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Depression and Anxiety Symptoms Before and After Breast-Cancer Diagnosis Among Young Women in the Northern Finland Birth Cohort 1966. 1966 年北芬兰出生队列中年轻女性诊断乳腺癌前后的抑郁和焦虑症状》(Northern Finland Birth Cohort 1966.
IF 1.3 Q4 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.4274/ejbh.galenos.2024.2024-7-1
Anniina Tastula, Arja Jukkola, Anni-Emilia Alakokkare, Tanja Nordström, Peeter Karihtala, Jouko Miettunen, Sami Räsänen

Objective: The aim of the study was to explore depressive, anxiety, and mental-health related somatic symptoms among young breast-cancer survivors by considering symptoms before and after cancer onset.

Materials and methods: The study sample included females from the prospective Northern Finland Birth Cohort 1966. Symptoms were assessed with the Hopkins Symptom Checklist-25 at the age of 31 and 46 years. We studied both subscales of depressive, anxiety, and somatic symptoms and single symptoms in secondary analyses.

Results: Thirty-one cases and 3.077 controls were included. Females diagnosed with breast cancer 3-8 years before the 46-year follow-up had increased depressive (p = 0.005) and somatic symptoms (p = 0.028) at the 46-year follow-up compared with the 31-year follow-up. This was not observed among those diagnosed <3 or >8 years before or among controls. Females diagnosed with breast cancer reported more lack of strength or energy compared with controls at the 46-year follow-up (p = 0.047). Among females who did not report feeling that the future is hopeless at the 31-year follow-up, significantly more females diagnosed with breast cancer reported this feeling at the 46-year follow-up compared with controls (p = 0.006).

Conclusion: Depressive and somatic symptoms increased significantly among young females at 3-8 years after breast-cancer diagnosis compared with the time before the cancer diagnosis. Psychosocial measures of support for breast-cancer survivors should be provided over the long-term.

研究目的研究旨在通过考虑癌症发病前后的症状,探讨年轻乳腺癌幸存者的抑郁、焦虑和与心理健康相关的躯体症状:研究样本包括1966年北芬兰前瞻性出生队列中的女性。在 31 岁和 46 岁时,使用霍普金斯症状检查表-25 对症状进行评估。我们对抑郁、焦虑和躯体症状的子量表以及单一症状进行了二次分析:结果:共纳入 31 例病例和 3.077 例对照。与 31 年的随访相比,在 46 年的随访中,在 3-8 年前诊断出乳腺癌的女性抑郁症状(p = 0.005)和躯体症状(p = 0.028)有所增加。而在 8 年前确诊的患者或对照组中则未观察到这种情况。与对照组相比,确诊为乳腺癌的女性在 46 年的随访中更多地表示缺乏力量或精力(p = 0.047)。在 31 年随访时未报告感觉未来无望的女性中,与对照组相比,在 46 年随访时报告感觉未来无望的确诊乳腺癌女性显著增多(p = 0.006):结论:与癌症确诊前相比,年轻女性在乳腺癌确诊后 3-8 年的抑郁症状和躯体症状明显增加。应为乳腺癌幸存者提供长期的社会心理支持措施。
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引用次数: 0
Dietary Patterns and Breast Cancer Risk: A KCPS-II Cohort Study. 饮食模式与乳腺癌风险:KCPS-II 队列研究。
IF 1.3 Q4 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.4274/ejbh.galenos.2024.2024-3-4
Ji-Young Lee, Hae In Cho, Heejin Kimm

Objective: There have been inconsistencies in the evidence for a role of dietary patterns in the development of breast cancer. In this study, we used a large-scale cohort [Korean Cancer Prevention Study-II (KCPS-II)] to examine the association between dietary patterns and breast cancer risk in Korean women.

Materials and methods: The dietary patterns of 14,807 women from the KCPS-II were derived by factor analysis and 135 cases of breast cancer were diagnosed during the follow-up period. Cox proportional models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of breast cancer.

Results: The following three major dietary patterns were identified: "Korean dietary pattern" (high intake of Kimchi, vegetables, and rice); "sweet dietary pattern" (high intake of soda and sugar); and "new (Western-like) dietary pattern" (high intake of dairy products, eggs, oil, fruits, and bread). After adjusting for potential confounders, neither the Korean (HR for the highest compared with the lowest tertile, 1.04; 95% CI 0.53-2.06) nor the sweet dietary patterns were associated with the risk of breast cancer. In contrast, the new (Western-like) dietary pattern was found to be significantly associated with an increased risk of breast cancer with an HR (95% CI) of 1.01 (0.65-1.60) for the second tertile and 1.61 (1.04-2.50) for the third tertile as compared with the lowest tertile. After stratifying by menopausal status, these effects were only statistically significant among premenopausal women for the third tertile, compared with those in the bottom tertile (HR 1.69; 95% CI 1.06-2.68; p = 0.028). No significant association was observed between the Korean or sweet dietary pattern and breast cancer among either pre- or postmenopausal women.

Conclusion: Our findings revealed that a greater consumption of a new (Western-like) diet was associated with an increased breast cancer risk and consequently offer a potential prevention strategy for Korean women.

目的:关于膳食模式在乳腺癌发病中的作用,证据并不一致。在这项研究中,我们利用大规模队列[韩国癌症预防研究-II(KCPS-II)]来研究韩国女性的饮食模式与乳腺癌风险之间的关系:通过因子分析得出了韩国癌症预防研究-II(KCPS-II)中 14 807 名女性的膳食模式,并在随访期间确诊了 135 例乳腺癌患者。采用 Cox 比例模型估算乳腺癌风险的危险比(HRs)和 95% 的置信区间(CIs):结果:确定了以下三种主要饮食模式:结果:确定了以下三种主要饮食模式:"韩国饮食模式"(泡菜、蔬菜和大米的高摄入量);"甜饮食模式"(苏打水和糖的高摄入量);以及 "新(类似西方)饮食模式"(乳制品、鸡蛋、油、水果和面包的高摄入量)。在对潜在的混杂因素进行调整后,韩国饮食模式(与最低三分位数相比,最高三分位数的 HR 为 1.04;95% CI 为 0.53-2.06)和甜食饮食模式都与乳腺癌风险无关。与此相反,新型(类西式)膳食模式被发现与乳腺癌风险的增加显著相关,与最低三分位数相比,第二三分位数的 HR(95% CI)为 1.01(0.65-1.60),第三三分位数的 HR 为 1.61(1.04-2.50)。根据绝经状况进行分层后,只有绝经前妇女的第三分层与最低分层相比才具有统计学意义(HR 1.69;95% CI 1.06-2.68;P = 0.028)。在绝经前或绝经后妇女中,均未观察到韩式或甜食饮食模式与乳腺癌之间存在明显关联:我们的研究结果表明,更多地摄入新式(类似西方的)饮食与乳腺癌风险的增加有关,因此为韩国妇女提供了一种潜在的预防策略。
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引用次数: 0
Predictors of Unilateral Arm Lymphedema in Non-obese Locoregionally Advanced Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy, Modified Radical Mastectomy, and Postoperative Irradiation. 接受新辅助化疗、改良根治性乳房切除术和术后放疗的非肥胖局部晚期乳腺癌患者单侧手臂淋巴水肿的预测因素
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2024-1-11
S. Dwivedi, Amiy Arnav, Varun Kumar Agarwal, S. K. Deshpande, Rohit Sharma, Naresh Saidha
ObjectiveThe most dreaded long-term complication of axillary lymph node dissection remains upper arm lymphedema. Our study has strategized the three most common identified causes of post treatment arm lymphedema, i.e., obesity, radiation, and neoadjuvant chemotherapy and tried to identify the histopathological and clinical or surgical factors which can predict arm lymphedema.Materials and MethodsThis is a prospective observational study was conducted at a tertiary care referral centre in India, with strict inclusion criteria of BMI <30 kg/m2, age <75 years, presence of metastatic axillary node proven by FNAC, received anthracycline based neoadjuvant chemotherapy and postoperative nodal irradiation, and completed 24 months of regular follow-up.ResultsTotal of 70 patients were included in the study. The mean age of the patients was 50.3 years (±12.9). lymphovascular invasion, total number of lymph nodes removed from level III, total number of days drain was left in situ and maximum drain output were found to be significantly (p<0.05) associated with arm lymphedema.ConclusionIn patients undergoing modified radical mastectomy with level III dissection, and postoperative irradiation, the incidence of unilateral arm lymphedema is significantly influenced by several clinicopathological factors like the total number of lymph nodes removed in level III, higher maximal drain output, prolonged duration of drain placement and the presence of lymphovascular invasion.
目的腋窝淋巴结清扫术后最可怕的长期并发症仍然是上臂淋巴水肿。我们的研究针对治疗后手臂淋巴水肿最常见的三个原因,即肥胖、放疗和新辅助化疗进行了分析、肥胖、放疗和新辅助化疗,并试图找出可预测手臂淋巴水肿的组织病理学、临床或手术因素。材料和方法这是一项前瞻性观察研究,在印度的一家三级医疗转诊中心进行,严格的纳入标准是体重指数小于 30 kg/m2、年龄小于 75 岁、经 FNAC 证实存在转移性腋窝结节、接受过以蒽环类为基础的新辅助化疗和术后结节照射,并完成了 24 个月的定期随访。研究发现,淋巴管侵犯、III级淋巴结切除总数、引流管留在原位的总天数和最大引流管输出量与手臂淋巴水肿有显著相关性(P<0.05)。结论 在接受改良根治性乳房切除术并进行 III 层清扫和术后照射的患者中,单侧手臂淋巴水肿的发生率受多个临床病理学因素的显著影响,如 III 层淋巴结清除总数、最大引流管输出量较高、引流管放置时间较长以及存在淋巴管侵犯。
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引用次数: 0
Evaluation of Breast Health Promotion Intervention Among Catholic Nuns in Lake Zone 'Tanzania. 坦桑尼亚湖区天主教修女乳房健康促进干预评估。
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2024-1-10
Gotfrida Marandu, Kija Malale, Rose Laisser, Joseph Mwanga, Paul Alikado Sabuni, P. Rambau
ObjectiveDespite facing unique barriers, Catholic nuns in Tanzania require accessible breast health promotion. This study explores interventions to empower nuns through knowledge, improved attitudes, and positive practices, ultimately promoting well-being and early detection for better breast cancer outcomes.Materials and MethodsA quasi-experimental design study guided by the Health Belief Model was conducted to monitor the implementation of a breast health intervention program aimed at increasing breast cancer screening knowledge among 385 Catholic nuns aged 20 to over 60 years old within Lake Zone, Tanzania. Data were collected at two-time points: pre-intervention (baseline) and implementation phase intervention (after three months). The intervention consisted of a 2-hour educational session. Participants had opportunities to ask questions and provide feedback.ResultsThe breast health promotion intervention was well-received by Catholic nuns, with 339 (88%) expressing strong motivation to learn and promote awareness. The training effectively increased knowledge and positive attitudes towards breast cancer screening. Researcher assistants successfully delivered the program, and 354 (92%) of participants expressed interest in continued education and support. The intervention addressed cultural barriers and empowered nuns to take charge of their health, though some challenges remain meanwhile 158 (41%) had limited prior knowledge, 81 (21%) hesitated to discuss breast health due to religious beliefs, and some faced difficulty applying the learnings.ConclusionOverall, the breast health promotion intervention had a positive outcome on the Catholic nuns' awareness and knowledge of breast health. However, addressing the identified barriers and challenges is crucial to further enhance the intervention's effectiveness and sustainability.
尽管面临独特的障碍,坦桑尼亚的天主教修女仍需要获得乳房健康促进服务。本研究探讨了通过知识、改善态度和积极实践来增强修女能力的干预措施,最终促进她们的健康和早期发现,从而改善乳腺癌的治疗效果。材料与方法在健康信念模型的指导下开展了一项准实验设计研究,以监测乳房健康干预计划的实施情况,该计划旨在提高坦桑尼亚湖区 385 名年龄在 20 岁至 60 岁以上的天主教修女的乳腺癌筛查知识。数据在两个时间点收集:干预前(基线)和干预实施阶段(三个月后)。干预包括 2 小时的教育课程。结果乳房健康促进干预受到了天主教修女们的欢迎,339 名修女(88%)表达了强烈的学习动机和促进意识。培训有效地提高了对乳腺癌筛查的认识和积极态度。研究人员助理成功实施了该计划,354 名参与者(92%)表示有兴趣继续接受教育和支持。这项干预措施消除了文化障碍,增强了修女对自身健康负责的能力,但仍存在一些挑战:158 名修女(41%)的先前知识有限,81 名修女(21%)因宗教信仰而在讨论乳房健康问题时犹豫不决,还有一些修女在应用所学知识时遇到困难。然而,解决已发现的障碍和挑战对于进一步提高干预的有效性和可持续性至关重要。
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引用次数: 0
The Relationship of Pathological Response and Visceral Muscle and Fat Volume in Women With Breast Cancer Who Received Neoadjuvant Chemotherapy. 接受新辅助化疗的乳腺癌妇女的病理反应与内脏肌肉和脂肪体积的关系
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2023-12-5
Tuba Kayan Tapan, Filiz Çelebi, Kourosh Yaghouti, F. Ağaçayak, Serkan Ilgün, G. Soybir, G. Alço, N. Ak, Ç. Ordu, E. Özkurt, Ç. Ünal, Sevgi Kurt, Alper Öztürk, Z. İyigün, T. Duymaz, V. Özmen
ObjectiveDifferences in individual muscle/fat volumes may change the effectiveness of chemotherapy. In this study, the relationship between trunkal muscle and fat volume and body mass index (BMI) obtained before receiving neoadjuvant chemotherapy (NCT) in patients with breast cancer and complete pathological response (pCR) was investigated.Materials and MethodsThe volumes of psoas, abdominal and paraspinal muscles, and trunkal subcutaneous and visceral fat were calculated using CoreSlicer AI 2.0 opensource program from the F-18 fluorodeoxyglucose positron emission tomography/computed tomography (CT) and CT images before NCT and postoperative pCR rates to NCT were recorded. Muscle/fat volumes and BMI prior to NCT were compared in terms of pathological pCR rates. Patients were followed up regularly for recurrence and survival.ResultsNinety-three patients were included with median (range) values for age, BMI, and body weights of 48 (28-72) years, 27 (16.8-51.6) kg/m2, and 71.94 (43-137) kg, respectively. The median follow-up time was 18.6 (6.7-59.6) months. No significant correlation was found between total muscle or fat volumes of patients with and without pCR. BMI [26.2 (16.8-51.6) kg/m2 vs. 24.6 (20.3-34.3) kg/m2, p = 0.03] and pCR rates in patients with low right-psoas muscle volume [11.74 (7.03-18.51) vs. 10.2 (6.71-13.36), p = 0.025] were significantly greater. A significant relationship was found between right psoas muscle volume and disease-free survival (DFS) (11.74 cm3 (7.03-18.51) vs. 10.2 cm3 (6.71-13.36), p = 0.025). However, no significant relationship was detected between total muscle-fat volume, BMI and overall survival and DFS (p>0.05).ConclusionThis is the first published study investigating the relationship between the pCR ratio and body muscle and fat volume measured by CoreSlicer AI 2.0 in patients with breast cancer who received NCT. No correlation was found between the pCR ratio and total muscle plus fat volume. However, these results need to be validated with larger patient series.
目的个体肌肉/脂肪体积的差异可能会改变化疗的效果。本研究探讨了乳腺癌完全病理反应(pCR)患者在接受新辅助化疗(NCT)前躯干肌肉和脂肪体积与体重指数(BMI)之间的关系。材料与方法 使用 CoreSlicer AI 2.0 开源程序从 F-18 氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(CT)和 NCT 前的 CT 图像中计算腰肌、腹肌和脊柱旁肌肉以及躯干皮下和内脏脂肪的体积,并记录术后 NCT 的 pCR 率。就病理 pCR 率而言,对 NCT 前的肌肉/脂肪体积和 BMI 进行了比较。结果共纳入 93 例患者,其年龄、体重指数和体重的中位值(范围)分别为 48 (28-72) 岁、27 (16.8-51.6) kg/m2 和 71.94 (43-137) kg。随访时间中位数为 18.6 (6.7-59.6) 个月。有 pCR 和无 pCR 患者的总肌肉或脂肪体积之间没有发现明显的相关性。体重指数[26.2 (16.8-51.6) kg/m2 vs. 24.6 (20.3-34.3) kg/m2,p = 0.03]和右侧腰肌体积低患者的 pCR 率[11.74 (7.03-18.51) vs. 10.2 (6.71-13.36),p = 0.025]明显更高。右侧腰肌体积与无病生存期(DFS)之间存在明显关系(11.74 cm3 (7.03-18.51) vs. 10.2 cm3 (6.71-13.36),p = 0.025)。结论这是第一项公开发表的研究,调查了接受 NCT 的乳腺癌患者的 pCR 比值与 CoreSlicer AI 2.0 测量的身体肌肉和脂肪体积之间的关系。没有发现 pCR 比值与肌肉和脂肪总体积之间存在相关性。不过,这些结果还需要通过更大规模的患者系列来验证。
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引用次数: 0
Histopathological Features Predicting Neuroendocrine Morphology in Primary Breast Tumors: A Retrospective Analysis. 预测原发性乳腺肿瘤神经内分泌形态的组织病理学特征:回顾性分析
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2023-12-10
M. Ozsen, K. Şenol, Ş. Tolunay, M. S. Gokgoz, T. Evrensel
ObjectiveNeuroendocrine neoplasms of primary breast tumors are rare compared to locations, such as the respiratory system and gastrointestinal system, where they are frequently observed. The diagnostic criteria for primary neuroendocrine tumors of the breast have been changed since first description. Morphological and immunohistochemical features helpful in their diagnosis, which vary due to the heterogeneous nature of these tumors, are highlighted in this retrospective study. The purpose was to determine specific histopathological features that can identify neuroendocrine morphology in primary breast tumors.Materials and MethodsCases diagnosed with invasive breast carcinoma from resection materials in a single center between 2011 and 2022 and in which neuroendocrine markers were investigated were included. Demographic information, initial histopathological diagnosis, presence of tumor in another organ, tumor location, size and surgical details of the cases were obtained from the hospital database and pathology reports. The slides were re-evaluated in terms of tumor growth pattern, cribriformity, tubule formation, nuclear features, prominence of nucleoli, palisading and basal location of nuclei, presence of grooves, cytoplasmic features and evidence of cytoplasmic border.ResultsThe presence of basally located nuclei, absence of tubule formation, inconspicuous nucleoli, fine nuclear chromatin, granular cytoplasm and inconspicuous cytoplasmic borders were frequent findings in tumors with neuroendocrine features (p<0.05). These features may help differentiate primary breast tumors with neuroendocrine features from other breast carcinomas.ConclusionThe histopathological features that are different from the specific features seen in classical neuroendocrine tumors, the absence of specific clinical and radiological findings, the inability to study neuroendocrine markers in every laboratory and the need to prove that the breast tumor is not a metastasis all create diagnostic difficulties for primary breast neuroendocrine neoplasms. We believe that the results of this study may help diagnose and identify more specific histomorphological features that help determine neuroendocrine morphology in primary breast tumors.
目的原发性乳腺神经内分泌肿瘤与呼吸系统和胃肠道系统等部位的肿瘤相比较为罕见。自首次描述以来,乳腺原发性神经内分泌肿瘤的诊断标准一直在变化。本回顾性研究强调了有助于诊断的形态学和免疫组化特征,这些特征因肿瘤的异质性而各不相同。材料与方法纳入 2011 年至 2022 年期间在一个中心从切除材料中诊断出浸润性乳腺癌并对神经内分泌标记物进行调查的病例。从医院数据库和病理报告中获取病例的人口统计学信息、最初的组织病理学诊断、肿瘤是否存在于其他器官、肿瘤位置、大小和手术细节。根据肿瘤生长模式、楔形、小管形成、核特征、核小叶突出、核淡化和基底位置、沟槽存在、细胞质特征和细胞质边界证据等方面对切片进行了重新评估。结果 在具有神经内分泌特征的肿瘤中,核基底位置、无小管形成、核小叶不明显、核染色质细、颗粒状细胞质和细胞质边界不明显是常见的发现(P<0.05)。这些特征可能有助于将具有神经内分泌特征的原发性乳腺肿瘤与其他乳腺癌区分开来。结论组织病理学特征不同于经典神经内分泌肿瘤的特异性特征,缺乏特异性临床和放射学发现,无法在每个实验室研究神经内分泌标记物,以及需要证明乳腺肿瘤不是转移瘤,所有这些都给原发性乳腺神经内分泌肿瘤的诊断带来了困难。我们相信,这项研究的结果可能有助于诊断和确定更具体的组织形态学特征,从而帮助确定原发性乳腺肿瘤的神经内分泌形态。
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引用次数: 0
Artificial Intelligence in Senology - Where Do We Stand and What Are the Future Horizons? 神学中的人工智能--我们的现状和未来前景如何?
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2023-12-13
Alexander Mundinger, Carolin Mundinger
Artificial Intelligence (AI) is defined as the simulation of human intelligence by a digital computer or robotic system and has become a hype in current conversations. A subcategory of AI is deep learning, which is based on complex artificial neural networks that mimic the principles of human synaptic plasticity and layered brain architectures, and uses large-scale data processing. AI-based image analysis in breast screening programmes has shown non-inferior sensitivity, reduces workload by up to 70% by pre-selecting normal cases, and reduces recall by 25% compared to human double reading. Natural language programs such as ChatGPT (OpenAI) achieve 80% and higher accuracy in advising and decision making compared to the gold standard: human judgement. This does not yet meet the necessary requirements for medical products in terms of patient safety. The main advantage of AI is that it can perform routine but complex tasks much faster and with fewer errors than humans. The main concerns in healthcare are the stability of AI systems, cybersecurity, liability and transparency. More widespread use of AI could affect human jobs in healthcare and increase technological dependency. AI in senology is just beginning to evolve towards better forms with improved properties. Responsible training of AI systems with meaningful raw data and scientific studies to analyse their performance in the real world are necessary to keep AI on track. To mitigate significant risks, it will be necessary to balance active promotion and development of quality-assured AI systems with careful regulation. AI regulation has only recently included in transnational legal frameworks, as the European Union's AI Act was the first comprehensive legal framework to be published, in December 2023. Unacceptable AI systems will be banned if they are deemed to pose a clear threat to people's fundamental rights. Using AI and combining it with human wisdom, empathy and affection will be the method of choice for further, fruitful development of tomorrow's senology.
人工智能(AI)的定义是通过数字计算机或机器人系统模拟人类智能,已成为当下的热门话题。深度学习是人工智能的一个子类别,它基于复杂的人工神经网络,模仿人类突触可塑性和分层大脑架构的原理,并使用大规模数据处理。在乳腺筛查项目中,基于人工智能的图像分析显示出非凡的灵敏度,通过预选正常病例,最多可减少 70% 的工作量,与人工双读相比,召回率降低了 25%。自然语言程序(如 ChatGPT (OpenAI))与黄金标准(即人类判断)相比,在建议和决策方面达到了 80% 或更高的准确率。就患者安全而言,这还不能满足医疗产品的必要要求。人工智能的主要优势在于,它可以比人类更快、更少地完成常规但复杂的任务。医疗保健领域的主要问题是人工智能系统的稳定性、网络安全、责任和透明度。更广泛地使用人工智能可能会影响人类在医疗保健领域的工作,并增加技术依赖性。人工智能在老年学领域的应用才刚刚开始,它正朝着具有更好特性的更佳形式发展。有必要利用有意义的原始数据对人工智能系统进行负责任的培训,并开展科学研究来分析其在现实世界中的表现,以确保人工智能的正常运行。为了降低重大风险,有必要在积极推广和开发有质量保证的人工智能系统与谨慎监管之间取得平衡。人工智能监管最近才被纳入跨国法律框架,欧盟的《人工智能法》是 2023 年 12 月公布的第一个全面法律框架。不可接受的人工智能系统如果被认为对人们的基本权利构成明显威胁,将被禁止使用。利用人工智能并将其与人类的智慧、同理心和感情相结合,将是进一步发展未来智能学并取得丰硕成果的首选方法。
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引用次数: 0
Radiomics Analysis of Contrast-Enhanced Breast MRI for Optimized Modelling of Virtual Prognostic Biomarkers in Breast Cancer. 对比度增强型乳腺磁共振成像的放射组学分析,用于优化乳腺癌虚拟预后生物标记物的建模。
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2023-12-12
Dogan S. Polat, Y. Xi, Keith Hulsey, Matthew Lewis, B. Dogan
ObjectiveBreast cancer clinical stage and nodal status are the most clinically significant drivers of patient management, in combination with other pathological biomarkers, such as estrogen receptor (ER), progesterone receptor or human epidermal growth factor receptor 2 (HER2) receptor status and tumor grade. Accurate prediction of such parameters can help avoid unnecessary intervention, including unnecessary surgery. The objective was to investigate the role of magnetic resonance imaging (MRI) radiomics for yielding virtual prognostic biomarkers (ER, HER2 expression, tumor grade, molecular subtype, and T-stage).Materials and MethodsPatients with primary invasive breast cancer who underwent dynamic contrast-enhanced (DCE) breast MRI between July 2013 and July 2016 in a single center were retrospectively reviewed. Age, N-stage, grade, ER and HER2 status, and Ki-67 (%) were recorded. DCE images were segmented and Haralick texture features were extracted. The Bootstrap Lasso feature selection method was used to select a small subset of optimal texture features. Classification of the performance of the final model was assessed with the area under the receiver operating characteristic curve (AUC).ResultsMedian age of patients (n = 209) was 49 (21-79) years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the model for differentiating N0 vs N1-N3 was: 71%, 79%, 76%, 74%, 75% [AUC = 0.78 (95% confidence interval (CI) 0.72-0.85)], N0-N1 vs N2-N3 was 81%, 59%, 24%, 95%, 62% [AUC = 0.74 (95% CI 0.63-0.85)], distinguishing HER2(+) from HER2(-) was 79%, 48%, 34%, 87%, 56% [AUC = 0.64 (95% CI 0.54-0.73)], high nuclear grade (grade 2-3) vs low grade (grades 1) was 56%, 88%, 96%, 29%, 61% [AUC = 0.71 (95% CI 0.63-0.80)]; and for ER (+) vs ER(-) status the [AUC=0.67 (95% CI 0.59-0.76)]. Radiomics performance in distinguishing triple-negative vs other molecular subtypes was [0.60 (95% CI 0.49-0.71)], and Luminal A [0.66 (95% CI 0.56-0.76)].ConclusionQuantitative radiomics using MRI contrast texture shows promise in identifying aggressive high grade, node positive triple negative breast cancer, and correlated well with higher nuclear grades, higher T-stages, and N-positive stages.
目的乳腺癌的临床分期和结节状态与其他病理生物标志物(如雌激素受体(ER)、孕激素受体或人表皮生长因子受体 2(HER2)受体状态和肿瘤分级)相结合,对患者的管理具有最重要的临床意义。准确预测这些参数有助于避免不必要的干预,包括不必要的手术。研究旨在探讨磁共振成像(MRI)放射组学在产生虚拟预后生物标志物(ER、HER2表达、肿瘤分级、分子亚型和T期)方面的作用。材料与方法回顾性研究了2013年7月至2016年7月期间在一个中心接受动态对比增强(DCE)乳腺磁共振成像检查的原发性浸润性乳腺癌患者。记录了年龄、N期、分级、ER和HER2状态以及Ki-67(%)。对 DCE 图像进行分割并提取 Haralick 纹理特征。采用 Bootstrap Lasso 特征选择法选出一小部分最佳纹理特征。结果患者(209 人)的平均年龄为 49(21-79)岁。该模型区分 N0 与 N1-N3 的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为:71%、79%、76%、74%、75% [AUC = 0.78(95% 置信区间 (CI) 0.72-0.85)],区分 N0-N1 与 N2-N3 的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为:81%、59%、24%、95%、62% [AUC = 0.74(95% 置信区间 (CI) 0.63-0.85)],区分 HER2(+)和 HER2(-)的比例分别为 79%、48%、34%、87%、56% [AUC = 0.64 (95% CI 0.54-0.73)],核分级高(2-3级)与核分级低(1级)的比例分别为56%、88%、96%、29%、61%[AUC=0.71(95% CI 0.63-0.80)];ER(+)与ER(-)的比例分别为[AUC=0.67(95% CI 0.59-0.76)]。结论使用磁共振成像对比纹理的定量放射组学有望识别侵袭性高级别、结节阳性的三阴性乳腺癌,并与较高的核分级、较高的T分期和N阳性分期有很好的相关性。
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引用次数: 0
Is STARD3 A New Biomarker for Breast Cancer? STARD3 是乳腺癌的新生物标记物吗?
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2024-1-7
Almila Nazli Korucu, N. Inandiklioğlu
Despite advances in diagnosis and treatment, breast cancer is still one of the three most common cancers in the world and a significant cause of morbidity and mortality. Lipids play a role in many basic physiological pathways in cells, from regulating cell homeostasis to energy expenditure. As in many types of cancer, changes in lipid metabolism and their relationship have been reported in breast cancer. The STARD3 gene encodes a member of the subfamily of lipid trafficking proteins. It is a sterol-binding protein that mediates the transport of cholesterol from the endoplasmic reticulum to endosomes. It has been shown that STARD3 is correlated with human epidermal growth factor receptor 2 (HER2) amplification since it has the same localization as HER2 in the chromosome. In this review, we aimed to emphasize that investigating lipid metabolism together with the STARD3 biomarker has great potential not only for subtype-specific strategies but also for patient-specific strategies.
尽管在诊断和治疗方面取得了进步,乳腺癌仍然是世界上最常见的三大癌症之一,也是发病和死亡的重要原因。脂质在细胞的许多基本生理途径中发挥作用,从调节细胞稳态到能量消耗。与许多类型的癌症一样,乳腺癌中脂质代谢的变化及其关系也有报道。STARD3 基因编码脂质转运蛋白亚家族的一个成员。它是一种固醇结合蛋白,介导胆固醇从内质网向内体的转运。研究表明,STARD3 与人表皮生长因子受体 2(HER2)扩增相关,因为它与 HER2 在染色体中的定位相同。在这篇综述中,我们旨在强调,结合 STARD3 生物标记物研究脂质代谢不仅在亚型特异性策略方面具有巨大潜力,而且在患者特异性策略方面也具有巨大潜力。
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引用次数: 0
Comparison of Volume Measurements and Bioimpedance Spectroscopy Using A Stand-on Device for Assessment of Unilateral Breast Cancer-Related Lymphedema. 在评估单侧乳腺癌相关性淋巴水肿时,比较使用站立式设备进行的体积测量和生物阻抗分光光度法。
Q2 Medicine Pub Date : 2024-04-01 DOI: 10.4274/ejbh.galenos.2024.2023-12-8
L. C. Ward, Belinda Thompson, K. Gaitatzis, Louise A. Koelmeyer
ObjectiveBreast cancer related lymphedema (BCRL) may be assessed through objective measurement of limb swelling with common techniques including volumetric measurement using a tape measure or perometry, and measurement of extracellular water using bioimpedance spectroscopy (BIS). This study aimed to evaluate the performance of a stand-on BIS device for detection of BCRL, introduce a novel graphical method to compare volumetric and BIS methods alongside traditional specificity and sensitivity analysis, and determine and compare BIS thresholds with those published previously.Materials and MethodsFemale participants with indocyanine green lymphography confirmed unilateral arm lymphedema (n = 197) and healthy controls (n = 267) were assessed using a cross-sectional study design. BIS and volumetric measures were obtained in a single session.ResultsThe BIS lymphedema index (L-Dex) method had a significantly higher sensitivity than the excess volume approach (area under the curve = 0.832 vs. 0.649, p = 0.0001). A threshold of L-Dex 6.5 had a higher true positive rate (70.6%) than L-Dex 10 (68.5%) although false positive rate increased from 0.4% to 2.6%. A threshold of 5% excess volume improved the true positive rate (68.5%) compared with 10% excess volume (49.7%) however the false positive rate increased to an unacceptable 47%. The L-Dex ranges in this study were not significantly different from previously published ranges.ConclusionBIS was superior for identifying BCRL compared with volume measurements, reaffirming the value of this technique. However, it is recommended that BIS be used in conjunction with comprehensive evaluation of symptoms and clinical presentation. The proposed graphical method provides a simple and easily interpretable approach to compare and define concordance between the two commonly used methods for BCRL assessment namely limb volume and BIS L-Dex indices. The existing BIS (L-Dex) thresholds for presence of BCRL were also validated.
目的乳腺癌相关淋巴水肿(BCRL)可通过客观测量肢体肿胀来进行评估,常用的技术包括使用卷尺或周径测量法进行体积测量,以及使用生物阻抗光谱法(BIS)测量细胞外水分。本研究旨在评估站立式 BIS 设备在检测 BCRL 方面的性能,引入一种新颖的图形方法,与传统的特异性和灵敏度分析方法一起比较体积测量法和 BIS 方法,并确定和比较 BIS 阈值与之前公布的阈值。材料和方法采用横断面研究设计,对患有吲哚菁绿淋巴造影术证实的单侧手臂淋巴水肿的女性参与者(n = 197)和健康对照组(n = 267)进行评估。结果BIS淋巴水肿指数(L-Dex)法的灵敏度明显高于过量体积法(曲线下面积 = 0.832 vs. 0.649,p = 0.0001)。尽管假阳性率从 0.4% 上升到 2.6%,但 L-Dex 6.5 临界值的真阳性率(70.6%)高于 L-Dex 10 临界值(68.5%)。与超量 10%(49.7%)相比,超量 5%的阈值提高了真阳性率(68.5%),但假阳性率却增加到令人无法接受的 47%。本研究中的 L-Dex 范围与之前公布的范围没有明显差异。结论与容积测量相比,BIS 在识别 BCRL 方面更具优势,再次证明了该技术的价值。不过,建议在使用 BIS 时结合症状和临床表现的综合评估。所提出的图形方法提供了一种简单且易于解释的方法,用于比较和确定 BCRL 评估的两种常用方法(即肢体体积和 BIS L-Dex 指数)之间的一致性。现有的 BIS(L-Dex)阈值也对 BCRL 的存在进行了验证。
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引用次数: 0
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European journal of breast health
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