Clinical breast cancer最新文献

Introduction: Focal non-mass enhancement (NME) is a common breast MRI finding with limited data to guide management. This study aimed to assess clinical and imaging features of malignant BI-RADS 4 focal NME.

Methods: This IRB-approved, retrospective study included breast MRI exams between August 1, 2013 and September 1, 2022 yielding BI-RADS 4 focal NME lesions that underwent core biopsy or excision with available pathology result or demonstrated decrease or resolution during follow-up MRI or at least 2 years of MRI stability.

Results: A total of 296 BI-RADS 4 focal NME lesions in 246 patients were included in the study. The overall malignancy rate of BI-RADS 4 focal NME was 36/296 (12.2%). Focal NME in a patient presenting for evaluation of extent of disease or other diagnostic concern was 5.5 and 3.4 times more likely, respectively, to be malignant compared to focal NME seen on a high-risk screening exam. There was also a significant association between malignancy and focal NME that was brighter than background parenchymal enhancement (BPE) on maximum intensity projection (MIP) images. There was no significant association between malignancy and lesion size, internal enhancement pattern, amount of BPE, amount of fibroglandular tissue, or signal intensity on T2-weighted images.

Conclusion: Our study yielded a malignancy rate of 12.2% for BI-RADS 4 focal NME lesions. Indication for MRI and signal intensity compared to BPE on MIP images were features associated with malignancy that may provide guidance on the management for focal NME.

Objective: This study was designed to investigate the efficacy and safety of pyrotinib-based therapy for HER2-positive breast cancer with brain metastases (BM) in the real-world setting.

Methods: Data of HER2-positive breast cancer patients with BM treated with pyrotinib-based therapy from a multicetre, registered, real-world study were analyzed.

Results: Among 45 female patients, the overall objective response rate (ORR) was 62.2%, higher in 1st/2nd-line than ≥ 3rd-line (71.0% vs. 42.9%, P = .072). The objective response rate of intracranial lesions (CNS-ORR) was 71.1 %, with a significantly higher CNS-ORR observed in the 1st or 2nd-line subgroup compared to that of ≥ 3rd-line subgroup (83.9% vs. 42.9%, P < .05). By the end of follow-up, 20 patients (44.4%) died, and the 1-year survival rate was 73.3%. The median progression-free survival (PFS) was 9.1 months (95% CI 6.7-11.5). Patients with 1 or 2 BM had a longer median PFS of 12.0 months compared to 7.7 months for those with ≥ 3 BM (P = .01). In addition, 1- or 2-line therapy and full dose exposure of pyrotinib of 320mg-400mg/day were associated with improved median PFS (all P > .05). The median intracranial PFS (CNS-PFS) was 11.4 months (95% CI 7.5-15.3). However, local intervention plus systemic treatment seemed to prolong CNS-PFS compared with systemic treatment alone (13.7 vs. 9.1 months, P = .128). Diarrhea was most common (88.9%), 24.4% grade 3.

Conclusions: The pyrotinib-based therapy is effective for HER-2 positive breast cancer with BM, especially in 1st- or 2nd-line treatment, with tolerable adverse events. However, insufficient dosing of pyrotinib may impair efficacy outcomes.

Background: Estrogen receptor (ER) status in breast cancer (BC) is routinely determined by immunohistochemistry (IHC); however, this technique is not without limitations, including false results. Imaging of Cerianna^TM (fluoroestradiol F18) injection provides high diagnostic accuracy of ER expression, supplementing information from biopsy. A Clinical Decision Support (CDS) tool was developed to better assess its clinical usefulness in metastatic and recurrent breast cancer management. This study evaluated a conceptual tool that reflects clinical practice variables.

Methods: Individual patient characteristics - candidacy for therapeutic treatment and rate of recurrence - determined initial eligibility. The CDS tool uses rules (IF-THEN statements) to produce an output on the diagnostic accuracy of ER status based on tumor burden, anatomical location(s) of metastasis, heterogeneity, and confidence in sample collection & pathology accuracy (CSC & PA). An Excel-based probability decision tree calculates the accuracy of ER expression.

Results: 360 oncologists in the United States participated in the survey study. 223 respondents identified as medical oncologists (62%), 77 as clinical oncologists (21%), and 60 as hematologic oncologists (17%). 93% of respondents found the CDS tool intuitive and easy to follow with medical and clinical oncologists favoring the tool more than hematologic oncologists. Individual CDS attributes - clinical criteria, diagnostic comparator, true positive and true negative, patient inclusion and exclusion, and clinical patient level inputs - were tested with overall positive feedback.

Conclusions: Based on respondent feedback, further development of CDS tools are warranted for potential use in patients' diagnostic workup.

Background: Low skeletal muscle mass and poor muscle quality are associated with poor outcomes in women with breast cancer. However, gaps exist in our understanding of prognostic factors for young women (≤ 40 years), as they often have different body composition than older women. We evaluated pretreatment body composition measures in young women with breast cancer, including associations with overall survival (OS) and progression-free survival (PFS).

Methods: The Young Women's Database at Levine Cancer Institute was queried for women aged 18 to 40 at diagnosis (2009-2018) of single primary breast cancer (N = 870); patients with Stage 0 and 4 were excluded. Deceased patients with pretreatment computed tomography (CT) scans were identified (N = 40) and matched (1:1) to patients presumed alive by age, diagnosis year, and disease characteristics. CT-derived body composition measures included skeletal muscle index (SMI) and intramuscular adipose tissue corrected (IMAT-C). Sarcopenia (low muscle mass) was defined as SMI<40.

Results: Of 80 subjects, median age at diagnosis was 35 years. Median follow-up 8.6 years. Total 33% had low muscle mass (sarcopenic), and 56% had poor muscle quality (high IMAT-C). Independent of age, clinical disease stage, and primary insurer, high IMAT-C was associated with shorter PFS (HR 2.33, 95% CI 1.15-4.72; P = .020).

Conclusions: Poor muscle quality at diagnosis was associated with shorter progression-free survival in young women with breast cancer. Future research should determine the significance of changes in muscle quality throughout treatment.

Background: Breast cancer brain metastasis (BCBM) prognosis has not been evaluated dynamically, which may underestimate patient survival. This study aimed to perform a conditional survival (CS) analysis and develop and validate an individualized real-time prognostic monitoring model for survivors.

Methods: The study included patients with BCBM from the Surveillance, Epidemiology, and End Results database (training group, n = 998) and our institution (validation group, n = 45) and updated patient overall survival (OS) over time using the CS method: CS(t2|t1)=OS(t1+t2)OS(t1). Multivariate Cox regression was used to identify prognostic factors for the nomogram, which estimated individualized OS. Furthermore, a novel CS-nomogram and its web version were further developed based on the CS formula.

Results: CS analysis showed that the 5-year OS of BCBM survivors gradually improved from 13.5% estimated at diagnosis to 26.0%, 39.7%, 57.9%, and 77.6% (surviving 1-4 years, respectively). Cox regression identified age, marital status, estrogen receptor status, human epidermal growth factor receptor 2 (Her-2) status, histological grade, surgery, and chemotherapy as significant factors influencing OS (P < .05). We then constructed and deployed the CS-nomogram based on the CS formula and the nomogram to predict real-time prognosis dynamically (https://wh-wang.shinyapps.io/BCBM/). During performance evaluation, the model performed well in both the training and validation groups.

Conclusions: CS analysis showed a gradual improvement in prognosis over time for BCBM survivors. We developed and deployed on the web a novel real-time dynamic prognostic monitoring system, the CS-nomogram, which provided valuable survival data for clinical decision-making, patient counseling, and optimal allocation of healthcare resources.

Objective: This study aimed to enhance outcomes for women undergoing breast cancer screening in a low utilization setting by implementing structured improvement cycles.

Methods: Improvement cycles were conducted using the Plan-Do-Study-Act (PDSA) methodology. Three cycles were implemented: (1) dedicating a specific day for breast screening and increasing appointment slots; (2) establishing a breast screening clinic with same-day registration; and (3) introducing a breast surgery clinic to expedite biopsy procedures for BI-RADS-4 category cases.

Results: Following each improvement cycle, dramatic increases in patient attendance were observed. In 2021, there was a 67.5% rise compared to the previous year, and a 72% increase in 2022 compared to 2021 figures. Patient characteristics revealed that 60% of attendees were new patients, with 53% of cancer and precancerous cases observed in women below 50 years old. Before the third cycle, the estimated diagnosis turnaround time (TAT) showed that only 23% of patients had their biopsy completed within 5 working days. However, after the third cycle (n = 131), 63.5% of biopsies were done within five working days.

Conclusion: Structured improvement cycles guided by the PDSA methodology effectively enhanced breast cancer screening outcomes. These cycles led to increased patient attendance, expedited biopsy procedures, and improved access to timely diagnosis. The findings highlight the importance of systematic approaches in optimizing breast cancer screening and improving patient care.

Objective: Literature regarding nonpharmacological interventions (NPI) for PMPS or CP after mastectomy is scarce and not fully appraised, therefore we conducted this systematic review to explore the current panorama of treatment options.

Methods: A systematic review to assess the existing evidence regarding nonpharmacological approaches for PMPS. We reviewed the following databases: PubMed-MEDLINE, Embase, and Ovid (including the Cochrane Database for Clinical studies) using the following search terms: CP, mastectomy, and PMPS, and adjusted the terms depending on the database used. We included observational studies including case reports, cross sectional studies, cohort studies, and clinical trials (randomized or not) that included a NPI to treat PMPS.

Results: Total 1061 records were identified. After duplicate elimination, 863 records were screened for eligibility. A total of 717 records were excluded using our criteria, 138 records were sought for retrieval, and 117 full text records were assessed. Finally, 30 studies were included: seven case series, one cross-sectional study, two cohort studies, one case-control study, five nonrandomized clinical trials, ten randomized clinical trials (RCT), one qualitative study, and three systematic reviews of the literature, including two meta analyses, were included.

Discussion: Findings suggest that there is a great response of patients to some NPI. Regarding surgical interventions, autologous fat grafting and lymph node transplantation showed to have the greatest benefit for patients in terms of quality of life and reduced pain scores. Pulsed radiofrequency demonstrated the highest quality of evidence for energy related procedures. Within the physical therapy interventions, transcutaneous electric nerve stimulation and dry needling showed the greatest benefit. Finally, virtual reality demonstrated the greatest benefit in educational interventions.

Purpose: The deubiquitylase OTUD7B plays a facilitates role in lung tumorigenesis through VEGF protein, but its role in breast cancer remains unclear. In the present study, we proposed to explore the role of deubiquitylase OTUD7B in breast cancer.

Methods: The expression of OTUD7B in breast cancer and adjacent tissues was detected. The role of OTUD7B in cell proliferation and invasion of breast cancer cell lines such as MCF-7 and MDA-MB-453 was explored.

Results: OTUD7B is highly expressed in human breast cancer tissues and its higher expression correlates with better survival of patients. Further mechanistic studies reveal that OTUD7B associates with RASGRF1 and PLCE1 to disrupt RAS signaling pathway. Knockdown of OTUD7B results in decreasing levels of RASGRF1 protein, suppression cell growth and invasion in breast cancer. Collectively, our results reveal a previously unappreciated anti-oncogentic role OTUD7B involved in RAS signaling pathway in breast cancer and indicate that deubiquitylases could induce tumor-suppressing or tumor-promoting activities in a cell- and tissue-dependent context.