European journal of breast health最新文献

Objective: To evaluate the diagnostic accuracy and efficiency of a proprietary breast-specific machine learning (ML) model-built upon the open-source Open Triage platform-in comparison to specialist physicians, using standardized real-world clinical data for breast referral triaging.

Materials and methods: A retrospective observational study was conducted using 174 standardized breast cases obtained from proprietary industry datasets, spanning 46 disease types, 23 of which were cancers. The cohort ranged from 19 to 75 years (mean: 39.4±12.0). Physicians and an ML model each generated three diagnostic predictions per case. Both modalities were compared after benchmarking their predictions against a gold-standard diagnosis established by imaging and biopsy. Performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) analysis. Time efficiency was also assessed to compare diagnostic turnaround times between physician- and ML-generated predictions.

Results: The ML model demonstrated superior diagnostic accuracy (100%) compared to physicians (83.9%), with higher sensitivity (0.947 vs. 0.826) and PPV (0.500 vs. 0.442). Both groups achieved comparable specificity and NPV values. ROC analysis showed an AUC of 0.91 for the ML model's first prediction versus 0.83 for the doctor's first prediction, indicating superior predictive power of the ML model.

Conclusion: The ML model demonstrated diagnostic accuracy comparable to or better than that of physicians while significantly reducing the time required. These findings suggest that AI-powered triage tools could enhance the efficiency and standardization of breast triage.

Objective: The Oncotype Dx^® assay is a validated tool for determining prognosis and predicting benefit from adjuvant systemic chemotherapy in patients with node-negative, early-stage hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER-2)-negative breast cancer. However, genomic testing could incur additional costs, impacting both the patient and the health system. This study aims to explore a subset of patients with a Magee equation score ≤18 who may safely forgo Oncotype Dx^® testing.

Materials and methods: Single institution retrospective analysis of postmenopausal patients with de novo, unifocal breast carcinoma that is node negative, Nottingham grade 1, T1, HR positive (>1%), and HER-2 negative. Magee equation 2 (ME2) (https://path.upmc.edu/onlineTools/mageeequations.html) scores were calculated for each patient. The correlation coefficient between Oncotype Dx^® and ME2 was determined.

Results: Oncotype Dx^® recurrence score, treatment, and outcomes were analyzed in 126 post-menopausal women diagnosed between 2015 and 2020. The mean tumor size was 1.09 cm, and the mean Oncotype DX^® score was 12. The average ME2 score was 13.6. The correlation coefficient between Oncotype and ME2 score was statistically significant (r = 0.3442; p<0.0001). At a median follow-up of 5.03 years, there were no local or distant recurrences or breast cancer-related deaths reported in this patient cohort.

Conclusion: This study suggests that omitting the Oncotype Dx^® assay may be feasible in postmenopausal women with early breast cancer and an ME2 score ≤18. Using comparable tools, such as ME2, may reduce financial toxicity in this population and overall costs to the system. Larger study recommended.

Invasive lobular carcinoma (ILC) is the second most common histologic subtype of invasive breast cancer, accounting for 5-15% of this type. Though its unique propensity to metastasize to the extra-hepatic gastrointestinal tract is well known, isolated colonic metastasis without disseminated or locoregional recurrence is rare. These isolated lesions may be amenable to curative treatment with a better prognosis. Here we present the diagnostic challenge faced while managing the case of a 62-year-old female who was treated for estrogen receptor-positive ILC of the breast 10-years previously, who presented with an ileocecal mass, which on biopsy revealed metastatic ILC. She was treated with laparoscopic hemicolectomy followed by hormonal therapy and remained asymptomatic at 18-months follow-up.

Objective: Breast cancer treatment disparities persist and include surgical approach. This study evaluated the association of race, ethnicity, employment, and insurance status with the selected surgical approach and the effect on recurrence-free survival (RFS) and overall survival (OS) in young women with breast cancer.

Materials and methods: A retrospective review of a prospectively maintained institutional database (Sandra Levine Young Women's Breast Cancer Program) identified women aged ≤40 years diagnosed with non-metastatic breast cancer from 2010-2019 who underwent surgery. Multivariable logistic regression models and Cox proportional-hazards models were fitted.

Results: Of the 700 women, 4% were Asian, 26% Black, and 69% White. Reported ethnicity was: 67% non-Hispanic, 5% Hispanic, and 27% unknown or unreported. Clinical stage distribution was 86% early stage (0-II) and 11% stage III. Among patients with invasive cancer (n = 624), 51% were hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 21% were HR-negative/HER2-negative, 20% were HR-positive/HER2-positive, and 8% were HR-negative/HER2-positive. Local, regional, or distant recurrence occurred in 13.1% of patients who underwent lumpectomy and in 16.4% of those who underwent mastectomy (p = 0.22). Death occurred in 6.5% of patients after lumpectomy and in 10.7% of patients after mastectomy (p = 0.07). Black women were more likely to undergo lumpectomy than White women [odds ratio = 2.26; 95% confidence interval (CI), 1.49-3.43; p<0.001; adjusted for ethnicity]. Private insurance was associated with improved OS (hazard ratio = 2.47; 95% CI, 1.26-4.84; p = 0.003) and RFS (hazard ratio = 2.02; 95% CI, 1.28-3.20; p = 0.010) compared with Medicaid. No association was noted between employment status and surgical approach, OS, or RFS.

Conclusion: Young Black women were more likely than White women to elect the less-invasive surgery (lumpectomy). Private insurance was associated with better OS and RFS.

Objective: Conventional axillary lymph node dissection (ALND) carries significant morbidity in breast cancer surgery. Sentinel lymph node biopsy (SLNB) offers a less invasive alternative but lacks validation in resource-constrained environments. To compare postoperative morbidity between SLNB and ALND in breast cancer and assess SLNB feasibility.

Materials and methods: A retrospective study was conducted at the Mother-Child Department of Bizerte, Tunisia (January 2022-August 2024). Patients with early-stage breast cancer undergoing SLNB or ALND were included. Primary outcomes were: lymphedema, lymphocele, pain [visual analog scale (VAS)], hemoglobin drop, and length of hospital stay. Statistical analyses were performed using SPSS v26.0. The Student's t-test was used for normally distributed quantitative variables, the Mann-Whitney U test for non-normally distributed variables, and Fisher's exact test for categorical variables with small sample sizes. Normality was assessed using the Shapiro-Wilk test.

Results: Among the 64 included patients, SLNB (n = 26) significantly reduced lymphedema (3.8% vs. 23%, p = 0.039), early postoperative pain (mean VAS: 3.92 vs. 4.7, p = 0.025), and length of hospital stay (5.69 vs. 7.71 days, p = 0.001) compared with ALND (n = 38). Lymphocele incidence was lower but not statistically significant (4% vs. 11; p = 0.640). The SLNB detection rate was 89%.

Conclusion: SLNB significantly reduces postoperative morbidity compared with ALND and is feasible in this resource-limited North African setting. Our findings support its integration into routine breast cancer surgery as a safe and effective alternative to axillary dissection.

Screening mammography plays a critical role in the early detection of breast cancer. Suspicious breast calcifications on mammography often prompt further diagnostic evaluation due to concern for malignancy, worrying physicians and patients alike. Here, we present a case of a woman in her 70s whose annual screening mammogram with digital breast tomosynthesis demonstrated two new groups of microcalcifications, confirmed after recall with magnification views. However, because of their superficial location, biopsy was thought to be too technically challenging and short follow-up was recommended. At 6-month mammographic follow-up, there was interval non-visualization of both calcifications. Additional clinical history interrogation revealed that due to a diffuse pruritic rash, the patient had been applying topical betamethasone dipropionate daily to her entire body, including her breasts, when she received her initial mammogram. This case illustrates how corticosteroid ointments and lotions may mimic suspicious calcifications on mammography, reinforcing the importance of guidelines recommending avoidance of topical products on the day of imaging.

Objective: To evaluate the predictive performance of dimensional and functional magnetic resonance imaging (MRI) parameters obtained from mid-treatment breast MRI for forecasting pathologic complete response (pCR) in patients with locally advanced breast cancer (LABC) undergoing neoadjuvant chemotherapy (NAC).

Materials and methods: Sixty-five women with LABC who underwent NAC followed by surgery were retrospectively included. Quantitative MRI parameters-including % change (Δ%) in longest diameter, bidimensional size, tumor volume, apparent diffusion coefficient (ADC), and enhancement percentage (Epeak) -were calculated between pre- and mid-NAC MRI. Receiver operating characteristic (ROC) analysis and logistic regression were used to identify predictors of pCR. Logistic regression and ROC analysis (with DeLong's test) were used to assess associations with pCR and compare area under the curves (AUCs).

Results: pCR was achieved in 19 of 65 patients (29%). Compared to non-pCR cases, patients with pCR showed significantly greater reductions in tumor size and Epeak, and larger increases in ADC value (all p<0.05). In multiple logistic regression, Δ% longest diameter >60% [odds ratio (OR)=7.1, p = 0.008] and Δ% ADC value ≥32% (OR=4.7, p = 0.016) remained statistically significant independent predictors of pCR. Δ% tumor volume >92% had the highest univariable AUC (0.754), while Epeak ≤21% showed perfect specificity but was excluded due to wide confidence intervals. Pairwise AUC comparisons showed no significant differences among Δ% longest diameter, bidimensional size, and tumor volume (all p>0.05).

Conclusion: Mid-treatment MRI biomarkers, particularly Δ% longest diameter and Δ% ADC value, are effective early predictors of pCR and may support individualized treatment strategies during NAC.

The mammary angiosarcoma is a rare malignant mesenchymal tumor that develops from the vascular tissue of the breast. It represents 0.004 to 1% of all malignant breast tumors and 8 to 10% of breast sarcomas. It can be primary in a 40-year-old woman or radiation-induced in an older woman who has undergone conservative treatment for breast cancer, including conservative surgery and adjuvant radiotherapy. Herein, we present four cases involving breast angiosarcoma in young and relatively older women and the different treatment they received. Our discussion encompasses the epidemiological, diagnostic, and therapeutic facets of this rare and aggressive tumor type.