The Role of Elastography in Diagnosis and Staging of Breast Cancer-Related Lymphedema

WOS: 000444392800001PubMed ID: 30212266Background: Early detection of lymphedema gives an opportunity for effective and successful treatment of lymphedema. However, the current diagnosis methods, except the bioimpedance analysis, perometry, and indocyanine green lymphography, have limitations in detecting early stage lymphedema. Sonoelastography is a diagnostic ultrasound technique that provides an opportunity to estimate soft tissue stiffness. Shear wave elastography (SWE) is a brand new elastography technique. Unlike strain elastography, this method is conducted automatically, that is, independently of user's manual tissue compression. The aim of this study is to establish the role of sonoelastography in diagnosis and staging of lymphedema by using the SWE technique in lymphedema patients. Methods and Results: A total of 36 female lymphedema patients were included in the study. There was no significant difference between patients with stages 1 (n = 17) and 2 (n = 19) lymphedema in terms of age, duration after surgery, and body mass index (p > 0.05). But, differences in terms of circumference measurements for forearm and arm, L-DEX values, and duration of lymphedema were found to be statistically significant (p = 0.002-0.000-0.000-0.001). Elastography measurements between normal forearm and forearm with lymphedema showed a statistically significant difference (p = 0.012). Correlation was found between circumference measurements and elastography values of forearms (p = 0.004, r = 0.471) and L-DEX scores and elastography measurements (p = 0.041, r = 0.352). When circumferential measurements of the forearms with lymphedema were compared with those with normal forearms, stage 1 patients showed no significant difference (p = 0.850), whereas a significant difference was detected in stage 2 patients (p = 0.003). Conclusion: SWE should be a useful tool in diagnosis and distinguishing early and late stages of lymphedema

A Rare Tumor that Mimicked Metastasis in a Patient with Breast Cancer: Epithelioid Hemangioendothelioma

WOS: 000382991600007PubMed ID: 28331739A woman aged 50 years was diagnosed as having an invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast and underwent bilateral mastectomy eight years ago. A mass was identified during follow-up in positron-emission tomography (PET) image in the left infraclavicular region, indicating metastasis. Histopathologic examination showed a mass of 1.9 x 1 x 0.7 cm in dimensions characterized by spindle or round nuclei cells that formed island or cords in hyaline and myxoid ground and intracytoplasmic vacuoles containing erythrocytes. In the immunohistochemical analysis, tumor cells were widespread with diffuse positivity with CD34 and vimentin. These findings redirected us from a diagnosis of metastatic carcinoma to epithelioid hemangioendothelioma, a rare tumor of intermediate vascular tumor groups. In this respect, confirmation through biopsy from considered cases of metastasis is important in making a definite pathologic differential diagnosis

Prognostic Significance of Adjuvant Chemotherapy Induced Amenorrhea in Luminal A and B Subtypes

WOS: 000439385200009PubMed ID: 30123884Objective: In this retrospective study, chemotherapy induced amenorrhea in patients with early stage breast cancer and its effects on survival were investigated. Materials and Methods: Two hundred fifty-two patients received adjuvant chemotherapy without ovarian suppression treatment (OST) from 600 premenopausal patients were included in the study. Patients were divided into two groups; with amenorrhea and without, and compared with clinicopathologic features and survival. SPSS version 17 was used. Results: Chemotherapy-induced amenorrhea (CIA) was observed in 145 (57.5%) of 252 patients who received no OST during follow-up. The 5-year OS rate of patients with CIA was significantly higher than patients without CIA (p=0.042, 95.9% vs. 89.7% vs. 158.88 vs. 135.33 months, respectively). In the subgroup analysis, the OS in patients with hormone receptor (+) was significantly higher than in those receptor (-) in patients with CIA (p=0.011, 97.5% vs. 90.9% vs. 162.13 vs. 126.16 months, respectively). The OS was significantly longer in the luminal A molecular subtype than in those with luminal B molecular subtype, in patients with CIA, but the difference was not significant in patients without CIA (p=0.027 vs. p=0.074, respectively).** Conclusion: As a conclusion; survival advantage of the chemotherapy induced amenorrhea more pronounced with hormone receptor positivity, lymph node involvement, and advanced disease over patients who do not develop amenorrhea. This advantage of amenorrhea development further prolongs survival compared with luminal B in the luminal A molecular subtype

A Rare Case of Sunitinib-Induced Hyperammonemic Encephalopathy and Hypothyroidism in Metastatic Renal Cell Carcinoma

WOS: 000372176400034PubMed ID: 24901901Sunitinib has become a standard treatment agent for metastatic renal cell carcinoma (RCC) for several years. However, various adverse events have been reported. We present a rare adverse effect of hyperammonemic encephalopathy induced by sunitinib. A 66-year-old woman with metastatic RCC referred to the emergency department with confusion that developed 14 days after the initiation of 50 mg/d of sunitinib. Her serum ammonia and thyroid-stimulating hormone levels were markedly elevated (146 mu g/dL and 27.27 mu IU/mL, respectively). Sunitinib was discontinued, and an enema with lactulose and l-thyroxine were administered. Her mental status and neurologic symptoms were normalized 7 days after the treatment. Serum ammonia level decreased to 61 mu g/dL and thyroid stimulating hormone level decreased 22.34 mu IU/mL. The incidence of sunitinib-induced hyperammonemia is rarely reported. The relationship between sunitinib and the development of hyperammonemia is not well understood, and the mechanism is unclear. Sunitinib-induced hyperammonemia is very rare, and to the best of our knowledge, this is fourth case hyperammonemia and first case hyperammonemic encephalopathy with hypothyroidism as an adverse effect. Therefore, it is important for clinicians to be aware of hyperammonemia that can occur in several days after the initiation of sunitinib treatment in metastatic RCC

Synchronous and metachronous bilateral breast cancer: A long-term experience.

Purpose: The objective of this study was to assess the demographic, pathologic and survival characteristics of patients who were diagnosed as having bilateral breast cancer

The Role of Elastography in Diagnosis and Staging of Breast Cancer-Related Lymphedema

Background: Early detection of lymphedema gives an opportunity for effective and successful treatment of lymphedema. However, the current diagnosis methods, except the bioimpedance analysis, perometry, and indocyanine green lymphography, have limitations in detecting early stage lymphedema. Sonoelastography is a diagnostic ultrasound technique that provides an opportunity to estimate soft tissue stiffness. Shear wave elastography (SWE) is a brand new elastography technique. Unlike strain elastography, this method is conducted automatically, that is, independently of user's manual tissue compression. The aim of this study is to establish the role of sonoelastography in diagnosis and staging of lymphedema by using the SWE technique in lymphedema patients

Pre-Treatment and Post-Treatment Anxiety, Depression, Sleep and Sexual Function Levels in Patients with Breast Cancer

Objective: In the phase of diagnosis and treatment of breast cancer cases, patients can usually experience sexual dysfunctions, sleep disorders and psychiatric disorders such as anxiety and depression. The main objective of our research is to study of the pre-treatment and post-treatment anxiety, depression, sleep and sexual function levels in the patients with breast cancer

Bioelectrical Impedance for Detecting and Monitoring Lymphedema in Patients with Breast Cancer. Preliminary Results of the Florence Nightingale Breast Study Group

The aim of this study was to evaluate the efficacy of bioimpedance spectroscopy for the follow-up of patients with lymphedema in Turkey and its benefits in the diagnosis of stage 0, 1, and 2 lymphedema in patients who are under treatment for breast cancer. Thirty-seven female patients with breast cancer who underwent surgical procedures in our Breast Health Centre were followed up for lymphedema using bioimpedance, and clinical measurements were taken for a minimum period of 1 year at 3-month intervals. Patients who had been monitored regularly between November, 2011, and September, 2013, were enrolled to the study. In total, 8 patients developed lymphedema with an overall rate of 21.6%. Among the 8 patients who developed lymphedema, 4 had Stage 2, 1 had Stage 1, and 3 had Stage 0 lymphedema. Stage 0 lymphedema could not be detected with clinical measurements. During the patients' 1-year follow-up period using measurements of bioimpedance, a statistically significant relationship was observed between the occurrence of lymphedema and the disease characteristics. including the number of the extracted and remaining lymph nodes and the region of radiotherapy (p=0.042, p=0.024, p=0.040). Bioimpedance analysis seems to be a practical and reliable method for the early diagnosis of lymphedema. It is believed that regular monitoring of patients in the high-risk group using bioimpedance analyses increases the ability to treat lymphedema

True Local Recurrences after Breast Conserving Surgery have Poor Prognosis in Patients with Early Breast Cancer

Background

Preoperative Lymphedema-Related Risk Factors in Early-Stage Breast Cancer

Background: Prolongation of survival in patients with breast cancer due to early diagnosis and modern methods of treatment has turned the attention on lymphedema, which is the most important morbidity secondary to the treatment of the disease. Determination of lymphedema and related risk factors in patients before a surgical intervention may provide protection for patients and early treatment. The aim of this study was to determine the presence of lymphedema before surgery by bioimpedance analysis in patients with breast cancer and to establish risk factors associated with lymphedema