to report the non-breast cancer patients' outcomes after receiving IORT in Shiraz, Iran. Methods: In this retrospective study, all cases who had received IORT and had non-breast malignancies were selected. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI) and computed tomography (CT). IORT was applied by self-shielded, LIAC 6-12 MeV Sordina mobile linear accelerator. Typically, a single dose of 10-21 Gy was given for maximally resected tumors. The statistical analyses were carried out using SPSS (version 21). Results: Twenty-six patients were treated with IORT alone or combined with EBRT. Different tumors were treated, including colorectal adenocarcinoma (10 cases, 38.4 %), Soft Tissue Sarcomas (STS, 11 cases, 42.3 %), head and neck cancers (3 cases, 11.5 %), one cervix malignancy case and one paravertebral fibromatosis case. Mean ± SD overall survival was 15±14.89 (0-38) and 34.3±15.72 (14-53) months for colorectal cancer and STS, respectively. Conclusion: IORT is mostly useful for pelvic and abdominal malignancies where normal bowel limits the dose that can be delivered with EBRT. However, the dose delivered in a single fraction with IORT is rarely sufficient for tumor control; therefore, IORT is usually preceded or followed by additional EBRT which should be further evaluated preferably in prospective randomized trials.
Collapse
Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrollahi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Vahabi
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hassan Hamedi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Karbasi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Pashnesaz
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Yasin Karami
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Mosallaei
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
16
|
Akrami M, Mojarad M, Ghoddusi Johari M, Zangouri V, Tahmasebi S, Talei A, Karimaghaei N. Do tumor size and biologic features interact with each other?! Which one is more important to affect breast cancer prognosis? Report of a breast cancer registry. Breast J 2020; 26:2292-2294. [PMID: 33459441 DOI: 10.1111/tbj.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Majid Akrami
- Breast diseases research center, Shiraz University of Medical sciences, Shiraz, Iran
| | - Mohammadreza Mojarad
- Breast diseases research center, Shiraz University of Medical sciences, Shiraz, Iran
| | | | - Vahid Zangouri
- Department of Surgery, Division of surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast diseases research center, Shiraz University of Medical sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast diseases research center, Shiraz University of Medical sciences, Shiraz, Iran
| | - Nazanin Karimaghaei
- Core Medical Trainee, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
17
|
Akrami M, Arasteh P, Tahmasebi S, Zangouri V, Mokhtari M, Talei A. Response to letter to editor on "Does metaplastic breast carcinoma demonstrate a different clinicopathological behavior in our region: The Shiraz Breast Cancer Registry". Breast J 2019; 25:1058. [PMID: 31187554 DOI: 10.1111/tbj.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
18
|
Akrami M, Arasteh P, Mokhtari M, Tahmasebi S, Zangouri V, Hosseini S, Talei A. Does metaplastic breast carcinoma demonstrate a different clinicopathological behavior in our region: The Shiraz Breast Cancer Registry. Breast J 2018; 25:157-159. [PMID: 30592108 DOI: 10.1111/tbj.13183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/10/2017] [Accepted: 10/19/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Maral Mokhtari
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Hosseini
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
19
|
Talei A, Tahmasebi S, Akrami M, Zangouri V, Rezaianzadeh A, Arasteh P, Eghbali T, Hosseini S. The Shiraz Breast Cancer Registry (SBCR): study design and primary reports. Per Med 2018; 15:471-479. [PMID: 30375263 DOI: 10.2217/pme-2018-0047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM This is a description of the largest breast cancer (BC) registry in Iran, termed the Shiraz Breast Cancer Registry (SBCR). METHODS Data on baseline and clinical characteristics, socioeconomic status, imaging, physical examination, histopathology, treatment and prognosis have been recorded for each individual. RESULTS Overall, 5937 were included in the report. Mean age of first presentation was 49.05 ± 11.69 years. Mean tumor size was 2.78 ± 1.76 cm. Most patients had stage 2 (46.9%) and 3 (25.5%) BCs, respectively. Most common type of BC was invasive ductal carcinoma (83.3%), followed by medullary carcinoma (3.8%). Overall, 12.9% were triple negative (HER2-, ER- and PR-). CONCLUSION The study provides an overview on the status of BC's in Iran and a wide opportunity for future studies.
Collapse
Affiliation(s)
- Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tannaz Eghbali
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Hosseini
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
20
|
Akrami M, Arasteh P, Eghbali T, Shahraki HR, Tahmasebi S, Zangouri V, Rezaianzadeh A, Talei A. Introducing novel and comprehensive models for predicting recurrence in breast cancer using the group LASSO approach: are estimates of early and late recurrence different? World J Surg Oncol 2018; 16:185. [PMID: 30208904 PMCID: PMC6136222 DOI: 10.1186/s12957-018-1489-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/05/2018] [Indexed: 12/02/2022] Open
Abstract
Background In here, we constructed personalized models for predicting breast cancer (BC) recurrence according to timing of recurrence (as early and late recurrence). Methods An efficient algorithm called group LASSO was used for simultaneous variable selection and risk factor prediction in a logistic regression model. Results For recurrence < 5 years, age (OR 0.96, 95% CI = 0.95–0.97), number of pregnancies (OR 0.94, 95% CI = 0.89–0.99), family history of other cancers (OR 0.73, 95% CI = 0.60–0.89), hormone therapy (OR 0.76, 95% CI = 0.61–0.96), dissected lymph nodes (OR 0.98, 95% CI = 0.97–0.99), right-sided BC (OR 0.87, 95% CI = 0.77–0.99), diabetes (OR 0.77, 95% CI = 0.60–0.98), history of breast operations (OR 0.38, 95% CI = 0.17–0.88), smoking (OR 5.72, 95% CI = 2.11–15.55), history of breast disease (OR 3.32, 95% CI = 1.92–5.76), in situ component (OR 1.58, 95% CI = 1.35–1.84), tumor necrosis (OR 1.87, 95% CI = 1.57–2.22), sentinel lymph node biopsy (SLNB) (OR 2.90, 95% CI = 2.05–4.11) and SLNB+axillary node dissection (OR 3.50, 95% CI = 2.26–5.42), grade 3 (OR 1.79, 95% CI = 1.46–2.21), stage 2 (OR 2.71, 95% CI = 2.18–3.35), stages 3 and 4 (OR 5.01, 95% CI = 3.52–7.13), and mastectomy+radiotherapy (OR 2.97, 95% CI = 2.39–3.68) were predictors of recurrence < 5 years. Moreover, relative to mastectomy without radiotherapy (as reference for comparison), quadrantectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence < 5 years. (OR 17.58, 95% CI = 6.70–46.10 vs. OR: 2.50, 95% CI = 2–3.12). Accuracy, sensitivity, and specificity of the model were 82%, 75.6%, and 74.9%, respectively. For recurrence > 5 years, stage 2 cancer (OR 1.67, 95% CI = 1.31–2.14) and radiotherapy+mastectomy (OR 2.45, 95% CI = 1.81–3.32) were significant predictors; furthermore, relative to mastectomy without radiotherapy (as reference for comparison), quadranectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence > 5 years (OR 7.62, 95% CI = 1.52–38.15 vs. OR 1.75, 95% CI = 1.32–2.32). Accuracy, sensitivity, and specificity of the model were 71%, 78.8%, and 55.8%, respectively. Conclusion For the first time, we constructed models for estimating recurrence based on timing of recurrence which are among the most applicable models with excellent accuracy (> 80%). Electronic supplementary material The online version of this article (10.1186/s12957-018-1489-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Tannaz Eghbali
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hadi Raeisi Shahraki
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
21
|
Akrami M, Sepahdar A, Arasteh P, Tahmasebi S, Zangouri V, Askari A, Pezeshki B, Talei A. Do site and type of metastasis in breast cancer show a changing pattern with increased age? A cross comparison of clinicopathological characteristics between age groups. World J Surg Oncol 2018; 16:147. [PMID: 30025533 PMCID: PMC6053760 DOI: 10.1186/s12957-018-1435-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022] Open
Abstract
Background In here, we evaluated pattern of metastasis and cross-compared clinicopathological features between different age groups with breast cancer (BC). Methods This study was conducted in the Shiraz Breast Cancer Registry (largest BC registry in Iran). Patients were classified as < 30 years old (group 1), 30–60 years old (group 2), and > 60 years old (group 3). The three age groups were compared regarding clinical and baseline characteristics. Results Overall, 564 individuals entered group 1, 4519 group 2, and 670 group 3. Group 1 had lower rates of tumor necrosis (p < 0.001), higher lymphatic or vascular invasion (p = 0.002), estrogen receptor-negative individuals, and HER2-positive individuals (p ≤ 0.001). Younger groups had more stage 3 BC (31.1, 25.6, and 19.7% for groups 1, 2, and 3, respectively) (p = 0.016), grade 3 BC (27.4, 20.6, and 16.5% for groups 1, 2, and 3, respectively) (p = 0.001), and grade 3 nucleus (43.1, 34.5, and 27.6% for groups 1, 2, and 3, respectively) (p < 0.001). Group 1 had higher rates of regional metastasis (4.7 vs. 1.5 and 2.1% for groups 2 and 3, respectively). Younger individuals had higher rates of brain metastasis (13.3, 5.4, and 1.1% for groups 1, 2, and 3, respectively). Moreover, those > 60 years old had more lung metastasis (33 vs. 12.6 and 6.7% for groups 2 and 1, respectively) (p < 0.001). Younger groups had more < 5-year recurrence (16.3, 11.7, and 8.9%, for groups 1, 2, and 3, respectively) (p = 0.023). Conclusion Pattern and site of recurrence changes according to age in BC. This brings up the question whether age is an independent predictor of organ of metastasis or is site of metastasis the result of other clinicopathological determinants which differ between age groups.
Collapse
Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afrooz Sepahdar
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Non-communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Askari
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Pezeshki
- Department of Internal Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
22
|
Zangouri V, Akrami M, Tahmasebi S, Talei A, Ghaeini Hesarooeih A. Medullary Breast Carcinoma and Invasive Ductal Carcinoma: A Review Study. Iran J Med Sci 2018; 43:365-371. [PMID: 30046204 PMCID: PMC6055214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medullary breast carcinoma (MBC) is a unique histological subtype of breast cancer. The present study aimed to evaluate the classic and non-classic characteristics of MBC and its differences with IDC. The present review study incorporates 22 years of practical experience from a breast disease research center-based series of cases. METHODS Retrospectively, the medical records of 3,246 patients were reviewed in the Breast Disease Research Center, Shiraz University of Medical Science (Shiraz, Iran), from December 1993 to December 2015. The tumor size, lymph node metastasis, pathologic stage, nuclear and histological grade, hormonal receptor status, recurrence, disease-free, and overall survival were reviewed. Differences between medullary breast carcinoma and invasive ductal carcinoma were analyzed statistically using the Chi-square, Fischer, independent-sample t test, and Kaplan-Meier analysis (SPSS version 19.0). P<0.05 were considered statistically significant. RESULTS A total of 179 patients were identified with MBC and 3,067 patients were identified with IDC. The MBC group had a significant association with a higher histological grade (P<0.001) as well as negative estrogen receptor (P<0.001), progesterone receptor (P<0.001), and HER-2 (P=0.004) status. The MBC patients predominantly had triple-negative breast cancer (TNBC) according to the molecular subtype (P<0.001). In local invasion, MBC was less invasive compared to IDC (P<0.001). The disease-free survival (DFS) and overall survival (OS) differed significantly between the MBC and IDC groups (5-year DFS: 94.2% vs. 86.3%, P=0.008; 5-year OS: 98.1% vs. 92.8%, P=0.004). CONCLUSION Despite the poor and aggressive pathological features of MBC, its clinical outcome is more favorable compared to IDC. Our findings can be useful in improvement of diagnosis and treatment of less known breast cancer subtypes, such as MBC.
Collapse
Affiliation(s)
- Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- Department of Surgery, Division of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
23
|
Alborzi Z, Zangouri V, Paydar S, Ghahramani Z, Shafa M, Ziaeian B, Radpey MR, Amirian A, Khodaei S. Diagnosing Myocardial Contusion after Blunt Chest Trauma. J Tehran Heart Cent 2016; 11:49-54. [PMID: 27928254 PMCID: PMC5027160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.
Collapse
Affiliation(s)
- Zahra Alborzi
- Department of Cardiology, Medical School, Yasouj University of Medical Sciences, Yasouj, Iran.
| | - Vahid Zangouri
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Shahram Paydar, Associate Professor of Trauma Surgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Chamran Boulevard, Shiraz, Iran. 71948-15711. Tel: +98 71 36360697. Fax: +98 71 36254206..
| | - Zahra Ghahramani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masih Shafa
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bizhan Ziaeian
- Department of Thoracic Surgery, Shiraz Universityof Medical Sciences, Shiraz, Iran.
| | - Mohammad Reza Radpey
- Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Armin Amirian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahin Khodaei
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
24
|
Akrami M, Karami M, Zangouri V, Deilami I, Maalhagh M. Small Bowel Obstruction Secondary to Femoral Hernia; Case Report and Review of the Literature. Bull Emerg Trauma 2016; 4:51-53. [PMID: 27162928 PMCID: PMC4779471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023] Open
Abstract
Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery.This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia.We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament .Laparotomy was performed and patient was treated successfully with surgical therapy.Herniawas repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause.
Collapse
Affiliation(s)
- Majid Akrami
- Department of Surgery, Shiraz University of Medical Sciences,Shiraz, Iran
| | | | - Vahid Zangouri
- Department of Surgery, Shiraz University of Medical Sciences,Shiraz, Iran
| | - Iman Deilami
- Department of Surgery, Shiraz University of Medical Sciences,Shiraz, Iran
| | - Mehrnoush Maalhagh
- Department of Ophthalmology, Shiraz University of Medical Sciences,Shiraz, Iran
| |
Collapse
|
25
|
Akrami M, Ghaeini Hesarooeih A, Barfei M, Zangouri V, Alborzi Z. Clinical Characteristics of Bowel Obstruction in Southern Iran; Results of a Single Center Experience. Bull Emerg Trauma 2015; 3:22-26. [PMID: 27162896 PMCID: PMC4771283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. METHODS This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients' demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. RESULTS Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5%) were men and 158 (38.5%) were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045) and abdominal distention (32.3% vs. 67.7%; p=0.007). Intraoperative findings included adhesion band formation in 50 (48.1%), mass 18 (17.3%), and hernia 7 (6.7%). We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042). The mean hospital stay was significantly higher in those who underwent operation (8.1±7.5 vs. 2.6±2.2 days; p=0.035). CONCLUSION The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better accuracy.
Collapse
Affiliation(s)
- Majid Akrami
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Barfei
- Medical Students, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Alborzi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|