European journal of breast health最新文献

Breast cancer represents the most frequently diagnosed malignancy among women globally, with significant progress in systemic therapy, surgical techniques, and radiotherapy contributing to improved clinical outcomes. However, many clinical scenarios encountered in daily practice are not fully addressed by randomized trials, leaving persistent grey zones in the management of early-stage breast cancer. To meet these challenges, the multidisciplinary panel at Research Institute of Senology, Acıbadem University outlined experience-based recommendations for clinical situations typically faced in daily practice. Herein we aim to reflect both current evidence and institutional practice and 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.

Objective: The superomedial pedicle technique combines aesthetic advantages with reliable vascularity in reduction mammaplasty. This study evaluated the safety and clinical outcomes of Doppler ultrasonography-guided identification of the superior perforator in the superomedial pedicle design.

Materials and methods: This retrospective study included 22 female patients who underwent bilateral superomedial pedicle reduction mammaplasty between April 2023 and April 2025. In all patients, the superior perforator was detected preoperatively using a portable handheld Doppler ultrasonography device and was incorporated into the pedicle design. All patients underwent surgery via an inverted-T pattern with the superomedial pedicle. The mean follow-up period was 1.2 years.

Results: The superior perforator was identified in all patients (mean time: 3.0±0.4 minutes). No partial or total necrosis of the nipple-areola complex was observed in any patient. Wound dehiscence occurred at the T-incision site in four patients, transient areolar hypoesthesia was observed in three patients, and hypertrophic scarring developed in one patient. Aesthetic outcomes were evaluated in all patients by physical examination and standardized photography.

Conclusion: Detection of the superior perforator with Doppler ultrasonography enables individualized planning of the superomedial pedicle and enhances vascular safety. This approach provides a feasible, individualized, and reliable surgical technique for reduction mammaplasty, thereby reducing complication rates.

Objective: Myofascial adhesions are an important cause of upper extremity dysfunction among breast cancer surgery (BCS) patients. Myofascial-adhesions-in-patients-after-breast-cancer (MAP-BC) is a quantitative method developed to assess scar tissue and adhesions. This study aims to create a Turkish version of the MAP-BC tool and to test its validity and reliability.

Materials and methods: This cross-cultural adaptation and validation study included 81 female BCS patients aged 18-80 years. For convergent validity, patients were assessed using MAP-BC and the Patient and Observer Scar Assessment Scale observer subscale. For test-retest reliability, the patients were assessed on days 0 and 14. Thirty-two patients were evaluated by a second researcher to assess interrater reliability.

Results: Validity was fair to good (rho = 0.631). For test-retest reliability, intraclass correlation (ICC) values for the subgroups ranged from 0.798 to 0.954, with an ICC = 0.948 for the total score, indicating good-to-excellent test-retest reliability. Interrater ICC values ranged from 0.417 to 0.949, with ICC = 0.938 for the total score, suggesting good to excellent interrater agreement, except for the "frontal chest wall" section.

Conclusion: The Turkish MAP-BC tool is valid and reliable for evaluating myofascial adhesions and scars after BCS and adjuvant treatments. Clinicians are encouraged to use MAP-BC to detect myofascial adhesions and evaluate treatment efficacy, as this is the first tool available in Turkish for this purpose.

Objective: Hypofractionated radiotherapy (RT) is the standard adjuvant treatment for breast cancer patients after surgery. The recent results of the FAST-FORWARD trial on ultra-hypofractionated RT, delivered over one week, support a viable alternative regimen for early-stage breast cancer. Whether the addition of a tumor bed boost could further improve patient outcomes is still under investigation.

Materials and methods: We report the results of a single-center prospective study involving 26 early-stage (T1, 2N0) breast cancer patients treated with whole-breast RT consisting of five daily fractions of 5.2 Gy (FAST-FORWARD regimen) followed by a tumor-bed boost of three daily fractions of 3 Gy.

Results: Grade 1 early breast toxicity (skin changes and altered breast consistency) was documented in 20% of patients within the first 3 months after treatment completion. No events of acute pneumonitis were reported. Whole-breast and tumor-bed boost volumes did not affect the occurrence of breast toxicity. Minimal radiation-induced lung injury (grade 1) was noted in 95.8% of patients, while one patient (4.2%) developed grade 2 lung toxicity, which was later downgraded to grade 1 at the 12-month post-RT time point. With a median follow-up of 72 months, none of the patients presented with locoregional recurrence or distant metastases.

Conclusion: The present study highlights the safety of a hypofractionated RT boost to the tumor bed after ultra-hypofractionated whole-breast RT. No clear evidence exists to date regarding the superiority of delivering a tumor bed boost after ultra-hypofractionated RT or the specific patient subgroups to which a boost should be prescribed.

In breast cancer (BC), surgical treatment of the axilla has undergone a paradigm shift from axillary lymph node dissection (ALND), through sentinel lymph node biopsy (SLNB), and ultimately to omission of axillary surgery. In BC, following neoadjuvant systemic therapy (NAST), there has also been a de-escalation from ALND to SLNB and targeted axillary dissection, with false-negative rates reduced to an acceptable level of less than 10%. Trials are ongoing to omit ALND when SLNB is positive in post-NAST BC cases. Additionally, ongoing trials are evaluating the omission of axillary surgery in post-NAST ycN0 patients. Based on an extensive literature search, this review highlights the sequential de-escalation of axillary surgery in patients with early breast cancer (EBC), irrespective of whether surgery was performed upfront or after NAST, with the same oncological outcomes on follow-up. cTis, 1-3 cN0 and cTis, 1-2 cN0-1 EBC patients have been included. Trials and studies involving cT0-4 and cN1-2 BC patients, and trials including both EBC and locally advanced BC patients, have been excluded to keep the study population uniform, consisting only of EBC cases. Examples of trials discussed in this review include NSABP-B04, NSABP-B 32, ACOSOG Z 11, IBCSG 23-01, AMAROS, SENOMAC, SOUND, INT 09/98, ALLIANCE A011202, AXSANA, EUBREAST-01, among others. In conclusion, de-escalation of surgical intervention to the axilla in EBC patients planned for upfront surgery or NAST requires an individualized approach based on the patient's condition and favorable tumor subtype. To date, a positive SLNB after NAST mandates ALND. Trials to nullify the same, with non-inferior oncological outcomes, are underway. There is a shift towards avoiding axillary surgery altogether in favourable BC cases.

Lead (Pb), a ubiquitous environmental contaminant, is a toxic heavy metal known to interfere with enzymatic and hormonal processes. Its classification as a probable human carcinogen by international agencies has raised concerns about its potential role in cancer, including breast cancer (BC). This review critically examines epidemiological and experimental evidence linking Pb exposure to BC, emphasizing the impact of biological matrices used for Pb measurement on the consistency of findings. A systematic review following PRISMA guidelines was conducted. Eligible studies quantified Pb in breast tissues, blood, urine, hair, or toenails and assessed its association with BC risk. Animal studies and non-English publications were excluded. Twenty-seven studies (described in 23 publications) quantified Pb in human biological matrices: breast tissue (n = 6), urine (n = 6), blood (n = 9), hair (n = 4), and toenail (n = 2). Among them, 16 reported a positive association between Pb and BC risk (breast tissues: 4; urine: 3; blood: 6; hair: 3; toenails: 0). By contrast, 11 studies found no significant correlation (breast tissues: 2; urine: 3; blood: 3; hair: 1; toenail: 2). Four studies quantified Pb in different matrices, and the same results were obtained from analyses of breast tissue, blood, and hair. Discrepancies across studies included small sample sizes, heterogeneous demographic characteristics, insufficient follow-up, and different Pb assessment methods. While the majority of studies suggest a potential link between Pb exposure and BC, significant heterogeneity in study design and population selection limits definitive conclusions. Future research should standardize Pb measurement protocols in selected populations and explore mechanistic pathways to clarify this potential association and improve prevention strategies.

Primary giant cell tumors (GCTs) of soft tissue of the breast are extremely rare breast tumors, with only ten cases previously reported in the English literature. They are not suspected clinically, and clinically and histopathologically too, can mimic breast carcinoma or phyllodes tumor, and cause diagnostic dilemma. It is important to correctly recognize these tumors, due to management implications. Hereby, we present a case of 58 year old female with GCT of the breast presenting as a malignant breast tumor.

Objective: Regional nodal irradiation (RNI) is one of the main causes of breast cancer-related lymphedema (BCRL). However, studies on the relationship between the radiation dose to the axillary-lateral thoracic vessel juncture (ALTJ) region and BCRL have reported conflicting results. Based on these findings, we aimed to evaluate the clinical relevance of the dose to the ALTJ region in our patient cohort.

Materials and methods: Patients diagnosed with breast cancer and who were treated at Koç University Hospital between 2016 and 2022 and received RNI were included. BCRL was defined as a difference in arm circumference between the ipsilateral and contralateral limb >2.5 cm at any single encounter or ≥2 cm on ≥2 visits. ALTJ was retrospectively contoured, and doses were recorded as equivalent dose (α/β = 3).

Results: Of the 129 patients (median age 49 years) who met the inclusion criteria, 12 (9.3%) had lymphedema. Two-thirds of the patients (66.7%) were stage II, and one-third (33.3%) were stage III. The median follow-up was 22 months. The median (range) ALTJ D_mean dose was 18.11 (1.87-50) Gy, the median ALTJ D_max was 44.53 (12.8-71.1) Gy, and the median ALTJ V35 was 38% (1-100%). No significant association was determined between ALTJ parameters and BCRL.

Conclusion: There is insufficient data to define ALTJ as an OAR for decreasing BCRL risk. It is not appropriate to define dose and target based on ALTJ. Prospective studies with larger patient populations are needed to clarify the relationship between ALTJ and lymphedema.

Objective: Accurate classification of breast cancer susceptibility gene (BRCA)1/2 variants is important to delineate candidates for surgical or medical treatment. We retrospectively analyzed BRCA1/BRCA2 sequencing data and reclassified the BRCA1/2 variants of unknown significance (VUS) in Turkish patients with breast, ovarian, pancreatic and prostate cancers.

Materials and methods: BRCA1/BRCA2 sequence data of a large cohort were retrospectively analyzed. The sequencing data were reinterpreted in the context of American College of Medical Genetics guidelines, the Evidence-based Network for the Interpretation of Germline Mutant Alleles BRCA1/2 classification rules, and current public genomic databases.

Results: Among the total of 2,713 patients, 254 (9.36%) had BRCA1 or BRCA2 variants. A total of 264 BRCA1/BRCA2 variants were detected. Of these, 130 (49.2%) were pathogenic variants (PV), 24 (9%) were likely pathogenic (LP) and 110 of 264 variants (41.6%) were VUS. For the 119 BRCA1 variants, 68% (n = 81) were PV, 7.5% (n = 9) were LP, and 24.5% (n = 29) were VUS. Similarly, for the 145 BRCA2 variants, 33.7% (n = 49) were PV, 10.3% (n = 15) were LP, and 55.8% (n = 81) were VUS. Reanalysis of the 110 BRCA1+BRCA2 VUS variants led to 22 (20%) being reclassified. Of these 22, 45.4% (n = 10) were reclassified as P/LP and 54.6% (n = 12) were reclassified as benign/likely benign.

Conclusion: These results show that it may be possible to reclassify VUS, in this case BRCA1/2 VUS, in light of changing genetic data. These results demonstrate the importance of VUS reclassification of BRCA1/2 variants in clinical management, surgical decisions, risk counseling and screening.