Influence of support group intervention on quality of life of Malaysian breast cancer survivors.

Given that breast cancer is the most prevalent form of cancer affecting Malaysian women and its low survival rate, this study investigates the possible influence of support group intervention on quality of life (QOL). It also examines the interrelationships between QOL subdomains as research has shown the influence of emotional expression on psychological and physical well-being. Rasch analysis was implemented to examine perception of QOL and the comparability of the Functional Assessment of Cancer Therapy General and Breast Cancer scales (FACT-G and FACT-B) of the Functional Assessment of Chronic Illness Therapy inventory. Results indicated that perception of QOL may be influenced by factors other than support group intervention. The FACT-G and FACT-B scales were comparable in the measurement of QOL for breast cancer, and the interrelationships between the QOL subdomains were supported. The findings of this study accentuate the importance of focusing support group interventions on improvement of emotional well-being to maintain patients' QOL despite the cancer.

Intermediate to highly suspicious calcification in breast lesions: a radio-pathologic correlation.

Breast calcification is an important feature in the radiological assessment of breast lesions. There are well established diagnostic criteria basing on the morphology and distribution of the calcifications radiologically with recommendation protocols. Pathologically, calcifications in breast lesions are of dystrophic type, and may occur in either the secretory materials or necrotic debris, with inflammation and osteopontin being plausible mediators. Detection of calcium phosphate (hydroyapaptite) is considerably easier than calcium oxalate. Radiologically amorphous calcification represents a borderline type of calcification, and occurs in both benign and malignant (low grade) lesions, and warrants careful follow up and investigation. Clustering of calcification alone may not be an accurate predictor for malignancy, but when there are associated features like pleomorphism, branching, architectural distortion, and associated mass or density, the predictive value for malignant increases. Adequate sampling of calcification in the biopsy is crucial in the management of patients; in general, needle core biopsy or mammotome biopsy achieve satisfactory calcification retrieval. In a benign biopsy that fails to identify the calcifications visible in the mammography, further evaluation or cutting of the histologic block is recommended to minimize the potential of a false negative investigation.

Magnetic resonance imaging of breast lesions--a pathologic correlation.

Magnetic resonance imaging of the breast is useful in assessing breast lesions. An understanding of the pathologic characteristics of the tumors may help to understand these magnetic resonance imaging observations.Large lesional size (>10 mm), ill-defined margin, and irregular outlines are associated with malignancy. These correlate with the pathological features of breast tumor, characterized by rapid growth rate, large size, and infiltrative growth pattern, invasion into stroma resulting in desmoplasia, and hence irregular outline and margin. The detection and estimation of tumor extent of invasive lobular carcinoma is problematic, even with magnetic resonance imaging, which is considered the most sensitivity. This inaccuracy likely derives from the characteristic linear, single cells infiltration growth pattern of the tumor, which is also often underestimated by clinical examination. Estimation of tumor extent after neoadjuvant chemotherapy is also essential but problematic by imaging, as the shrunken tumor becomes fibrotic, with stromal hyalinization, diminished microvasculature and tumor break up causing size underestimation. Non-enhancement of breast tumors occurs in about 8% of cases correlates with diffuse growth pattern, particularly of infiltrative lobular carcinoma. The observation of disproportionately high non-enhancing ductal carcinoma in situ remains an enigma. Finally, early rim enhancement correlates with small cancer nests, low ratio of peripheral to central fibrosis and high ratio of peripheral to central microvessel density. These may be related to increased vascular endothelial growth factor mediated increased microvessel density as well as increased permeability, which manifest as increased rapid contrast uptake and dissipation.

In vivo proton magnetic resonance spectroscopy of breast lesions: an update.

In vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been demonstrated to be successful in the differentiation of benign and malignant breast lesions in a non-invasive manner by detecting increased levels of composite choline (Cho) compounds. Currently there is molecular evidence of increased Cho metabolism in breast cancer cells. In breast malignancies, (1)H-MRS achieved a high-overall sensitivity (82%). Most test cases were infiltrating duct carcinoma, but infiltrating lobular, medullary, mucinous and adenoid cystic carcinomas were also positive by (1)H-MRS. Large lesional size is a pre-requisite for (1)H-MRS testing, and technical problems account for some of the false negative results. Another potential of (1)H-MRS is to assess patients' response to neoadjuvant chemotherapy. In ductal carcinoma in situ, the results of (1)H-MRS on the limited number of cases were negative. Most of the assessed benign breast lesions including fibroadenoma, fibrocystic changes, cysts and galactoceles, papilloma, tubular adenoma and phyllodes tumours and were mostly negative by (1)H-MRS, with an overall false positive rate was about 8%. Normal breast tissue was almost always negative by (1)H-MRS, whereas, lactating breast tissue showed positivity with a slightly different spectrum on further analysis. With the clinical use of stronger field MR scanners and better coils, the sensitivity of (1)H-MRS may be further improved. With these improvements, (1)H-MRS may potentially be useful in detection of smaller malignant lesions, characterization of malignant lesions into non-invasive or invasive, and as an invaluable tool in disease progression monitoring.

Relationship between lesion size and signal enhancement on subtraction fat-suppressed MR imaging of the breast.

OBJECTIVE: To investigate the relationship between size and whole lesion enhancement of breast neoplasms. MATERIALS AND METHODS: Fat-suppressed subtraction MRI was performed in 94 breast lesions (44 malignant, 50 benign) with pathologically confirmed diagnoses. Of these, all malignant lesions and 31 of the 50 benign lesions showed enhancement. The degree of enhancement was quantified by using an ROI tracing around the whole lesion and calculated as the percentage increase in signal intensity between the corresponding precontrast and postcontrast images. RESULTS: The 44 malignant lesions showed enhancement percentage of 38.3% to 186.4% (mean 109.9%), and the 31 benign lesions showed enhancement percentage of 12.8% to 180.2% (mean 79.5%). The difference is statistically significant (P = .002). In 54 small lesions (28 malignant, 26 benign) with enhancing pixel areas of <300 mm(2) corresponding to a diameter of approximately 19.5 mm, an enhancement exceeding 75% of baseline separated malignant lesions (mean enhancement 116.7%) from benign ones (mean enhancement 72.8%) (P = .0001). This gave a sensitivity of 100% and a specificity of 69%, a positive predictive value of 78%, negative predictive value of 100% and an accuracy of 85% in using >75% enhancement increase in detecting malignancy in small (<300 mm(2)) enhancing lesions. CONCLUSION: The high sensitivity in the detection of small malignant lesions suggests a potential for the method to be used in assessment of small enhancing breast lesions.

Granulomatous mastitis: a clinicopathological review of 26 cases.

AIMS: Twenty-six cases of granulomatous mastitis were examined to determine the common histological and clinical features and the possible association with micro-organisms. METHODS: A retrospective review of the clinical and histological features of these cases was undertaken, including granuloma, inflammatory cell infiltrate, multinucleated giant cells, necrosis and lymphocytic lobulitis, as well as special stains for micro-organisms including Mycobacterium, other bacteria and fungus. PCR for Mycobacterium tuberculosis DNA was also performed in 19 cases. RESULTS: Granulomas were present in all cases (100%) while multinucleated giant cells were seen in 17 cases (65%), background inflammatory cell infiltrate in 23 cases (88%), predominantly lymphocytes in 18 cases (69%), significant lymphocytic lobulitis in 13 of 19 cases (68%) and necrosis in three cases (11%). Special stains and cultures for micro-organisms were all negative. Clinically, four cases (15%) were associated with duct ectasia, eight (31%) with abscess, and there was no such association in 14 cases (54%). Of the 19 cases with PCR for tuberculosis, one case showed Mycobacterium DNA in the sample, raising the possibility of occult tuberculosis infection. CONCLUSIONS: Granulomatous mastitis is a heterogeneous group of diseases with a diverse clinical picture and association. Most idiopathic cases are not associated with specific micro-organisms.

Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors.

OBJECTIVE: Proton MR spectroscopy is a recently described technique with high sensitivity and specificity for differentiating breast carcinoma from benign lesions. We evaluated the possible relationship between spectroscopy results and the tumor proliferative index, angiogenesis, and HER2/neu oncogene overexpression. SUBJECTS AND METHODS. We prospectively evaluated 19 breast carcinomas, 21 benign breast lesions (including 18 fibroadenomas, one fibrocystic change, one hamartoma, and one papilloma), and six phyllodes tumors (four benign, two of borderline malignancy) using proton MR spectroscopy. All lesions were larger than 1.5 cm. Tumor Ki-67 proliferative index, tumor angiogenesis, and HER2/neu oncogene overexpression were evaluated by immunohistochemistry of the histologic material. RESULTS: Spectroscopy findings were positive in 17 (89%) of 19 carcinomas but negative for all benign lesions and phyllodes tumors (sensitivity, 89%; specificity, 100%). Significantly higher levels were obtained for all biologic parameters in carcinomas compared with benign lesions and phyllodes tumors. HER2/neu oncogene overexpression was present in 37% of carcinomas but not in other lesions. The two false-negative findings of breast carcinoma showed similar Ki-67 proliferative index and microvessel density compared with the remaining carcinomas, but both cases were negative for HER2/neu overexpression. CONCLUSION: Proton MR spectroscopy is useful in the in vivo characterization of breast masses when the lesion exceeds 1.5 cm in maximal dimension. Spectroscopy is unable to reveal benign breast lesions and phyllodes tumors of benign and borderline malignancy. We suggest that a false-negative spectroscopic result may be related to an absence of HER2/neu overexpression in carcinoma of the breast.

Fine needle aspiration cytologic features of mammary phyllodes tumors.

OBJECTIVE: To evaluate specific diagnostic fine needle aspiration cytologic (FNAC) features of phyllodes tumor (PT), particularly in the differentiation from fibroadenoma (FA). STUDY DESIGN: Twenty-eight FNAC of PT were reviewed for smear cellularity, epithelial and stromal fragments, their size and atypia, epithelial/stromal area ratio, background single stromal cells (oval or columnar), multinucleated giant cells, and squamous and apocrine cells. Twenty-one FNAC of fibroadenoma were also assessed for comparison. RESULTS: PT was significantly larger than FA. Epithelial fragments were found in all cases, with atypia present in PT. Stromal fragments were present in half the cases; there was no difference in stromal size, but the epithelial/stromal area ratio was significantly lower in PT than FA. Single columnar stromal cells with recognizable cytoplasm and multinucleated stromal giant cells were seen in some PT but not in FA. CONCLUSION: Cytologic diagnosis of PT remains difficult, with significant overlap with FA. The presence of large size, low epithelial/stromal ratio, epithelial atypia, columnar stromal cells with visible cytoplasm and stromal giant cells favors a diagnosis of PT over FA.