Breast Journal最新文献

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.

Introduction: Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory disease with no effective treatment and high relapse rate. The pathophysiology is poorly understood. Tinosporin, an immunomodulator obtained from Tinospora cordifolia, is known to be useful in treating immune-mediated diseases. We report our experience of using Tinosporin for IGM and the effectiveness of this “steroid-free” regimen.

Methods: We analysed the clinicopathological characteristics of patients diagnosed with IGM on histopathology during January 2018 and December 2022. Tinosporin tablet (500 mg Guduchi stem extract) was prescribed for 3–6 months; data were collected from electronic medical records and analysed in SPSS v-29.

Results: Of 315 patients, 132 had complete clinical records. Median age was 39 years (25–77), and 107 (81.7%) were premenopausal. Seventy-eight (59.09%) had clinical suspicion of malignancy. On imaging, 84 (63.64%) were BIRADS 4/5 lesions. Empirical broad-spectrum antibiotics were prescribed to 101 patients. Tinosporin tablets were prescribed to 91 patients. Symptomatic response was seen in 72 (79.12%). Five patients did not achieve response, while 14 patients (15.38%) were lost to follow-up. At a median follow-up of 36 months (14–62 months), only 2 patients on Tinosporin had recurrence. None of the patients needed surgical intervention other than diagnostic biopsy or control of infection, and none received steroids.

Conclusion: IGM is a benign, often self-limiting disorder. However, it mimics malignancy in 60% cases, and histology clinches the diagnosis. We report the efficacy of steroid-free management of IGM with immunomodulatory herbal origin phytopharmaceutical drug Tinosporin. It is safe, inexpensive and effective. Large volume excisions or mastectomies can be reserved for severe and refractory cases.

Introduction: Although idiopathic granulomatous mastitis (GM) of the breast is a benign condition, it can be locally aggressive and frequently chronic, causing significant pain and distress to the patient. Treatment often involves multiple disciplines including general practice, breast surgery/physicians, rheumatology and/or immunology. Traditional options for treatment include observation, oral steroids, methotrexate and/or surgery, all with variable outcomes. A more recent alternative treatment option involves intralesional steroid injections.

Methods: Using PRISMA methodology, a systematic review of intralesional steroid injection for the management of GM was conducted. Medline, PubMed, Embase and Cochrane databases were searched for original studies reporting treatment protocols and clinical outcomes, published up to the end of September 2023.

Results: Nine eligible studies reported outcomes in 474 patients undergoing treatment of GM with intralesional injections. All studies reported success (improvement in clinical and/or imaging appearance) with intralesional injections. Studies that had a comparison group showed statistically significantly fewer side effects compared to oral steroids or surgical management. The recurrence rate was less for intralesional injections than for other treatments in all studies except one. No studies included patient-reported outcomes.

Conclusion: There is consistent evidence for the safety, efficacy and low recurrence rate with intralesional steroid injections for GM. The existing literature is heterogenous with respect to injection protocols, and the optimal protocol is unclear. Future research should compare the various steroid agents and dose/frequency of administration. Future studies should include cost analysis and patient-reported outcomes to ensure that the treatment is cost-effective and acceptable to people with idiopathic GM.

Aim: Purpose of this study is to investigate the quality and reliability of YouTube video contents on prophylactic mastectomy.

Material and Methods: The search terms “prophylactic mastectomy,” “prophylactic mastectomy surgery,” “preventive surgery for breast cancer,” “risk-reducing mastectomy,” and “prophylactic mastectomy and breast reconstruction” were searched on YouTube. The uploader, video content, length (seconds), upload date, number of days since upload date, number of views, number of comments, and likes were recorded and evaluated. Finally, the videos included in the study were evaluated using modified Quality Criteria for Consumer Health Information (DISCERN) and Global Quality Scale (GQS).

Results: The total number of views of the 50 videos reviewed in the study was found as 3.674.469. The mean DISCERN score of the two observers was calculated as 3.35 ± 1, and the videos were found to be of medium reliability. The mean GQS score of all videos was 3.39 ± 0.9 and the videos were of medium quality. The researchers gave 1-2 points (misleading) to 7 (14%) videos, 3 points (somewhat helpful) to 20 (40%) videos, 4 points (beneficial) to 16 (32%) videos, and 5 points (excellent) to 7 (14%) videos.

Conclusion: In our study, we found that the videos uploaded by doctors were of good quality, the videos uploaded by health channels were of medium quality, and the videos uploaded by patients were of poor quality and misleading. The videos with health contents should be evaluated by the relevant specialists, and only useful videos should be broadcast.