Breast Journal最新文献

Background: Florid lobular carcinoma in situ is an uncommon lobular neoplasia variant that is frequently associated with invasive carcinoma. However, there remains a paucity of information to guide management. The authors aimed to study imaging features associated with pathologic upgrade rates for patients with florid lobular carcinoma in situ identified on core biopsy undergoing surgical excision.

Methods: Patients with florid lobular carcinoma in situ on core biopsy were selected from an institutional pathology database. Patients were excluded if pleomorphic lobular carcinoma in situ was also present on core biopsy. Clinical, radiologic, and pathologic features for each case were reviewed focusing on imaging features which led to core biopsy and those associated with pathologic upgrade on surgical excision.

Results: Eighteen cases of florid lobular carcinoma in situ underwent surgical excision. Upgrade rates on surgical excision were higher in cases with suspicious calcifications (8/11, 73%, p = 0.049) compared to those without (1/7, 14.3%) and in cases with larger breast lesions (p = 0.011). The overall upgrade rate was 50% (9/18), 89% (8/9) with invasive lobular carcinoma and 11% (1/9) with ductal carcinoma in situ. Of the 8 cases with upgrade to invasive lobular carcinoma, 7/8 (87.5%) were Stage I cancers and only 1/8 (12.5%) had macroscopic lymph node involvement and was upgraded to Stage II.

Conclusion: Florid lobular carcinoma in situ on core biopsy had an upgrade rate on surgical excision of 50% overall, with 89% of these cases upgraded to invasive lobular carcinoma. Pathologic upgrade was seen more frequently with suspicious calcifications and larger breast lesions. These findings can help guide surgical management of this uncommon lobular neoplasia variant including planning extent of excision and consideration for lymph node evaluation.

Background: Breast carcinoma is divided into at least 21 separate histologies, according to the 2019 World Health Organization (WHO) classification. The present study is dedicated to a 5% or rarer group of all breast cancer cases.

Method: In this study, we retrospectively considered the data of 4550 patients operated on for breast carcinoma at the Ankara Oncology Training and Research Hospital of the University of Health Sciences between January 2018 and February 2024. Of those cases, 401 were discovered to have rare breast cancer types. We also explored the cases by clinicopathological features, overall survival (OS), and disease-free survival (DFS).

Results: Our findings revealed a total of 10 rare breast cancer types in patients explored: mucinous carcinoma, micropapillary carcinoma, papillary group carcinomas, metaplastic carcinoma, neuroendocrine carcinoma, tubular carcinoma, cribriform carcinoma, apocrine carcinoma, acinic cell carcinoma, and secretory carcinoma. While mucinous, tubular, cribriform, papillary group carcinomas, micropapillary, and secretory carcinomas are described as types associated with good prognosis, metaplastic, neuroendocrine, apocrine, and carcinomas are described as types associated with relatively poor prognosis.

Conclusion: Scrutinizing the clinicopathological features of rare breast cancer types altogether may be the distinct contribution of this paper to the relevant literature and future research.

Purpose: Meningeal carcinomatosis (MC) has a dismal prognosis in patients with breast cancer and requires invasive therapies. The aim of the present retrospective study was to determine a prognostic score for overall survival (OS) in patients with breast cancer and treated for MC.

Methods: The data of 109 patients with proven breast cancer MC treated with at least one intrathecal (IT) injection of methotrexate or thiotepa at Institut Curie were retrospectively recorded from 2011 to 2019. We developed prognostic clinical scores for OS and 24-week survival.

Results: The diagnosis and evaluation of MC were based on a combination of clinical, imaging, and laboratory studies. Three significant prognostic factors for OS were identified. Clinical response or stabilization after one month of IT therapy had a favorable independent prognostic value for both OS and 24-week survival. Additionally, a baseline CSF Cyfra 21-1 concentration lower than 79 ng/mL in the cerebrospinal fluid (CSF) and the absence of 1-month CSF malignant cells had borderline favorable independent prognostic value for OS and 24-week survival, respectively. We constructed 2-class and 3-class prognostic scores for each outcome, identifying a population with a very poor prognosis.

Conclusions: To our knowledge, this is the first study to develop a response-based prognosis score for patients with breast cancer-related MC. This one-month prognostic score may help to determine which patient could actually benefit from prolonged IT therapy.

Background: T regulatory cells (Tregs) are essential for preserving immune tolerance. They are present in large numbers in many tumors, hindering potentially beneficial antitumor responses. However, their predictive significance for breast cancer (BC) remains ambiguous. This study aimed to explore genes associated with Tregs and develop a prognostic signature associated with Tregs.

Methods: The gene expression and clinical data on BC were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. The integration of CIBERSORT and weighted correlation network analysis (WGCNA) algorithms was utilized to identify modules associated with Tregs. The consensus cluster algorithm was utilized to create molecular subtypes determined by genes associated with Tregs. Then, a prognostic signature associated with Tregs was constructed and its relationship to tumor immunity and the prognosis was evaluated.

Results: The blue module genes exhibited the most significant correlation with Tregs, and 1080 genes related to Tregs were acquired. A total of 93 genes from the TCGA dataset were found to have a significant impact on patient prognosis. Samples from BC were categorized into two clusters by consensus cluster analysis. The overall survival, immune checkpoint genes, molecular subtype, and biological behaviors varied significantly between these two subtypes. A 10-gene signature developed from differentially expressed genes between two subtypes demonstrated consistent prognostic accuracy in both TCGA and GEO datasets. It functioned as a standalone prognostic marker for individuals with BC. In addition, patients with low risk are more inclined to exhibit increased immune cell infiltration, TME score, and tumor mutation burden (TMB). Meanwhile, Individuals classified within the low-risk group showed better responses to immunotherapies compared to their counterparts in the high-risk group.

Conclusions: The prognostic model derived from Tregs-related genes could aid in assessing the prognosis, guiding personalized treatment, and potentially enhancing the clinical outcomes for patients with BC.

Background: Limited data exist on complication rates in nipple-sparing mastectomy (NSM) in patients with large-volume breasts. Our aim was to evaluate the early complication rates of NSM with immediate reconstruction in a consecutive cohort of patients with large-volume breasts.

Methods: After IRB approval, patients treated with prophylactic or therapeutic NSM and immediate reconstruction from January 2020 to June 2022 at our health network were identified. Patients with breast weights > 600 g (the extreme NSM group) were compared to patients with breast weights of 600 g or less (the average-volume NSM group).

Results: A total of 184 patients underwent NSM with immediate reconstruction. Forty-three of 184 (23.37%) NSM patients had breast weights > 600 g. Of these, 30 patients had bilateral NSM, for a total of 73 breasts with volumes over 600 g, ranging from 603 to 1658 g. There were significantly more total complications in the extreme NSM compared to average-volume NSM groups (41.86% vs. 21.99%, p = 0.009852). When broken down into major and minor complications, the extreme NSM group had significantly more major complications than the average-volume NSM group (27.91% vs. 12.86%, p = 0.01072), but no difference in minor complications (13.95% vs. 9.29%, p = 0.2205). Overall, one (2.33%) patient in the extreme NSM group had a reconstruction failure, compared to three (2.14%) in the average-volume NSM group. Only two of 43 (4.65%) patients in the extreme NSM group lost their nipples due to total or partial nipple necrosis.

Conclusions: NSM with immediate reconstruction was successful in the majority of patients with large-volume breasts. The rate of nipple loss was acceptably low. Women with breast volumes larger than 600 g who are motivated to save their nipples at the time of mastectomy could be offered NSM.

Objective: To enhance the diagnostic accuracy of new nodules on the surgical side after breast cancer surgery using machine learning techniques and to explore the role of multifeature fusion.

Methods: Data from 137 breast cancer postoperative patients with new nodules from January 2016 to April 2024 were analyzed. Clinical, ultrasound, immunohistochemistry, and surgical features were combined. Multiple machine learning models, including support vector machine (SVM), random forest, gradient boosting, AdaBoost, and XGBoost, were trained and tested. Model performance was evaluated using stratified ten-fold cross-validation. Ablation experiments assessed the impact of different feature combinations on diagnostic performance.

Results: The SVM model performed best, with an AUC of 0.8664, an accuracy of 0.8099, a sensitivity of 0.565, and a specificity of 0.9267. Ablation experiments indicated that multifeature fusion significantly improved diagnostic performance, especially when combining clinical, ultrasound, immunohistochemistry, and surgical features. Gradient boosting and random forest models showed slightly inferior performance, while AdaBoost had balanced but lower effectiveness.

Conclusion: Machine learning, particularly the multifeature fusion SVM model, shows significant potential in diagnosing new nodules after breast cancer surgery. It can assist doctors in developing more effective treatment plans, improving patient outcomes. Future studies should expand sample sizes, include multicenter data, and explore advanced algorithms to further enhance diagnostic performance.

Background: The routine use of venous thromboembolism (VTE) prophylaxis in breast cancer surgery has caused substantial polarity among breast cancer surgeons across the globe. The aim of this study is to assess the use of VTE prophylaxis in breast cancer surgery outcomes.

Methods: A comprehensive electronic search was undertaken of all comparative studies that described the role of VTE prophylaxis in breast cancer surgery. Studies that reported on postoperative outcomes between patients who received VTE prophylaxis (prophylaxis) and those who did not (no prophylaxis) were included in the review. A meta-analysis using random-effect model was used to analyse key outcomes, with data presented as odd ratio (OR).

Results: A total of 2470 patients from 6 studies were included in this study. Among these patients, 60.9% (n: 1504) received prophylaxis. The haematoma rate in this study is 0.05% (n: 133). The incidence of haematoma was significantly associated with the use of prophylaxis (6.85% versus 3.11%, p : 0.001). Surgical intervention for haematomas was also significantly associated in this group (3.15% versus 0.83%, p : 0.004). However, there was no difference in VTE events between both groups (0.26% versus 0.36%, p : 0.88).

Conclusions: The use of VTE prophylaxis in breast cancer surgery is associated with increased haematomas without any benefit in preventing VTE events. Future studies that examine the use of risk assessment tools for VTE prophylaxis in high risk patients may be beneficial.

Background: Breast tubular carcinoma is a special pathological type of invasive breast cancer, accounting for about 0.8% to 10.0% of breast cancer cases, and it is a rare type of breast cancer. Currently, there is still a lack of relevant diagnostic and treatment consensus. Exploring the relationship between the pathological characteristics, molecular subtypes, and prognosis of ductal breast cancer is of great scientific value and clinical significance for improving patients’ survival rate and quality of life.

Methods: The clinical data of 22 patients with tubular breast carcinoma diagnosed by pathology in The First Medical Center of PLA General Hospital from January 2001 to December 2021 were collected, and their pathological features, molecular classification, and prognosis were analyzed retrospectively.

Results: The clinicopathological features of 22 patients with tubular breast carcinoma were age ≥ 35 years, married, tumor ≤ 2 cm, single focal, mixed type, no lymph node metastasis, estrogen receptor (ER) positive, progesterone receptor (PR) positive, Ki-67 ≤ 14%, CyclinD1 negative, less recurrence, and metastasis. Twenty-two patients with breast tubular carcinoma were followed up for 5 years after surgery, and the survival rate of disease-free survival (DFS) was 90.9% (20/22). The positive rates of ER, PR, and human epidermal growth factor receptor-2 (HER-2) are 100.0%, 100.0%, and 40.9%, respectively. The proportion of tumor cells expressing Ki-67 is 45.4%. Among them, the difference of HER-2 level, recurrence and metastasis, and postoperative comprehensive treatment showed different prognoses.

Conclusion: Tubular breast carcinoma is a kind of tumor with a low malignant degree. The prognosis is significantly related to its HER-2 level, recurrence and metastasis, and postoperative comprehensive treatment by univariate analysis, in which HER-2 is an independent risk factor, postoperative comprehensive treatment is a protective factor, but postoperative recurrence and metastasis have nothing to do with the prognosis by the multivariate analysis.

Introduction: Tumescent dissection (TUM) combines the use of crystalloid, local anesthetic, and epinephrine to create a bloodless plane to raise skin flaps. We aim to compare outcomes of TUM versus standard electrocautery dissection in mastectomies with and without reconstruction.

Methods: We conducted a retrospective cohort study of patients who underwent mastectomy by a single surgeon between January 2016 and October 2020 utilizing the electronic medical record. The primary outcome was complication rate, and the secondary outcome was operative time. Chi-squared analysis and two-sample t-tests were used to examine outcomes.

Results: Among 242 patients, 141 patients underwent TUM and 101 patients underwent electrocautery. 44.68% of TUM patients experienced one or more complications compared to 59.41% of electrocautery patients (p = 0.024). There were fewer cases of wound healing complications in the TUM group with reconstruction compared to the electrocautery group with reconstruction (6.1% vs. 21%, p = 0.005). Infection rate was higher in the TUM group with reconstruction compared to the electrocautery group with reconstruction (14.3% vs. 3.2%, p = 0.023). There was no significant difference in rates of hematoma, seroma, skin flap necrosis, nipple areolar complex necrosis, or re-exploration by dissection technique. The mean operative time was shorter with TUM compared to electrocautery (216.09 min vs. 250.16 min, p = 0.016).

Conclusion: TUM yields comparable results with decreased overall complication rates compared to electrocautery dissection. Electrocautery thermal effect may account for skin-related complications. Additionally, tumescent mastectomies have shorter length of operative time which could reduce the risk of complications associated with increased time under general anesthesia.