[Granulomatous mastitis].

Granulomatous mastitis (GM) is a quite rare inflammatory condition of the breast with varying clinical presentations and microbiological findings. Having excluded specific diseases connected with GM, a group of idiopathic GM (IGM) remains including a special form presenting with multiple small cysts named cystic neutrophil GM (CNGM). The aetiology is unknown, and clinical investigation methods as well as treatment options are controversial. The purpose of this review is to describe diagnostic considerations and controversies in the treatment of IGM and CNGM.

Radioactive Seed Localization or Wire-guided Localization of Nonpalpable Invasive and In Situ Breast Cancer: A Randomized, Multicenter, Open-label Trial.

OBJECTIVE: To compare the rate of positive resection margins between radioactive seed localization (RSL) and wire-guided localization (WGL) after breast conserving surgery (BCS). BACKGROUND: WGL is the current standard for localization of nonpalpable breast lesions in BCS, but there are several difficulties related to the method. METHODS: From January 1, 2014 to February 4, 2016, patients with nonpalpable invasive breast cancer or DCIS visible on ultrasound were enrolled in this randomized, multicenter, open-label clinical trial, and randomly assigned to RSL or WGL. The primary outcome was margin status after BCS. Secondary outcomes were duration of the surgical procedure, weight of surgical specimen, and patients' pain perception. Analyses were performed by intention-to-treat (ITT) and per protocol. RESULTS: Out of 444 eligible patients, 413 lesions representing 409 patients were randomized; 207 to RSL and 206 to WGL. Twenty-three did not meet inclusion criteria, chose to withdraw, or had a change in surgical management and were excluded. The remaining 390 lesions constituted the ITT population. Here, resection margins were positive in 23 cases (11.8%) in the RSL group compared with 26 cases (13.3%) in the WGL group (P = 0.65). The per-protocol analysis revealed no difference in margin status (P = 0.62). There were no significant differences in the duration of the surgical procedure (P = 0.12), weight of the surgical specimen (P = 0.54) or the patients' pain perception (P = 0.28). CONCLUSION: RSL offers a major logistic advantage, as localization can be done several days before surgery without any increase in positive resection margins compared with WGL.

Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons.

INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level of implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all symmetrisation procedures were performed by plastic surgeons. Breast surgeons had sought more specific education, both international observerships and specific courses. In both groups of surgeons, the majority expressed that both tumour removal and reconstruction should be performed by doctors of their own specialty. CONCLUSION: OPS has become integrated in all breast centres, but has not yet been fully implemented. For optimal results in all patients, this study underlines the importance of the inclusion of a dedicated plastic surgeon within the multidisciplinary team for optimal initial evaluation of all breast cancer patients. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Smoking and increased risk of mastitis]. / Rygning øger risiko for brystbetaendelse.

INTRODUCTION: Non-puerperal mastitis (NPM) is a common condition that often proves tricky to treat as it may give rise to complications and recurrences. NPM has been related to cigarette smoking through mechanisms that are not fully known. This study was aimed at analyzing the course of this patient group and at promoting guidelines for adequate treatment. MATERIAL AND METHODS: This is an audit of 178 files for patients diagnosed with NPM in 2008 at the Breast Unit at Herlev Hospital. The audit included: number of contacts, treatment, bacteriology, complications, recurrences and coding. A questionnaire was sent to all breast units in Denmark to review treatment guidelines. RESULTS: We found a large majority of smokers (73%). Non-smokers often had systemic disease or immunosuppressive conditions, and many patients had been misclassified with infections related to skin diseases. Smokers on average had 5.3 (versus 3.0 among non-smokers) outpatient visits to the unit and more than twice as many recurrences. We found quite good accordance between different breast units in Denmark in terms of treatment and follow-up regimes. CONCLUSIONS: This study confirms that NPM is a smoker's disease. Nearly all patients can be treated on an outpatient basis with no need for open incision of abscesses. We found a lack of diagnostic precision and also incorrect coding of patients with infected skin diseases or complications to surgery or radiation therapy. We find that smoking intervention should be mandatory to prevent the majority of complications and recurrences.

Contrast kinetics of the malignant breast tumour--border versus centre enhancement on dynamic midfield MRI.

PURPOSE: To quantify the border versus centre enhancement of malignant breast tumours on dynamic magnetic resonance mammography. MATERIALS AND METHODS: Fifty-two women diagnosed with primary breast cancer underwent dynamic magnetic resonance mammography (Omniscan 0.2 mmol/kg bodyweight) on a midfield scanner (0.6 T), prior to surgery. The following five variables were recorded from the border and centre regions of the tumours: Early Enhancement, Time to Peak, Wash-in rate, Wash-out rate and Area under Curve. Information on histology type, oestrogen and progesterone receptor status was collected. Statistical analysis was performed in SAS 9.1 as paired samples t-tests. RESULTS: Fifty of 52 malignant tumours displayed a faster Early Enhancement in the border region compared to the centre (p<0.0001). Significant differences between the border and centre values were found for Time to Peak, Wash-in rate, Wash-out rate and Area under Curve. Hormone receptor positive tumours displayed an over-all highly significant difference between border and centre enhancement, whereas no significant differences for any of the five variables were recorded in neither oestrogen nor progesterone hormone receptor negative tumours. CONCLUSION: The border/centre enhancement difference in malignant breast tumours is easily visualized on midfield dynamic magnetic resonance mammography. The dynamic behaviour is significantly correlated to histological features and receptor status of the tumours.

Prognostic effect of estrogen receptor status across age in primary breast cancer.

Estrogen receptor (ER) status is considered as an important prognostic factor as well as a predictive factor for endocrine responsiveness in breast cancer. We analyzed the distribution of ER status across age and estimated variations in the prognostic impact of ER status related to patients' age and time since diagnosis. Overall, 26,944 patients with primary breast cancer diagnosed from 1989 to 2004 were included. The proportion of ER positive tumors increased over age from 51 to 82%. In multivariate analysis of overall survival, ER positive status was found to be a significantly positive prognostic factor over all age groups. This effect was limited to the first 5 years after diagnosis, RR: 2.08 (95% CI: 1.95-2.22, p < 0.0001). Overall survival during the following 5 years was slightly superior for women with ER negative tumors, RR of death: 0.89 (95% CI: 0.79-1.00, p = 0.049). Results were unchanged in patients who did not receive adjuvant systemic therapy (n = 6,272). Thus, positive ER status does not confer a negative impact on survival in young women as has been previously reported. The inferior prognosis for ER negative patients during the first 5 years after diagnosis changes into a slightly superior residual prognosis compared to ER positive patients independent of use of adjuvant systemic therapy. This may have an impact on future designing of guidelines for adjuvant endocrine therapy beyond 5 years.

[Patients' experiences--indications for treatment quality in breast cancer surgery]. / Patientoplevelser--indikatorer for behandlingskvaliteten i brystkraeftkirurgien.

INTRODUCTION: After the establishment of a centralised unit for the surgical treatment of breast cancer in the county of Copenhagen, Denmark, a number of parameters concerning the quality of patients' in-hospital stay were established. A survey of patients' experiences was done via a questionnaire in which they described their satisfaction level. MATERIALS AND METHODS: Two questionnaires including 43 questions were sent to 400 women recently operated on for primary breast cancer. They were returned by 269 patients, who were included in the study. RESULTS: The patients indicated a high degree of satisfaction with the general aspects of their hospital stay, but problems and possible areas of future improvement were also identified. CONCLUSION: Even with a malignant diagnosis and a short hospital stay, patients may regard the treatment course positively if and when the course is firmly anchored in well-established quality goals.