Pub Date : 2021-11-01Epub Date: 2021-08-25DOI: 10.1111/tbj.14282
Sofiane Allali, Vincent Servois, Arnaud Beddok, Alain Fourquet, Youlia Kirova
The COVID-19 caused by the SARS-CoV-2 coronavirus is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early toxicity in patients infected with COVID-19 treated at the same time for early-stage breast cancer (BC). This is a monocentric prospective study of patients treated in our hospital between March 2020 and June 2020 and were diagnosed with COVID-19 infection. The inclusion criteria were to be irradiated for early-stage BC and to have a positive COVID-19 diagnosis on a PCR test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. Radiotherapy (RT) consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the CTCAE (version 4.03). All 350 patients treated for early-stage BC were studied. Of them, 16 were presented with clinical symptoms of COVID-19 infection and of them, 12 had clinical, CT scan, and PCR confirmation. This entire cohort of 12 pts with median age of 56 (42-72) underwent their RT. During the radiotherapy, there were 9 pts presented radiation dermatitis, 8 (66%) were grade 1 and one was (8%) grade 2. Two patients with lymph nodes irradiation presented esophagitis grade 2. This prospective COVID-19 cohort, treated for early-stage BC demonstrated an acceptable toxicity profile with few low-grade adverse events. Longer follow-up is needed to confirm these findings.
{"title":"Evaluation of the early adverse effects of radiotherapy in breast cancer patients with COVID-19: Prospective single institutional study.","authors":"Sofiane Allali, Vincent Servois, Arnaud Beddok, Alain Fourquet, Youlia Kirova","doi":"10.1111/tbj.14282","DOIUrl":"https://doi.org/10.1111/tbj.14282","url":null,"abstract":"<p><p>The COVID-19 caused by the SARS-CoV-2 coronavirus is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early toxicity in patients infected with COVID-19 treated at the same time for early-stage breast cancer (BC). This is a monocentric prospective study of patients treated in our hospital between March 2020 and June 2020 and were diagnosed with COVID-19 infection. The inclusion criteria were to be irradiated for early-stage BC and to have a positive COVID-19 diagnosis on a PCR test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. Radiotherapy (RT) consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the CTCAE (version 4.03). All 350 patients treated for early-stage BC were studied. Of them, 16 were presented with clinical symptoms of COVID-19 infection and of them, 12 had clinical, CT scan, and PCR confirmation. This entire cohort of 12 pts with median age of 56 (42-72) underwent their RT. During the radiotherapy, there were 9 pts presented radiation dermatitis, 8 (66%) were grade 1 and one was (8%) grade 2. Two patients with lymph nodes irradiation presented esophagitis grade 2. This prospective COVID-19 cohort, treated for early-stage BC demonstrated an acceptable toxicity profile with few low-grade adverse events. Longer follow-up is needed to confirm these findings.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 11","pages":"824-827"},"PeriodicalIF":2.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tbj.14282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2021-09-12DOI: 10.1111/tbj.14288
Ashley D Marumoto, Srivarshini C Mohan, Stephanie A K Angarita, Marissa K Srour, Vicky E Norton, Farnaz Dadmanesh, Armando E Giuliano
For women with breast cancer in whom multiple Oncotype DX® Recurrence Scores (RS) are obtained, RS concordance utilizing current NCCN recommendations has not been evaluated. Patients with two or more RS were identified. RS were stratified by NCCN guidelines and compared for concordance. Twenty-four patients were evaluated. RS concordance varied by tumor type: 100% in the same tumor, 91.7% in multiple ipsilateral tumors, 71.4% in contralateral tumors, and 66.7% in in-breast recurrent tumors. RS concordance for multiple assays in the same patient is not high enough to omit Oncotype DX® testing for each tumor.
{"title":"Comparison of multiple oncotype DX<sup>®</sup> from the same patient.","authors":"Ashley D Marumoto, Srivarshini C Mohan, Stephanie A K Angarita, Marissa K Srour, Vicky E Norton, Farnaz Dadmanesh, Armando E Giuliano","doi":"10.1111/tbj.14288","DOIUrl":"https://doi.org/10.1111/tbj.14288","url":null,"abstract":"<p><p>For women with breast cancer in whom multiple Oncotype DX<sup>®</sup> Recurrence Scores (RS) are obtained, RS concordance utilizing current NCCN recommendations has not been evaluated. Patients with two or more RS were identified. RS were stratified by NCCN guidelines and compared for concordance. Twenty-four patients were evaluated. RS concordance varied by tumor type: 100% in the same tumor, 91.7% in multiple ipsilateral tumors, 71.4% in contralateral tumors, and 66.7% in in-breast recurrent tumors. RS concordance for multiple assays in the same patient is not high enough to omit Oncotype DX<sup>®</sup> testing for each tumor.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 11","pages":"828-831"},"PeriodicalIF":2.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tbj.14288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39411811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2021-09-12DOI: 10.1111/tbj.14289
Anoop T M, Rona Joseph P, Anju Anna Abraham, Mintu Mathew, Bhavya S Kumar
FinHer regimen is considered a relatively cardiac safe regimen for Her 2 positive breast cancer in resource-limited settings. There is limited data on cardiotoxicity of this regimen. Out of 1200 patients diagnosed with carcinoma breast during the study period, three hundred Her2-positive early-breast cancer patients received FinHer protocol were included. Among the 300 patients, a total of 71 patients (24%) experienced cardiac toxicity including asymptomatic EF loss in 62 patients (21%) and symptomatic LVEF loss in nine patients (3%). Among patients with symptomatic LVEF loss, six patients had symptomatic cardiac toxicity, one patient (0.3%) had symptoms with fall in EF after completion of treatment, one patient (0.3%) had Congestive cardiac failure (CHF); one patient (0.3%) had non-ST elevation myocardial infarction (NSTEMI). Later, trastuzumab was rechallenged in all 62 patients (24%) with asymptomatic LVEF loss and six patients (2%) with symptomatic LVEF loss. One patient with CHF and NSTEMI was not rechallenged. Hypertension and diabetic mellitus which were the two factors found to have risk on univariate logistic regression analysis although it was not statistically significant. None of these patients further experienced cardiac toxicity at 24 months follow-up except one patient. Although FinHer protocol is considered a cardiac safe protocol, cardiotoxicity associated with trastuzumab which can manifest as an asymptomatic decline in LVEF is more than usually expected in a real-world scenario.
{"title":"Cardiac toxicity of patients on short course trastuzumab in combination with chemotherapy (FinHer Protocol) in breast cancer.","authors":"Anoop T M, Rona Joseph P, Anju Anna Abraham, Mintu Mathew, Bhavya S Kumar","doi":"10.1111/tbj.14289","DOIUrl":"https://doi.org/10.1111/tbj.14289","url":null,"abstract":"<p><p>FinHer regimen is considered a relatively cardiac safe regimen for Her 2 positive breast cancer in resource-limited settings. There is limited data on cardiotoxicity of this regimen. Out of 1200 patients diagnosed with carcinoma breast during the study period, three hundred Her2-positive early-breast cancer patients received FinHer protocol were included. Among the 300 patients, a total of 71 patients (24%) experienced cardiac toxicity including asymptomatic EF loss in 62 patients (21%) and symptomatic LVEF loss in nine patients (3%). Among patients with symptomatic LVEF loss, six patients had symptomatic cardiac toxicity, one patient (0.3%) had symptoms with fall in EF after completion of treatment, one patient (0.3%) had Congestive cardiac failure (CHF); one patient (0.3%) had non-ST elevation myocardial infarction (NSTEMI). Later, trastuzumab was rechallenged in all 62 patients (24%) with asymptomatic LVEF loss and six patients (2%) with symptomatic LVEF loss. One patient with CHF and NSTEMI was not rechallenged. Hypertension and diabetic mellitus which were the two factors found to have risk on univariate logistic regression analysis although it was not statistically significant. None of these patients further experienced cardiac toxicity at 24 months follow-up except one patient. Although FinHer protocol is considered a cardiac safe protocol, cardiotoxicity associated with trastuzumab which can manifest as an asymptomatic decline in LVEF is more than usually expected in a real-world scenario.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 11","pages":"811-816"},"PeriodicalIF":2.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tbj.14289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39425991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2021-08-17DOI: 10.1111/tbj.14281
Majid Akrami, Hamidreza Hosseinpour, Masoumeh Ghoddusi Johari, Mehdi Shariat, Vahid Zangouri, Sedigheh Tahmasebi, Zahra Keumarsi, Alireza Hosseinpour, Abdolrasoul Talei
Performing a re-intervention following a positive margin after primary lumpectomy in patients with breast cancer entails several disadvantages such as additional costs and postponing the follow-up treatments. In the present study, we sought to measure the incidence rate of residual disease in specimens taken from breast cancer patients who had positive margins after quadrantectomy and also compare the clinical and pathological factors between patients with and without a residual disease after the secondary surgery. All of the medical records of patients undergoing quadrantectomy from December 1994 to December 2019 were collected from Shiraz Breast Cancer Registry (SBCR). Patients were divided into two subgroups of patients with and without residual disease from the secondary surgery and also with and without positive margin from the first operation. Two groups were compared in terms of all clinicopathological factors. The records of 4843 patients undergoing quadrantectomy were reviewed, of which 132 (2.3%) had involved margins. Of these, 112 patients underwent a secondary surgery and 28 had residual disease (25%). No clinicopathological factor was correlated with presence of residual cancer. Also, bigger tumor size (p < 0.001) and the presence of in situ component (p < 0.001) were associated with positive margin and hence the need for a re-excision surgery. These results revealed that the significant rate of residual disease in the specimens of the secondary surgery indicates that a re-operation (either re-excision or simple mastectomy) cannot be omitted after obtaining a positive margin from the primary quadrantectomy.
乳腺癌患者原发乳房肿瘤切除术后在切缘呈阳性的情况下进行再干预有一些缺点,如额外的费用和延迟后续治疗。在本研究中,我们试图测量四象限切除术后边缘呈阳性的乳腺癌患者标本中残留疾病的发生率,并比较二次手术后有无残留疾病患者的临床和病理因素。从设拉子乳腺癌登记处(Shiraz Breast Cancer Registry, SBCR)收集1994年12月至2019年12月接受四分切除的所有患者的医疗记录。患者被分为两个亚组,有和没有第二次手术的残余疾病,也有和没有第一次手术的阳性边缘。比较两组患者的所有临床病理因素。我们回顾了4843例行四象限切除术的患者的记录,其中132例(2.3%)涉及切缘。其中,112名患者接受了二次手术,28名患者有残留疾病(25%)。没有临床病理因素与残留癌的存在相关。此外,更大的肿瘤大小(p
{"title":"Occurrence of residual disease in specimens of re-excision surgery in patients with positive margins of primary quadrantectomy.","authors":"Majid Akrami, Hamidreza Hosseinpour, Masoumeh Ghoddusi Johari, Mehdi Shariat, Vahid Zangouri, Sedigheh Tahmasebi, Zahra Keumarsi, Alireza Hosseinpour, Abdolrasoul Talei","doi":"10.1111/tbj.14281","DOIUrl":"https://doi.org/10.1111/tbj.14281","url":null,"abstract":"<p><p>Performing a re-intervention following a positive margin after primary lumpectomy in patients with breast cancer entails several disadvantages such as additional costs and postponing the follow-up treatments. In the present study, we sought to measure the incidence rate of residual disease in specimens taken from breast cancer patients who had positive margins after quadrantectomy and also compare the clinical and pathological factors between patients with and without a residual disease after the secondary surgery. All of the medical records of patients undergoing quadrantectomy from December 1994 to December 2019 were collected from Shiraz Breast Cancer Registry (SBCR). Patients were divided into two subgroups of patients with and without residual disease from the secondary surgery and also with and without positive margin from the first operation. Two groups were compared in terms of all clinicopathological factors. The records of 4843 patients undergoing quadrantectomy were reviewed, of which 132 (2.3%) had involved margins. Of these, 112 patients underwent a secondary surgery and 28 had residual disease (25%). No clinicopathological factor was correlated with presence of residual cancer. Also, bigger tumor size (p < 0.001) and the presence of in situ component (p < 0.001) were associated with positive margin and hence the need for a re-excision surgery. These results revealed that the significant rate of residual disease in the specimens of the secondary surgery indicates that a re-operation (either re-excision or simple mastectomy) cannot be omitted after obtaining a positive margin from the primary quadrantectomy.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 11","pages":"797-803"},"PeriodicalIF":2.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tbj.14281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39321152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2021-09-12DOI: 10.1111/tbj.14287
Jassem Al Sayegh, Jamila Alazhri, Suha Albadr
Coronary artery bypass grafting (CABG) using internal mammary artery is a frequently performed procedure for the treatment of coronary artery disease nowadays. Ipsilateral breast necrosis is a rare and seldom reported complication that may mimic breast cancer on presentation. However, contralateral breast necrosis has not been reported to date. We are reporting the first case of bilateral breast necrosis after CABG using the left internal mammary artery. We discuss the different underlying mechanisms and possible co-factors behind the development of this rare complication, and we also share a successful management approach to conserve the breast and improve the patient's outcome.
{"title":"First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery.","authors":"Jassem Al Sayegh, Jamila Alazhri, Suha Albadr","doi":"10.1111/tbj.14287","DOIUrl":"https://doi.org/10.1111/tbj.14287","url":null,"abstract":"<p><p>Coronary artery bypass grafting (CABG) using internal mammary artery is a frequently performed procedure for the treatment of coronary artery disease nowadays. Ipsilateral breast necrosis is a rare and seldom reported complication that may mimic breast cancer on presentation. However, contralateral breast necrosis has not been reported to date. We are reporting the first case of bilateral breast necrosis after CABG using the left internal mammary artery. We discuss the different underlying mechanisms and possible co-factors behind the development of this rare complication, and we also share a successful management approach to conserve the breast and improve the patient's outcome.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 11","pages":"832-837"},"PeriodicalIF":2.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tbj.14287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39429320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2021-10-08DOI: 10.1111/tbj.14296
Tania Buttiron Webber, Domenico Marra, Matteo Puntoni, Silvia Giuliano, Irene Maria Briata, Isabella Cevasco, Matteo Clavarezza, Mauro D'Amico, Carlotta Defferrari, Alberto Gozza, Nicoletta Provinciali, Matteo Lazzeroni, Bernardo Bonanni, Andrea DeCensi
Background: We recently conducted a de-escalation trial of low-dose tamoxifen 5 mg/day ("babytam", BT) or placebo given for 3 years in 500 women with noninvasive breast cancer. Women on babytam had a 52% reduction of recurrence (invasive breast cancer or DCIS) after 5 years. Since menopausal symptoms are major reasons for treatment withdrawal during tamoxifen preventive therapy, we compared and analyzed the patient-reported outcomes (PROs) with the physician-reported adverse events and studied their association with recurrence.
Methods: Menopausal symptoms recorded by physicians using the Common Terminology Criteria (CTCAEs) were compared with a patient self-reported validated questionnaire reviewed by a research nurse at baseline and every 6 months up to 36 months. Hot flashes (HF), the main outcome measure, were detected through a self-report 7-day diary for frequency and intensity. Treatment adherence and efficacy were assessed by the Kaplan-Meier curves and the Cox model.
Results: The number of HF events at 12, 24, and 36 months for PROs versus CTCAEs was 246 versus 12, 238 versus 8, and 210 versus 4, respectively. The majority of events were grade 1. There was no difference in PROs between babytam and placebo except for HF daily frequency, which increased by 1.5 events (95% CI, 1.1-1.8) on placebo to 2.1 on babytam (95% CI, 1.7-2.5, p = 0.05). The presence of HF at baseline was a favorable prognostic factor for recurrence and a predictive factor for response to babytam. Adherence was similar between babytam and placebo.
Conclusions: The use of PROs is effective for identifying frequent mild grade menopausal symptoms which are underestimated by physicians but important prognostic and predictive factors. Research nurse can use these results as a tool to reassure patients about symptoms, improve adherence to treatment, and limit dropouts.
背景:我们最近对500名非侵袭性乳腺癌妇女进行了一项降低剂量的试验,低剂量他莫昔芬5mg /天(“babytam”,BT)或安慰剂,为期3年。服用babytam的女性在5年后复发(浸润性乳腺癌或DCIS)的几率降低了52%。由于绝经期症状是他莫昔芬预防治疗期间停药的主要原因,我们比较并分析了患者报告的预后(PROs)和医生报告的不良事件,并研究了它们与复发的关系。方法:将医生使用通用术语标准(CTCAEs)记录的更年期症状与患者自我报告的有效问卷进行比较,该问卷由研究护士在基线和每6个月至36个月审查一次。热潮热(HF)是主要的结局指标,通过自我报告的7天日记来检测频率和强度。采用Kaplan-Meier曲线和Cox模型评价治疗依从性和疗效。结果:在12、24和36个月时,PROs与CTCAEs的HF事件数量分别为246对12,238对8,210对4。大多数活动都是1年级的。除了HF每日发生频率,安慰剂组增加1.5次(95% CI, 1.1-1.8),而babytam组增加2.1次(95% CI, 1.7-2.5, p = 0.05)。基线时HF的存在是复发的有利预后因素,也是对babytam反应的预测因素。依从性在babytam和安慰剂之间相似。结论:使用pro可有效识别常见的轻度更年期症状,这些症状被医生低估,但却是重要的预后和预测因素。研究护士可以使用这些结果作为一种工具,使患者对症状放心,提高对治疗的依从性,并限制退出。
{"title":"Patient- versus physician-reported outcomes in a low-dose tamoxifen trial in noninvasive breast cancer.","authors":"Tania Buttiron Webber, Domenico Marra, Matteo Puntoni, Silvia Giuliano, Irene Maria Briata, Isabella Cevasco, Matteo Clavarezza, Mauro D'Amico, Carlotta Defferrari, Alberto Gozza, Nicoletta Provinciali, Matteo Lazzeroni, Bernardo Bonanni, Andrea DeCensi","doi":"10.1111/tbj.14296","DOIUrl":"https://doi.org/10.1111/tbj.14296","url":null,"abstract":"<p><strong>Background: </strong>We recently conducted a de-escalation trial of low-dose tamoxifen 5 mg/day (\"babytam\", BT) or placebo given for 3 years in 500 women with noninvasive breast cancer. Women on babytam had a 52% reduction of recurrence (invasive breast cancer or DCIS) after 5 years. Since menopausal symptoms are major reasons for treatment withdrawal during tamoxifen preventive therapy, we compared and analyzed the patient-reported outcomes (PROs) with the physician-reported adverse events and studied their association with recurrence.</p><p><strong>Methods: </strong>Menopausal symptoms recorded by physicians using the Common Terminology Criteria (CTCAEs) were compared with a patient self-reported validated questionnaire reviewed by a research nurse at baseline and every 6 months up to 36 months. Hot flashes (HF), the main outcome measure, were detected through a self-report 7-day diary for frequency and intensity. Treatment adherence and efficacy were assessed by the Kaplan-Meier curves and the Cox model.</p><p><strong>Results: </strong>The number of HF events at 12, 24, and 36 months for PROs versus CTCAEs was 246 versus 12, 238 versus 8, and 210 versus 4, respectively. The majority of events were grade 1. There was no difference in PROs between babytam and placebo except for HF daily frequency, which increased by 1.5 events (95% CI, 1.1-1.8) on placebo to 2.1 on babytam (95% CI, 1.7-2.5, p = 0.05). The presence of HF at baseline was a favorable prognostic factor for recurrence and a predictive factor for response to babytam. Adherence was similar between babytam and placebo.</p><p><strong>Conclusions: </strong>The use of PROs is effective for identifying frequent mild grade menopausal symptoms which are underestimated by physicians but important prognostic and predictive factors. Research nurse can use these results as a tool to reassure patients about symptoms, improve adherence to treatment, and limit dropouts.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 11","pages":"817-823"},"PeriodicalIF":2.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39499163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xuejin Ma ME, Xiaoxi Chen MD, Guoyuan Jiang MBBS, Lin Jiang MD, Tingchao Li MBBS, Ling Wei MBBS, Shiguang Li MD
Rhabdomyosarcoma (RMS) is a common malignancy in children, but embryonal rhabdomyosarcoma (ERMS) deposits rarely occur in the breast in adults. Therefore, little is known about magnetic resonance imaging (MRI) features of breast metastases from RMS, especially the embryonal type. We reported a case of a 22-year-old woman who was diagnosed with ERMS at left foot 2 years ago and accepted operation and chemotherapy. She was confirmed to have breast metastases from the left foot. Successive imaging examinations were performed 3 months apart. Breast ultrasound indicated a benign lesion, and further examination did not reveal any bone metastases. However, predominant restricted diffusion and rim contrast enhancement on MRI combined with the patient's medical history suggested a malignancy of BI-RADS 5. After 3 months, breast ultrasound revealed masses detected last time became larger and lobulated. In addition, internal heterogeneous intensity and rim contrast enhancement with restricted diffusion were revealed on MRI. We speculated that typical MRI findings of breast metastases from RMS may include iso- to hypointensity on T1WI, heterogeneous hyperintensity on T2WI, and circular enhancement with restricted diffusion. Moreover, mild peritumoral edema, rapid expansion of necrosis, and ascending time-intensity curve detected on MRI may be features of the ERMS type.
{"title":"Metastatic embryonal rhabdomyosarcoma of the breast: A case report and literature review","authors":"Xuejin Ma ME, Xiaoxi Chen MD, Guoyuan Jiang MBBS, Lin Jiang MD, Tingchao Li MBBS, Ling Wei MBBS, Shiguang Li MD","doi":"10.1111/tbj.14284","DOIUrl":"10.1111/tbj.14284","url":null,"abstract":"<p>Rhabdomyosarcoma (RMS) is a common malignancy in children, but embryonal rhabdomyosarcoma (ERMS) deposits rarely occur in the breast in adults. Therefore, little is known about magnetic resonance imaging (MRI) features of breast metastases from RMS, especially the embryonal type. We reported a case of a 22-year-old woman who was diagnosed with ERMS at left foot 2 years ago and accepted operation and chemotherapy. She was confirmed to have breast metastases from the left foot. Successive imaging examinations were performed 3 months apart. Breast ultrasound indicated a benign lesion, and further examination did not reveal any bone metastases. However, predominant restricted diffusion and rim contrast enhancement on MRI combined with the patient's medical history suggested a malignancy of BI-RADS 5. After 3 months, breast ultrasound revealed masses detected last time became larger and lobulated. In addition, internal heterogeneous intensity and rim contrast enhancement with restricted diffusion were revealed on MRI. We speculated that typical MRI findings of breast metastases from RMS may include iso- to hypointensity on T1WI, heterogeneous hyperintensity on T2WI, and circular enhancement with restricted diffusion. Moreover, mild peritumoral edema, rapid expansion of necrosis, and ascending time-intensity curve detected on MRI may be features of the ERMS type.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 12","pages":"890-894"},"PeriodicalIF":2.1,"publicationDate":"2021-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39538547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily B. Ambinder MD, MS, Eniola Oluyemi MD, MPH, Xiangrong Kong PhD, Derek L. Nguyen MD, Kala Visvanathan MD, MHS
We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.
我们提出了一项回顾性队列研究,评估数字乳房断层合成(DBT)在乳腺癌筛查中的应用和有效性,重点关注种族差异。在2013年1月4日至2020年3月30日期间,46,236名女性接受了乳房x光筛查,在此期间,DBT的使用率从第一年的18.8%增加到第七年的89.6%。与白人女性相比,黑人和亚洲女性接受DBT筛查的可能性明显较低。总体而言,DBT组的召回率较低(9.1%对11.2%,p <0.001)和更高的癌症检出率(6.0 vs 4.1, p <0.001),与FFDM组相比。
{"title":"Disparities in the uptake of digital breast tomosynthesis for breast cancer screening: A retrospective cohort study","authors":"Emily B. Ambinder MD, MS, Eniola Oluyemi MD, MPH, Xiangrong Kong PhD, Derek L. Nguyen MD, Kala Visvanathan MD, MHS","doi":"10.1111/tbj.14292","DOIUrl":"10.1111/tbj.14292","url":null,"abstract":"<p>We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, <i>p</i> < 0.001) and higher cancer detection rate (6.0 vs 4.1, <i>p</i> < 0.001) compared to the FFDM group.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 12","pages":"872-876"},"PeriodicalIF":2.1,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39534239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Most adequately powered studies confirm a worse prognosis for males versus matched females with breast cancer. There is in-stage migration for stage I cancers with a different ratio of tumor/normal breast tissue in males. Younger men have a better prognosis, largely the result of increased morbidity in the elderly, exacerbated by smoking, low socioeconomic differences, and ethnic disparity. BRCA2 carriers with MBC have a worse outcome than noncarriers as do men with amplification of EMSY. Men with tumors having a high cytosol level of plasminogen activator inhibitor 1 (PAI-1) may have more invasive cancers leading to earlier spread and hence a worse outcome. PREDICT+ is a useful prognostic model for MBC and multigene testing enables more specific systemic therapies to be used.
{"title":"Prognostic difficulties of men with breast cancer","authors":"Ian S. Fentiman MD DSc FRCS","doi":"10.1111/tbj.14297","DOIUrl":"10.1111/tbj.14297","url":null,"abstract":"<p>Most adequately powered studies confirm a worse prognosis for males versus matched females with breast cancer. There is in-stage migration for stage I cancers with a different ratio of tumor/normal breast tissue in males. Younger men have a better prognosis, largely the result of increased morbidity in the elderly, exacerbated by smoking, low socioeconomic differences, and ethnic disparity. <i>BRCA2</i> carriers with MBC have a worse outcome than noncarriers as do men with amplification of <i>EMSY</i>. Men with tumors having a high cytosol level of plasminogen activator inhibitor 1 (PAI-1) may have more invasive cancers leading to earlier spread and hence a worse outcome. PREDICT+ is a useful prognostic model for MBC and multigene testing enables more specific systemic therapies to be used.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 12","pages":"877-882"},"PeriodicalIF":2.1,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39522855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malke Asaad MD, Jennifer A. Yonkus MD, Tanya L. Hoskin MS, Tina J. Hieken MD, James W. Jakub MD, Judy C. Boughey MD, Amy C. Degnim MD
The role of surgery in the management of stage IV breast cancer is controversial. Existing studies in Stage IV breast cancer have not closely evaluated the role of patient response to induction systemic therapy (IST) in its relationship to survival outcomes. We identified all patients with a diagnosis of de novo stage IV breast cancer who underwent surgery of their primary tumor from January 2008 to December 2018. Patients were grouped according to their response in the primary disease site into progression (progressive primary disease) or no progression (nonprogressive primary; comprising complete, partial and stable response). We identified a total of 45 stage IV breast cancer patients who underwent operative intervention of their primary breast tumor. Prior to surgical intervention, progression in the primary site during IST was identified in 13/42 patients (31%), of whom four patients also had progression in the distant disease. The 5-year survival was higher in the nonprogressive primary (74%) than the progressive primary disease group (52%) which did not reach statistical significance (p = 0.08). Age, pathologic tumor size, clinical nodal status, number of positive lymph nodes, and distant disease response to systemic therapy were significantly associated with survival. In this single institution experience, select patients with stage IV breast cancer at initial diagnosis who underwent resection of the primary tumor following systemic therapy achieved favorable overall and distant progression-free survival. Surgery is reasonable to consider for local palliation or in selected patients who have excellent response to systemic therapy and good performance status.
{"title":"Primary tumor resection in patients with stage IV breast cancer: 10-year experience","authors":"Malke Asaad MD, Jennifer A. Yonkus MD, Tanya L. Hoskin MS, Tina J. Hieken MD, James W. Jakub MD, Judy C. Boughey MD, Amy C. Degnim MD","doi":"10.1111/tbj.14294","DOIUrl":"10.1111/tbj.14294","url":null,"abstract":"<p>The role of surgery in the management of stage IV breast cancer is controversial. Existing studies in Stage IV breast cancer have not closely evaluated the role of patient response to induction systemic therapy (IST) in its relationship to survival outcomes. We identified all patients with a diagnosis of de novo stage IV breast cancer who underwent surgery of their primary tumor from January 2008 to December 2018. Patients were grouped according to their response in the primary disease site into progression (progressive primary disease) or no progression (nonprogressive primary; comprising complete, partial and stable response). We identified a total of 45 stage IV breast cancer patients who underwent operative intervention of their primary breast tumor. Prior to surgical intervention, progression in the primary site during IST was identified in 13/42 patients (31%), of whom four patients also had progression in the distant disease. The 5-year survival was higher in the nonprogressive primary (74%) than the progressive primary disease group (52%) which did not reach statistical significance (<i>p</i> = 0.08). Age, pathologic tumor size, clinical nodal status, number of positive lymph nodes, and distant disease response to systemic therapy were significantly associated with survival. In this single institution experience, select patients with stage IV breast cancer at initial diagnosis who underwent resection of the primary tumor following systemic therapy achieved favorable overall and distant progression-free survival. Surgery is reasonable to consider for local palliation or in selected patients who have excellent response to systemic therapy and good performance status.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":"27 12","pages":"863-871"},"PeriodicalIF":2.1,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39519596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}