Breast Journal最新文献

Background: The lipofilled latissimus dorsi mini-flap (LDMF-L) broadens autologous breast-reconstruction options, yet its functional impact on the shoulder remains uncertain.

Objective: To evaluate shoulder strength, range of motion (ROM) and patient-reported upper-limb function QuickDash 90 days after breast reconstruction with the LDMF-L.

Methods: Prospective cohort of 20 patients operated on between November 2022 and November 2024.

Inclusion: Breast cancer requiring immediate or delayed reconstruction with LDMF-L; exclusion: Implant use or major pre-existing limitation. Strength (Oxford scale), ROM (goniometry) and QuickDASH score were assessed preoperatively and at 90 days. Wilcoxon, Student's t-test, Mann-Whitney and McNemar tests were used appropriately (α = 0.05).

Results: Mean age 54 ± 11.8 years; immediate/delayed reconstruction = 50/50%. Strength remained unchanged in 85% (p = 1.000). Active flexion and abduction showed significant reductions (p = 0.016 and 0.045), with no difference in rotations. QuickDASH increased from 8 ± 16 to 19 ± 24 (p = 0.008); nevertheless, 80% stayed within minimal/mild disability.

Conclusions: The LDMF-L preserves strength and produces only mild early ROM decreases with limited functional impact, supporting its functional safety as an implant-free autologous option.

Purpose: To assess the added diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating small breast lesions initially categorized as ACR BI-RADS 4A.

Materials and methods: A total of 1595 patients with small breast lesions (≤ 20 mm) from 37 tertiary hospitals were enrolled from August 2021 to August 2022. B-mode ultrasound, color Doppler, and CEUS were performed to evaluate the lesions. The integration of CEUS led to the reclassification of BI-RADS 4A lesions into three pathways: upgrade to 4B, downgrade to 3, or no change in category. The diagnostic performance of CEUS was evaluated, and the contrast modes which could be used to correctly downgrade or upgrade BI-RADS 4A lesions were explored.

Results: A total of 1340 lesions were finally included in the analysis of CEUS performance. The average age of all included participants was 43 ± 8 (range from 20 to 84). The average diameter of the lesions was 12.4 ± 3.8 mm (range from 5 mm to 20 mm). The diagnostic performances of CEUS + BI-RADS were 98.3% for sensitivity, 81.7% for specificity, 34.1% for positive predictive value, 99.8% for negative predictive value, and 83.1% for overall accuracy, respectively. The sensitivity was slightly downgraded (98.3% vs. 100%, p = 0.1555), while the specificity and accuracy were greatly elevated (p < 0.05). The receiver operating characteristic curve (ROC) value was calculated using a binary classification threshold, with BI-RADS 3 as low-risk and BI-RADS 4A as high-risk. The area under ROC was 0.896 (95% CI: 0.878, 0.911) for BI-RADS + CEUS. The decision curve analysis showed that using CEUS + BI-RADS to guide biopsy decisions provided net benefit compared to the default strategy of biopsying all lesions.

Conclusion: The addition of CEUS allows for the correct downgrading of most benign BI-RADS 4A lesions, thereby avoiding unnecessary biopsies. An upgrade from BI-RADS 4A to 4B on CEUS warrants immediate biopsy to ensure prompt diagnosis and treatment.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2100050719.

Introduction: Breast cancer is the most common cancer among women globally, with 2.3 million new cases in 2020. Globally, incidence rates of breast cancer are highest in Australia, yet only 29% of Australian women opt for breast reconstruction (BR). The decision-making process for BR is complex, involving various surgical and nonsurgical considerations. Approximately 50% of women would choose BR if adequately informed and given the option. This study evaluates the factors contributing to reduced BR rates in regional and rural New South Wales over a 10-year period.

Methods: A multicentre, retrospective observational cohort study analysed 2052 women who were diagnosed with breast cancer in the Illawarra Shoalhaven Local Health District between 2012 and 2022, focussing on primary resection outcomes and other objective factors that contributed to BR rates. Descriptive statistics, chi-squared tests and logistic regression were used to assess relationships between age, comorbidities, language and rurality, with reconstruction rates.

Results: Among the 2052 women diagnosed with breast cancer who required oncologic resection, the mean age was 65 years. Only 127 (6.2%) underwent BR across the total cohort of 2052 patients, and just 65 of the 724 (9%) patients in the post-mastectomy subgroup underwent BR, significantly lower than state averages. Significant relationships were found between age and reconstruction rates (p < 0.001), with younger patients (< 55 years old) more likely to opt for BR. Logistic regression confirmed that increased age and rurality both significantly affected the likelihood of undergoing reconstruction.

Conclusion: Women aged < 55 years old and those residing in metropolitan areas showed a higher likelihood of opting for BR, highlighting the influence of age and rural residency on access to reconstruction services. These findings emphasise the need for targeted interventions to enhance BR access, particularly for older and rural patients.

Background: Breast-conserving surgery (BCS) has become the standard treatment for early-stage breast cancer, offering oncological safety, better breast aesthetics, and enhanced health-related quality of life. The optimal margins for BCS have been debated. However, evidence on the impact of margin widths greater than 0 mm for invasive breast cancer remains limited. Cambridge Breast Unit (CBU) has adopted a policy where a single margin of < 1 mm (not at ink) for invasive disease would be acceptable, provided the other three radial margins are ≥ 1 mm.

Method: Retrospective cohort study analyzed 372 women who underwent BCS for invasive breast cancer at CBU between 2015 and 2016. Patients with pure ductal carcinoma in situ (DCIS), prior breast cancer treatment, or neoadjuvant chemotherapy were excluded. Clinical data, including patient demographics, tumor characteristics, margin status, and recurrence and survival outcomes, were extracted from electronic records.

Results: At a median follow-up of 5.2 years, the ipsilateral breast tumor recurrence (IBTR) rate was 1.6% (6/372) with an overall recurrence rate of 5.6% (21/372). No significant association was found between final resection margins and local or overall recurrence rates, nor was margin status correlated with breast cancer recurrence-free survival. A total of 53 patients (14.2%) required additional surgeries due to margin status. By accepting a single radial margin < 1 mm, our margin policy reduced reoperations by 33%.

Conclusion: Margin assessment in breast surgery is multifaceted, requiring a personalized approach that considers tumor biology, systemic treatments, and pathological variability. Our findings support accepting a margin width of < 1 mm (no tumor on ink) for a single radial margin in invasive breast cancer, provided the other three radial margins are ≥ 1 mm. It reduces reoperations without compromising oncological outcomes. Integrating advanced intraoperative techniques and multidisciplinary decision-making will further optimize patient care and long-term outcomes.

Background: This study presents our observations on the management and follow-up of patients diagnosed with lobular granulomatous mastitis (LGM) in a cohort study. Additionally, characteristics associated with a longer disease course, as well as treatment challenges in patients with erythema nodosum, diabetes, and hyperprolactinemia, would be discussed.

Methods: From 2015 to 2021, a total of 246 consecutive LGM patients referred to the internal medicine clinic of Ghaem teaching hospital, Mashhad, Iran, were enrolled. Regular assessments were conducted every 3 months until complete symptom resolution. Treatment responses were categorized into five groups: complete resolution, incomplete resolution, resolution with subsequent relapse, no significant improvement, and treatment cessation, with all data meticulously recorded. Telephone follow-ups were conducted with all patients at the end of the study in December 2022.

Results: A total of 156 episodes were analyzed. Prednisone was administered to 136 patients, while oral methotrexate (MTX) was prescribed to 48 cases. The median age of the cohort was 33 years (interquartile range [IQR], 29-38). Of those on prednisone, 57 (41.9%) achieved complete resolution, with 15 (11%) experiencing subsequent relapse, 33 (24.3%) showing no significant improvement, and 31 (19.9%) discontinuing treatment. Among the MTX recipients, 23 (47.9%) achieved complete resolution, while one showed incomplete resolution. Over the median follow-up of five years (IQR, 4-6), 139 (89.1%) reported complete resolution, nine (5.8%) showed incomplete resolution, and 8 (5.1%) remained symptomatic. The median disease duration was 18 months (IQR, 7-36). Abscess formation during treatment correlated with prolonged disease duration (p < 0.04), and higher plasma prolactin levels were associated with extended disease duration (p = 0.001). However, the disease course did not significantly differ in diabetic cases or those with erythema nodosum compared to others.

Conclusions: Although more than half of LGM patients experienced no significant improvement, recurrence, or discontinued treatment on prednisone or MTX, however, over a median follow-up of 5 years, approximately 90% of LGM patients achieved complete resolution within a median course of 18 months. The presence of abscesses during treatment and elevated plasma prolactin levels was linked to longer disease duration.

Breast reconstruction post-mastectomy restores breast aesthetics and significantly enhances patients’ self-confidence and psychological well-being. However, despite the effectiveness of current breast reconstruction techniques in restoring the aesthetic appearance of the breast, many patients continue to experience the loss of breast sensation following surgery, particularly the loss of nipple sensitivity, which significantly impacts postoperative quality of life. To address this issue, the use of nerve grafting techniques in breast reconstruction is increasingly being recognized and explored. This review summarizes the research progress of nerve grafting in breast reconstruction, highlighting its clinical applications, technical challenges, and future directions.