Solitary biceps muscle metastasis from neuroendocrine breast tumor.

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Risk-Reducing Bilateral Salpingo-Oophorectomy for BRCA Mutation Carriers and Hormonal Replacement Therapy: If It Should Rain, Better a Drizzle than a Storm [editorial].

Women carrying a BRCA mutation have an increased risk of developing breast and ovarian cancer. The most effective strategy to reduce this risk is the bilateral salpingo-oophorectomy, with or without additional risk-reducing mastectomy. Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended between age 35 and 40 and between age 40 and 45 years for women carriers of BRCA1 and BRCA2 mutations, respectively. Consequently, most BRCA mutation carriers undergo this procedure prior to a natural menopause and develop an anticipated lack of hormones. This condition has a detrimental impact on various systems, affecting both the quality of life and longevity; in particular, women carrying BRCA1 mutation, who are likely to have surgery earlier as compared to BRCA2. Hormonal replacement therapy (HRT) is the only effective strategy able to significantly compensate the hormonal deprivation and counteract menopausal symptoms, both in spontaneous and surgical menopause. Although recent evidence suggests that HRT does not diminish the protective effect of RRBSO in BRCA mutation carriers, concerns regarding the safety of estrogen and progesterone intake reduce the use in this setting. Furthermore, there is strong data demonstrating that the use of estrogen alone after RRBSO does not increase the risk of breast cancer among women with a BRCA1 mutation. The additional progesterone intake, mandatory for the protection of the endometrium during HRT, warrants further studies. However, when hysterectomy is performed at the time of RRBSO, the indication of progesterone addition decays and consequently its potential effect on breast cancer risk. Similarly, in patients conserving the uterus but undergoing risk-reducing mastectomy, the addition of progesterone should not raise significant concerns for breast cancer risk anymore. Therefore, BRCA mutation carriers require careful counselling about the scenarios following their RRBSO, menopausal symptoms or the fear associated with HRT use

Status of axillary lymph nodes in 365 breast cancer patients with positive US-guided FNA or positive SLN.

<p>Legend: SLN: Sentinel Lymph Node; US: Ultrasonography; FNA: Fine-Needle Aspiration cytology. MTS: metastases; ALND: axillary lymph node dissection; LN: lymph node.</p><p>*Including SLN.</p><p>Status of axillary lymph nodes in 365 breast cancer patients with positive US-guided FNA or positive SLN.</p

Axillary lymph nodes management in breast cancer patients US: ultrasound; FNA: fine needle aspiration; SLN: sentinel lymph node; ITC: isolated tumour cells.

<p>Axillary lymph nodes management in breast cancer patients US: ultrasound; FNA: fine needle aspiration; SLN: sentinel lymph node; ITC: isolated tumour cells.</p

Clinical and histopathological characteristics of 1287 breast cancer patients who underwent axillary US examination.

<p>Legend: SLN: Sentinel Lymph Node; ITC: Isolated Tumour Cells.</p><p>Clinical and histopathological characteristics of 1287 breast cancer patients who underwent axillary US examination.</p

Metastatic involvement of the axilla in 154 breast cancer patients that underwent US-guided FNA.

<p>Legend: US: Ultrasonography; FNA: Fine-Needle Aspiration cytology; ALND: Axillary Lymph Node Dissection; SLN: Sentinel Lymph Node.</p><p>Metastatic involvement of the axilla in 154 breast cancer patients that underwent US-guided FNA.</p

Number of axillary metastatic lymph nodes in breast cancer patients with positive (micro- and macrometastases) sentinel lymph nodes (SLNs) and in patients with positive ultrasound (US) guided fine needle aspiration cytology (FNA).

<p>The percentage of cases with >3 axillary metastatic lymph nodes is higher in patients with positive US-guided FNA cytology than in patients with metastatic SLNs.</p