European journal of breast health最新文献

Objective: The role of baseline and post-treatment standardized uptake value (SUV_max) values in predicting pathological response in patients with breast cancer after neoadjuvant chemotherapy (NAC).

Materials and methods: Thirty patients with invasive ductal breast cancer were included in this retrospective study. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) examinations were performed before and after NAC. Pretreatment SUV_max (SUV_max I), post-treatment SUV_max (SUV_max II) and ΔSUV_max values of primary breast cancer were obtained. Breast tumor pathology preparations were examined for the evaluation of tumor response according to the Miller and Payne classification. Patients were grouped as responding to treatment (pCR) and unresponsive to treatment (nonpCR). In all analyses, p<0.05 was considered statistically significant.

Results: The mean age of the 30 patients included in the study was 51.2±11.98 years. In the study-defined grouping, 13 patients (43.3%) were nonresponders and 17 patients (56.7%) were responders. ΔSUV_max was significantly greater in the responders group compared to the nonresponders group, while SUV_max II was lower (p = 0.001 and p = 0.004, respectively). There was no significant difference between the responders and nonresponders in terms of age, tumor diameter, and SUV_max I values. Multivariate logistic regression analysis showed ΔSUV_max to be the only independent predictive factor for pCR.

Conclusion: F-18 FDG PET/CT was an effective method in evaluating the treatment response after NAC in breast cancer, and ΔSUV_max and post-treatment SUV_max can be used to predict the response of the primary tumor to treatment.

Objective: Tumour regression is defined as continuity of changes leading to the elimination of a neoplastic population and is reflected as periductal fibrosis and intraductal tumour attenuation. The aim of this study was to describe the radiological and clinicopathological characteristics of high-grade breast ductal carcinoma in situ (DCIS) with regressive changes (RC).

Materials and methods: Thirty-two cases of high-grade DCIS with RC on biopsy specimens followed by excision were included. The mammographic, ultrasonographic (US), and magnetic resonance imaging (MRI) findings of cases were retrospectively reviewed according to the breast imaging reporting and data system (BI-RADS) lexicon. Clinical and histopathological findings [comedonecrosis, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Ki-67 proliferation index] were recorded. The rate of upgrade to invasive cancer after surgical excision and lymph node involvement were evaluated.

Results: The most common mammographic finding was microcalcifications alone (68.8%). The most frequently seen findings on US were microcalcifications only (21.9%), followed by microcalcifications and hypoechoic area (18.7%). On MRI, most lesions presented as clumped non-mass enhancement with segmental distribution. ER/PR negativity (53.1%, 65.6%), HER2 positivity (56.3%) and high Ki-67 (62.5%), which are known to be associated with more aggressive behavior, were found to be proportionally higher. The rate of upgrade to invasive cancer was 21.8%.

Conclusion: DCIS with RC lesions present most often as microcalcifications alone on both mammography and US. MRI features are not distinguishable from those of other DCIS lesions. DCIS with RC lesions show biomarker status reflecting more aggressive behavior and high upgrade rate to invasive cancer.

Objective: A radial scar (RS) is a benign breast lesion (BBL) that has an obscure etiology. RS is easily confused with breast carcinoma and therefore correct identification radiologically and pathologically is important. The aim of this study was to determine the incidence of atypical lesions by evaluating RS detected with BBL and to investigate whether atypia and RS are related to their characteristics.

Materials and methods: A total of 1.370 patients with a diagnosis of BBL postoperatively in a single department were analyzed retrospectively. Forty-six confirmed RS/complex sclerosing lesion (CSL) cases were selected. The demographic and clinical characteristics of the patients and the relationship between RS and other BBL were evaluated. In addition, the relationship between RS/CSL and the presence of atypia was interpreted.

Results: The mean age was 45.17±8.72 years. Spiculated lesion (34.8%) on mammography and microcalcification (37%) on histopathological examination were the most common features. The most common BBL accompanying RS/CSL was adenosis. Atypical epithelial hyperplasia (AEH) was presented in 15 (32.6%) of those diagnosed with RS. Although all patients were benign, the frequency of AEH accompanying RS was found to be significantly higher. The mean size of RS was 10.8±8.4 mm (2-30 mm). The size of RS/CSL was not significantly associated with atypia.

Conclusion: RS/CSLs usually present as suspicious lesions that must be distinguished radiologically from malignancy. However RS, which can be present with malign breast lesions, can be also seen with all BBL. Therefore, core biopsy and/or excisional biopsy continue to be important for definitive histopathological diagnosis.

Objective: The aim was to assess the prognostic variables in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer patients receiving lapatinib plus capecitabine.

Materials and methods: Retrospective data on HER2-positive metastatic breast cancer patients who received lapatinib and capecitabine were analyzed. Survival outcome was obtained with Cox regression analysis and the Kaplan-Meier method.

Results: The study included 102 patients. Forty-four (43.1%) patients had de novo metastatic disease. The most frequent metastatic sites were, in order, bone (61.8%), brain (57.8%), liver (35.3%), and lung (34.3%). All of the patients had previously received chemotherapy based on trastuzumab. With combined lapatinib and capecitabine, complete response was observed in 7.8%, partial response in 30.4%, and stable disease in 24.5%. Progression-free survival was 8 (95% confidence interval, 5.1-10.8) months. In multivariable analysis, endocrine therapy (p = 0.02), de novo metastatic disease (p = 0.02), and age (p = 0.02) were prognostic factors for progression-free survival. However, the number of chemotherapy cycles with trastuzumab, palliative radiotherapy, history of breast surgery, and the number of metastatic sites were not significant in this respect.

Conclusion: These results have demonstrated the effectiveness of lapatinib plus capecitabine in metastatic HER2-positive breast cancer patients. Furthermore, unfavorable prognostic factors for progression-free survival were shown to be hormone-negative tumor, de novo metastatic disease, and young age.

Objective: To investigate the effectiveness of the different imaging modalities in detecting recurrence in breast cancer follow-up.

Materials and methods: Sixty-four women with recurrent breast cancer were examined between January 2020 and July 2022. Recurrency was divided into four categories: local; regional; second primary; and distant metastasis. The detectability of recurrent lesions with mammography (MG), ultrasound (US) and magnetic resonance imaging (MRI), was evaluated. In addition, recurrences that firstly appeared by positron emission tomography (PET) scan were recorded.

Results: Twenty-seven (42.2%) recurrences were local, 10 (15.6%) were regional and 27 (42.2%) were second primary. Forty-six (71.9%) of them were determined to have invasive carcinoma, 8 (12.5%) were ductal carcinoma in situ, and 10 (15.6%) were axillary metastases. Eight (12.5%) of them were first diagnosed by PET-computed tomography/MRI. Among the available images performed, 78.7% could be detected pathologically by MG, 95.2% by US, and 100% by MRI. Distant metastasis associated with other types of recurrence was detected in 6 (9.4%) cases.

Conclusion: MRI is the most powerful imaging modality in detecting recurrent breast cancer. With the addition of US to routine MG follow-up, a higher rate and early detection of recurrent cancers can be achieved.

Objective: To determine the fear of breast cancer and assess the efficiency of mammography scanning among a female population working in a university.

Materials and methods: This descriptive study was performed in a university in the city center of Samsun between March 2019 and October 2019. Instead of choosing samples, all volunteers were included. The data were collected by a study-specific form prepared by the researchers, the breast cancer fear scale and mammography efficacy scale. Descriptive statistical analyses were performed and data were analyzed using the Statistical Package for the Social Sciences, version 20.0.

Results: The mean age of women participating in this study was 38.07±8.58 (range 20-62) years and the mean health perception score was 7.46±1.51 (range 3-10). Most (70.3%) women were academic staff and 17.9% reported income less than expenses. Of the participants, 16.1% had breast-related health problem and 18.4% had breast cancer in the family. Most (85.0%) believed that they should have mammography scanning to be protected from breast cancer. The mean score on the breast cancer fear scale was 25.60±7.29, indicating a high score and the mean score on the mammography efficacy scale was 41.18±6.47, indicating a high score of mammography efficacy. The score of breast cancer fear scale was higher for; married women (26.19±7.21) than single women (24.33±7.39) and women with history of having health problem related with breast (28.94±7.30) while those without a history of health problem (24.96±7.13) and postmenopausal women (27.64±6.19) while non-menopausal women (25.30±7.40).

Conclusion: The score of breast cancer fear scale was higher for; married women, history of having health problem related with breast and postmenopausal women.

Objective: The lack of objective documentation of pre-neoadjuvant chemotherapy (NAC) tumour margins is a major constraint in performing safe breast conserving surgery (BCS) in patients with breast cancer. Using a novel method of marking pre-NACT tumour margins with indigenous silver wire markers, this retrospective observational study attempted to assess the feasibility of safe BCS in breast cancer patients by performing excision wide of the marked pre-NACT margins.

Materials and methods: This retrospective observational study was conducted on breast cancer patients who were attending our oncology centre between May, 2015 and April, 2022. All patients had received NAC followed by surgery as recommended by our multidisciplinary team. All the patients had a primary operable solitary breast cancer. We used radiopaque metallic rods made from silver to localize tumour margins prior to NAC.

Results: Sixty-four breast cancer patients were included; none had marker-related complications. Following NAC, BCS could be easily performed in 60 patients guided by the silver markers, which were used as temporary implants and removed during surgery. Only 2 patients were seen with positive margins and were converted to mastectomy.

Conclusion: Breast cancer localization using sterile silver markers before the initiation of NAC is safe, easy, inexpensive, and effective, causing no morbidity or significant pain to the patients.

Objective: Radial scar (RS) is a low-risk breast lesion that can be associated with or mimic malignancy. Management guidelines remain controversial for patients with RS without atypia on core needle biopsy (CNB). The aim was to evaluate the upgrade rate of these lesions and factors associated with malignancy risk and excision rate to more definitively guide management.

Materials and methods: In this retrospective study, 123 patients with RS without atypia, diagnosed with CNB between January 2008 to December 2014 who were either referred for surgical excision or followed-up with imaging, were reviewed. The differences in clinical presentation, imaging features, and biopsy technique among the benign RS patients and those upgraded, as well as the excised versus the observed patients were compared.

Results: Of 123 RS reviewed, 93 cases of RS without atypia as the highest-grade lesion in the ipsilateral breast and with either 24-month imaging follow-up or surgical correlation were included. Seventy-four (79.6%) lesions were surgically excised and 19 (20.4%) were followed-up for at least 24 months. A single upgrade to malignancy (1%) and 15 upgrades to high-risk lesions (16%) were found. There was no association of any upgraded lesion with presenting symptoms or imaging features. The use of vacuum-assistance and larger biopsy needles, along with obtaining a higher number of samples, was associated with fewer upgrades and lower surgical excision rates.

Conclusion: The upgrade rate of RS without atypia in our population was low, regardless of the imaging features and biopsy technique utilized. Close imaging surveillance is an acceptable alternative to surgical excision in these patients.

Objective: Radiotherapy continues to play an important role in the management of breast cancer. This study compared the dosimetric differences between the techniques of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in breast cancer patients who had radiotherapy after mastectomy.

Materials and methods: Forty post-mastectomy patients (19 right-sided breast and 21 left-sided breast) treated with the IMRT technique using 7-9 fields who were re-planned with VMAT using 2 coplanar arc on the Varian Vital beam linear accelerator between January, 2020 and August, 2021 were included in this study. The patients received 42 Gy in 15 fractions to the chest wall, lymph nodes and supraclavicular nodes. The dosimetric parameter for planning target volume (PTV), organs at risk (OAR) and the integral dose to the body were analysed. Student's t-test for two independent means was used to analyse the dosimetric differences between the plans.

Results: Clinical goals were achieved for both techniques. In terms of PTV coverage at 95% (IMRT: 712.17±233) vs (VMAT: 694.9±214) and the homogeneity index (IMRT: 0.075±0.04) vs (VMAT: 0.104±0.03), IMRT resulted in better dose coverage and homogeneity than VMAT. However, with the conformity index, no significant difference was seen. As regards the OARs, the mean doses, V₅, V₁₀, V₂₀, V₃₀, and V₄₀ for the Ipsilateral-lung were lower in IMRT plans than in VMAT plans with a non-significant variation (p-values = 0.141, 0.416, 0.954, 0.443, and 1 respectively). Regarding the mean dose to the heart, low-dose volumes V₅, V₁₀, and high-dose volume V30 were significantly reduced in IMRT compared to VMAT. When comparing the dose to the contralateral breast, IMRT achieved a significantly lower mean dose than VMAT (2.9 vs 3.62, p = 0.0148). For MU, VMAT showed lower MU compared to IMRT with a non-significant difference.

Conclusion: With IMRT, better PTV coverage, homogeneity and OAR sparing were observed. Additionally, VMAT resulted in a lower delivery time than IMRT. Overall, both techniques offered dosimetric qualities that were clinically acceptable.