Clinical breast cancer最新文献

Background: It is unclear whether breast cancer (BC) subtypes or CSF cytology results are associated with overall survival (OS) among patients with BC leptomeningeal disease (LMD). This single-institution retrospective study compares OS among BC patients with LMD across various breast cancer subtypes and CSF cytology results.

Methodology: The study enrolled BC patients diagnosed with LMD between 2010 and 2023. Breast cancer subtypes were classified as A. ER+/HER2-, HER2+, or triple-negative BC (TNBC); B. HER2+, HER2-Low, HER2-Zero. CSF cytology subtypes included CSF+, CSF-, or CSF not tested (NT). OS was summarized via Kaplan-Meier analysis and compared using log-rank test. Cox models were used for multivariate analyses.

Results: Out of 69 patients registered, median OS (95% CI) for ER+/HER2- (n = 33), HER2+ (n = 12) and TNBC (n = 24) subtypes were 8.0 (3.02, 24.8), 5.71 (1.61, not estimated) and 3.2 (1.11, 4.95) months (P = .17). In multivariate analysis, TNBC was associated with worse OS versus ER+/HER2- [Hazard Ratio (HR), 95% CI: 2.64, 1.23-5.80, P = .04]. HER2 subtypes (HER2-Zero, n = 21; HER2-Low, n = 32; HER2+, n = 12) showed no significant differences in OS. Median OS (95% CI) for CSF+ (n = 16), CSF- (n = 18), and CSF NT (n = 35) groups were 3.54 (1.61, 12.72), 13.41 (4.95, 61.93) and 3.28 (1.44, 6.92) months (P = .04). Multivariate analysis showed both CSF+ and CSF NT were associated with shorter OS compared to CSF- group [HR (95% CI) 4.50 (1.75, 12.11) for CSF+ vs. CSF-; 2.91 (1.45, 6.26) for CSF NT vs. CSF-; P = .002].

Conclusion: TNBC LMD group was associated with worse OS than ER+/HER2- BC LMD when adjusting for other prognostic factors. CSF- LMD patients had better OS than CSF+ or CSF NT LMD.

Introduction: We sought to develop clinical guidelines within our multidisciplinary Breast Center to support decision-making for managing high-risk breast lesions. The objective is to describe the process used to develop these guidelines and assess perceived acceptability.

Methods: We recruited clinical stakeholders to identify key "high-risk" topics. Stakeholder groups (surgery, radiology, pathology) met separately to review the topics, leveraging existing literature reviews and best available evidence. Guidelines were initially developed in 2015 and updated in 2019. We surveyed breast clinical team members in 2023 regarding the perceived acceptability of the guidelines and summarized the data.

Results: We created clinical guidelines to address the management of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia/lobular carcinoma in situ, radial scar/complex sclerosing lesion, and papillomas. Key guideline components included process for radiologic-pathologic correlation, patient disposition after biopsy (surgical referral needed, follow-up imaging recommended), recommendation for the role of surgical excision, and recommendation regarding imaging follow-up if excision not performed. Forty clinical team members (66% [40/60] response rate) completed the acceptability survey from varied disciplines. Most (78%) were aware of the guidelines. Respondents rated the recommendations for disposition after biopsy, surgical management, and follow-up imaging as the most helpful components. Most (> 80%) rated them to be very/extremely useful.

Conclusion: We leveraged input from key stakeholders to develop clinical guidelines to support the multidisciplinary management of patients with high-risk breast lesions. Our guidelines have been successfully implemented across our academic and community practice. Future steps will assess the impact of implementation on clinical outcomes.

Background: Breast cancer is a prevalent malignancy in women, with mastectomy as the main surgery. Common postmastectomy complications are seroma (15%-81%), infections (2.9%-3.8%), and flap necrosis (10%-18%), severely impacting quality of life and costs. However, there's a lack of standardized flap care protocols and limited staff knowledge.

Objectives: This study aims to apply best evidence for flap management post-mastectomy to standardize practices, reduce complications, and enhance patient's quality of life.

Methods: This project followed JBI PACES and GRiP principles, implementing evidence-based practices in a Chinese tertiary hospital between January and May 2023. It entailed evidence identification, integration into clinical context, protocol development, baseline audits, barrier/enabler analysis. The study compared pre- and post-evidence implementation rates of flap complications, healthcare staff's knowledge/skill scores on mastectomy flap management, and audit indicator adherence by both staff and patients.

Results: After evidence application, flap ischemia/necrosis rates dropped from 8.57% to 5.56% (P < .001), wound infection rates after surgery reduced from 5.71% to 2.78% (P < .001), and seroma rates decreased from 17.14% to 2.78% (P < .001). Healthcare staff's knowledge and skill scores for flap management following mastectomy increased from 50.67 ±18.32 preimplementation to 98.33 ± 4.01 (t = -13.90, P < .001). Audit criterion compliance rates increased from 8.57% to 94.29% to between 91.67% and 100%, with statistically significant differences in all 15 criteria (P < .001).

Conclusions: Evidence-based management of flaps after mastectomy improves healthcare staff's knowledge and skills, enhances nursing quality, effectively reduces flap complications in patients, and boosts their quality of life.

Purpose: Mucinous breast carcinoma (MBC) tends to be misdiagnosed as fibroadenomas (FA) due to its benign imaging characteristics. We aimed to develop a deep learning (DL) model to differentiate MBC and FA based on ultrasound (US) images. The model could contribute to the diagnosis of MBC for radiologists.

Methods: In this retrospective study, 884 eligible patients (700 FA patients and 184 MBC patients) with 2257 US images were enrolled. The images were randomly divided into a training set (n = 1805 images) and a test set (n = 452 images) in a ratio of 8:2. First, we used the training set to establish DL model, DL+ age-cutoff model and DL+ age-tree model. Then, we compared the diagnostic performance of three models to get the optimal model. Finally, we evaluated the diagnostic performance of radiologists (4 junior and 4 senior radiologists) with and without the assistance of the optimal model in the test set.

Results: The DL+ age-tree model yielded higher areas under the receiver operating characteristic curve (AUC) than DL model and DL+ age-cutoff model (0.945 vs. 0.835, P < .001; 0.945 vs. 0.931, P < .001, respectively). With the assistance of DL+ age-tree model, both junior and senior radiologists' AUC had significant improvement (0.746-0.818, P = .010, 0.827-0.860, P = .005, respectively).

Conclusions: The DL+ age-tree model based on US images and age showed excellent performance in the differentiation of MBC and FA. Moreover, it can effectively improve the performance of radiologists with different degrees of experience that may contribute to reducing the misdiagnosis of MBC.

Aim: To evaluate the role of Indocyanine Green Lymphography (ICG_L) in the early diagnosis and personalized management of breast cancer-related lymphedema (BCRL) among high-risk breast cancer (BC) survivors.

Methods: Patients who admitted to the UPMC Magee-Womens Hospital Lymphedema Program between October 2018 and December 2021 with episodic symptoms were enrolled into the study. Patient demographics, clinical characteristics, and outcomes were prospectively collected and retrospectively analysed. Lymphatic flow disruptions were identified and guided personalized therapeutic interventions were guided by ICG_L.

Results: Among 154 BC survivors, 184 arms were evaluated. Initial ICG_L showed 57.1% had no lymphedema, while 42.9% were classified as stage 1 to 3 lymphedema. Early diagnosis and personalized interventions provided improved outcomes, with only 4.3% developing clinical lymphedema after a median follow-up of 27 months. Patients exhibited stable or improved symptoms with individualized treatments such as manual lymphatic drainage, compression therapies, and physiotherapy.

Conclusion: ICG_L evaluation is essential for patients at high-risk of developing BCRL. Early diagnosis before clinical onset of lymphedema, and ICG_L guided therapy significantly enhances the clinical outcomes and improves lymphedema management.

The objective of this scoping review is to evaluate the potential of Magnetic Resonance Imaging (MRI) and to determine which of the available MRI techniques reported in the literature are the most promising for assessing treatment response in breast cancer patients following neoadjuvant radiotherapy (NRT). Ovid Medline, Embase, CINAHL, and Cochrane databases were searched to identify relevant studies published from inception until March 13, 2023. After primary selection, 2 reviewers evaluated each study using a standardized data extraction template, guided by set inclusion and exclusion criteria. A total of 5 eligible studies were selected. The positive and negative predictive values for MRI predicting pathological complete response across the studies were 67% to 88% and 76% to 85%, respectively. MRI's potential in assessing postradiotherapy tumor sizes was greater for volume measurements than uni-dimensional longest diameter measurements; however, overestimation in surgical tumor sizes was observed. Apparent diffusion coefficient (ADC) values and Time to Enhance (TTE) was seen to increase post-NRT, with a notable difference between responders and nonresponders at 6 months, indicating a potential role in assessing treatment response. In conclusion, this review highlights tumor volume measurements, ADC, and TTE as promising MRI metrics for assessing treatment response post-NRT in breast cancer. However, further research with larger cohorts is needed to confirm their utility. If MRI can accurately identify responders from nonresponders to NRT, it could enable a more personalized and tailored treatment approach, potentially minimizing radiation therapy related toxicity and enhancing cosmetic outcomes.

Purpose: There is limited data on the use of low dose tamoxifen (LDT) for chemoprevention since its introduction in 2019. This study sought to determine the rate of LDT uptake at our institution and describe factors associated with its use.

Methods: We performed a retrospective chart review of women diagnosed with ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and/or atypical hyperplasia from 2019 to 2021. Log-binomial models were used to compare the probabilities of receiving standard dose tamoxifen (SDT) relative to LDT by patient and disease characteristics. Since most patients did not experience any AEs, a zero-inflated poison regression model was used to estimate and compare adverse event rates between groups.

Results: Among 477 patients with DCIS, LCIS, and atypical hyperplasia, 27% (N = 129) initiated SDT, 19% (N = 89) LDT, 32% (N = 155) aromatase inhibitor, 2% (N = 9) raloxifene, and 20% (N = 95) declined therapy. LDT was used more frequently than SDT in patients with LCIS or atypical hyperplasia compared to DCIS (31.4% vs 17.4%, P < .0001). There were no significant differences in the frequency of adverse events between patients on SDT and LDT but the incidence rate of AEs in the SDT group was higher (1.9 vs. 1.3 per 1000 days, P = .0186).

Conclusion: In our population, 19% of women with DCIS, LCIS, or atypical hyperplasia, initiated chemoprevention with LDT with higher usage in patients with atypical lesions and/or LCIS. Physicians should strongly consider LDT in women with high-risk lesions who are eligible for chemoprevention.

Purpose: There is scarce literature about the role of race/ethnicity and socioeconomic status on the incidence of invasive lobular carcinoma (ILC). We sought to assess trends in ILC incidence by race/ethnicity across age, cancer stage, and socioeconomic status subgroups in the United States from 1992 to 2019.

Methods: This population-based cross-sectional study included data from SEER12 registries. We used the NCI's Join point Regression Program to estimate longitudinal trends in age-adjusted breast cancer incidence rates from 1992 to 2019, reported as average annual percent change (AAPC) or annual percent change (APC). We evaluated incidence trends by a combination of race/ethnicity and stage, county-level poverty, county-level metro/nonmetro status, high school education, and age.

Results: From 1992 to 2019, ILC incidence rates increased across all race/ethnicity groups, with the greatest increase in non Hispanic Black (AAPC 2.6%), followed by Hispanic (AAPC 2.2%), and non Hispanic White women (AAPC 1.6%). The stronger increase in ILC incidence among Hispanic and non Hispanic Black women was predominantly seen among those living in low poverty or metropolitan areas and those older than 70. In recent years, from 2002 to 2019, the largest increase in ILC incidence was found in Hispanic women (APC 3.3%).

Conclusion: Although the incidence of ILC continues to be highest in non Hispanic White women, in recent years the largest increases are seen in non Hispanic Black women and Hispanic women. Further research is warranted to better understand these trends and appropriately target at-risk populations for screening.

Background: The use of robotic-assisted nipple-sparing mastectomy (R-NSM) with immediate direct-to-implant (DTI) reconstruction in treatment of breast cancer has been a controversial topic. The adoption of robotic surgery in breast cancer treatment has gained traction globally due to its minimally invasive nature, potential for improved cosmetic outcomes and better intraoperative visualization. This study provides insights on safety and feasibility robotic mastectomy at one of the largest centers in Asia.

Methods: This retrospective study included patients who underwent robotic nipple-sparing mastectomy (R-NSM) with immediate direct-to-implant (DTI) reconstruction from April 2018 to September 2024. Our endpoints were mainly focused on perioperative outcomes, patient satisfaction, and oncologic outcomes.

Results: A total of 266 procedures were included in our series, with 233 patients undergoing unilateral R-NSM with either DTI reconstruction or a tissue expander, and 33 patients underwent surgery on both breasts. Postoperative complications were recorded in 11 patients (4.14 %). The median follow-up of this study is 37.2 ± 23.3 months. Locoregional recurrence (LRR) was observed in 6 patients (2.5 %), with isolated skin recurrence being the most common. Distant metastasis was observed in 9 patients (3.86 %). The 3-year overall survival rate was 98.3 %.

Conclusion: Robotic NSM is a safe and feasible novel minimal invasive surgical approach for breast cancer surgery, providing both excellent cosmetic results and oncological outcomes that are noninferior to conventional or endoscopic approaches.