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Introduction Breast cancer is the most common type of cancer worldwide, and even with all the screening and education, great numbers of diagnoses are made in advanced stages. Additionally, patients in remission always remain at risk of relapse and metastasis. Pakistan has the highest incidence of breast cancer among Asian countries. The purpose of this clinical audit was to compare data from the largest cancer hospital in Pakistan with international standards to provide room for quality improvement. Methods A retrospective review of patients with advanced breast carcinoma over a period of six months was done. Permission was obtained from the Quality Assurance and Patent Safety Department before the commencement of the audit. Standards Data obtained were audited against nine standards of four different categories from the National Institute for Health and Care Excellence (NICE) guidelines on advanced breast carcinoma. Results For the diagnosis and assessment category, for which a target of 100% was set, 99.66% was achieved; for disease monitoring, for which a target of 100% was set, 91.8% was achieved; for systemic disease-modifying therapy, for which the majority was the target, only 1% was achieved; for managing complications, for which a target of 100% was set, 71.8% was achieved. Conclusion Continuous research and breakthrough advancements have made health care an ever-evolving field. Clinical audits like these that compare international standards with local data are beneficial and lead to quality improvement. They highlight issues that may be overlooked otherwise, raise questions that may never be asked, and may inspire prospective research studies. Limitations of the audit were that this clinical audit was conducted outside of the NHS where NICE guidelines are not followed and local guidelines differ from NICE guidelines.
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Objective The objective of this study is to determine any association between mammographic density (MD) and breast cancer in Pakistani population. The study will also investigate relationship between mammographic breast density, clinical characteristics, and molecular tumor markers of the disease. Methods A retrospective review of data was carried out from January 2020 to December 2020 with stage 0-3 patients with histologically proven breast cancer included in the study. Mammograms were reviewed and density grade was recorded in accordance with "Breast Imaging Reporting and Data System (BIRADS)" guidelines. Patient age, tumor, and receptor characteristics were studied and their association with mammographic density was investigated by using chi-square test. P-value ≤0.05 was considered statistically significant. Results A total of 361 patients were included with a mean age of 46 years. The frequencies of BIRAD categories were as follows: category A: 8.9%, category B: 43.2%, category C: 33.5%, and category D: 14.4%. Cumulative frequency of categories B and C was 76.7%. There is a statistically significant p-value ≤0.05 association observed between age, estrogen receptors (ER) status, and T-stage versus MD. Also, majority of our patients were in T-stage category 2 or 3, which can easily be picked on mammogram. Conclusion Most of the breast cancer patients in our population had a mammographic density of B or C, indicating that breast cancer is more common in dense breasts. Strong significant association of mammographic density with age, ER status, and tumor stage was found in our population. Future studies need to address and confirm MD and its association with subtypes and aggressiveness of breast cancer.
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Bronchogenic cysts originate from the tracheobronchial bud, which arises from the embryonic foregut. Congenital bronchogenic cysts in the cervical region, especially in the thyroid or perithyroidal area, are extremely rare. Moreover, distinguishing them from other cervical cystic lesions such as thyroglossal duct and branchial cleft cysts and metastatic cervical lymph nodes is difficult preoperatively. In this report, we discuss a case of a 41-year-old woman who presented to us with a history of anterior neck swelling for two weeks with occasional palpitations and bilateral flank pain. On workup, she was diagnosed as a case of multiple neuroendocrine neoplasm type 2A for which she underwent adrenalectomy first followed by total thyroidectomy with central neck dissection and parathyroidectomy. On the final histopathology specimen, an incidental bronchogenic cyst was diagnosed. A bronchogenic cyst is a rare entity, especially in the head and neck region, and can be confused with a metastatic lymph node. Diagnosis is made based on the histopathological examination, which requires surgical excision. The bronchogenic cyst should be considered in the differential diagnosis for midline and lateral neck masses.