European journal of breast health最新文献

Objective: Mastectomy rates are increasing in young patients despite few data supporting improved outcomes. We investigated the association between surgical approach and survival in young patients with breast cancer.

Materials and methods: Retrospective review identified women ≤40 years old with operable, non-metastatic invasive breast cancer treated between 2010-2019. Cox proportional hazard analyses, stratified by hormone receptor and human epidermal growth factor receptor 2 (HER2) status, identified factors associated with increased risk of recurrence and death.

Results: Of 588 patients, 65% underwent mastectomy and 35% breast conserving surgery (BCS). Median follow-up was 5.9 years. Overall recurrence and mortality rates were 15% and 12%, respectively. On multivariable analysis, black race [hazard ratio (HR), 2.14 (1.26-3.61), p = 0.005], lymphovascular space invasion (LVSI) [HR, 1.98 (1.17-3.36), p = 0.01], and extranodal extension [HR, 2.12 (1.09-4.12), p = 0.03] were associated with increased risk of death. Stage III disease [HR, 2.06 (1.05-4.03), p = 0.04] and LVSI [HR, 2.18 (1.43-3.32), p<0.001] were associated with increased risk of recurrence. Increasing age decreased the risk of death [HR, 0.94 (0.88-0.99), p = 0.02] and recurrence [HR, 0.95 (0.90-0.99), p = 0.02]. Mastectomy versus BCS did not impact recurrence [HR, 1.18 (0.73-1.92), p = 0.51] or overall survival (OS) [HR, 0.86 (0.46-1.58), p = 0.62] in the entire cohort. BCS was associated with increased risk of recurrence in the hormone receptor-/HER2+ subtype [HR, 9.06 (1.03-80.00), p = 0.047] but did not affect survival.

Conclusion: OS does not differ by surgery type in young patients with breast cancer. Future research should focus on racial disparities in breast cancer care.

Objective: Developing nations with resource limited settings see a higher proportion of presentation at advanced stages of breast cancer compared to developed nations because of poor public awareness and lack of screening guidelines. This study aimed to assess the impact of a video-based teaching module on breast cancer awareness and self-examination among literate women in a developing country.

Materials and methods: This quasi-experimental, community-based, intervention study was conducted among literate women of a metropolitan city in a developing country, to evaluate the impact of a video-based teaching module on breast cancer awareness and self-examination. Female school teachers over 25 years old with virtual platform access were included. Simple random sampling was used to select participant schools. The target sample size was 103 based on a reference study. An educational video and questionnaires were validated through expert and volunteer feedback, followed by baseline and follow-up surveys at 6 weeks and 10 weeks after intervention. The Friedman test for overall change in scores and Wilcoxon signed-rank test were used for pairwise comparison between time points.

Results: The survey was completed by 181 participants. Mean (standard deviation) age was 41.79 (9.20) years. Median (interquartile range) cumulative score for the knowledge domain was 18 (14-21), 24 (19-32) and 25 (20-33) at baseline, 6 weeks and 10 weeks respectively with significant differences between each of these time points (p<0.001). There was a significant increase in the number of participants with a median score of 3 at 6 and 10 weeks compared to baseline in the attitude domain after intervention. The proportion of study participants with a score of ≥3 points in the practices domain increased from 22% (40/181) at baseline to 41.2% (74/181) at 6 weeks and 49.1% (89/181) at 10 weeks of educational intervention.

Conclusion: A video-based educational intervention may enhance breast cancer knowledge, attitudes, and self-examination practices in educated women with access to electronic media. This may contribute to early breast cancer detection in resource-constrained settings with limited screening options.

The breast constitutes an essential component of a woman's identity, body image, and self-esteem. The objective of this article is to present a rare case of breast skin pathology and to examine its differential diagnosis. A fifty-year-old woman consulted our department for a burning sensation in her right breast in combination with a rash involving the nipple-areola complex. The patient received treatment for evolving bacterial mastitis; however, a zosteriform vesicular rash subsequently developed over the right scapular region. The diagnosis of varicella zoster virus infection was confirmed, and oral medication was adjusted to antivirals, resulting in progressive reduction of the rash. To the best of our knowledge, reports on herpes zoster involving the nipple are scarce in the literature. This article presents such an atypical manifestation, underscoring the importance of including herpes zoster in the differential diagnosis of nipple-areolar complex lesions, and provides a brief review of the relevant literature.

Objective: Multidisciplinary teams (MDTs) are essential for optimizing breast cancer treatment, yet the role of general-purpose artificial intelligence (AI), such as ChatGPT, in supporting these teams remains underexplored. This study compared ChatGPT versions 3.5 and 4 with a hospital-based MDT in making treatment and follow-up recommendations, using St. Gallen, European Society for Medical Oncology, National Comprehensive Cancer Network, and American Society of Clinical Oncology guidelines as a reference.

Materials and methods: A retrospective analysis of 100 consecutive breast cancer patients diagnosed between January 2023 and January 2024 at a training hospital in İstanbul, Türkiye, was conducted. The MDT provided consensus-based recommendations, while anonymized patient data were processed by ChatGPT using English prompts based on guideline summaries. Two experienced breast surgeons independently rated recommendation appropriateness on a five-point scale post-treatment, focusing on clinical outcomes, with agreement assessed using weighted Cohen's kappa across cancer stage, molecular subtype, and proliferation index.

Results: ChatGPT-4 (with a knowledge cut-off of March 2023) demonstrated substantial agreement with the MDT for primary treatments (weighted κ = 0.712), whereas ChatGPT-3.5 showed moderate agreement (κ = 0.600). Agreement for additional recommendations, such as genetic counseling, was lower (GPT-4: κ = 0.398; GPT-3.5: κ = 0.302), with better performance in early-stage and less aggressive subtypes compared to advanced or aggressive cases. Discrepancies were noted in complex or aggressive cases.

Conclusion: The study suggests ChatGPT, particularly version 4, may serve as a supportive tool for breast cancer teams, especially in early-stage cases, though clinical expertise remains vital for complex scenarios, warranting further research to refine AI integration.

Juvenile giant fibroadenoma (GFA) is defined as a benign tumor larger than 5 cm, 500 grams, and/or involving at least 80% of the breast. It typically occurs in young patients and causes breast deformity and asymmetry. Surgical treatment involves resection of the tumor (enucleation), rearrangement of the skin envelope, and repositioning of the nipple-areola complex. However, the expected re-expansion of the breast following tumor removal, often managed through periareolar approaches, can be unpredictable and prolonged in certain cases. For this reason, oncoplastic surgery techniques have been developed, which allow for immediate partial reconstruction and are now among the available therapeutic options. This report describes three cases in which an oncoplastic approach was used for the treatment of GFA.

Objective: Minimally invasive nipple-sparing mastectomy (NSM), performed via endoscopic or robotic-assisted approaches, has been developed to improve cosmetic and psychosocial outcomes without compromising oncologic safety. While international experience is growing, data from low- and middle-income countries remain limited.

Materials and methods: We conducted a retrospective case series of five consecutive patients (six breasts) who underwent minimally invasive NSM between January 2024 and June 2025 in an Indian center. Three patients underwent conventional endoscopic NSM and two underwent robotic-assisted NSM (one unilateral and one bilateral). Data collected included demographic and genetic status, tumor biology, operative details, reconstruction method, perioperative complications, pathology, and short-term follow-up. Primary endpoints were feasibility and safety; secondary endpoints were margin status, early oncologic outcomes, and cosmetic satisfaction.

Results: All procedures were completed successfully without conversion to open surgery. Median (range) operative time was 210 (180-300) minutes, with robotic procedures requiring longer duration. No intraoperative complications, nipple-areolar necrosis, or implant losses were observed. Two patients developed minor seromas that resolved with aspiration. Pathological margins were negative in all cases. At a median follow-up of six (4-18) months, all patients were alive, disease-free, and reported good-to-excellent cosmetic satisfaction.

Conclusion: Our early experience demonstrates that both endoscopic and robotic-assisted NSM are feasible and safe in carefully selected patients, providing satisfactory oncologic and esthetic outcomes. However, these results should be interpreted with caution due to the very small sample size, short follow-up, and absence of a comparator group. Larger prospective multicenter studies with long-term outcomes are required to confirm oncologic safety and define the role of minimally invasive NSM India.

Objective: To evaluate the feasibility of using deep learning models applied to digital breast tomosynthesis (DBT) images for non-invasive prediction of breast cancer biomarkers, including estrogen receptor (ER), progesterone receptor (PR), human epithelial growth factor receptor 2 (HER2), Ki-67 proliferation index, and triple-negative breast cancer (TNBC).

Materials and methods: In this retrospective study, patients with histopathologically-confirmed, invasive breast cancer were included. Furthermore, all included patients had complete, immunohistochemically-assessed biomarker data available. For each case, a representative DBT slice showing the tumor was selected and preprocessed using histogram equalization. Two pretrained convolutional neural networks (VGG19 and ResNet50) were fine-tuned for binary classification of each biomarker. Model performance was evaluated using accuracy, area under the curve (AUC), F1 score, and Matthews correlation coefficient.

Results: The study sample included 43 anonymized female patients. Deep learning models achieved strong predictive performance for ER (AUC = 0.81) and TNBC (AUC = 0.93). HER2 (AUC = 0.74) and Ki-67 index (AUC = 0.70) were predicted with moderate accuracy. PR results varied, with VGG19 reaching AUC = 0.76 while ResNet50 performed poorly (AUC = 0.24).

Conclusion: Deep learning models applied to DBT images enabled non-invasive prediction of some key breast cancer biomarkers, especially ER status and TNBC type. This approach may function as a virtual biopsy to complement histopathology, guide biopsy targeting, and support treatment planning. Although preliminary, the findings highlight the potential of artificial intelligence-enhanced DBT assessment and warrant validation in larger, multi-center prospective studies.

Objective: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast condition lacking standardized treatment and with unpredictable outcomes. To address these issues, using clinical and ultrasound findings from an initial subset, we created the Pittsburgh Classification to stratify severity and developed a corresponding treatment algorithm for IGM, then evaluated its effectiveness in a larger cohort of IGM patients.

Materials and methods: This retrospective multicenter study reviewed clinical and sonographic findings and outcomes of women with biopsy-proven IGM treated at multiple breast centers between 2020 and 2025. The Pittsburgh clinical classification ranges from Type 1 (minimal skin irritation) to Type 5 (widespread involvement); ultrasound classification spans Type A (localized mass ≤2 cm) to Type D (diffuse disease). Treatments were assessed utilizing the Pittsburgh algorithm, with responses classified as full response (CR), near-complete response (nCR), or no response (NR). Chi-square tests assessed associations (p<0.05).

Results: Of 522 patients included (mean age 37.0±8.8 years), 86.4% (n = 451) received algorithm-concordant treatment, achieving CR in 68.7% (n = 310), nCR in 35.3% (n = 159) and NR in 11.8% (n = 53). Among these, 65.4% (295/451) of patients with CR were concordant with the Pittsburgh treatment algorithm, whereas 13.6% (n = 71) patients received discordant treatments, with a significantly lower CR rate of 21.1% (15/71) (p<0.001). Multifocal disease was significantly more prevalent in NR (83.0%, 44/53) and nCR (70.4%; 112/159) patients compared to CR (20.6%; 64/310) (p<0.001), although lesion-based response rates were similar (CR 56.8%, nCR 57.0%, NR 56.6%). Regarding concordance with treatment algorithm, clinical Type 4 IGM was more prevalent in NR (67.9%; 36/53) and nCR (72.9%, 116/159), whereas in clinical Type 1 IGM, NR, nCR, and CR were 1.8% (1/53), 4.4% (7/159), and 30.6% (95/310), respectively (p<0.001). Surgery at presentation was preferred in 16.9% (n = 88) of patients, with 6% (n = 30) requiring subsequent surgical treatments to treat residual disease.

Conclusion: Concordance with the proposed IGM treatment algorithm based on clinical and ultrasound findings resulted in significantly higher CR rates. Multiple foci and stratified clinical types correlated with outcomes. Prospective global research is needed to validate these findings.

Breast cancer is the most frequently diagnosed malignancy among women worldwide, and significant progress in systemic therapy, surgical techniques, and radiotherapy has contributed to improved clinical outcomes. However, many clinical scenarios encountered in daily practice are not fully addressed by randomized trials, leaving persistent areas of uncertainty in the management of early-stage breast cancer. To meet these challenges, the multidisciplinary panel at Research Institute of Senology, Acıbadem University developed consensus-driven recommendations for clinical scenarios that are encountered in daily practice. Herein, we aim to reflect both current evidence and institutional practice, and to provide practical guidance in areas where uncertainty persists. As breast cancer treatment continues to evolve, updates will be required to integrate emerging data and refine individualized patient care.