PATHOLOGIC FINDINGS IN GENDER-AFFIRMING MASTECTOMY: A SYSTEMATIC REVIEW.

Following increased cultural awareness, expanded access to care, and decreased stigmatization, the number of transgender individuals seeking gender affirmation surgery such as gender-affirmation mastectomy (GAM) continues to rise. While post-mastectomy breast tissue is often sent for pathologic evaluation, few studies address the utility and standardization of this practice. This literature review evaluates the pathology findings in GAM specimens reported in the medical literature. A systematic review following PRISMA guidelines was performed to evaluate all medical publications related to pathology reports following GAM. The overall type and incidence of benign and malignant breast lesions were analyzed to elucidate which patient characteristics significantly affect the pathology findings. Overall, eight of 488 identified studies met inclusion criteria (1278 patients). The incidence of pre-malignant lesions was 2.42%, including flat epithelial atypia (0.08%), atypical hyperplasia (0.23%), atypical ductal hyperplasia (1.33%), atypical lobular hyperplasia (0.39%), and lobular carcinoma in situ (0.39%).Patient age, hormonal therapy, and family / patient history of breast cancer were inconsistently reported among included studies. Lack of standardized pathologic classification did not permit further statistical analysis. Although patients who undergo GAM are unlikely to have premalignant or malignant findings on breast pathology examination, pathologic evaluation of breast tissue remains common practice. Additional studies, which include a standardized method of pathologic evaluation, are necessary before practice guidelines can be recommended.

Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada.

OBJECTIVE: This study attempted to estimate the prevalence of dissociative symptoms and disorders in a Canadian adult psychiatric inpatient population and also attempted to determine the extent to which dissociative disorders were recognized by the attending clinical staff. METHOD: All appropriate and consenting adult psychiatric inpatients at the Kingston Psychiatric Hospital in Kingston, Ontario, were given the Dissociative Experiences Scale. Patients scoring 25 or greater were interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Admission or discharge diagnoses data were used to determine whether or not dissociative disorders were being recognized. RESULTS: A total of 48 patients completed the Dissociative Experiences Scale and 14 (29%) scored 25 or greater. The prevalence of dissociative disorders in this hospital population was estimated to be 17%. Dissociative identity disorder was found in six percent, dissociative amnesia in eight percent and dissociative disorder not otherwise specified in two percent of the population. These disorders tended to be under-recognized. CONCLUSION: Research on more extensive populations is required to establish the true prevalence of dissociative symptoms and disorders in psychiatric inpatients.