Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Adenomyoepithelioma of the breast with malignant transformation and repeated local recurrence:A case report

BACKGROUND Adenomyoepithelioma(AME)of the breast is a rare type of benign breast tumor.Many AMEs show benign behavior,but reports of the malignant type are rare.We present the case of a patient with AME with repeated local recurrences and further malignant transformation.CASE SUMMARY A 53-year-old woman visited our hospital with a 16-mm palpable mass in the right breast.A core needle biopsy was performed.The pathological diagnosis was AME.Lumpectomy with a safety margin was performed without axillary lymph node dissection(ALND).Two years later,local recurrence developed,and the patient again underwent lumpectomy with a safety margin.The pathology showed malignant AME,and the margin was negative.Eight months later,local recurrence developed again in the same location,and a total mastectomy was performed without ALND.The pathological diagnosis was malignant AME.The patient was disease-free for three years posttreatment.CONCLUSION The treatment of AME requires caution,as it may exhibit repeated recurrences after local excision as well as malignant transformation.

Malignant fibrous histiocytoma of the axilla with breast cancer:A case report

BACKGROUND Multiple primary malignant neoplasms refer to multiple tumors with different origins.They may be synchronous or metachronous.The incidence is 0.73%–11.7%.Synchronous cases of breast cancer with sarcoma are rare.CASE SUMMARY Here,we report a 78-year-old female patient admitted to hospital after accidental discovery of a left axillary mass.Preoperative examination revealed a breast mass.Pathology showed left breast cancer and left axillary sarcoma.The patient underwent surgery,endocrine therapy and radiotherapy.She has been followed up for 1 year,and no local recurrence or distant metastasis was observed.CONCLUSION Attention should be paid to multiple primary malignant neoplasms,not limited to the current diagnosis and analysis,avoiding missed diagnosis and misdiagnosis.

Paraben Content in Adjacent Normal-malignant Breast Tissues from Women with Breast Cancer

Objective Accumulation of estrogenic compounds and other carcinogens in normal breast tissues contributes to unpredictable breast cancer incidence during adolescence and throughout life.To assess the role of parabens in this phenomenon,the paraben content of adjacent normal-malignant breast tissues is measured in women with breast cancer living in Isfahan Province,Iran.Methods Adjacent normal-malignant breast tissue samples were obtained from 53 subjects.The parabens including methyl-paraben(Me PB),ethyl-paraben(Et PB),propyl-paraben(Pr PB),and butylparaben(Bu PB)were extracted from the sample supernatant and then subjected to gas chromatography analysis.Results Some risk factors for breast cancer were stimulated by parabens in adjacent malignant-normal breast tissues among young and middle-aged women with breast cancer.We observed a significant association for dose-response pattern of Me PB[OR=98.34(11.43–185.2),P=0.027]for both ER+and PR+women and Me PB[OR=164.3(CI:112.3–216.3),P<0.001]for HER2+women than women with negative receptors.The risk of 95-fold increase in Me PB dose and 164-fold increase in∑PBs dose were significant for women with hereditary breast cancer in first-degree relatives.Conclusions These results may promote future epidemiology studies and strategies to improve women's lifestyle and consume paraben-free products.

Malignant adenomyoepithelioma of the breast:Two case reports and review of the literature

BACKGROUND Malignant adenomyoepithelioma(AME)of the breast is a rare tumor in which malignancy can arise from either epithelial or myoepithelial components,or from both cell types.The incidence and prognosis of malignant AME of the breast are difficult to assess due to its rarity.Therefore,the optimal treatment for this disease is still controversial.CASE SUMMARY We present two middle-aged women(48 and 56 years old)with malignant AME of the breast.Core needle biopsy was performed before surgery.However,breast adenoma and malignant tumors were observed.The preoperative diagnosis of malignant AME of the breast is still challenging for pathologists and clinicians.Both patients underwent mastectomy and sentinel lymph node biopsy,both of which were negative,followed by adjuvant chemotherapy.CONCLUSION The follow-up duration of the two patients was two years and four months,respectively.No signs of relapse or metastasis have been observed thus far.

A RETROSPECTIVE ANALYSIS OF SURGICAL TREATMENT FOR BREAST MALIGNANT TUMORS

Objective: To review the evolution of the current surgical treatment for breast malignant tumors over the past twenty years in the First Hospital of Jilin University (the former Bethune University of Medical Sciences). Methods: 1195 eligible patients with primary breast malignant tumor diagnosed and surgically treated at the First Teaching Hospital from January 1980 and December 2000 were retrospectively analyzed. Results: The peak frequency was in 40–49 years of age (40.00%), the age of the patients with breast malignant tumors trends to become young. The most common pTNM classification was Stage II. The most common histological type was infiltrating ductal carcinoma (398 patients, 33.31%), and simple carcinoma (279 patients, 23.53%). Modified radical mastectomy was the most common operation procedure performed (779 patients, 65.19%), and was increasingly used while radical mastectomy was adopted decreasingly in recent decade. Conclusion: The variation of operation procedures performed on patients with breast malignant tumors reflected the advance of our understanding of the biology of cancer and the progression of new treatment principles.

Classification of Breast Masses Using Ultrasound Images by Approaching GAN,Transfer Learning,and Deep Learning Techniques

Breast cancer is a common cause of death among women worldwide.Ultrasonic imaging is a valuable diagnostic tool in breast cancer detection.However,the accuracy of computer-aided diagnosis systems for breast cancer classification is limited due to the lack of well-annotated datasets.This study proposes a deep learning(DL)-based framework for breast mass classification using ultrasound images,which incorporates a novel data augmentation technique,generative adversarial network(GAN),and transfer learning(TL).Automating early tumor identification and classification in breast cancer diagnosis can save lives by improving the accuracy of diagnoses and reducing the need for invasive procedures.However,the limited availability of wellannotated datasets for ultrasound images of breast cancer has hampered the development of accurate computer-aided diagnosis systems.The accuracy of breast mass classification using ultrasound images is limited due to the lack of well-annotated datasets.Conventional data augmentation techniques have limitations in applications with strict guidelines,such as medical datasets.Therefore,there is a need to develop a novel data augmentation technique to improve the accuracy of breast mass classification using ultrasound images.The proposed framework can be extended to other medical imaging applications,where the availability of well-annotated datasets is limited.The GAN-based data augmentation technique and TL-based feature extraction can be used to improve the accuracy of classification models in other medical imaging applications.Additionally,the proposed framework can be used to develop accurate computer-aided diagnosis systems for breast cancer detection in clinical settings.The proposed framework incorporates a DL-based approach for breast mass classification using ultrasound images.The framework includes a GAN-based data augmentation technique and TL for feature extraction.The dataset used for training and testing the model is the breast ultrasound images(BUSI)dataset,which includes 1311 images with normal and abnormal breast masses.The proposed framework achieved an accuracy of 99.6%for breast mass classification using ultrasound images,which outperformed existing methods.The GAN-based data augmentation technique and TL-based feature extraction improved the accuracy of the classification model.The results suggest that DL algorithms can be effectively applied for breast ultrasound categorization.The proposed framework presents a novel approach for breast mass classification using ultrasound images,which incorporates a GAN-based data augmentation technique and TL-based feature extraction.The results demonstrate that the proposed framework outperforms existing methods and achieves high accuracy in breast mass classification using ultrasound images.This framework can be useful for developing accurate computer-aided diagnosis systems for breast cancer detection.

Primary Malignant Peripheral Nerve Sheath Tumor of the Breast—A Case Report

Malignant peripheral nerve sheath tumor is a rare soft tissue sarcoma. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer. We report such a lesion in a 60 year-old female who presented with hard and painless breast lump for 2 years. Histopathology revealed a malignant spindle cell tumor of low grade potential. It was subsequently confirmed to be malignant peripheral nerve sheath tumor (MPNST) on the basis of immunopositivity for vimentin, neurone specific enolase and S-100.

Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Evaluation of Diagnostic Value of Ultrasound and Magnetic Resonance Imaging for Malignant and Benign Breast Lesions

Objectives:To investigate diagnostic value of ultrasound and magnetic resonance imaging(MRI)for malignant and benign breast lesions.Methods:Retrospective analysis of treatment data of 48 patients diagnosed with malignant and benign breast lesions in our hospital,collected from December 2017 to November 2018.A total number of 56 breast masses were examined by both ultrasound and MRI,and were compared with postoperative pathological biopsy results.Results:Postoperative pathological biopsy results showed that there were 26 and 30 malignant and benign lesions respectively.Comparison of MRI curve type of malignant and benign lesions showed statistical significance(P<0.05).By comparison with pathological biopsy results,specificity and sensitivity of ultrasound diagnosis were 83.33%(25/30)and 84.61%(22/26)respectively;specificity and sensitivity of MRI diagnosis were 96.66%(29/30)and 92.30%(24/26)respectively.Conclusions:Ultrasonographic examination of malignant and benign breast lesions is straight-forward,simple and inexpensive.Accuracy,specificity and sensitivity of MRI are significantly higher than ultrasound in examining malignant and benign breast lesions,this can reduce misdiagnosis.

Liposarcoma of the breast arising in a malignant phyllodes tumor:A case report and review of the literature

Liposarcoma of the breast is a very rare malignant tumor. It can clinically manifest as a palpable breast mass and mimic primary breast cancer. We report an unusual case of a 51-year-old female who presented with an asymptomatic right breast mass, which was histologically diagnosed as well differentiated liposarcoma arisen within malignant phyllodes tumor. The patient underwent breast conserving surgery, received no adjuvant treatment and is disease-free after 2 years. Radiological and histopathological features are presented and described in detail. Data from the literature are presented and therapy recommendations discussed.

Segmentation Method of Breast Masses on Ultrasonographic Images Using Level Set Method Based on Statistical Model

It is important to segment mass region accurately in a computer-aided diagnosis (CADx) scheme for evaluating the likelihood of malignancy of the mass on ultrasonographic breast image. The purpose of this study was to develop a novel level set method for segmentation of breast mass on ultrasonographic image. Our database consisted of 151 ultrasonographic images with 70 malignant and 81 benign breast masses. In a novel level set method, an energy function was defined with region-based, edge-based, and regularizing terms. The region-based term analyzed global information, whereas the edge-based term analyzed local information. The regularizing term also controlled the length of the boundary curve. The region of breast mass was segmented so that the energy based on those terms was minimized. With our proposed method, true positive (TP) ratio, false positive (FP) ratio, jaccard similarity (JS), and Dice similarity coefficient (DSC) were 92.2%, 9.1%, 84.2%, and 91.3%, respectively. These results tended to be substantially higher than those with two conventional segmentation methods. Our proposed method based on the novel level set method was shown to segment mass region accurately on ultrasonographic breast image.

Evaluation of Breast Masses Using Mammography and Sonography as First Line Investigations

Purpose: To study the specificity of mammography and ultrasonography separately and in combination for detection of breast masses (ultrasonography-mammography correlation);To study the investigations to evaluate various breast masses;To describe suitable indications, advantages and limitations of each technique compared with other available modalities;To study the mimics of breast masses;To have histopathology follow-up and retrospective evaluation with imaging findings to improve diagnostic skills in series of 166 patients complaining of breast mass. Material: The prospective clinical study was carried out in the department of Radiodiagnosis for a period of 2 year extending from December 2010 to December 2012 infemale patients complaining of breast mass. Well informed written consent was obtained from them. Histopathology follow up was obtained from either biopsy or post operative tissue. USG machine: Philips HD 11 XE USG of the breasts and axillary region done in supine position in presence of female attendant;Mammography machine: Allengers machine with Agfa special mammography cassettes. Cranio caudal and Medio-Lateral Oblique views are taken in the presence of female attendant. MRI: PHILIPS 1.5 T machine;CT: SIEMENS duel slice CT machine. Results: Ultrasonography and mammography was done in most of the cases were sufficient to diagnose the lesion in most of the cases especially in benign breast masses. MRI and CT scan was used in special cases to know the extent of the lesions, in mimics of breast masses, bony extensions, primary muscular and bony lesions. Total 166 patients complaining of breast mass in one or both breasts were examined and evaluated with USG and mammography. The lesions were confirmed on histopathology (FNAC/biopsy). Out of 30 diagnosed malignancies two lesions were missed on mammography and four lesions were missed on ultrasonography. One of them was missed on both. For malignancies specificity of mammography is 93.3% and that of ultrasonography is 86.67%. Combining both the modalities specificity is near 97%. Out of total 92 abnormal breasts 12 were missed on USG and 20 were missed on mammography. Combining both the modalities only 2 lesions were missed and were diagnosed on histopathology alone. Overall specificity for USG in breast masses is 86.9% and for mammography it is 78.6%. Combining both the modalities the specificity is 97.6%. The “p” value is obtained which is highly significant for combination of ultrasonography and mammography in comparison with any individual modality (p = 0.0059 & p = 0.0001 respectively). Conclusion: Our study confirms the higher combined sensitivity rate for ultrasonography and mammography for detection of breast masses including malignancies. USG is useful in cystic lesions, ectasias, infections, pregnancy-lactation, and dense breast evaluation and for image guidance, whereas mammography is useful in detecting microcalcifications, spiculated masses for early detection of malignancies and for stereotactic biopsies. To suggest single modality, ultrasonography is better in younger population and BIRAD 1, 2 & 3 lesions. Whereas, mammography is better in older population and BIRAD 4 & 5 lesions. However, sono-mammographic correlation is best in both.

Complex Cystic Breast Masses: An Ultrasound Imaging Review

Cystic lesions are very commonly encountered entities in the breast. Among these, Complex Cystic Breast Masses (CCBMs), which contain both anechoic and echogenic components, can result in a variety of imaging appearances. These include cystic lesions with thick walls and/or internal septa, intracystic nodular lesions, and solid-cystic masses of varying compositions. Ultrasound is the mainstay for evaluating cystic lesions, and thus recognizing the imaging features appropriately and suggesting suitable interventional procedures are included in their management. In this pictorial essay, we describe the wide range of ultrasound appearances of CCBMs with a number of clinically encountered examples from our institution. This article would enhance the understanding of readers in possible differentials to be included in their clinical practice and to suggest appropriate further intervention, when deemed necessary.

A Patient with Malignant Spinal Epidural Lymphoma with Initial Rapidly Aggravating Paraplegia

We report the case of a 51-year-old female with rapid neurological deterioration as an initial presentation of non-Hodgkin’s lymphoma. Paraplegia occurred suddenly after a 4-day history of weakness and numbness of the lower extremity. MRI revealed a dorsal epidural mass from T10 to T11 that compressed the spinal cord. There was neither bone destruction nor a paravertebral mass. Emergency decompressive laminectomy and tumor resection were performed. Histological analysis of the surgical specimen indicated diffuse large B cell lymphoma. The clinical stage was IV on CT and complete remission was achieved by subsequent chemotherapy. Spinal cord compression occurs in the course of non-Hodgkin’s lymphoma in 0.1% - 6.5% of cases, but this situation usually develops in the late phase with bone destruction and/or a paravertebral mass. Cord compression and especially the severe symptoms such as paraplegia are rare as the initial presentation of lymphoma.

Malignant pheochromocytoma:Hepatectomy for liver metastases

Malignant pheochromocytoma accounts for approximately 10% of pheochromocytoma cases. The main site of distant metastasis is the liver. Hypertensive crisis due to catecholamine oversecretion is potentially fatal. We present a case of malignant pheochromocytoma with multiple liver metastases. A 60-year-old female with repeated hypertensive episodes was diagnosed with malignant pheochromocytoma. She underwent a left adrenalectomy and partial hepatectomy with resection of segment 6. Catecholamine levels remained high after surgery and she received repeated cycles of chemotherapy. Four months after surgery, multiple liver metastases were detected. In spite of ongoing chemotherapy, catecholamine levels eventually became uncontrollable. Serum and urine noradrenaline andvanillylmandelic acid levels increased, but adrenaline and dopamine levels stayed within the normal range. Preoperative liver imaging revealed multiple metastases in all segments except segment 4. Percutaneous transhepatic portal vein embolization(PTPE) of the right and lateral branches of the portal vein was performed. The functional liver volume of segment 4 increased after PTPE. Right hepatectomy, lateral segmentectomy and partial resection of segment 1 were performed 10 mo after the initial surgery. Intraoperative ultrasonography detected two small tumors in segment 4, which were treated with intraoperative microwave coagulation therapy. Noradrenaline levels normalized immediately after the second hepatectomy. As there was increased telomerase activity in the resected specimen, she received adjuvant chemotherapy. She remained in good health for 2 years. However, further metastases eventually occurred and she subsequently died due to a brain hemorrhage. Hepatectomy may be a therapeutic option for reduction of tumor mass in pheochromocytoma with liver metastases.

Mass-like extragonadal endometriosis associated malignant transformation in the pelvis:A rare case report

BACKGROUND Endometriosis affects approximately 10%of reproductive-age women,however,endometriosis associated malignant transformation is rare and is often report as a rare case.CASE SUMMARY Herein,we report of a 49-year-old female patient who suffered from severe left lower abdominal pain and imaging examination revealed an irregular mass in the left iliac fossa.Histopathological examination revealed main undifferentiated adenocarcinoma with a few typical endometrial epithelial and stromal tissues in the adjacent area.Combined with the immunohistochemical staining and the negative intra-or postoperative results from exploratory laparotomy,gastroscopy,enteroscopy and positron emission tomography,the tumor was considered to be derived from endometriosis.The patient underwent hysterectomy,bilateral salpingectomy,bilateral ovariectomy,and multipoint biopsy of the pelvic peritoneum.Subsequent radiotherapy and chemotherapy were performed.The patient recovered well post-operation and there was no evidence of recurrence after 10 mo of follow-up via computed tomography and magnetic resonance imaging.CONCLUSION This case highlights a rare presentation of mass-like extragonadal endometriosis associated malignant transformation in the pelvis.Endometriosis associated malignant transformation is rare and difficult to diagnose in clinical settings,with diagnoses depending on pathological results and the exclusion of metastasis from other organs.Fortunately,patients are often diagnosed at younger ages,as well as at early stages;thus they generally have relatively favorable prognoses.

Diagnosis of an extremely rare case of malignant adenomyoepithelioma in pleomorphic adenoma:A case report

BACKGROUND Pleomorphic adenoma(PA)is the most common type of salivary gland tumor,and its common sites are parotid gland,sinus,nasal septum and cleft palate.PA is an uncommon benign type of tumor occurring in the breast,and there are few reports of cases in Asia.CASE SUMMARY An 84-year-old woman found a mass in the upper outer quadrant of the right breast>1 year ago.The patient underwent a right breast lumpectomy and sentinel lymph node biopsy.The pathological diagnosis was PA in the upper outer quadrant of the right breast,and the malignant component was malignant adenomyoepithelioma.The postoperative course was uneventful,and no chemotherapy was administered.At 18 mo of follow-up,the patient is alive and well,with no evidence of recurrent disease.CONCLUSION Patients with breast PA should first undergo extended excision of breast masses followed by pathological examination.If malignancy is confirmed or the surgical margin is positive,modified radical mastectomy should be performed.

Test Accuracy of CT-Scan for the Detection of Malignant Liver Mass

Background: Detection of malignant liver mass is very important for the treatment modalities. Objective: The purpose of the present study was to establish the usefulness of CT scan in the diagnosis of malignant hepatic mass. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of 1st January 2006 to 31st December 2007. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study. Mean age of all patients was 51.28 ± 14 years with a range of 17 year to 78 years. Among all patients 28 had multiple lesion, of them 71.4% was malignant and 28.6% was benign. On the other side 22 patients had solitary lesion, of them 36.4% was malignant and 63.6% was benign

Ultrasound Features Improve Diagnostic Performance of Ovarian Cancer Predictors in Distinguishing Benign and Malignant Ovarian Tumors

To determine whether ultrasound features can improve the diagnostic performance of tumor markers in distinguishing ovarian tumors,we enrolled 719 patients diagnosed as having ovarian tumors at Nanfang Hospital from September 2014 to November 2016.Age,menopausal status,histopathology,the International Federation of Gynecology and Obstetrics(FIGO)stages,tumor biomarker levels,and detailed ultrasound reports of patients were collected.The area under the curve(AUC),sensitivity,and specificity of the bellow-mentioned predictors were analyzed using the receiver operating characteristic curve.Of the 719 patients,531 had benign lesions,119 had epithelial ovarian cancers(EOC),44 had borderline ovarian tumors(BOT),and 25 had non-EOC.AUCs and the sensitivity of cancer antigen 125(CAI25),human epididymis-specific protein 4(HE4),Risk of Ovarian Malignancy Algorithm(ROMA),Risk of Malignancy Index(RMI1),HE4 model,and Rajavithi-Ovarian Cancer Predictive Score(R-OPS)in the overall population were 0.792,0.854,0.856,0.872,0.893,0.852,and 70.2%,56.9%,69.1%,60.6%,77.1%,71.3%,respectively.For distinguishing EOC from benign tumors,the AUCs and sensitivity of the above mentioned predictors were 0.888,0.946,0.947,0.949,0.967,0.966,and 84.0%,79.8%,87.4%,84.9%,90.8%,89.1%,respectively.Their specificity in predicting benign diseases was 72.9%,94.4%,87.6%,95.9%,86.3%,90.8%,respectively.Therefore,we consider biomarkers in combination with ultrasound features may improve the diagnostic performance in distinguishing malignant from benign ovarian tumors.