Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy: Risk of Malignant Upgrade on Surgical Excision / 한국유방암학회지

Purpose@#This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making. @*Methods@#This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010–2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. @*Results@#Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound (p = 0.018) or mammography (p = 0.026), microcalcifications (p = 0.047), diffuse microcalcification distribution (p = 0.034), mammographic parenchymal density (p = 0.008). and ≥ 3 separate ADH foci found on biopsy (p = 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005–0.35; p = 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21–25.2; p = 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831–1.920; p = 0.002) remained significant in multivariate analysis and were included in the nomogram. @*Conclusion@#Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74–0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.

Male breast cancer in Singapore: 15 years of experience at a single tertiary institution

<p><b>INTRODUCTION</b>Male breast cancer is a rare disease entity, with little data from the Southeast Asian perspective. Hence, this study aims to review the data from our local experience in order to better delineate the disease characteristics in our population.</p><p><b>MATERIALS AND METHODS</b>Male patients with histologically proven breast cancer were identified from a prospectively collected database. The clinical, histopathological and survival data were reviewed retrospectively and analysed.</p><p><b>RESULTS</b>Twenty-one patients were identified. The median age at diagnosis was 68 years. Eighteen patients underwent simple mastectomy with curative intent, with the remaining patients having metastatic disease at presentation. Almost half of the patients presented with stage III or IV disease. At the time of analysis, median overall survival was 50 months and median disease-free survival was 47.5 months. None of the patients had any documented family history or risk factors for male breast cancer.</p><p><b>CONCLUSION</b>The disease appears to be a sporadic and rare occurrence in the local male population. A high index of suspicion should be maintained in males presented with a unilateral breast lump so that appropriate treatment can be instituted.</p>

Managing breast cancer diagnosed in first trimester pregnancy: a case report

<p><b>INTRODUCTION</b>Breast cancer is the most common malignancy in pregnant women, occurring at a rate of about 1 in 3000 pregnancies. Unfortunately, this will sometimes occur during the first trimester of pregnancy and this situation warrants discussion of management options with regard to the mother and child, especially with the current trend of deferring child bearing to a later age.</p><p><b>CLINICAL PICTURE</b>We present a 34-year-old primigravida who had a breast lump prior to confirmation of her pregnancy and received her diagnosis of invasive breast cancer at 7 weeks' amenorrhoea. The oncologic management options of this pregnant patient with breast cancer are discussed.</p><p><b>TREATMENT</b>The patient eventually opted to undergo wide excision of the breast cancer with sentinel lymph node biopsy and possible axillary clearance together with termination of her pregnancy.</p><p><b>RESULTS</b>The patient successfully underwent surgery for her breast cancer and was subsequently treated with adjuvant therapy as per normal protocol for a non-pregnant patient.</p><p><b>CONCLUSION</b>The management of breast cancer and pregnancy occurring concurrently is a complex problem fraught with many dilemmas for both the medical team, the patient and her family. The option chosen must involve a multidisciplinary team and have full informed consent of the patient.</p>