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Lim SM, Han Y, Kim SI, Park HS. Utilization of bioelectrical impedance analysis for detection of lymphedema in breast Cancer survivors: a prospective cross sectional study. BMC Cancer 2019; 19:669. [PMID: 31286884 PMCID: PMC6613266 DOI: 10.1186/s12885-019-5840-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/17/2019] [Indexed: 11/28/2022] Open
Abstract
Background Breast cancer survivors are at risk of developing breast cancer-related lymphedema (BCRL) after surgical treatment, which may have a negative effect on quality of life. The purpose of this study was to investigate the clinical role of bioelectrical impedance analysis (BIA) and the relationship between the development of BCRL in breast cancer survivors who have undergone axillary surgery. Methods A total of 228 patients with breast cancer were enrolled in the study between May 2016 and January 2017. BCRL was assessed by measuring the circumference of both arms at 15 cm below the acromion process and the olecranon process. Patients were classified as BCRL (n = 22) and non-BCRL (n = 206) based on the difference of the arm circumference of 2 cm. Data including lymphedema, anthropometry, BIA measurements, food frequency questionnaire, type of surgery, total number of dissected lymph nodes, and post-operative treatment were collected. Results Of the breast cancer survivors, 10.4% had BCRL by the definition. The BCRL group contained 22 patients, while the non-BCRL group contained 206 patients. Compared to the non-BCRL group, the BCRL group had a higher body mass index, a larger percentage of ideal body weight, more dissected lymph nodes, and higher single frequency BIA (SFBIA) ratio (P = 0.027, P = 0.031, P < 0.001, and P < 0.001, respectively). The SFBIA ratio provided 63.64% sensitivity and 95.15% specificity in estimating the risk of BCRL. Conclusion Our data provides evidence to support that the use of SFBIA ratio can serve as an alternative method to monitor and/or diagnose BCRL. Trial registration This trial was retrospectively registered at Clinicaltrials.gov identifier (NCT03391206) on the 5 January 2018.
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Affiliation(s)
- Sung Mook Lim
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yujin Han
- Department of Food and Nutrition, College of Human Ecology, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Kondov B, Milenkovikj Z, Kondov G, Petrushevska G, Basheska N, Bogdanovska-Todorovska M, Tolevska N, Ivkovski L. Presentation of the Molecular Subtypes of Breast Cancer Detected By Immunohistochemistry in Surgically Treated Patients. Open Access Maced J Med Sci 2018; 6:961-967. [PMID: 29983785 PMCID: PMC6026408 DOI: 10.3889/oamjms.2018.231] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/27/2018] [Accepted: 05/28/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The detection of estrogen, progesterone and HER-2 neu receptors on the surface of the tumour cell is a significant prognostic factor, alone or in combination. The presence or absence of receptors on the surface of the tumour cell is associated with the conditional gene expression in the tumour cell itself. Based on these genetically determined expressions of the tumour cell, five molecular subtypes of breast cancer have been classified on the St. Gallen International Expert Consensus in 2011 that can be immunohistochemically detected, with each subtype manifesting certain prognosis and aggression. AIM Analyzing the presentation of molecular subtypes of breast cancer that are immunohistochemically detected in surgically treated patients at the Clinic for Thoracic and Vascular Surgery. MATERIAL AND METHODS We used the international classification on molecular subtypes of breast cancer which divides them into: Luminal A (ER+ and/or PR+, HER-2 negative, Ki-67 < 14%), Luminal B with HER-2 negative (ER+ and/or PR+, HER-2 negative, Ki-67 ≥ 14%), Luminal B with HER-2 positive (ER+ and/or PR+, HER-2+, any Ki-67), HER-2 enriched (ER-, PR-, HER-2+), and basal-like (triple negative) (ER-, PR-, HER-2 negative, CK5/6+ and/or EGFR+). A total of 290 patients, surgically treated for breast cancer, were analysed during 2014. RESULTS In our analysis, we found that Luminal A was present in 77 (26.55%) patients, Luminal B HER-2 negative was present in 91 (31.38%) patients, Luminal B HER-2 positive was present in 70 (24.14%) patients, HER-2 enriched was present in 25 (8.62%) patients and basal-like (or triple negative) was present in 27 (9.31%) patients. CONCLUSION Detecting the subtype of breast cancer is important for evaluating the prognosis of the disease, but also for determining and providing an adequate therapy. Therefore, determining the subtype of breast cancer is necessary for the routine histopathological assay.
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Affiliation(s)
- Borislav Kondov
- University Clinic for Thoracic and Vascular Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Zvonko Milenkovikj
- University Clinic for Infectious Disease and Febrile Conditions, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Goran Kondov
- University Clinic for Thoracic and Vascular Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Gordana Petrushevska
- Institute of Pathology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Neli Basheska
- Laboratory for Cytology and Pathology, University Clinic of Oncology and Radiotherapy, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | | | - Natasha Tolevska
- University Clinic for Thoracic and Vascular Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Marrazzo A, Boscaino G, Marrazzo E, Taormina P, Toesca A. Breast cancer subtypes can be determinant in the decision making process to avoid surgical axillary staging: A retrospective cohort study. Int J Surg 2015; 21:156-61. [PMID: 26253849 DOI: 10.1016/j.ijsu.2015.07.702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/18/2015] [Accepted: 07/27/2015] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The need for performing axillary lymph-node dissection in early breast cancer when the sentinel lymph node (SLN) is positive has been questioned in recent years. The purpose of this study was to identify a low-risk subgroup of early breast cancer patients in whom surgical axillary staging could be avoided, and to assess the probability of having a positive lymph-node (LN). METHODS We evaluated the cohort of 612 consecutive women affected by early breast cancer. We considered age, tumor size, histological grade, vascular invasion, lymphatic invasion and cancer subtype (Luminal A, Luminal B HER-2+, Luminal B HER-2-, HER-2+, and Triple Negative) as variables for univariate and multivariate analyses to assess probability of there being a positive SLN o nonsentinel lymph node (NSLN). Chi-square, Fisher's Exact test and Student's t tests were used to investigate the relationship between variables; whereas logit models were used to estimate and quantify the strength of the relationship among some covariates and SLN or the number of metastases. RESULTS A significant positive effect of vascular invasion and lymphatic invasion (odds ratios are 4 and 6), and a negative effect of TN (odds ratios is 10) were noted. With respect to positive NSLN, size alone has a significant (positive) effect on tumor presence, but focusing on the number of metastases, also age has a (negative) significant effect. CONCLUSION This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary surgical staging.
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Affiliation(s)
- Antonio Marrazzo
- Department of Surgical, Oncological and Stomatological Sciences, Policlinico Hospital "Paolo Giaccone", University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy.
| | - Giovanni Boscaino
- Department of Economics, Business and Statistics Sciences, University of Palermo, Viale delle Scienze, 90128 Palermo, Italy
| | - Emilia Marrazzo
- Department of Surgical, Oncological and Stomatological Sciences, Policlinico Hospital "Paolo Giaccone", University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy.
| | - Pietra Taormina
- Breast Unit, Clinic "Macchiarella", Viale Regina Margherita, 25, 90138 Palermo, Italy
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology, Via Giuseppe Ripamonti, 435, 20141 Milan, Italy.
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Kang DG, Park SI, Kim SH, Chung MJ, Lee KM, Lee JH. Evaluation of the Flash effect in breast irradiation using TomoDirect: an investigational study. JOURNAL OF RADIATION RESEARCH 2015; 56:397-404. [PMID: 25672612 PMCID: PMC4380062 DOI: 10.1093/jrr/rru118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/25/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
Flash is a specified function in TomoDirect that enables beam expansion by opening additional leaves to the target. This study assessed the theoretical dose distribution resulting from Flash in breast irradiation using TomoDirect. A cylindrical phantom that enabled dose distribution of the breast was used for verifying the effect of planning target volume (PTV) contouring and Flash. A total of 18 Gy in 10 fractions were prescribed to the PTV. Five PTVs were then created by Contracting this contour by 0, 1, 2, 3, 4 and 5 mm, giving PTV-x. Flash ±x is defined by opening x (number) of the leaves. The Flash effect in the air was compared with each set-up error of 5, 10 and 15 mm, respectively. The minimum PTV dose from PTV-1 to PTV-3 increased from 13.88 Gy to 15.86 Gy. In contrast, Dmin in PTV-4 and PTV-5 was 17.80 Gy in 98.88% of the prescription dose. Without Flash, when 5-, 10- and 15-mm set-up errors applied in the PTV, relative doses of 87.88, 23.73 and 7.94% were observed, respectively. However, in Flash 3, which was equal to the usual air margin of 1.875 cm, a relative dose of 104.24% ± 0.30% was observed, irrespective of set-up errors (5 mm to 15 mm). Flash opening is useful for countervailing set-up errors in breast cancer patients who receive breast irradiation with TomoDirect.
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Affiliation(s)
- Dae Gyu Kang
- Department of Radiation Oncology, St Vincent's Hospital, the Catholic University of Korea, 93, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do, Korea Department of Biomedical Engineering, Electronic Engineering, Jeju National University of Korea, Jeju-si, Jeju Special Self-Governing Province, Korea
| | - Sung Ill Park
- Department of Medical Physics, Kyong-gi University of Korea, Yeongtong-gu, Suwon, Gyeonggi-do, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St Vincent's Hospital, the Catholic University of Korea, 93, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do, Korea
| | - Mi Joo Chung
- Department of Radiation Oncology, St Vincent's Hospital, the Catholic University of Korea, 93, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do, Korea
| | - Kwang-Man Lee
- Department of Biomedical Engineering, Electronic Engineering, Jeju National University of Korea, Jeju-si, Jeju Special Self-Governing Province, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St Vincent's Hospital, the Catholic University of Korea, 93, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do, Korea
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Jones T, Neboori H, Wu H, Yang Q, Haffty BG, Evans S, Higgins S, Moran MS. Are breast cancer subtypes prognostic for nodal involvement and associated with clinicopathologic features at presentation in early-stage breast cancer? Ann Surg Oncol 2013; 20:2866-72. [PMID: 23661183 DOI: 10.1245/s10434-013-2994-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Breast cancer subtypes (BCS) determined from immunohistochemical staining have been correlated with molecular subtypes and associated with prognosis and outcomes, but there are limited data correlating these BCS and axillary node involvement. This study was conducted to assess whether BCS predicted for nodal metastasis or was associated with other clinicopathologic features at presentation. METHODS Patients with stage I/II disease who underwent breast-conserving surgery and axillary surgical assessment with available tissue blocks underwent a institutional pathological review and construction of a tissue microarray. The slides were stained for estrogen receptor, progesterone receptor, and HER-2/neu (HER-2) for classification into BCS. Nodal involvement and other clinicopathologic features were analyzed to assess associations between BCS and patient and tumor characteristics. Outcomes were calculated a function of BCS. RESULTS The study cohort consisted of 453 patients (luminal A 48.6%, luminal B 16.1%, HER-2 11.0%, triple negative 24.2%), of which 22% (n=113) were node positive. There were no significant associations with BCS and pN stage, node positivity, or absolute number of nodes involved (p>0.05 for all). However, there were significant associations with subtype and age at presentation (p<0.001), method of detection (p=0.049), tumor histology (p<0.001), race (p=0.041), and tumor size (pT stage, p<0.001) by univariate and multivariate analysis. As expected, 10-year outcomes differed by BCS, with triple negative and HER-2 subtypes having the worse overall (p=0.03), disease-free (p=0.03), and distant metastasis-free survival (p<0.01). CONCLUSIONS There is a significant association between BCS and age, T stage, histology, method of detection, and race, but no associations to predict nodal involvement. If additionally validated, these findings suggest that BCS may not be a useful prognostic variable for influencing regional management considerations.
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Affiliation(s)
- Tiffanie Jones
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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