Routine histopathological examination after female-to-male gender-confirming mastectomy

Renterghem, S M J Van; Dorpe, Jo Van; Monstrey, Stan; Defreyne, Justine; Claes, Karel; Praet, Marleen; Verbeke, Sofie; T’Sjoen, Guy; Bockstal, Mieke Van

doi:10.1002/bjs.10794

Cited by 27 publications

(42 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 The reported incidence of atypical/significant findings has ranged from 1.5% to 4.7%. [2][3][4][5] Atypical breast lesions were identified in our investigation at a rate of 2.8% (6 of 211) in the transmasculine cohort, which falls within the reported range of 1.5% to 4.7%. Resection of clinically benign RM specimens returned the diagnosis of atypia or carcinoma in our study with a rate of 5.5% (14 of 252 patients) and 24% (5 of 21 patients) undergoing bilateral and unilateral balancing RM, respectively (7% overall).…”

Section: Comparative Analysis Between Gender-affirming Surgery and Rmsupporting

confidence: 77%

“…Recent investigations have shown that histologic findings are predominantly benign, including lobular atrophy and stromal fibrosis reminiscent of the fibrotic stage of gynecomastia (Table 2). [3][4][5] Similarly, a recent study compared a transmasculine cohort to women undergoing RM and showed a significantly greater proportion of benign changes including fibrous stroma, ectatic ducts, fibroadenomatous change, and calcifications in the gender-affirming group. 2 The reported incidence of atypical/significant findings has ranged from 1.5% to 4.7%.…”

Section: Comparative Analysis Between Gender-affirming Surgery and Rmmentioning

confidence: 99%

“…The rate of significant pathologic findings, defined as atypical hyperplasia, carcinoma in situ, and invasive carcinoma, ranges from 1.5% and 4.7%. [2][3][4][5] Hypothetically, multiple factors can impact the rate of significant pathologic findings, including age, family history, personal history, presurgical hormone therapy, and tissue submission policies. The lack of standardized guidelines for gross handling and tissue submission for surgical specimens from transmasculine individuals confounds the interpretation of the pathologic findings.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

Hernández¹,

Schwartz²,

Warfield³

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

Context.— Bilateral mastectomy for chest masculinization is one of the gender-affirming procedures for transmasculine individuals. Objective.— To optimize gross handling protocols and assess histopathologic findings in transmasculine breast tissue specimens. Design.— We identified all gender-affirming mastectomies from 2015 to 2018. We sequentially identified reduction mammoplasty (RM) cases for macromastia from the same period as control. Significant findings were defined as atypical ductal or lobular hyperplasia (ADH, ALH), ductal or lobular carcinoma in situ (DCIS, LCIS), or invasive carcinoma. Results.— Significant findings were present in 6 of 211 gender-affirming mastectomies (2.8%) as follows: ADH (n = 5) and LCIS together with ALH (n = 1). By comparison, 19 of 273 RM specimens (7%) yielded significant findings as follows: ALH (n = 11), ADH (n = 4), LCIS (n = 2), DCIS (n = 1), and invasive lobular carcinoma (n = 1). In the gender-affirming group, 142 transmen underwent androgen therapy before surgery, of whom 2 had significant pathologic findings. Thirty and 41 individuals had a family history of breast cancer in the gender-affirming and RM group, of whom 1 and 3 individuals had significant pathologic findings, respectively. Conclusions.— Our study demonstrates that we handle transmasculine mastectomy specimens by examining 2.8 times more slides on average than for RMs, with a 2.5 times lower rate of significant pathologic findings. Prior family history of breast cancer or the use of androgen therapy before surgery in gender-affirming individuals did not increase the risk of identifying significant breast lesions. We recommend submitting 4 tissue blocks per mastectomy for individuals undergoing gender-affirming breast surgery.

show abstract

Section: Comparative Analysis Between Gender-affirming Surgery and Rmsupporting

confidence: 77%

Section: Comparative Analysis Between Gender-affirming Surgery and Rmmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

Hernández¹,

Schwartz²,

Warfield³

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…(2018) [ 33 ] Case report 58 Yes, incidental finding Unknown 25 Invasive ductal carcinoma Unknown ER+, PR-, HER2- Van Renterghem et al. (2018) [ 18 ] Retrospective cohort study 31 Yes, incidental finding Negative 1.3 Moderately differentiated invasive carcinoma Unknown ER+, PR+, HER2- Fledderus et al. (2020) (current article) Case report 50 Yes, incidental finding Positive 3 DCIS Not tested Not tested No∗: suspicion for malignancy, diagnosis confirmed by histological examination after mastectomy; Yes, incidental finding: by histological analysis after mastectomy; ER: estrogen receptor; PR: progesterone receptor; HER2: Human Epidermal growth factor Receptor; AR: androgen receptor; -: negative; +: positive; DCIS: ductal carcinoma in situ.…”

Section: Resultsmentioning

confidence: 99%

“…A study with 1579 American veteran FtM transsexuals found seven FtM transsexuals with breast cancer, whereas only one was documented to use testosterone prior to diagnosis [16] . Three cohort studies including 795, 96, and 283 FtM transsexuals receiving testosterone all found one subject with breast malignancy or premalignancy in their cohort [17] , [18] , [19] . A recent Dutch study evaluated the incidence of breast cancer in the FtM transsexual population in their clinical center [20] .…”

Section: Resultsmentioning

confidence: 99%

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

et al. 2020

View full text Add to dashboard Cite

Background Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup. Methods We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included. Results We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing. Conclusion Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.

show abstract

Testosterone in Transgender Population

Cocchetti

Fisher

2021

Controversies in Testosterone Deficiency

View full text Add to dashboard Cite

Routine histopathological examination after female-to-male gender-confirming mastectomy

Abstract: The discovery of an unexpected breast cancer in a 31-year-old transman emphasizes the importance of thorough routine histopathological examination of mastectomy specimens. The number of tissue blocks taken should be based on age and breast weight.

Cited by 27 publications

References 21 publications

Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

Testosterone in Transgender Population

Contact Info

Product

Resources

About