RESUMO
Breast cancer is the most common malignancy in women in the UK with well-defined algorithms of management in place in the western world. Squamous cell carcinoma of the breast is a rare entity and as such knowledge about the pathophysiology, treatment and prognosis are still uncertain. The report describes an unusual case of squamous cell carcinoma arising in an area of Zuska's disease of the breast. It illustrates the heterogeneity of the imaging findings with review of the literature. Decisions on management should be taken on an individual basis with full discussion in the multidisciplinary team meetings where all facets of the case are considered.
Assuntos
Abscesso/complicações , Doenças Mamárias/complicações , Neoplasias da Mama/etiologia , Carcinoma de Células Escamosas/etiologia , Fístula/complicações , Abscesso/diagnóstico por imagem , Abscesso/patologia , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Fístula/diagnóstico por imagem , Fístula/patologia , Fístula/cirurgia , Humanos , Biópsia Guiada por Imagem , Mamografia , Mastectomia , Prognóstico , Biópsia de Linfonodo Sentinela , Ultrassonografia MamáriaRESUMO
BACKGROUND: Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Oncotype DX testing in the U.K. METHODS: Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subsequently offered Oncotype DX testing, with changes in chemotherapy decisions recorded. A subset of patients completed questionnaires about their uncertainties regarding chemotherapy decisions pre- and post-testing. All patients were asked to complete a diary of medical interactions over the next 6 months, from which economic data were extracted to model the cost-effectiveness of testing. RESULTS: Oncotype DX testing resulted in changes in chemotherapy decisions in 38 of 142 (26.8%) women, with 26 of 57 (45.6%) spared chemotherapy and 12 of 85 (14.1%) requiring chemotherapy when not initially recommended (9.9% reduction overall). Decision conflict analysis showed that Oncotype DX testing increased patients' confidence in treatment decision making. Economic analysis showed that routine Oncotype DX testing costs £6232 per quality-adjusted life year gained. CONCLUSION: Oncotype DX decreased chemotherapy use and increased confidence in treatment decision making in patients with ER+ early-stage breast cancer. Based on these findings, Oncotype DX is cost-effective in the UK setting.
