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Pittman SM, Rosen EL, DeMartini WB, Nguyen DH, Poplack SP, Ikeda DM. The Postoperative Breast: Imaging Findings and Diagnostic Pitfalls After Breast-Conserving Surgery and Oncoplastic Breast Surgery. J Breast Imaging 2024; 6:203-216. [PMID: 38262628 DOI: 10.1093/jbi/wbad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Indexed: 01/25/2024]
Abstract
Breast surgery is the cornerstone of treatment for early breast cancer. Historically, mastectomy and conventional breast-conserving surgery (BCS) were the main surgical techniques for treatment. Now, oncoplastic breast surgery (OBS), introduced in the 1990s, allows for a combination of BCS and reconstructive surgery to excise the cancer while preserving or enhancing the contour of the breast, leading to improved aesthetic results. Although imaging after conventional lumpectomy demonstrates typical postsurgical changes with known evolution patterns over time, OBS procedures show postsurgical changes/fat necrosis in locations other than the lumpectomy site. The purpose of this article is to familiarize radiologists with various types of surgical techniques for removal of breast cancer and to distinguish benign postoperative imaging findings from suspicious findings that warrant further work-up.
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Affiliation(s)
- Sarah M Pittman
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric L Rosen
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy B DeMartini
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dung H Nguyen
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven P Poplack
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Debra M Ikeda
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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Yang XJ, Wang WH, Zou JY, Wang J, Yang ZQ. Triplane technique for breast reconstruction after breast cancer surgery: A case series report. Medicine (Baltimore) 2024; 103:e37559. [PMID: 38552090 PMCID: PMC10977549 DOI: 10.1097/md.0000000000037559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. PATIENT CONCERNS The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. DIAGNOSES The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. INTERVENTIONS The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. OUTCOMES No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. LESSONS The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.
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Affiliation(s)
- Xiao-Juan Yang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Wen-Huan Wang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Jie-Ya Zou
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Ji Wang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Zhuang-Qing Yang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
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Lv FY, Mo Z, Chen B, Huang Z, Mo Q, Tan Q. Locoregional recurrence and survival of breast-conserving surgery compared to mastectomy following neoadjuvant chemotherapy in operable breast cancer. Front Oncol 2024; 14:1308343. [PMID: 38606101 PMCID: PMC11007173 DOI: 10.3389/fonc.2024.1308343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/26/2024] [Indexed: 04/13/2024] Open
Abstract
Background The risk of locoregional recurrence (LRR) and the long-term prognosis of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) are still controversial. This study aimed to evaluate oncological outcomes for patients undergoing BCS after NAC and determine LRR and survival predictors. Methods This study was a retrospective cohort study of patients with locally advanced breast cancer (LABC) who received NAC and underwent BCS or mastectomy from June 2011 to November 2020. LRR, disease-free survival (DFS), and overall survival (OS) were compared in patients undergoing BCS or mastectomy. Univariate and multivariate analyses were performed to determine LRR, DFS, and OS predictors. Results A total of 585 patients were included, of whom 106 (18.1%) underwent BCS and 479 (81.9%) underwent a mastectomy. The LRR rate was 11.3% in the BCS group and 16.3% in the mastectomy group, revealing no significant difference(p = 0.200). In patients who underwent BCS, clinical lymph node status, histological grade and pathological complete response (pCR) were independent factors to predict LRR. There was no significant difference in DFS and OS between the BCS and the mastectomy groups. Multivariable analysis showed that lymph node status, histological grade, molecular subtypes, pCR and Miller&Payne (M&P) classification were independent predictors of DFS. Lymph node status, molecular subtypes and pCR were independent predictors of OS. BCS or mastectomy was not an independent predictor of DFS or OS. Conclusion Compared with mastectomy, BCS after NAC may not increase the risk of local recurrence or mortality, BCS can be performed in selected patients with small tumor size and good response to NAC.
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Affiliation(s)
- Fa-you Lv
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zongming Mo
- Department of Breast Surgery, Guangxi Zhuang Autonomous Region People’s Hospital, Nanning, Guangxi, China
| | - Binjie Chen
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zhen Huang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Qinguo Mo
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Qixing Tan
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
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Guo G, Li J, Zheng Y, Liu ZX, Lin H. Breast-conserving surgery is associated with a lower incidence of suicide among females with breast cancer in the United States: a population-based retrospective cohort study. Int J Surg 2024; 110:1392-1401. [PMID: 38215250 PMCID: PMC10942248 DOI: 10.1097/js9.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND With comparable overall survival and local recurrence rates with mastectomy, breast-conserving surgery (BCS) has become the cornerstone of therapy for breast cancer; however, the difference in the incidence of suicide between BCS and mastectomy among breast cancer survivors remains unclear. This study evaluated the mortality risk from suicide among breast cancer survivors and compared suicide risk between BCS and mastectomy using a population-based cohort. MATERIALS AND METHODS Female patients newly diagnosed with first primary breast cancer, recorded in the Surveillance, Epidemiology and End Results database, were included. Standardized mortality ratio (SMR) and cumulative mortality rate from suicide among those who underwent BCS and mastectomy were compared. RESULTS A total of 1 190 991 patients with newly diagnosed first primary breast cancer were included in the study, of whom 56.5% underwent BCS and 36.1% underwent mastectomy. During the follow-up period, 667 suicides were recorded. Patients who underwent mastectomy exhibited significantly higher suicide mortality than the general population [mortality rate, 8.16 per 100 000 person-years; SMR 1.18 (95% CI 1.05-1.33)], while there was no significant difference in suicide rate between patients who underwent BCS and the general population [SMR 0.92 (95% CI 0.83-1.02)]. Multivariate Cox analysis revealed that BCS, compared with mastectomy, was associated with a significantly decreased risk of suicide among females with breast cancer [hazard ratio 0.80 (95% CI 0.68-0.95); P = 0.009]. CONCLUSION BCS was associated with a significantly lower incidence of suicide among females with breast cancer. BCS offers a compelling option for improving the quality of life and self-esteem of patients with cancer and provides a novel perspective on cancer management.
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Affiliation(s)
- Guiping Guo
- Department of Breast Surgery, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University
| | - Junteng Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Zheng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Ze-Xian Liu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Huan Lin
- Department of Breast Surgery, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University
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Jong LJS, Appelman JGC, Sterenborg HJCM, Ruers TJM, Dashtbozorg B. Spatial and Spectral Reconstruction of Breast Lumpectomy Hyperspectral Images. Sensors (Basel) 2024; 24:1567. [PMID: 38475103 DOI: 10.3390/s24051567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
(1) Background: Hyperspectral imaging has emerged as a promising margin assessment technique for breast-conserving surgery. However, to be implicated intraoperatively, it should be both fast and capable of yielding high-quality images to provide accurate guidance and decision-making throughout the surgery. As there exists a trade-off between image quality and data acquisition time, higher resolution images come at the cost of longer acquisition times and vice versa. (2) Methods: Therefore, in this study, we introduce a deep learning spatial-spectral reconstruction framework to obtain a high-resolution hyperspectral image from a low-resolution hyperspectral image combined with a high-resolution RGB image as input. (3) Results: Using the framework, we demonstrate the ability to perform a fast data acquisition during surgery while maintaining a high image quality, even in complex scenarios where challenges arise, such as blur due to motion artifacts, dead pixels on the camera sensor, noise from the sensor's reduced sensitivity at spectral extremities, and specular reflections caused by smooth surface areas of the tissue. (4) Conclusion: This gives the opportunity to facilitate an accurate margin assessment through intraoperative hyperspectral imaging.
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Affiliation(s)
- Lynn-Jade S Jong
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Jelmer G C Appelman
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, 1081 HV Amsterdam, The Netherlands
| | - Henricus J C M Sterenborg
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo J M Ruers
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Ferreira HHJ, de Souza CD, Pozzo L, Ribeiro MS, Rostelato MECM. Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:441. [PMID: 38396480 PMCID: PMC10887864 DOI: 10.3390/diagnostics14040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study is a systematic review with meta-analysis comparing radioactive seed localization (RSL) versus radio-guided occult lesion localization (ROLL) and wire-guided localization (WGL) for patients with impalpable breast cancer undergoing breast-conserving surgery and evaluating efficacy, safety, and logistical outcomes. The protocol is registered in PROSPERO with the number CRD42022299726. METHODS A search was conducted in the Embase, Lilacs, Pubmed, Scielo, Web of Science, and clinicaltrials.gov databases, in addition to a manual search in the reference list of relevant articles, for randomized clinical trials and cohort studies. Studies selected were submitted to their own data extraction forms and risk of bias analysis according to the ROB 2 and ROBINS 1 tools. A meta-analysis was performed, considering the random effect model, calculating the relative risk or the mean difference for dichotomous or continuous data, respectively. The quality of the evidence generated was analyzed by outcome according to the GRADE tool. Overall, 46 articles met the inclusion criteria and were included in this systematic review; of these, 4 studies compared RSL and ROLL with a population of 1550 women, and 43 compared RSL and WGL with a population of 19,820 women. RESULTS The results showed that RSL is a superior method to WGL in terms of surgical efficiency in the impalpable breast lesions' intraoperative localization, and it is at least equivalent to ROLL. Regarding security, RSL obtained results equivalent to the already established technique, the WGL. In addition to presenting promising results, RSL has been proven to be superior to WGL and ROLL technologies.
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Affiliation(s)
| | - Carla Daruich de Souza
- Nuclear and Energy Research Institute (IPEN/CNEN—SP), University of São Paulo (USP), Av. Professor Lineu Prestes 2242, São Paulo 05508-000, SP, Brazil; (H.H.J.F.); (L.P.); (M.S.R.); (M.E.C.M.R.)
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Hashem M, Rehman S, Salhab M. The Role of Human Epidermal Growth Factor Receptor 2 (HER2)-Targeted Therapies in Early-Stage Breast Cancer: Current Practices, Treatment De-escalation, and Future Prospects. Cureus 2024; 16:e55230. [PMID: 38558735 PMCID: PMC10981386 DOI: 10.7759/cureus.55230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-targeted therapy has transformed the treatment paradigm for early-stage HER2-positive breast cancer, providing personalized and effective interventions. This comprehensive review delves into the current state of HER2-targeted therapies, emphasizing pivotal clinical trials that have demonstrated their substantial impact on long-term outcomes. Combination therapies that integrate HER2-targeted agents with chemotherapy exhibit enhanced tumor responses, particularly in neoadjuvant settings. Neoadjuvant chemotherapy (NACT) is explored for its role in tumor downsizing, facilitating breast-conserving surgery (BCS), and incorporating oncoplastic solutions to address both oncologic efficacy and aesthetic outcomes. Innovative axillary management post-NACT, such as targeted axillary dissection (TAD), is discussed for minimizing morbidity. The review further explores the delicate balance between maximal therapy and de-escalation, reflecting recent trends in treatment approaches. The therapeutic landscape of HER2-low breast cancer is examined, highlighting considerations in HER2-positive breast cancer with BReast CAncer gene (BRCA) mutations. Emerging immunotherapeutic strategies, encompassing immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell therapy, are discussed in the context of their potential integration into treatment paradigms. In conclusion, the evolving landscape of HER2-positive early-stage breast cancer treatment, characterized by targeted therapies and multidisciplinary approaches, underscores the need for ongoing research and collaborative efforts. The aim is to refine treatment strategies and enhance patient outcomes in this dynamic and rapidly evolving field.
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Affiliation(s)
- Mohamed Hashem
- Breast Surgery, Mid Yorkshire NHS Teaching Trust, Wakefield, GBR
| | - Shazza Rehman
- Oncology, Airedale NHS Foundation Trust, Airedale, GBR
| | - Mohamed Salhab
- Breast Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, GBR
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Moreno-Palacios E, Martí C, Frías L, Meléndez M, Loayza A, Roca MJ, Córdoba V, Oliver JM, Hernández A, Sánchez-Méndez JI. Breast-Conserving Surgery Guided with Magnetic Seeds vs. Wires: A Single-Institution Experience. Cancers (Basel) 2024; 16:566. [PMID: 38339317 PMCID: PMC10854709 DOI: 10.3390/cancers16030566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The aim of this study is to describe our initial experience using magnetic seeds (Magseed®) to guide breast-conserving surgery in non-palpable breast lesions and compare the use of magnetic seed with wires to guide breast-conserving surgery in terms of clinical and pathological characteristics. METHODS We performed a retrospective study including all breast-conserving surgeries for non-palpable breast lesions under 16 mm from June 2018 to May 2021. We compared breast-conserving surgeries guided with magnetic seeds (Magseed®) to those guided with wires, analyzing tumor and patient characteristics, surgical time, and pathological results of the surgical specimens. RESULTS Data from 225 cases were collected, including 149 cases guided by magnetic seeds and 76 cases guided by wires. The breast lesion was localized in every case. Both cohorts were similar regarding clinical and pathological characteristics. We found significant statistical differences (p < 0.02) in terms of the median volume (cm3) of the excised specimen, which was lower (29.3%) in the magnetic seed group compared with the wire group (32.5 [20.5-60.0]/46.0 [20.3-118.7]). We did not find significant differences regarding surgical time (min) or the affected or close margins. CONCLUSION In our experience, the use of magnetic seed (Magseed®) is a feasible option to guide breast-conserving surgery of non-palpable lesions and enabled us to resect less breast tissue.
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Affiliation(s)
- Elisa Moreno-Palacios
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Covadonga Martí
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Laura Frías
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Marcos Meléndez
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Adolfo Loayza
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - María José Roca
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - Vicenta Córdoba
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - José María Oliver
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - Alicia Hernández
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - José Ignacio Sánchez-Méndez
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
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Zhang M, Sun Y, Wu H, Xiao J, Chen W, Wang H, Yang B, Luo H. Prognostic analysis of cT1-3N1M0 breast cancer patients who have responded to neoadjuvant therapy undergoing various axillary surgery and breast surgery based on propensity score matching and competitive risk model. Front Oncol 2024; 14:1319981. [PMID: 38327751 PMCID: PMC10847357 DOI: 10.3389/fonc.2024.1319981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) in breast cancer patients with positive clinical axillary lymph nodes (cN1+) remains a topic of controversy. The aim of this study is to assess the influence of various axillary and breast surgery approaches on the survival of cN1+ breast cancer patients who have responded positively to neoadjuvant therapy (NAT). Methods Patients diagnosed with pathologically confirmed invasive ductal carcinoma of breast between 2010 and 2020 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. To mitigate confounding bias, propensity score matching (PSM) analysis was employed. Prognostic factors for both overall survival (OS) and breast cancer-specific survival (BCSS) were evaluated through COX regression risk analysis. Survival curves were generated using the Kaplan-Meier method. Furthermore, cumulative incidence and independent prognostic factors were assessed using a competing risk model. Results The PSM analysis matched 4,890 patients. Overall survival (OS) and BCSS were slightly worse in the axillary lymph node dissection (ALND) group (HR = 1.10, 95% CI 0.91-1.31, p = 0.322 vs. HR = 1.06, 95% CI 0.87-1.29, p = 0.545). The mastectomy (MAST) group exhibited significantly worse OS and BCSS outcomes (HR = 1.25, 95% CI 1.04-1.50, p = 0.018 vs. HR = 1.37, 95% CI 1.12-1.68, p = 0.002). The combination of different axillary and breast surgery did not significantly affect OS (p = 0.083) but did have a significant impact on BCSS (p = 0.019). Competing risk model analysis revealed no significant difference in the cumulative incidence of breast cancer-specific death (BCSD) in the axillary surgery group (Grey's test, p = 0.232), but it showed a higher cumulative incidence of BCSD in the MAST group (Grey's test, p = 0.001). Multivariate analysis demonstrated that age ≥ 70 years, black race, T3 stage, ER-negative expression, HER2-negative expression, and MAST were independent prognostic risk factors for both OS and BCSS (all p < 0.05). Conclusion For cN1+ breast cancer patients who respond positive to NAT, the optimal surgical approach is combining breast-conserving surgery (BCS) with SLNB. This procedure improves quality of life and long-term survival outcomes.
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Affiliation(s)
- Maoquan Zhang
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Yingming Sun
- Department of Medical and Radiation Oncology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Huasheng Wu
- Department of Hepatobiliary Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Jian Xiao
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Wenxin Chen
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Hebin Wang
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Binglin Yang
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Huatian Luo
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
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Urooj N, Abubakar M, Asghar K, Hassan M, Malik AA, Rehman B, Sajjad B, Farooqi N, Chaudhry Z, Parvaiz A, Khan A. Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience. J Cancer Allied Spec 2024; 10:559. [PMID: 38259677 PMCID: PMC10793721 DOI: 10.37029/jcas.v10i1.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/22/2023] [Indexed: 01/24/2024]
Abstract
Introduction Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS. Materials and Methods We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods. Results A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines. Conclusion Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.
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Affiliation(s)
- Namra Urooj
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Abubakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Kashif Asghar
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Hassan
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Bushra Rehman
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Bakra Sajjad
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nifasat Farooqi
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Zulqarnain Chaudhry
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asad Parvaiz
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Amina Khan
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Uomori T, Horimoto Y, Ueki Y, Ishizuka Y, Onagi H, Hayashi T, Watanabe J, Shikama N. Efficacy of radiation therapy in Japanese patients with positive margins after breast-conserving surgery. Jpn J Clin Oncol 2024:hyad196. [PMID: 38251759 DOI: 10.1093/jjco/hyad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Additional surgical resection is recommended after breast-conserving surgery if the surgical margin is pathologically positive. However, in clinical practice, radiation therapy is sometimes used instead for several reasons. Irradiation may be appropriate for some patients, but real-world data is still insufficient to establish it as standard treatment. We retrospectively investigated the status of local control in patients who received irradiation for positive margins. METHODS We investigated 85 patients with positive margins after curative partial mastectomy who were treated with irradiation instead of additional excision during the period 2006-2013. The patients received whole-breast irradiation (43.2-50 Gy) using photon beams and additional tumour-bed boost (8.1-16 Gy) using electron beams. Intrabreast tumour recurrence was defined as secondary cancer within the ipsilateral conserved breast. Surgical margin was defined as positive if tumour cell exposure was pathologically confirmed on the margin. RESULTS Seven patients (8.2%) developed intrabreast tumour recurrence during a mean observation period of 119 months. As to components of positive margin, 76 cases were positive for an intraductal component, of which seven (9.2%) developed intrabreast tumour recurrence. Meanwhile, all nine cases positive for an invasive component were free from intrabreast tumour recurrence. Two of the intrabreast tumour recurrence cases seemed to develop new lesions rather than recurrence, considering tumour location. The cumulative incidence of intrabreast tumour recurrence over 10 years was 6.1%. Limited to true recurrence, intrabreast tumour recurrence incidence was 4.9%. CONCLUSION Our real-world data supports irradiation as an alternative to additional surgical intervention for positive margins after breast-conserving surgery and offers a basis for further research.
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Affiliation(s)
- Toshitaka Uomori
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiya Horimoto
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Breast Surgery and Oncology, Tokyo Medical University, 6-1-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Yuko Ueki
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yumiko Ishizuka
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroko Onagi
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takuo Hayashi
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Junichiro Watanabe
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Naoto Shikama
- Faculty of Medicine, Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Jia S, Yang Y, Zhu Y, Yang W, Ling L, Wei Y, Fang X, Lin Q, Hamaï A, Mehrpour M, Gao J, Tan W, Xia Y, Chen J, Jiang W, Gong C. Association of FTH1-Expressing Circulating Tumor Cells With Efficacy of Neoadjuvant Chemotherapy for Patients With Breast Cancer: A Prospective Cohort Study. Oncologist 2024; 29:e25-e37. [PMID: 37390841 PMCID: PMC10769790 DOI: 10.1093/oncolo/oyad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/23/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The association between different phenotypes and genotypes of circulating tumor cells (CTCs) and efficacy of neoadjuvant chemotherapy (NAC) remains uncertain. This study was conducted to evaluate the relationship of FTH1 gene-associated CTCs (F-CTC) with/without epithelial-mesenchymal transition (EMT) markers, or their dynamic changes with the efficacy of NAC in patients with non-metastatic breast cancer. PATIENTS AND METHODS This study enrolled 120 patients with non-metastatic breast cancer who planned to undergo NAC. The FTH1 gene and EMT markers in CTCs were detected before NAC (T0), after 2 cycles of chemotherapy (T1), and before surgery (T2). The associations of these different types of CTCs with rates of pathological complete response (pCR) and breast-conserving surgery (BCS) were evaluated using the binary logistic regression analysis. RESULTS F-CTC in peripheral blood ≥1 at T0 was an independent factor for pCR rate in patients with HER2-positive (odds ratio [OR]=0.08, 95% confidence interval [CI], 0.01-0.98, P = .048). The reduction in the number of F-CTC at T2 was an independent factor for BCS rate (OR = 4.54, 95% CI, 1.14-18.08, P = .03). CONCLUSIONS The number of F-CTC prior to NAC was related to poor response to NAC. Monitoring of F-CTC may help clinicians formulate personalized NAC regimens and implement BCS for patients with non-metastatic breast cancer.
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Affiliation(s)
- Shijie Jia
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yingying Zhu
- Division of Clinical Research Design, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wenqian Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yanghui Wei
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
| | - Xiaolin Fang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qun Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Ahmed Hamaï
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université de Paris, Paris, France
| | - Maryam Mehrpour
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université de Paris, Paris, France
| | - Jingbo Gao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weige Tan
- Department of Breast Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Yuan Xia
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jiayi Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wenguo Jiang
- Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Bai H, Song H, Li Q, Bai J, Wang R, Liu X, Chen F, Pan X. Application of dose-gradient function in reducing radiation induced lung injury in breast cancer radiotherapy. J Xray Sci Technol 2024; 32:415-426. [PMID: 38189733 DOI: 10.3233/xst-230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Try to create a dose gradient function (DGF) and test its effectiveness in reducing radiation induced lung injury in breast cancer radiotherapy. MATERIALS AND METHODS Radiotherapy plans of 30 patients after breast-conserving surgery were included in the study. The dose gradient function was defined as DGH=VDVp3, then the area under the DGF curve of each plan was calculated in rectangular coordinate system, and the minimum area was used as the trigger factor, and other plans were triggered to optimize for area reduction. The dosimetric parameters of target area and organs at risk in 30 cases before and after re-optimization were compared. RESULTS On the premise of ensuring that the target dose met the clinical requirements, the trigger factor obtained based on DGF could further reduce the V5, V10, V20, V30 and mean lung dose (MLD) of the ipsilateral lung in breast cancer radiotherapy, P < 0.01. And the D2cc and mean heart dose (MHD) of the heart were also reduced, P < 0.01. Besides, the NTCPs of the ipsilateral lung and the heart were also reduced, P < 0.01. CONCLUSION The trigger factor obtained based on DGF is efficient in reducing radiation induced lung injury in breast cancer radiotherapy.
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Affiliation(s)
- Han Bai
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
- Department of Physics and Astronomy, Yunnan University, Kunming, Yunnan
| | - Hui Song
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
| | - Qianyan Li
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
| | - Jie Bai
- Department of Radiation Oncology, Daqin Tumor Hospital, Guiyang, Guizhou, China
| | - Ru Wang
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
| | - Xuhong Liu
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
| | - Feihu Chen
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
| | - Xiang Pan
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People's Republic of China
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Dung HA, Quang LH, Quang LV, Cong BT. Level-2 Oncoplastic Surgical Techniques for Breast Cancer: A Preliminary Vietnamese Report. Med Arch 2024; 78:131-138. [PMID: 38566877 PMCID: PMC10983099 DOI: 10.5455/medarh.2024.78.131-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Background Breast cancer is the most common malignancy and remains the first cause of death related to cancer among Vietnamese women, with an incidence of 21,555 cases in 2020. Most breast cancer patients present with invasive disease and relatively large tumor sizes. While oncoplastic surgery (OPS) are commonly applied in Western countries, data on Asian population remains relatively limited. Objective This study aims to assess the outcomes of level-2 oncoplastic techniques in breast-conserving surgeries at the Vietnam National Cancer Hospital. Methods From January 2017 to June 2021, a cohort of 257 breast cancer patients who underwent breast-conserving surgery with OPS techniques were examined. Surgical complications, cosmetic outcome, recurrence and survival rates were assessed. Results The mean age was 47.6±9.4 years, most patients had breast cup sizes B and C. The mean tumor size upon pathological examination was 2.00 ± 0.74 cm. Only 7 cases required reoperation, resulting in a mastectomy rate of 1.17%. The overall complication rate was low at 11.46%, with 9 cases (3.56%) experiencing delayed complications. Cosmetic results were rated as "excellent" in 20.6% and "good" in 60.5%, with a statistically significant difference. The rates of local recurrence, regional recurrence, and distant metastasis at five years were 2.78%, 1.19%, and 2.36%, respectively. Conclusion The level 2 oncoplastic techniques had low complication rates, favorable oncological outcomes, and cosmetically satisfying results.
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Affiliation(s)
- Hoang Anh Dung
- Departement of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Departement of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Le Hong Quang
- Departement of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Departement of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Le Van Quang
- Departement of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Departement of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Bui Tien Cong
- Department of Nuclear Medicine, Hanoi Medical University, Hanoi, Vietnam
- Center of Nuclear Medicine and Oncology, Hanoi, Vietnam
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Pasteris A, Pili N, Nonnis R, Marras V, Patetta R, Cossu A, Rubino C. A rare case of radiation-induced breast angiosarcoma: a case report. Case Reports Plast Surg Hand Surg 2023; 11:2296697. [PMID: 38179209 PMCID: PMC10763889 DOI: 10.1080/23320885.2023.2296697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
We describe a rare case of a 77-year-old woman with radiation-induced breast angiosarcoma (RIAS) in whom radical surgery with negative margins determined that at 14-month of follow-up there is no evidence of either local or systemic recurrence without having to resort to adjuvant chemotherapy.
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Affiliation(s)
- Andrea Pasteris
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Nicola Pili
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Rita Nonnis
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | | | - Antonio Cossu
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
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Luo J, Chen F, Cao H, Zhu W, Deng J, Li D, Li W, Deng J, Zhong Y, Feng H, Li Y, Gong X, Zeng J, Chen J. Customised 3D-Printed Surgical Guide for Breast-Conserving Surgery after Neoadjuvant Chemotherapy and Its Clinical Application. Bioengineering (Basel) 2023; 10:1296. [PMID: 38002420 PMCID: PMC10669255 DOI: 10.3390/bioengineering10111296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
For patients eligible to undergo breast-conserving surgery (BCS) after neoadjuvant chemotherapy, accurate preoperative localisation of tumours is vital to ensure adequate tumour resection that can reduce recurrence probability effectively. For this reason, we have developed a 3D-printed personalised breast surgery guide (BSG) assisted with supine magnetic resonance imaging (MRI) and image 3D reconstruction technology, capable of mapping the tumour area identified on MRI onto the breast directly using dual positioning based on the manubrium and nipple. In addition, the BSG allows the colour dye to be injected into the breast to mark the tumour region to be removed, yielding more accurate intraoperative resection and satisfactory cosmetic outcomes. The device has been applied to 14 patients from January 2018 to July 2023, with two positive margins revealed by the intraoperative biopsy. This study showed that the BSG-based method could facilitate precise tumour resection of BCS by accurately localising tumour extent and margin, promoting the clinical efficacy in patients with breast cancer as well as simplifying the surgical process.
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Affiliation(s)
- Jie Luo
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Feng Chen
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha 410082, China
| | - Hong Cao
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Wei Zhu
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha 410082, China
| | - Jian Deng
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Dan Li
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Wei Li
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Junjie Deng
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Yangyan Zhong
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Haigang Feng
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Yilin Li
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Xiongmeiyu Gong
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Jutao Zeng
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
| | - Jiaren Chen
- Department of Breast and Thyroid Surgery, Clinical Research Center for Breast & Thyroid Disease Prevention in Hunan Province (2018SK4001), The Second Hospital, University of South China, Hengyang 421001, China
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Nobrega GB, Mota BS, de Freitas GB, Maesaka JY, Mota RMS, Goncalves R, Trinconi AF, Ricci MD, Piato JR, Soares-Jr JM, Baracat EC, Filassi JR. Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment. Front Oncol 2023; 13:1293288. [PMID: 38023121 PMCID: PMC10657840 DOI: 10.3389/fonc.2023.1293288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain. Methods We conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs). Results Among the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069-2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006-1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561-3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220-0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177-0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347-1.383). Conclusion Our findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes.
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Affiliation(s)
- Gabriela Bezerra Nobrega
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruna Salani Mota
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela Boufelli de Freitas
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jonathan Yugo Maesaka
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Rodrigo Goncalves
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Angela Francisca Trinconi
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Desidério Ricci
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Piato
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Maria Soares-Jr
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Filassi
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Senoga A, Wasike R, Ali Mwanzi S, Mutebi M. Quality of life of patients one year after breast-conserving surgery versus modified radical mastectomy for early breast cancer: a Kenyan tertiary hospital five-year review. Pan Afr Med J 2023; 46:69. [PMID: 38282779 PMCID: PMC10822102 DOI: 10.11604/pamj.2023.46.69.39151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/09/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the most common surgical techniques utilized in treatment of early breast cancer (EBC) with similar overall survival and recurrence rates. Western literature suggests that these treatments impact the quality of life (QOL) of patients variably. There are no comparison studies on these treatments as per patient's QOL in East Africa. The objectives were to compare the QOL of patients with EBC at least one year after BCT or MRM and assess the factors that affect this QOL. Methods this was a cross-sectional study conducted at Aga Khan University Hospital-Nairobi (AKUHN). Eligible female patients with EBC who had undergone either BCT or MRM between January 2013 and December 2018 were invited to fill out European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Data on participant demographics and clinical information was also obtained. Average scores for each aspect of QOL were obtained and overall means for each surgical treatment were compared. Linear regression was done to assess the factors that affected this QOL. Results forty-two patients had BCS/BCT and 39 had MRM. Patients who had undergone BCS/BCT had a better overall QOL than those who had undergone MRM (p=0.0149). Multivariate analysis revealed that five years from time of surgery, level of education and diabetes mellitus significantly (p<0.05) affected the QOL of these patients. Conclusion after one year from surgery for EBC, patients who had undergone BCS/BCT had a better QOL as compared to MRM.
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Affiliation(s)
- Andrew Senoga
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Ronald Wasike
- Department of Surgery, Masinde Muliro University Medical School, Kakamega, Kenya
| | - Sitna Ali Mwanzi
- Medical Oncology, Cancer Treatment Center, Kenyatta National Hospital, Nairobi, Kenya
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
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Han T, Shi M, Chen Q, Chen D, Hao J. Effect of adjuvant radiotherapy after breast-conserving surgery in elder women with early-stage breast cancer: a propensity-score matching analysis. Front Oncol 2023; 13:1012139. [PMID: 37901322 PMCID: PMC10613027 DOI: 10.3389/fonc.2023.1012139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/14/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose The study aimed to explore the role of adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) in elder women with early-stage breast cancer (BC). Methods BC patients with 70-79 years of age, stage T1-2N0-1M0, undergoing BCS were screened in the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2015. The clinicopathological characteristics were balanced with propensity-score matching (PSM) method. Kaplan-Meier curves and Cox regression analyses were performed to determine the impact of adjuvant RT on BC patients. Results Ultimately, 12,310 patients treated with adjuvant RT and 4837 patients treated with no RT, were involved in the analysis. Overall, patients treated with adjuvant RT was associated with a better breast cancer-specific survival (BCSS) (HR: 1.980 [1.596- 2.456], P < 0.001) and overall survival (OS) (HR: 2.214 [1.966- 2.494], P < 0.001) than those who did not undergo RT. After 1:1 PSM, adjuvant RT still performed advantage in both BCSS (HR: 1.918 [1.439- 2.557], P < 0.001) and OS (HR: 2.235 [1.904- 2.624], P < 0.001). In the multivariate COX analysis of BCSS, widowed, divorced and separated patients, tumor grade III, T2 stage, N1 stage, no RT, molecular subtypes with luminal B and triple negative were associated with a shorter BCSS (P < 0.05). In the multivariate COX analysis of OS, age ≥74 years, widowed, divorced and separated patients, tumor grade II/III, T2 stage, no RT, no chemotherapy, molecular subtypes with triple negative were associated with a shorter OS (P < 0.05). Furthermore, the advantages of adjuvant RT were observed in all subgroup analysis. Conclusion Adjuvant RT after BCS can improve both BCSS and OS in elderly patients with early-stage BC. Additionally, all subgroups analysis-derived BCSS and OS were in support of RT.
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Affiliation(s)
- Tingting Han
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingwei Shi
- Department of Oncology, Hefei BOE Hospital, Hefei, China
| | - Qiwei Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongbo Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiqing Hao
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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20
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Xu L, Mao Q, Liu Q, Gao Y, Luo L, Guo C, Qu W, Yan N, Cao Y. Encapsulated papillary carcinoma of the breast: A single institution experience. Oncol Lett 2023; 26:459. [PMID: 37736553 PMCID: PMC10509775 DOI: 10.3892/ol.2023.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/20/2023] [Indexed: 09/23/2023] Open
Abstract
Encapsulated papillary carcinoma (EPC) is a relatively rare form of breast cancer. To date, no evidence-based guidelines for the treatment of EPC have been established. Between January 2015 and December 2021, patients with histologically confirmed EPC of the breast were recorded in a database by The Third Hospital of Nanchang City (Nanchang, China). A total of 46 patients with EPC were retrieved from the database. Age at diagnosis ranged from 41-88 years (median age, 62 years). A total of 21 of these patients had pure EPC, 6 patients had EPC associated with ductal carcinoma in situ and 19 patients had EPC associated with invasive carcinoma. The majority of EPC cases were low nuclear grade, hormone receptor-positive and human epidermal growth factor receptor-2-negative. Additionally, myoepithelial cells were always absent in the papillae of the EPC. All patients underwent lumpectomy or mastectomy with sentinel lymph node biopsy, and almost all of the patients received adjuvant hormonal therapy. Adjuvant chemotherapy was only suggested to 4 patients who were diagnosed with axillary lymph node involvement. Subsequently, the clinicopathological features of non-invasive EPC were compared with invasive EPC. The results indicated that larger tumor sizes and axillary lymph node metastases were more common in invasive tumors. During the follow-up, only 2 patients with invasive EPC experienced recurrence or metastasis. In conclusion, a substantial proportion of invasive EPC cases display aggressive characteristics and metastatic potential, despite it being considered a subtype of carcinoma in situ with excellent prognosis, and local surgical resection is the initial method of treatment. Therefore, adjuvant endocrine therapy, radiotherapy and chemotherapy should be considered in select patients, especially in those diagnosed with invasive EPC tumors.
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Affiliation(s)
- Liang Xu
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Qixin Mao
- Department of Breast Disease, Henan Breast Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Qiuming Liu
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Yufeng Gao
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Lihua Luo
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Chungen Guo
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Wei Qu
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Ningning Yan
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Yali Cao
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
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Yoshino R, Yoshida N, Ujiie N, Ito A, Nakatsubo M, Kamikokura Y, Kitada M. Radiation-Associated Breast Angiosarcoma. Cureus 2023; 15:e46673. [PMID: 37942397 PMCID: PMC10628990 DOI: 10.7759/cureus.46673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
Radiation-associated breast angiosarcomas are rare following breast-conserving surgery. These angiosarcomas are considered adverse events associated with radiation therapy and are characterized by a high risk of both local and distant recurrence, even after complete resection. Despite this, there is currently no established standard treatment for them. The patient was a 70-year-old woman who had breast-conserving surgery for right breast cancer 10 years before presentation. She was followed up for 10 years after receiving 50 Gy of residual breast irradiation and an aromatase inhibitor for 5 years. During follow-up, a painless purplish area with induration, measuring 10 cm by 5.4 cm, was noted on the right nipple. A skin biopsy confirmed hemangiosarcoma. Treatment included surgery with a 2.0 cm margin from the area, followed by skin excision and total mastectomy. A final diagnosis of radiation-associated breast angiosarcoma was made. Radiation-associated breast angiosarcoma is a rare disease with a poor prognosis that lacks standard treatment. An aggressive skin biopsy should be considered when skin findings such as purpura are seen after breast cancer radiotherapy, as in this case.
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Affiliation(s)
- Ryusei Yoshino
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nana Yoshida
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nanami Ujiie
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Akane Ito
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masaki Nakatsubo
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Yuki Kamikokura
- Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masahiro Kitada
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
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Franco A, Di Leone A, Conti M, Fabi A, Carbognin L, Terribile AD, Belli P, Orlandi A, Sanchez MA, Moschella F, Mason EJ, Cimino G, De Filippis A, Marazzi F, Paris I, Visconti G, Barone Adesi L, Scardina L, D’Archi S, Salgarello M, Giannarelli D, Masetti R, Franceschini G. An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy. J Pers Med 2023; 13:1280. [PMID: 37623530 PMCID: PMC10455579 DOI: 10.3390/jpm13081280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/05/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons' expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. METHODS Patients (stage I-III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed. RESULTS A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896-8.724 was predictive for BCS, 8.725-9.375 for OPS, and 9.376-14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5-14.7%; p = 0.010), a better locoregional disease-free survival (98.8-88.9%; p < 0.001) and a better overall survival (96.1-86.5%; p = 0.017), and a better satisfaction with breasts (39.8-27.5%; p = 0.017) and physical wellbeing (93.5-73.6%; p = 0.001). CONCLUSION A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.
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Affiliation(s)
- Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Marco Conti
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Luisa Carbognin
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Andreina Daniela Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Paolo Belli
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Martin Alejandro Sanchez
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Francesca Moschella
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Elena Jane Mason
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Giovanni Cimino
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Alessandra De Filippis
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Fabio Marazzi
- Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Giuseppe Visconti
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Liliana Barone Adesi
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Sabatino D’Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Marzia Salgarello
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
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Wang Y, Shen J, Gu P, Wang Z. Recent advances progress in radiotherapy for breast cancer after breast-conserving surgery: a review. Front Oncol 2023; 13:1195266. [PMID: 37671064 PMCID: PMC10475720 DOI: 10.3389/fonc.2023.1195266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Adjuvant radiotherapy after breast-conserving surgery has become an integral part of the treatment of breast cancer. In recent years, the development of radiotherapy technology has made great progress in this field, including the comparison of the curative effects of various radiotherapy techniques and the performance of the segmentation times. The choice of radiotherapy technology needs to be co-determined by clinical evidence practice and evaluated for each individual patient to achieve precision radiotherapy. This article discusses the treatment effects of different radiotherapy, techniques, the risk of second cancers and short-range radiation therapy techniques after breast-conserving surgery such as hypo fractionated whole breast irradiation and accelerated partial breast irradiation. The choice of radiotherapy regimen needs to be based on the individual condition of the patient, and the general principle is to focus on the target area and reduce the irradiation of the normal tissues and organs. Short-range radiotherapy and hypofractionated are superior to conventional radiotherapy and are expected to become the mainstream treatment after breast-conserving surgery.
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Affiliation(s)
- Yun Wang
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Jingjing Shen
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Peihua Gu
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Zhongming Wang
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Chen Z, Huang M, Lyu J, Qi X, He F, Li X. Machine learning for predicting breast-conserving surgery candidates after neoadjuvant chemotherapy based on DCE-MRI. Front Oncol 2023; 13:1174843. [PMID: 37621690 PMCID: PMC10446166 DOI: 10.3389/fonc.2023.1174843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose This study aimed to investigate a machine learning method for predicting breast-conserving surgery (BCS) candidates, from patients who received neoadjuvant chemotherapy (NAC) by using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) obtained before and after NAC. Materials and methods This retrospective study included 75 patients who underwent NAC and breast surgery. First, 3,390 features were comprehensively extracted from pre- and post-NAC DCE-MRIs. Then patients were then divided into two groups: type 1, patients with pathologic complete response (pCR) and single lesion shrinkage; type 2, major residual lesion with satellite foci, multifocal residual, stable disease (SD), and progressive disease (PD). The logistic regression (LR) was used to build prediction models to identify the two groups. Prediction performance was assessed using the area under the curve (AUC), accuracy, sensitivity, and specificity. Results Radiomics features were significantly related to breast cancer shrinkage after NAC. The combination model achieved an AUC of 0.82, and the pre-NAC model was 0.64, the post-NAC model was 0.70, and the pre-post-NAC model was 0.80. In the combination model, 15 features, including nine wavelet-based features, four Laplacian-of-Gauss (LoG) features, and two original features, were filtered. Among these selected were four features from pre-NAC DCE-MRI, six were from post-NAC DCE-MRI, and five were from pre-post-NAC features. Conclusion The model combined with pre- and post-NAC DCE-MRI can effectively predict candidates to undergo BCS and provide AI-based decision support for clinicians with ensured safety. High-order (LoG- and wavelet-based) features play an important role in our machine learning model. The features from pre-post-NAC DCE-MRI had better predictive performance.
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Affiliation(s)
| | | | | | | | | | - Xiang Li
- Department of Radiology, the Second Hospital of Dalian Medical University, Dalian, China
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de Oliveira-Junior I, da Costa Vieira RA, Biller G, Sarri AJ, da Silva FCB, Nahás EAP. Factors associated with unsatisfactory cosmetic results in oncoplastic surgery. Front Oncol 2023; 13:1071127. [PMID: 37554162 PMCID: PMC10405917 DOI: 10.3389/fonc.2023.1071127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Oncoplastic surgery (OS) has expanded the indications for breast-conserving surgery associated with an adequate aesthetic result. However, few studies have described the factors associated with unsatisfactory cosmetic outcomes from this surgical modality. MATERIALS AND METHODS This is a cross-sectional prospective study that included patients undergoing breast-conserving surgery (BCS) with or without OS. The patients self-evaluated the cosmetic results of the breasts posttreatment and had them photographed. The photos were analyzed by BCCT.core. Individual and treatment factors (local and systemic) for all patients were evaluated. These factors were dichotomized according to the use of OS and to the cosmetic result (satisfactory and unsatisfactory). Categorical variables were tested for association with surgical outcome using the chi-square test while numerical variables using the Mann-Whitney U test. Variables with p <0,2 were selected for multivariate analysis. RESULTS Of the 300 patients evaluated, 72 (24,0%) underwent OS. According to the patient self-evaluations, an unsatisfactory cosmetic result from OS was significantly associated with younger age at diagnosis, higher body mass index (BMI) at the time of evaluation, larger tumor size and greater weight of the surgical specimen. According to the BCCT.core, only the laterality of the tumor (left) was significantly associated with an unsatisfactory cosmetic result. In logistic regression, considering OS as a control variable, the risk of an unsatisfactory outcome according to patient self-evaluation was related to the tumor ≥ T2 odds ratio (OR) 1,85 (1,027-3,34) and age at diagnosis < 40 [OR 5,0 (1,84-13,95)]. However, according to the software, the variables were associated with an increased risk of an unsatisfactory outcome were the time interval between surgery and evaluation [OR 1,27 (1,16-1,39)], the presence of lymphedema [OR 2,97 (1,36-6,46)], surgical wound infection [OR 3,6 (1,22-11,16)], tumor location on the left side [OR 3,06 (1,69-5,53)], overweight [OR 2,93 (1,48-5,8)] and obesity [OR 2,52 (1,2-5,31)]. CONCLUSION There is no standard methodology for breast cosmesis evaluation, which influences the factors associated with unsatisfactory results. Younger patients and those with increased BMI, left breast cancer and extensive resections tend to present with unsatisfactory cosmetic results when OS is performed.
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Affiliation(s)
- Idam de Oliveira-Junior
- Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - René Aloísio da Costa Vieira
- Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Gabriele Biller
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Faculty of Health Sciences of Barretos Dr. Paulo Prata (FACISB) School of Medicine, Sao Paulo, Brazil
| | - Almir José Sarri
- Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Fabíola Cristina Brandini da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Eliana Aguiar Petri Nahás
- Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
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Rabindran B, Corben AD. Wide-field optical coherence tomography for microstructural analysis of key tissue types: a proof-of-concept evaluation. Pathol Oncol Res 2023; 29:1611167. [PMID: 37521364 PMCID: PMC10374948 DOI: 10.3389/pore.2023.1611167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
Introduction: The presence of positive margins following tumor resection is a frequent cause of re-excision surgery. Nondestructive, real-time intraoperative histopathological imaging methods may improve margin status assessment at the time of surgery; optical coherence tomography (OCT) has been identified as a potential solution but has not been tested with the most common tissue types in surgical oncology using a single, standardized platform. Methods: This was a proof-of-concept evaluation of a novel device that employs wide-field OCT (WF-OCT; OTIS 2.0 System) to image tissue specimens. Various cadaveric tissues were obtained from a single autopsy and were imaged with WF-OCT then processed for permanent histology. The quality and resolution of the WF-OCT images were evaluated and compared to histology and with images in previous literature. Results: A total of 30 specimens were collected and tissue-specific microarchitecture consistent with previous literature were identified on both WF-OCT images and histology slides for all specimens, and corresponding sections were correlated. Application of vacuum pressure during scanning did not affect specimen integrity. On average, specimens were scanned at a speed of 10.3 s/cm2 with approximately three features observed per tissue type. Conclusion: The WF-OCT images captured in this study displayed the key features of the most common human tissue types encountered in surgical oncology with utility comparable to histology, confirming the utility of an FDA-cleared imaging platform. With further study, WF-OCT may have the potential to bridge the gap between the immediate information needs of the operating room and the longer timeline inherent to histology workflow.
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Affiliation(s)
| | - Adriana D. Corben
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
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Song YC, Huang Z, Fang H, Tang Y, Jing H, Song YW, Jin J, Liu YP, Chen B, Tang Y, Qi SN, Lu NN, Li N, Li YX, Wang SL. Breast-conserving surgery versus mastectomy for treatment of breast cancer after neoadjuvant chemotherapy. Front Oncol 2023; 13:1178230. [PMID: 37496664 PMCID: PMC10368492 DOI: 10.3389/fonc.2023.1178230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background To compare recurrence and survival outcomes between breast-conserving surgery (BCS) and mastectomy after neoadjuvant chemotherapy (NACT). Methods The data of 730 patients who underwent NACT between 2000 and 2014 were retrospectively reviewed. A total of 104 (14.2%) patients received BCS and 626 (85.8%) received mastectomy. Locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS) were analyzed using the Kaplan-Meier method. The impact of BCS versus mastectomy on outcomes was assessed by multivariate Cox models. Inverse probability of treatment weighting (IPTW) was used to balance covariates between the two groups. Results The median follow-up of BCS and mastectomy groups were 86.5 and 87.4 months, respectively. There were significant differences in distribution of most baseline characteristics between two groups. Compared with those who underwent mastectomy, the patients with BCS had similar 5-year LRR, DM, and DFS rates, but had significantly higher 5-year BCSS (98.9% vs. 90.4%, P = 0.005) and OS (98.9% vs. 90.1%, P = 0.003) rates. Multivariate analysis also showed that BCS significantly improved BCSS (HR = 0.27, 95% CI: 0.08-0.85, P = 0.025) and OS (HR = 0.25, 95% CI: 0.08-0.79, P = 0.018). After IPTW adjustment, the LRR, DM, DFS, BCSS and OS between two groups had no significant differences. Conclusions The recurrence and survival outcomes are comparable with BCS and mastectomy. Thus, BCS is a safe treatment option for selected breast cancer patients after NACT.
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Affiliation(s)
- Yu-Chun Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhou Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital &Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Vartanian A, Papas PV, Guarecuco Castillo JE, Sistare M, Masri MM. Ultrasound Guided Intraoperative Wire Localization Under General Anesthesia in Breast-Conserving Surgery. Cureus 2023; 15:e41662. [PMID: 37565099 PMCID: PMC10412144 DOI: 10.7759/cureus.41662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Breast-conserving surgery (BCS) is becoming an increasingly preferred surgical technique for treating breast cancer. For the last several decades, using a preoperative wire placed by a radiologist has been the gold standard to help guide surgeons to excise a suspicious mass. In recent years, there has been an increasing focus on using surgeon-performed intraoperative ultrasound (IOUS) during breast-conserving therapy, suggesting improved cosmetic outcomes and a decreased need for re-excision. However, studies have also highlighted that ultrasound may be uncomfortable for surgeons who have become most familiar with a wire-localization technique. Wire localization and intraoperative ultrasound are valuable tools that can improve the accuracy of tumor localization and reduce the need for re-excision. We present a 45-year-old female with a right breast mass, measuring breast imaging reporting and data system (BIRADS) 4A on preoperative ultrasound. Intraoperative wire-localization was performed by the surgeon utilizing ultrasound guidance. The right breast lesion was successfully excised with negative margins. The patient was discharged home and recovered well. Surgeon-performed intraoperative ultrasound can be combined with surgeon-performed wire localization to reduce the need for re-excision surgery and allow the surgeon to retain the familiarity of utilizing a gold-standard technique. Further research is needed to determine the optimal use of surgeon-performed IOUS and wire-localization, and its impact on long-term outcomes.
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Affiliation(s)
- Artin Vartanian
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Paraskevi V Papas
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | | | - Michael Sistare
- General Surgery, Larkin Community Hospital, South Miami, USA
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Okonogi N, Kono S, Karasawa K, Banu PA, Xu X, Erawati D, Adylkhanov T, Jang WI, E Y, Calaguas MJ, Thephamongkhol K, Dung TA, Ng WNP, Kato S. Significance of Hypofractionated Radiotherapy in Postoperative Irradiation for Breast Cancer: An Asian Multi-institutional Prospective Study. Clin Oncol (R Coll Radiol) 2023; 35:463-471. [PMID: 37179216 DOI: 10.1016/j.clon.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
AIMS There is a need for the adequate distribution of healthcare resources in Southeast Asia. Many countries in the region have more patients with advanced breast cancer who are eligible for postmastectomy radiotherapy (PMRT). Therefore, it is critical that hypofractionated PMRT is effective in most of these patients. This study investigated the significance of postoperative hypofractionated radiotherapy in patients with breast cancer, including advanced breast cancer, in these countries. MATERIALS AND METHODS Eighteen facilities in 10 Asian countries participated in this prospective, interventional, single-arm study. The study included two independent regimens: hypofractionated whole-breast irradiation (WBI) for patients who had undergone breast-conserving surgery and hypofractionated PMRT for patients who had undergone total mastectomy at a dose of 43.2 Gy in 16 fractions. In the hypofractionated WBI group, patients with high-grade factors received additional 8.1 Gy boost irradiation sessions for the tumour bed in three fractions. RESULTS Between February 2013 and October 2019, 227 and 222 patients were enrolled in the hypofractionated WBI and hypofractionated PMRT groups, respectively. The median follow-up periods in the hypofractionated WBI and hypofractionated PMRT groups were 61 and 60 months, respectively. The 5-year locoregional control rates were 98.9% (95% confidence interval 97.4-100.0) and 96.3% (95% confidence interval 93.2-99.4) in the hypofractionated WBI and hypofractionated PMRT groups, respectively. Regarding adverse events, grade 3 acute dermatitis was observed in 2.2% and 4.9% of patients in the hypofractionated WBI and hypofractionated PMRT groups, respectively. However, no other adverse events were observed. CONCLUSION Although further follow-up is required, hypofractionated radiotherapy regimens for postoperative patients with breast cancer in East and Southeast Asian countries are effective and safe. In particular, the proven efficacy of hypofractionated PMRT indicates that more patients with advanced breast cancer can receive appropriate care in these countries. Hypofractionated WBI and hypofractionated PMRT are reasonable approaches that can contain cancer care costs in these countries. Long-term observation is required to validate our findings.
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Affiliation(s)
- N Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba City, Chiba, Japan
| | - S Kono
- Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - K Karasawa
- QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba City, Chiba, Japan; Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - P A Banu
- Department of Radiation Oncology, Delta Hospital Limited, Dhaka, Bangladesh
| | - X Xu
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - D Erawati
- Department of Radiotherapy, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - T Adylkhanov
- National Research Oncology Center, Astana, Kazakhstan
| | - W I Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Yadamsuren E
- Department of Radiation Oncology, National Cancer Center of Mongolia, Ulaanbaatar, Mongolia
| | - M J Calaguas
- Department of Radiation Oncology, St Luke's Medical Center, Quezon City, Philippines
| | - K Thephamongkhol
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T A Dung
- Department of General Radiation Oncology, National Cancer Hospital, Hanoi, Viet Nam
| | - W N P Ng
- Department of Radiotherapy & Oncology, National Cancer Institute, Putrajaya, Malaysia
| | - S Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Heeling E, van de Kamer JB, Methorst M, Bruining A, van de Meent M, Vrancken Peeters MJTFD, Lok CAR, van der Ploeg IMC. The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy. Cancers (Basel) 2023; 15:3229. [PMID: 37370839 DOI: 10.3390/cancers15123229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. METHODS To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA). RESULTS The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv. CONCLUSION The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv.
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Affiliation(s)
- Eva Heeling
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Michelle Methorst
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Mette van de Meent
- Department of Obstetrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Christianne A R Lok
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Salafuddin MF, Yarso KY, Nugroho HA, Renardi AS. Breast Conserving Surgery is Better for Sexual Satisfaction Compared to a Modified Radical Mastectomy for Breast Cancer. Asian Pac J Cancer Prev 2023; 24:2083-2088. [PMID: 37378939 PMCID: PMC10505883 DOI: 10.31557/apjcp.2023.24.6.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study aimed to determine the difference between the level of sexual satisfaction in breast cancer patients with Modified Radical Mastectomy (MRM) and Breast Conserving Surgery (BCS). METHODS This study used a cross-sectional study using a validated Female Sexual Function Index questionnaire. This study was conducted from 2020 until 2021. Data were collected and analyzed using the chi-square test for bivariate variables and logistic regression for multivariate variables. RESULTS Patients with BCS were more satisfied with their sexual activity than patients undergoing modified radical mastectomy (p = 0.0001, OR 6.25, CI = 2.78 - 14.01). Other factors having effect on sexual satisfactions were: age that showed a statistically effect on sexual satisfaction (patients <55 years were more satisfied than patients ≥55 years ( p = 0.004, OR = 3.23, CI 1.44 - 7.22), the period after operation (<5 years vs >5 years) showed a statistically significant difference in sexual satisfaction ( p = 0.087, OR=0.53, CI = 0.25-1.10), Having chemotherapy treatment showed statistically significant risk for sexual satisfaction (p = 0.003, OR=7.39, CI= 1.62-33.83). Factors having no statistically significant effect on sexual satisfactions were: Radiotherapy treatment (p = 0.133, OR=1.75 and CI = 0.84 -3.64), length of marriage as defined with <10 years and > 10 years (p = 0.616, OR=1.39 and CI = 0.38-5.09), marital status (p = 0.082, OR =0.39, CI=0,13 - 1.16), educational status (p = 0.778, OR = 1.18, CI = 0.37 - 3.75), and work at home vs outside home (p = 0.117, OR=1.8, and CI = 0.86 - 3.78). CONCLUSION BCS as surgical therapy option is the most dominant factor related to sexual satisfaction followed by age group, and chemotherapy group.
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Affiliation(s)
- Muhammad Fahmi Salafuddin
- Oncology Surgeon, Department of Surgery, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
| | - Kristanto Yuli Yarso
- Oncology Surgeon, Department of Surgery, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
| | - Henky Agung Nugroho
- Department of Oncology, Moewardi Hospital, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
| | - Arga Scorpianus Renardi
- Oncology Surgeon, Department of Surgery, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
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Shanthakumar D, Leiloglou M, Kelliher C, Darzi A, Elson DS, Leff DR. A Comparison of Spectroscopy and Imaging Techniques Utilizing Spectrally Resolved Diffusely Reflected Light for Intraoperative Margin Assessment in Breast-Conserving Surgery: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15112884. [PMID: 37296847 DOI: 10.3390/cancers15112884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Up to 19% of patients require re-excision surgery due to positive margins in breast-conserving surgery (BCS). Intraoperative margin assessment tools (IMAs) that incorporate tissue optical measurements could help reduce re-excision rates. This review focuses on methods that use and assess spectrally resolved diffusely reflected light for breast cancer detection in the intraoperative setting. Following PROSPERO registration (CRD42022356216), an electronic search was performed. The modalities searched for were diffuse reflectance spectroscopy (DRS), multispectral imaging (MSI), hyperspectral imaging (HSI), and spatial frequency domain imaging (SFDI). The inclusion criteria encompassed studies of human in vivo or ex vivo breast tissues, which presented data on accuracy. The exclusion criteria were contrast use, frozen samples, and other imaging adjuncts. 19 studies were selected following PRISMA guidelines. Studies were divided into point-based (spectroscopy) or whole field-of-view (imaging) techniques. A fixed-or random-effects model analysis generated pooled sensitivity/specificity for the different modalities, following heterogeneity calculations using the Q statistic. Overall, imaging-based techniques had better pooled sensitivity/specificity (0.90 (CI 0.76-1.03)/0.92 (CI 0.78-1.06)) compared with probe-based techniques (0.84 (CI 0.78-0.89)/0.85 (CI 0.79-0.91)). The use of spectrally resolved diffusely reflected light is a rapid, non-contact technique that confers accuracy in discriminating between normal and malignant breast tissue, and it constitutes a potential IMA tool.
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Affiliation(s)
- Dhurka Shanthakumar
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK
| | - Maria Leiloglou
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK
| | - Colm Kelliher
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK
| | - Daniel S Elson
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK
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Di Leone A, Franco A, Zotta F, Scardina L, Sicignano M, Di Guglielmo E, Castagnetta V, Magno S, Terribile D, Sanchez AM, Franceschini G, Masetti R. Local Treatment of Triple-Negative Breast Cancer: Is Mastectomy Superior to Breast-Conserving Surgery? J Pers Med 2023; 13:jpm13050865. [PMID: 37241035 DOI: 10.3390/jpm13050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). TNBC accounts for about 15% of breast cancers and has a poorer prognosis as compared with other subtypes of breast cancer. The more rapid onset of this cancer and its aggressiveness have often convinced breast surgeons that mastectomy could provide better oncological results. However, there is no relevant clinical trial that has assessed differences between breast-conserving surgery (BCS) and mastectomy (M) in these patients. This population-based study aimed to investigate the distinct outcomes between conservative treatment and M in a case series of 289 patients with TNBC treated over a 9-year period. This monocentric study retrospectively evaluated patients with TNBC who underwent upfront surgery at Fondazione Policlinico Agostino Gemelli IRCCS, in Rome, between 1 January 2013 and 31 December 2021. First, the patients were divided in two groups according to the surgical treatment received: BCS vs. M. Then, the patients were stratified into four risk subclasses based on combined T and N pathological staging (T1N0, T1N+, T2-4N0 and T2-4N+). The primary endpoint of the study was to evaluate locoregional disease-free survival (LR-DFS), distant disease-free survival (DDFS) and overall survival (OS) in the different subclasses. We analyzed 289 patients that underwent either breast-conserving surgery (247/289, 85.5%) or mastectomy (42/289, 14.5%). After a median follow-up of 43.2 months (49.7, 22.2-74.3), 28 patients (9.6%) developed a locoregional recurrence, 27 patients (9.0%) showed systemic recurrence and 19 patients (6.5%) died. No significant differences due to type of surgical treatment were observed in the different risk subclasses in terms of locoregional disease-free survival, distant disease-free survival and overall survival. With the limits of a retrospective, single-center study, our data seem to indicate similar efficacy in terms of locoregional control, distant metastasis and overall survival with the use of upfront breast-conserving surgery as compared with radical surgery in the treatment of TNBC. Therefore, TNBC should not be considered to be a contraindication for breast conservation.
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Affiliation(s)
- Alba Di Leone
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Zotta
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Scardina
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Margherita Sicignano
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Guglielmo
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Virginia Castagnetta
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Magno
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Terribile
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Su A, Zhang J, Liu J, Yang Y, He Z, Bao H, Deng H, Wu J. Impact of Atypical Hyperplasia at Surgical Margins on breast cancer outcomes in patients treated with neoadjuvant chemotherapy. Front Oncol 2023; 13:1202689. [PMID: 37274293 PMCID: PMC10235679 DOI: 10.3389/fonc.2023.1202689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background Women with atypical hyperplasia (AH) is associated with a higher risk of future breast cancer. However, whether AH found at margins in patients with breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) needs re-excision is not well-defined. The aim of the present study was to evaluate the impact of AH at the surgical margins on the local recurrence and survival outcomes in breast cancer patients treated with NAC and BCS. Methods A retrospective analysis comparing patients who treated with NAC and BCS with AH at the margins to those without AH was performed. Results 598 patients were included in this study. The 5-year rates of ipsilateral breast tumor recurrence (IBTR) were 4.6% and 6.2% in patients with and without AH, respectively. No significant differences were observed among the two groups in terms of IBTR, DMFS, or OS. HER2 overexpressing breast cancer patients with severe AH at margins have a significantly higher risk of IBTR compared to those without severe AH. Conclusion Our study suggests that the presence of AH at the surgical margins of BCS in patients who received NAC does not appear to increase the risk of ipsilateral breast cancer. Therefore, there is no need for surgeons to routinely perform additional re-excision of AH found at the margins of BCS in these patients. However, selective re-excision should be considered in certain cases, particularly in patients with HER2 overexpression.
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Affiliation(s)
- An Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jing Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Anesthesiology Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jieqiong Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhou He
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haoshi Bao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Heran Deng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiannan Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Jong LJS, Post AL, Veluponnar D, Geldof F, Sterenborg HJCM, Ruers TJM, Dashtbozorg B. Tissue Classification of Breast Cancer by Hyperspectral Unmixing. Cancers (Basel) 2023; 15:2679. [PMID: 37345015 DOI: 10.3390/cancers15102679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
(1) Background: Assessing the resection margins during breast-conserving surgery is an important clinical need to minimize the risk of recurrent breast cancer. However, currently there is no technique that can provide real-time feedback to aid surgeons in the margin assessment. Hyperspectral imaging has the potential to overcome this problem. To classify resection margins with this technique, a tissue discrimination model should be developed, which requires a dataset with accurate ground-truth labels. However, establishing such a dataset for resection specimens is difficult. (2) Methods: In this study, we therefore propose a novel approach based on hyperspectral unmixing to determine which pixels within hyperspectral images should be assigned to the ground-truth labels from histopathology. Subsequently, we use this hyperspectral-unmixing-based approach to develop a tissue discrimination model on the presence of tumor tissue within the resection margins of ex vivo breast lumpectomy specimens. (3) Results: In total, 372 measured locations were included on the lumpectomy resection surface of 189 patients. We achieved a sensitivity of 0.94, specificity of 0.85, accuracy of 0.87, Matthew's correlation coefficient of 0.71, and area under the curve of 0.92. (4) Conclusion: Using this hyperspectral-unmixing-based approach, we demonstrated that the measured locations with hyperspectral imaging on the resection surface of lumpectomy specimens could be classified with excellent performance.
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Affiliation(s)
- Lynn-Jade S Jong
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Anouk L Post
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Freija Geldof
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Henricus J C M Sterenborg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Chen W, Lu W, Yuan Y, Li L, Deng H, Ye X. The role of ultrasound quantitative parameters in the assessment of acute radiodermatitis after breast-conserving surgery. J Radiat Res 2023:7153713. [PMID: 37154691 DOI: 10.1093/jrr/rrad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Indexed: 05/10/2023]
Abstract
This study aimed to assess the severity of acute radiodermatitis (ARD) by ultrasound quantitative parameters and to try to identify the influencing factors of skin toxicity. A total of 55 patients who underwent radiotherapy after unilateral breast-conserving surgery (BCS) were included in the study. The irradiated side of the breast was used as the research object and the quantitative ultrasound parameters (skin thickness, shear wave elasticity) were evaluated before radiotherapy, every week during radiotherapy. Two weeks after radiotherapy, the patients were divided into two groups, according to the World Health Organization scoring standard: mild (0-2 grade) and severe (3-4 grade). The differences in the parameters between the groups and the changes during radiotherapy were compared, and the relationship between these parameters and the severity of ARD was analyzed. In addition, some clinical factors that may affect ARD were also included in our study. Ninety-eight percent of patients developed different degrees of ARD, and Group 2 accounted for ~31%. At the end of 5 weeks of radiotherapy, the difference in thickness between the two groups was statistically significant (P < 0.05). There was no significant change in the elastic modulus of breast skin between the two groups (P > 0.05). Body mass index >25 kg/m2, breast thickness ≥18 mm, skin basic elastic modulus <23 kPa and skin thickness increment >0.3 mm were considered to be associated with severe skin reactions (P < 0.05). Ultrasound can be a useful tool for the non-invasive and objective assessment of skin changes during radiotherapy, documenting quantitative changes in the skin of breast cancer patients following BCS undergoing radiotherapy.
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Affiliation(s)
- Wenqin Chen
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Wenjuan Lu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Ya Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Lu Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Hongyan Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xinhua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
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Harbin Z, Sohutskay D, Vanderlaan E, Fontaine M, Mendenhall C, Fisher C, Voytik-Harbin S, Tepolea AB. Computational Mechanobiology Model Evaluating Healing of Postoperative Cavities Following Breast-Conserving Surgery. bioRxiv 2023:2023.04.26.538467. [PMID: 37162899 PMCID: PMC10168325 DOI: 10.1101/2023.04.26.538467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through the Gaussian Process. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.
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Affiliation(s)
- Zachary Harbin
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - David Sohutskay
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Vanderlaan
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muira Fontaine
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
| | - Carly Mendenhall
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - Carla Fisher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sherry Voytik-Harbin
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Department of Basic Medical Sciences Purdue University, West Lafayette, IN, USA
| | - Adrian Buganza Tepolea
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
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Rogowski P, Schönecker S, Konnerth D, Schäfer A, Pazos M, Gaasch A, Niyazi M, Boelke E, Matuschek C, Haussmann J, Braun M, Pölcher M, Würstlein R, Harbeck N, Belka C, Corradini S. Adjuvant Therapy for Elderly Breast Cancer Patients after Breast-Conserving Surgery: Outcomes in Real World Practice. Cancers (Basel) 2023; 15:2334. [PMID: 37190263 PMCID: PMC10137115 DOI: 10.3390/cancers15082334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
We aimed to evaluate the standard of care of adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) in elderly female patients (≥65 years) treated outside of clinical trials and to identify potential factors related to the omission of RT and the interaction with endocrine therapy (ET). All women treated with BCS at two major breast centers between 1998 and 2014 were evaluated. Data were provided by the Tumor Registry Munich. Survival analyses were conducted using the Kaplan-Meier method. Prognostic factors were identified using multivariate Cox regression analysis. The median follow-up was 88.4 months. Adjuvant RT was performed in 82% (2599/3171) of patients. Irradiated patients were younger (70.9 vs. 76.5 years, p < 0.001) and were more likely to receive additional chemotherapy (p < 0.001) and ET (p = 0.014). Non-irradiated patients more often had non-invasive DCIS tumors (pTis: 20.3% vs. 6.8%, p < 0.001) and did not undergo axillary surgery (no axillary surgery: 50.5% vs. 9.5%, p < 0.001). Adjuvant RT was associated with improved locoregional tumor control after BCS in invasive tumors (10-year local recurrence-free survival (LRFS): 94.0% vs. 75.1%, p < 0.001, 10-year lymph node recurrence-free survival (LNRFS): 98.1% vs. 93.1%, p < 0.001). Multivariate analysis confirmed significant benefits for local control with postoperative RT. Furthermore, RT led to increased locoregional control even in patients who received ET (10-year LRFS 94.8% with ET + RT vs. 78.1% with ET alone, p < 0.001 and 10-year LNRFS: 98.2% vs. 95.0%, p = 0.003). Similarly, RT alone had significantly better locoregional control rates compared to ET alone (10-year LRFS 92.6% with RT alone vs. 78.1% with ET alone, p < 0.001 and 10-year LNRFS: 98.0% vs. 95.0%, p = 0.014). The present work confirms the efficacy of postoperative RT for breast carcinoma in elderly patients (≥65 years) treated in a modern clinical setting outside of clinical trials, even in patients who receive ET.
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Affiliation(s)
- Paul Rogowski
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
| | - Dinah Konnerth
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
| | - Annemarie Schäfer
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
| | - Aurélie Gaasch
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
- German Cancer Consortium (DKTK), 81377 Munich, Germany
| | - Edwin Boelke
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Michael Braun
- Breast Centre, Red Cross Hospital, 80634 Munich, Germany
| | - Martin Pölcher
- Breast Centre, Red Cross Hospital, 80634 Munich, Germany
| | - Rachel Würstlein
- Breast Centre, Department of Obstetrics and Gynecology, CCC Munich LMU, University Hospital LMU, 81377 Munich, Germany
| | - Nadia Harbeck
- Breast Centre, Department of Obstetrics and Gynecology, CCC Munich LMU, University Hospital LMU, 81377 Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
- German Cancer Consortium (DKTK), 81377 Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital LMU, 81377 Munich, Germany
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Li YH, Wang XY, Shen JW, Ma LL, Wang CP, He K, Liu DS, Li YF. Clinical factors affecting the long-term survival of breast cancer patients. J Int Med Res 2023; 51:3000605231164004. [PMID: 36988307 PMCID: PMC10064465 DOI: 10.1177/03000605231164004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The average 5-year survival rate of breast cancer (BC) patients has been significantly prolonged with new therapeutic methods. However, their effects on BC patient long-term survival rates are unclear. Therefore, this study aimed to analyze the specific clinical factors that can affect BC long-term survival. METHODS Here, we conducted a retrospective study and analyzed long-term survival using data of 3,240 BC patients from 1977 to 2005 from the Genotype-Tissue Expression (GTEx) database using the Kaplan-Meier method. RESULTS Breast tumor size and stage were negatively correlated with long-term survival, but age showed no significant correlation. Estrogen receptor (ER) and progesterone receptor (PR) expression were each positively correlated with patient survival time, while ERBB2 receptor (HER2) expression was negatively correlated with survival time. Patients with high Nottingham prognostic index (NPI) values did not benefit from available therapies. Furthermore, breast-conserving surgery is more conducive to BC patient long-term survival than mastectomy. CONCLUSIONS Early detection and breast-conserving surgery may support long-term survival for BC patients. Elevated expression of ER and PR were both associated with longer patient survival time, while positive expression of HER2 showed the opposite trend. The long-term survival rates of patients with high NPI values can potentially be increased.
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Affiliation(s)
- Yong-Hui Li
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Luoyang Normal University, Henan, China
| | - Xiao-Ying Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun-Wei Shen
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Lin-Lin Ma
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Cui-Ping Wang
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Kai He
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ding-Sheng Liu
- Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Yan-Fei Li
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Abdelsattar JM, Afridi FG, Dai Z, Yousaf N, Seldomridge A, Battin AO, Wen S, Gray D, Marsh JW, Cowher MS, Partin JF, Hazard-Jenkins H, Lupinacci K. The Effect of Lumpectomy and Cavity Shave Margin Status on Recurrence and Survival in Breast-Conserving Surgery. Am Surg 2023; 89:424-433. [PMID: 34196595 DOI: 10.1177/00031348211030464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVE Cavity shave margins (CSMs) decrease rate of positive margins and need for re-excision. Recurrence data following breast-conserving surgery (BCS) are not always available in large cancer registries. We sought to define our recurrence and survival data in BCS with routine excision of CSMs. METHODS A single institution, 10-year retrospective review of breast cancer patients who underwent BCS with routine CSMs was conducted. Cavity shave margin technique was standard. Cox proportional hazard analyses and the Kaplan-Meier method were used to estimate recurrence and survival. RESULTS Breast-conserving surgery with CSM was performed in 839 patients. Re-excision rate to achieve negative margins was 8.5%. Fifty-two patients (75%) underwent margin re-excision vs 18 patients (25%) underwent salvage mastectomy. Positive margin rate stratified by tumor histology was highest for invasive lobular carcinoma followed by mixed invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS), followed by pure DCIS and lowest for IDC. Length of follow-up was (4.7 ± 2.6, years). Overall recurrence rate (locoregional and systemic) was 4.3%: highest in patients with negative lumpectomy margin but positive CSM (L-S+ = 15%) followed by positive lumpectomy and CSMs (L+S+ = 14%), followed by patients with positive lumpectomy margin but negative CSMs (L+S- = 13%) and lowest for negative lumpectomy and CSM (L-S- = 5%), (P = .0008). There was no difference in 5-year breast cancer-specific survival between the 4 subgroups: 96% for L-S-, 86.7% L-S+, 94.7% L+S+ and 90% L+S- (P = .094). CONCLUSIONS Recurrence following BCS with CSMs can be stratified based on both lumpectomy and cavity shave margin positivity. Routine excision of CSMs allows identification of these patient subsets.
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Affiliation(s)
- Jad M Abdelsattar
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Faryal G Afridi
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Zheng Dai
- Department of Epidemiology, 53422West Virginia University, Morgantown, WV, USA
| | - Natasha Yousaf
- School of Medicine, 53422West Virginia University, Morgantown, WV, USA
| | | | | | - Sijin Wen
- Department of Biostatistics, 53422West Virginia University, Morgantown, WV, USA
| | - Dana Gray
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - J Wallis Marsh
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Michael S Cowher
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | | | | | - Kristin Lupinacci
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
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Lin N, Liu W, Wang M, Zhou W, Zheng S, Yang J, Fang Y, Wu W, Yang W, Jiang Y, Wang Y. Ultrasound-assisted carbon nanoparticle labeling of neoadjuvant chemotherapy for breast-conserving surgery in breast cancer. Quant Imaging Med Surg 2023; 13:1825-1837. [PMID: 36915352 PMCID: PMC10006115 DOI: 10.21037/qims-22-361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
Background Neoadjuvant chemotherapy has gradually become an important means of breast cancer treatment; however, tumor regression following chemotherapy remains a concern. This study was conducted to investigate the effect of ultrasound-assisted carbon nanoparticle labeling in neoadjuvant chemotherapy for breast-conserving surgery in breast cancer. Methods This was a prospective clinical trial study (clinical registration number: ChiCTR-OOC-15006844). Sixty-eight breast cancer patients confirmed by biopsy between July 2015 and January 2017 were randomly selected from the clinical data. Of these, 32 patients were screened for neoadjuvant chemotherapy, forming a consecutive, random series. An ultrasound-guided carbon nanotube was used to mark the original tumor, and sentinel lymph node biopsies were performed. After 4-6 cycles of standard neoadjuvant chemotherapy, 26 patients were selected for breast-conserving surgery. The feasibility and validity of carbon nanoparticle labeling were analyzed through the negative rate of incision margin, the volume of resected tumors, the detection rate of black-stained sentinel lymph nodes, the recurrence rate of ipsilateral breast, and postoperative survival. Results In all, 32 patients underwent sentinel lymph node biopsy, 29 cases were detected (90.6%), the false-negative rate was 3.8% (1/26), and 0-4 sentinel lymph nodes (mean 1.8±1.1) were detected. A total of 26 patients underwent breast-conserving surgery, 5 underwent secondary excision, and 1 underwent subcutaneous adenectomy due to a positive margin. The minimum margin between the resected site and the infiltrated part was 1.0-2.1 cm (1.3±0.3 cm). The diameter of resected tumors ranged from 2.2 to 4.5 cm (3.1±0.6 cm). No recurrence or distant metastasis of ipsilateral breast tumors was observed during follow-up (the median follow-up time was 9 months). Conclusions Ultrasound-assisted carbon nanoparticle labeling is effective for sentinel lymph node tracing before neoadjuvant chemotherapy and has a high detection rate for metastatic lymph nodes. During breast-conserving surgery, it can determine the extent of tumor resection to achieve precision surgical treatment.
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Affiliation(s)
- Nan Lin
- Fuzong Clinical Medical College of Fujian Medical University, Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Wangwu Liu
- Fuzong Clinical Medical College of Fujian Medical University, Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Mingwei Wang
- Fuzong Clinical Medical College of Fujian Medical University, Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Weikang Zhou
- Fuzong Clinical Medical College of Fujian Medical University, Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Shiyao Zheng
- Fuzong Clinical Medical College of Fujian Medical University, Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Jin Yang
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Dongfang Hospital, Xiamen University, Fuzhou, China
| | - Yongchao Fang
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Dongfang Hospital, Xiamen University, Fuzhou, China
| | - Weihang Wu
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Dongfang Hospital, Xiamen University, Fuzhou, China
| | - Weijin Yang
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Dongfang Hospital, Xiamen University, Fuzhou, China
| | - Yanyan Jiang
- Department of Ultrasonography, 900th Hospital of Joint Logistics Support Force, PLA, Dongfang Hospital, Xiamen University, Fuzhou, China
| | - Yu Wang
- Fuzong Clinical Medical College of Fujian Medical University, Department of General Surgery, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
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David S, Tran T, Dallaire F, Sheehy G, Azzi F, Trudel D, Tremblay F, Omeroglu A, Leblond F, Meterissian S. In situ Raman spectroscopy and machine learning unveil biomolecular alterations in invasive breast cancer. J Biomed Opt 2023; 28:036009. [PMID: 37009577 PMCID: PMC10062385 DOI: 10.1117/1.jbo.28.3.036009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
SIGNIFICANCE As many as 60% of patients with early stage breast cancer undergo breast-conserving surgery. Of those, 20% to 35% need a second surgery because of incomplete resection of the lesions. A technology allowing in situ detection of cancer could reduce re-excision procedure rates and improve patient survival. AIM Raman spectroscopy was used to measure the spectral fingerprint of normal breast and cancer tissue ex-vivo. The aim was to build a machine learning model and to identify the biomolecular bands that allow one to detect invasive breast cancer. APPROACH The system was used to interrogate specimens from 20 patients undergoing lumpectomy, mastectomy, or breast reduction surgery. This resulted in 238 ex-vivo measurements spatially registered with standard histology classifying tissue as cancer, normal, or fat. A technique based on support vector machines led to the development of predictive models, and their performance was quantified using a receiver-operating-characteristic analysis. RESULTS Raman spectroscopy combined with machine learning detected normal breast from ductal or lobular invasive cancer with a sensitivity of 93% and a specificity of 95%. This was achieved using a model based on only two spectral bands, including the peaks associated with C-C stretching of proteins around 940 cm - 1 and the symmetric ring breathing at 1004 cm - 1 associated with phenylalanine. CONCLUSIONS Detection of cancer on the margins of surgically resected breast specimen is feasible with Raman spectroscopy.
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Affiliation(s)
- Sandryne David
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Trang Tran
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Frédérick Dallaire
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Guillaume Sheehy
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Feryel Azzi
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Dominique Trudel
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Institut du cancer de Montréal, Montreal, Quebec, Canada
- Université de Montréal, Department of Pathology and Cellular Biology, Montreal, Quebec, Canada
| | - Francine Tremblay
- McGill University Health Center, Department of Surgery, Montreal, Quebec, Canada
| | - Atilla Omeroglu
- McGill University Health Center, Department of Pathology, Montreal, Quebec, Canada
| | - Frédéric Leblond
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Institut du cancer de Montréal, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- McGill University Health Center, Department of Surgery, Montreal, Quebec, Canada
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Sheng Y, Carpenter JS, Paul SM, Cooper BA, Conley YP, Kober KM, Levine JD, Miaskowski C. Palpitations and Co-Occurring Menopausal Symptoms in Women Prior to Breast Cancer Surgery. Oncol Nurs Forum 2023; 50:215-228. [PMID: 37677805 DOI: 10.1188/23.onf.215-228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To determine the occurrence rate of palpitations in women prior to breast cancer surgery and evaluate for differences in demographic and clinical characteristics and menopausal symptoms in patients with and without palpitations. SAMPLE & SETTING Presurgery data on palpitations and menopausal symptoms from 398 patients who underwent breast cancer surgery were analyzed. METHODS & VARIABLES The Menopausal Symptoms Scale was used to evaluate the occurrence, severity, and distress of 46 symptoms, including palpitations. Parametric and nonparametric tests were used to evaluate for differences between patients with and without palpitations. RESULTS Women with palpitations had lower annual income, lower functional status, higher comorbidity burden, and higher rates of back pain than women without palpitations. Women with palpitations had twice the number of menopausal symptoms and had higher occurrence rates for 39 of the 45 menopausal symptoms. They reported significantly higher severity scores for difficulty concentrating, dizziness, swollen hands/feet, and wake during the night, and higher distress scores for anxiety, hot flashes, swollen hands/feet, and wake during the night. IMPLICATIONS FOR NURSING Clinicians should perform routine assessments of palpitations and make appropriate referrals to a cardiologist.
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Riaz N, Jeen T, Whelan TJ, Nielsen TO. Recent Advances in Optimizing Radiation Therapy Decisions in Early Invasive Breast Cancer. Cancers (Basel) 2023; 15. [PMID: 36831598 DOI: 10.3390/cancers15041260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
Adjuvant whole breast irradiation after breast-conserving surgery is a well-established treatment standard for early invasive breast cancer. Screening, early diagnosis, refinement in surgical techniques, the knowledge of new and specific molecular prognostic factors, and now the standard use of more effective neo/adjuvant systemic therapies have proven instrumental in reducing the rates of locoregional relapses. This underscores the need for reliably identifying women with such low-risk disease burdens in whom elimination of radiation from the treatment plan would not compromise oncological safety. This review summarizes the current evidence for radiation de-intensification strategies and details ongoing prospective clinical trials investigating the omission of adjuvant whole breast irradiation in molecularly defined low-risk breast cancers and related evidence supporting the potential for radiation de-escalation in HER2+ and triple-negative clinical subtypes. Furthermore, we discuss the current evidence for the de-escalation of regional nodal irradiation after neoadjuvant chemotherapy. Finally, we also detail the current knowledge of the clinical value of stromal tumor-infiltrating lymphocytes and liquid-based biomarkers as prognostic factors for locoregional relapse.
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Sun Y, He N, Ye F, Zhou C, Wu Y, Xie C, Tang J. Cone-beam breast CT-guided surface location facilitates breast-conserving surgery in breast cancer patients with extensive calcifications: A pilot study. Front Surg 2023; 10:1070868. [PMID: 36843987 PMCID: PMC9947353 DOI: 10.3389/fsurg.2023.1070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
Background Extensive malignant-appearing calcifications have traditionally been considered a contraindication for breast-conserving surgery. The evaluation of calcifications largely depends on mammography, which is limited by tissue superimposition and is unable to reveal spatial information about extensive calcifications. Three-dimensional imaging modality is needed to reveal the architecture of extensive calcifications. In the present study, a novel cone-beam breast CT-guided surface location technique was investigated to facilitate breast-conserving surgery in breast cancer patients with extensive malignant breast calcifications. Methods Biopsy-proved early breast cancer patients with extensive malignant-appearing breast calcifications were included. A patient will be considered suitable for breast-conserving surgery if the spatial segmental distribution of calcifications is found by 3D images of cone-beam breast CT. Then, the margins of the calcifications were located in contrast-enhanced cone-beam breast CT images. Next, skin markers were located using radiopaque materials, and cone-beam breast CT was reperformed to confirm the accuracy of surface location. During breast-conserving surgery, lumpectomy was performed according to the previous surface location, and an intraoperative specimen x-ray was applied to double-check that the entire lesion was removed. Margin assessment was made for both intraoperative frozen section and postoperative pathology examination. Results From May 2019 to Jun 2022, 11 eligible breast cancer patients in our institution were included. Breast-conserving surgery was performed successfully in all patients using the surface location approach mentioned before. All patients achieved negative margins and satisfied cosmetic results. Conclusion This study proved the feasibility of cone-beam breast CT-guided surface location for facilitating breast-conserving surgery in breast cancer patients with extensive malignant breast calcifications.
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Affiliation(s)
- Ya Sun
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ni He
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Feng Ye
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chunyan Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yaopan Wu
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chuanmiao Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun Tang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Correspondence: Jun Tang
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Wang F, Gu Z, Zhao X, Chen Z, Zhang Z, Sun S, Han M. Metabolic characteristics of the various incision margins for breast cancer conservation surgery. Front Oncol 2023; 12:959454. [PMID: 36686765 PMCID: PMC9846322 DOI: 10.3389/fonc.2022.959454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Background Breast cancer (BC) has recently become the most prevalent malignancy in women. There are many alternative treatments for BC, and for aesthetic and postoperative quality of life concerns, breast-conserving surgery and corresponding adjuvant therapy have become the predominant treatment for early invasive BC. Currently, the main method used to assess the margins for breast-conserving surgery is intraoperative pathological diagnosis. However, the designation of surgical margins is controversial, and metabolomics may be a novel approach to evaluate surgical margins. Methods We collected specimens from 10 breast cancer patients and samples from its surrounding tissues and divided them into cancerous tissue and 1 mm, 2 mm, 3 mm, 5 mm and 10 mm cutting edge tissues, with a total of 60 samples. The samples were analyzed by mass spectrometry on an ultra-performance liquid chromatography-quadrupole/Orbitrap high resolution platform. The data were then statistically analyzed to detect metabolic changes in the different cutting edges and to identify possible surgical cutting edges with statistically significant findings. Abnormal metabolic pathways were identified by Kyoto Encyclopedia of Genes and Genomes (KEGG), which elucidated potential markers. Results Statistical analysis indicated that there were substantial differences between the 1 mm margin tissue and the cancer tissue, while there were no statistically significant differences between the 1 mm tissue and tissues from the other margins. The levels of 6 metabolites in the 1 mm tissue were significantly different from those in the cancer tissue and were not significantly different from those in the 2 mm tissue. The six metabolites were pyruvate, N-acetyl-L-aspartate, glutamic acid, γ-aminobutyric acid, fumaric acid, and citric acid. Metabolic pathways such as amino acid metabolism and amino t-RNA synthesis in the margin tissue were significantly distinct from those in cancer tissues based on KEGG analysis. Conclusion There was a significant difference between the 1 mm margin tissue and the cancerous tissue. Based on metabolomic analysis, the 1 mm negative margin is sufficient for surgery, and the six metabolites that we identified as abnormal, including pyruvic acid, N-acetyl-L-aspartic acid, glutamic acid, gamma-aminobutyric acid, fumaric acid and citric acid, may serve as biomarkers for a negative margin and help surgeons select an appropriate surgical margin.
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Yang H, Qiu M, Feng Y, Wen N, Zhou J, Qin X, Li J, Liu X, Wang X, Du Z. The role of radiotherapy in HER2+ early-stage breast cancer patients after breast-conserving surgery. Front Oncol 2023; 12:903001. [PMID: 36686782 PMCID: PMC9845557 DOI: 10.3389/fonc.2022.903001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Due to radioresistance, some HER2+ patients may gain limited benefit from radiotherapy (RT) after breast-conserving surgery (BCS). This study aimed to develop an individualized nomogram to identify early-stage HER2+ patients who could omit RT after BCS. Methods The data of HER2+ patients with T0-2N0M0 breast cancer after BCS between 2010 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER). Based on the independent prognostic factors determined by the Cox analysis in patients without RT after propensity score matching (PSM), the nomogram and risk stratification model were constructed, and then the prognosis of patients with and without RT was compared in each stratified group. Results A total of 10799 early-stage HER2+ patients after BCS were included. Baseline characteristics were similar between groups after PSM. Multivariate Cox analysis indicated that RT could improve overall survival (OS) (HR: 0.45, P<0.001) and breast cancer-specific survival (BCSS) (HR: 0.53, P<0.001). Age, marital status, tumor location, tumor size, and chemotherapy were identified by multivariate Cox analysis in patients without RT and were incorporated into a well-validated nomogram. The risk stratification model based on the nomogram indicated that RT was associated with improved OS (HR 0.40, P< 0.001) and BCSS (HR 0.39, P< 0.001) in the high-risk group but not in the low-risk group [OS: HR 1.04, P = 0.94; BCSS: HR 1.06, P = 0.93]. Conclusion RT could significantly improve the OS and BCSS of HER2+ early-stage breast cancer patients after BCS on the whole. For high-risk patients, RT is an essential component of cancer therapy. However, the omission of radiotherapy may be considered for low-risk HER2+ early-stage patients. Further validation and improvement of the nomogram by prospective study or randomized controlled trials are warranted.
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Affiliation(s)
- Huanzuo Yang
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxue Qiu
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Feng
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nan Wen
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiao Zhou
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangquan Qin
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Li
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Province People’s Hospital, Chengdu, China
| | - Xinran Liu
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Wang
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Zhenggui Du, ; Xiaodong Wang,
| | - Zhenggui Du
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Zhenggui Du, ; Xiaodong Wang,
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Adaş YG, Uyar S, Yazıcı Ö. Intra-operative partial breast irradiation versus external whole breast irradiation for early breast cancer. J Cancer Res Ther 2023; 19:165-168. [PMID: 37006056 DOI: 10.4103/jcrt.jcrt_1843_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Aims Intra-operative radiotherapy (IORT) is a new alternative way to give radiation therapy. During surgery to remove breast cancer, radiation is given as a single dose directly to the area where the tumor used to be. The aim of the study was to compare the results of IORT as partial breast irradiation and external whole breast irradiation (EBRT) for early breast cancer in elderly patients after breast-conserving surgery. The results were retrospectively analyzed from a single institution. We report 7-year results for local control. Settings and Design Cross-sectional study. Methods and Material Between November 2012 and December 2019, 21 Gy partial breast irradiation was applied intra-operatively to 40 selected patients. Two of these patients were excluded from the study, and 38 patients were evaluated. Also, 38 patients who had EBRT and had similar properties to that of IORT patients were selected to compare the treatment results in terms of local control. Statistical Analysis Used SPSS version 21 was used for statistical analysis. Patient groups undergoing IORT and EBRT were analyzed with the Kolmogorov-Smirnov test. The groups were examined in terms of demographic features using t-test, and P < 0.05 was considered as statistically significant. Local recurrence rates were calculated by Kaplan-Meier analysis. Results The median follow-up time was 58 months (range 20-95 months). The local control was 100% in both groups, and no local recurrences were observed. Conclusion IORT seems to be a safe and effective alternative to EBRT for early breast cancer in elderly patients.
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Affiliation(s)
- Yasemin Güzle Adaş
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Serab Uyar
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ömer Yazıcı
- Department of Radiation Oncology, İstanbul Medipol University Başakşehir Hospital, İstanbul, Turkey
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Zhong Y, Wang Z, Xu Y, Zhou Y, Mao F, Shen S, Sun Q. Breast-conserving surgery without axillary surgery and radiation versus mastectomy plus axillary dissection in elderly breast cancer patients: A retrospective study. Front Oncol 2023; 13:1126104. [PMID: 37020865 PMCID: PMC10067658 DOI: 10.3389/fonc.2023.1126104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Background The high relative mortality rate in elderly breast cancer patients is most likely the result of comorbidities rather than the tumor load. Foregoing axillary lymph node dissection or omitting radiotherapy after breast-conserving surgery (BCS) does not affect the prognosis of elderly breast cancer patients. We sought to assess the safety of breast-conserving surgery without axillary lymph node dissection as well as breast and axillary radiotherapy (BCSNR) in elderly patients with early-stage breast cancer. Methods We retrospectively included 541 consecutive breast cancer patients aged over 70 years with clinically negative axillary lymph nodes in one clinical center. Of these patients, 181 underwent mastectomy plus axillary lymph node dissection (MALND) with negative axillary cleaning and 360 underwent BCSNR. Results After a median follow-up of 5 years, there was no significant difference between the BCSNR and MALND groups in either distant recurrence-free survival (DRFS) (p=0.990) or breast cancer-specific survival (p=0.076). Ipsilateral axillary disease was found in 11 (3.1%) patients in the BCSNR group and 3 (1.7%) patients in the MALND group; this difference was not significant (p=0.334). We did not observe a significant difference in distant recurrence between the groups (p=0.574), with 25 (6.9%) patients in the BCSNR group experiencing distant recurrence compared to 15 (8.3%) patients in the MALND group. Our findings did show a significant difference in ipsilateral breast cancer recurrence (IBTR), with 31 (8.6%) patients in the BCSNR group experiencing IBTR compared to only 2 (1.1%) patients in the MALND group (p=0.003). Conclusion BCSNR is a safe treatment option for elderly breast cancer patients with clinically negative axillary lymph nodes.
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Kim R, Kawai A, Wakisaka M, Shimoyama M, Yasuda N, Kin T, Arihiro K. Breast cancer recurrence and survival rates in patients who underwent breast-conserving surgery under non-mechanically ventilated anesthesia. Cancer Rep (Hoboken) 2023; 6:e1643. [PMID: 35655440 PMCID: PMC9875645 DOI: 10.1002/cnr2.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recurrence after primary treatment is an important obstacle to the curing of primary breast cancer. Less-immunosuppressive anesthetic techniques, such as local anesthesia with lidocaine, intravenous anesthesia (IVA) with propofol, and/or sedation with midazolam under spontaneous breathing may reduce breast cancer recurrence compared with standard general anesthesia techniques such as IVA and inhalation anesthesia with opioids under mechanical ventilation. AIM The aim of this study was to analyze the factors involved in breast cancer recurrence in patients who underwent breast-conserving surgery (BCS) under non-mechanically ventilated anesthesia. METHODS The study included 491 consecutive patients with stages 0-III breast cancer who underwent BCS/axillary lymph-node management with local anesthesia and IVA and/or sedation under non-mechanical ventilation between May 2008 and September 2021. Survival and recurrence were assessed by retrospective cohort analysis. RESULTS The median follow-up period was 2565 days (range, 28-4834 days). The overall and breast cancer-specific survival rates were 92.9% and 95.6%, respectively. Twenty-one deaths, of which 11 were breast cancer-related, occurred. Disease recurred in 29 (5.9%) patients, of whom 15 patients received neoadjuvant chemotherapy (NAC) and 14 patients received adjuvant therapy (chemotherapy in 12 cases). The surgical procedure performed, but not other clinicopathological factors [recurrence site, P stage, tumor subtype, and disease-free interval (DFI)], differed between the NAC and adjuvant therapy groups. The DFI tended to be shorter in the NAC group than in the adjuvant therapy group. The pathological therapeutic effect grade after NAC was 1 in 12 patients and ≥2 in 3 patients. CONCLUSION More than 50% (15/29) of patients with recurrence who underwent BCS were given NAC, but most patients did not respond to it. Similarly, adjuvant chemotherapy may not have contributed to the eradication of residual tumor cells after BCS. To reduce breast cancer recurrence in patients undergoing BCS, treatment strategies, especially for patients who do not respond to NAC or adjuvant chemotherapy, need to be developed. Non-mechanical ventilation anesthesia may also affect the incidence of breast cancer recurrence.
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Affiliation(s)
- Ryungsa Kim
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Ami Kawai
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Megumi Wakisaka
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Mika Shimoyama
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Naomi Yasuda
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Takanori Kin
- Department of Breast SurgeryHiroshima City HospitalHiroshimaJapan
| | - Koji Arihiro
- Department of Anatomical PathologyHiroshima University HospitalHiroshimaJapan
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