European journal of breast health最新文献

Objective: Breast lesions of uncertain malignant potential (B3) pose a diagnostic and management challenge. Surgical excision (SE) has traditionally been the standard for definitive diagnosis, but it may represent overtreatment. Percutaneous vacuum-assisted excision (VAE) offers a minimally invasive alternative. This study aimed to evaluate the safety and efficacy of VAE compared with SE for the management of B3 breast lesions, with the aim of reducing overtreatment.

Materials and methods: This retrospective single-center study included 64 patients with histologically confirmed B3 lesions diagnosed by tomosynthesis-guided vacuum-assisted breast biopsy between January 2018 and January 2024. Patients were managed by SE, VAE, or imaging follow-up, based on multidisciplinary team recommendations. Imaging characteristics, histopathology, upgrade rates, and follow-up outcomes were analyzed.

Results: Most lesions presented as microcalcifications (92%). The most common histological subtypes were atypical intraductal epithelial proliferation (37.5%) and lobular neoplasia (25%). SE was performed in 26 patients (40%), VAE in 22 (34%), and 16 (25%) underwent follow-up. Malignant upgrades occurred in 8 of 26 SE-treated lesions (30.8%), predominantly atypical intraductal epithelial proliferation, while no upgrades were observed in the VAE group (p = 0.007). Mean follow-up was longer for SE (42 months) than VAE (21 months, p = 0.036). One SE patient developed invasive carcinoma at 48 months; no malignant progression occurred after VAE.

Conclusion: VAE is a safe, minimally invasive and effective alternative to SE for carefully selected B3 lesions, particularly those without atypia and with imaging-pathology concordance, potentially reducing overtreatment. Multidisciplinary evaluation remains essential.

Objective: BRCA1/2 pathogenic variant carriers face a high risk of breast cancer, making early detection vital for minimizing systemic treatments. Contrast-enhanced magnetic resonance imaging (MRI) outperforms mammography and ultrasound in detecting lesions that are often missed, particularly in individuals with BRCA1 or BRCA2 variants. However, the effectiveness of MRI-guided biopsy remains unclear. Thus, the aim was to evaluate the effectiveness of MRI-guided biopsy in detecting malignancy among BRCA1/2 pathogenic variant carriers with MRI-only-detected breast lesions and compare these findings with those in non-carriers and assess lesion characteristics and diagnostic yield.

Materials and methods: We retrospectively analyzed. We compared the effectiveness of MRI-guided biopsy for BRCA1/2 pathogenic variant carriers with MRI-only-detected lesions with that of non-carriers between April 2018 and December 2022. We examined the clinicopathological characteristics and MRI findings of the BRCA1/2 carriers.

Results: A total of 130 lesions from 126 patients were reviewed. The BRCA1/2 mutation group had a significantly higher incidence of category 3 lesions on MRI. Invasive carcinoma was more prevalent among BRCA1/2 carriers, and non-carriers predominantly presented with ductal carcinoma in situ. MRI-guided biopsy identified malignant tumors in 30.1% of lesions. The positive predictive values were 42.9% for BRCA1/2 carriers and 28.6% for non-carriers.

Conclusion: MRI-guided biopsy was effective in detecting early-stage invasive carcinoma in BRCA1/2 carriers, highlighting its role in tailored surveillance strategies. For new lesions categorized as breast imaging reporting and data system 3 on MRI, biopsy should be considered, particularly for BRCA1/2 carriers. Prospective studies are needed to validate these findings and assess long-term clinical outcomes to inform personalized management approaches for high-risk populations.

Self-injection of non-medical substances, such as mineral or baby oil, into the breast for augmentation is an unsafe practice and can lead to serious complications. Chronic granulomatous inflammation and fat necrosis may develop, and the imaging findings may mimic breast cancer, creating diagnostic and therapeutic challenges. We present the case of an 18-year-old woman who developed bilateral breast pain and masses after self-injection of baby oil. We highlight the radiological and histopathological features and remind clinicians to consider foreign-body granulomatous reactions in the differential diagnosis of suspicious breast lesions.

Objective: This study examined body composition changes during neoadjuvant chemotherapy (NACT) for breast cancer and aimed to identify clinical parameters associated with skeletal muscle loss.

Materials and methods: We retrospectively analyzed women with stage I-III breast cancer who received NACT. Skeletal muscle and subcutaneous fat areas at the third lumbar vertebra were quantified on computed tomography and normalized for height to calculate the skeletal muscle index (SMI, cm²/m²) and subcutaneous fat index (SFI, cm²/m²). Pre- and post-NACT values were compared, and the prevalence of low skeletal muscle mass (LSMM, SMI <38.5 cm²/m²) and sarcopenic obesity (body mass index ≥30 kg/m² with LSMM) was determined. Multivariable linear regression assessed independent predictors of post-NACT SMI.

Results: A total of 177 patients (mean age 51.0±10.7 years; 24% with diabetes) were included. Mean SMI declined significantly after NACT (43.1±7.4 to 41.4±7.1 cm²/m²; mean change -1.7±3.1, p<0.001). SFI also decreased (132.9±59.2 to 123.5±55.1 cm²/m²; mean change -9.5±27.0, p<0.001). The prevalence of LSMM increased from 27.7% to 37.3% (p = 0.003), and sarcopenic obesity from 8.5% to 12.4%. Patients with diabetes experienced greater muscle loss than those without diabetes (-2.7 vs. -1.4 cm²/m²). Diabetes mellitus was the only independent predictor of post-NACT SMI decline (β = -1.42, p = 0.013), while age and chemotherapy regimen were not significant.

Conclusion: NACT is associated with significant reductions in skeletal muscle and subcutaneous fat, together with increased rates of LSMM. Diabetes mellitus independently predicted lower post-treatment SMI.

Objective: Mastectomy with immediate reconstruction is a primary surgical treatment for breast cancer. While both synthetic meshes and biological grafts are used in these procedures, their comparative effectiveness requires further investigation. This study evaluates the use of polytetrafluoroethylene (PTFE) mesh versus allogeneic dura mater (DM) in direct-to-implant breast reconstruction for reinforcing the inframammary fold (IMF) and stabilizing the implant.

Materials and methods: A prospective, randomized, open-label trial enrolled 116 patients (192 breasts) who underwent subcutaneous or skin-sparing mastectomies or subtotal radical resections, all followed by immediate subpectoral implant-based reconstruction. Participants were randomized to receive either a PTFE mesh (60 patients; 96 breasts) or a DM graft (56 patients; 96 breasts) for implant support. Outcomes were assessed through radiological imaging for complications, anthropometric measurements for IMF and implant stability, and the breast evaluation questionnaire version 2.0^© (reconstruction module) for quality of life.

Results: The PTFE group demonstrated a lower rate of major complications (3 vs. 7, respectively), while minor complications were comparable (23 vs. 28, respectively). Anthropometric analysis demonstrated that PTFE mesh provided superior stabilization of the IMF and the implant position postoperatively. Quality of life scores were comparable between the two groups.

Conclusion: The use of PTFE mesh in immediate subpectoral breast reconstruction provides reliable anti-gravitational stabilization of the IMF and implant, and is associated with a favorable complication profile and high patient-reported quality of life.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory breast disease of uncertain etiology. It often mimics infectious mastitis and inflammatory breast cancer in both clinical and radiologic presentations, leading to diagnostic and therapeutic challenges. This review aims to provide a comprehensive summary of the current literature regarding the etiology, pathogenesis, clinical manifestations, diagnostic strategies, and treatment options for IGM. A narrative review was conducted using an extensive search of the PubMed database, focusing on articles that discuss various aspects of IGM, including its potential autoimmune, hormonal, and infectious origins, as well as current diagnostic and management approaches. IGM most commonly affects women of reproductive age, often within a few years postpartum. Histologically, it is characterized by non-caseating granulomatous inflammation centered on breast lobules. Although corticosteroids are widely used as the first-line therapy, treatment regimens vary significantly across centers, and relapse is not uncommon. Immunosuppressive agents, such as methotrexate, have shown promising results in steroid-resistant cases. Surgical interventions are generally reserved for refractory cases because of the risk of recurrence and unfavourable cosmetic outcomes. The role of infectious agents, particularly Corynebacterium kroppenstedtii, remains controversial, and distinguishing between idiopathic and infectious GM is crucial for management. IGM is a multifactorial and clinically heterogeneous condition requiring individualized, multidisciplinary management. There remains a need for further prospective studies and consensus guidelines to optimize diagnosis and treatment, especially in recurrent or refractory cases.

Objective: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast disease with a high risk of relapse. The study objective was to evaluate relapse predictors and treatment outcomes in a large cohort of IGM patients.

Materials and methods: We retrospectively analyzed female patients diagnosed with IGM (2018-2024) at the Central Military Hospital, Baku. Diagnosis was confirmed by core needle biopsy. Patients were managed with systemic therapy (corticosteroids and/or immunosuppressants) when clinically indicated; local measures (e.g., aspiration/drainage, intralesional steroid) were used selectively in localized disease. Relapse was defined as reappearance of clinical or radiological findings after remission. Univariable and multivariable logistic regression models were applied to identify independent predictors.

Results: The cohort consisted of 92 patients. Relapse occurred in 22/85 methotrexate-treated patients (25.9%), with most relapses occurring between the third and fifth months. No relapse events were observed in the azathioprine subgroup (n = 7). However, this finding should be considered observational only due to the small numbers and zero-event data. In multivariable analysis, erythrocyte sedimentation rate (ESR) >20 mm/h (and angiotensin converting enzyme >52 U/L, where applicable) were associated with relapse, whereas apparent associations with tumor necrosis factor alpha inhibitors and cyclosporine likely reflect confounding by indication because these agents were used as rescue therapy in refractory/relapsing disease. Elevated ESR was also associated with prolonged treatment duration (p =0.006).

Conclusion: A structured and individualized treatment approach may contribute to favorable clinical outcomes in patients with IGM. Observed relapse patterns support the importance of risk-adapted management rather than a uniform therapeutic strategy. Given the retrospective design and limited subgroup sizes, these findings should be interpreted cautiously and considered hypothesis-generating. Prospective, multicenter studies are required to validate relapse-associated factors and optimize treatment strategies.

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.

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.