European journal of breast health最新文献

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.

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.

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.

Objective: Breast cancer is the most common cancer and the leading cause of cancer-related deaths in women. Texture analysis provides crucial prognostic information about many types of cancer, including breast cancer. The aim was to examine the relationship between texture features (TFs) of 2-deoxy-2[¹⁸F] fluoro-D-glucose positron emission tomography (PET)/computed tomography and disease progression in patients with invasive breast cancer.

Materials and methods: TFs of the primary malignant lesion were extracted from PET images of 112 patients. TFs that showed significant differences between patients who achieved one-, three-, and five-year progression-free survival (PFS) and those who did not were selected and subjected to the least absolute shrinkage and selection operator regression method to reduce features and prevent overfitting. Machine learning (ML) was used to predict PFS using TFs and selected clinicopathological parameters.

Results: In models using only TFs, random forest predicted one-, three-, and five-year PFS with area under the curve (AUC) values of 0.730, 0.758, and 0.797, respectively. Naive Bayes predicted one-, three-, and five-year PFS with AUC values of 0.857, 0.804, and 0.843, respectively. The neural network predicted one-, three-, and five-year PFS with AUC values of 0.782, 0.828, and 0.780, respectively. These findings indicated increased AUC values when the models combined TFs with clinicopathological parameters. The lowest AUC values of the models combining TFs and clinicopathological parameters when predicting one-year, three-year, and five-year PFS were 0.867, 0.898, and 0.867, respectively.

Conclusion: ML models incorporating PET-derived TFs and clinical parameters may assist in predicting progression during the pre-treatment period in patients with invasive breast carcinoma.

Objective: High mobility group box 1 (HMGB1) is a nonhistone chromatin-associated protein involved in chromatin remodeling, transcription, DNA replication, and repair. The purpose of this study was to assess the relationship between tissue expression of HMGB1, clinical outcomes, and histopathological characteristics in patients with breast cancer.

Materials and methods: The study included 282 patients with breast cancer. An in vitro diagnostic HMGB1 antibody was applied to the slides of tumor specimens.

Results: Overexpression of HMGB1 was found in tumor cells of 123 (43.6%) patients. HMGB1 was only expressed in the nucleus in most tumors (88.7%), while in 32 (11.3%) tumors HMBG1 expression was cytoplasmic and/or extracellular. Severe inflammatory infiltration of the peritumoral stroma was observed in 76 (27%) patients. There was a correlation between remarkable inflammatory cell infiltration in the tumor microenvironment and HMGB1 overexpression, regardless of the molecular subtype, as well as the extranuclear location of HMGB1 expression (p = 0.023). HMGB1 expression was not found to be associated with overall or disease-free survival. However, axillary lymph node metastasis was significantly more common in tumors with intense inflammation (p = 0.024).

Conclusion: The proportion of breast cancer patients with HMGB1 expression was lower in the present study than that reported previously. Furthermore, we did not detect a relationship between HMGB1 expression and prognosis. However, the relationship between HMGB1 expression and prognosis had been previously reported only in aggressive breast cancers. It is suggested that understanding the significance of HMGB1 expression in breast cancer may open new treatment opportunities, especially in aggressive and/or triple negative tumors.

Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade, fibroblastic mesenchymal tumor derived from the dermis. Breast is an uncommon site with an incidence of only 0.8-4.5% and an overall population incidence at any site of 4.2-4.5 per million. Surgical excision with 2-3 cm margin is the gold standard treatment. Selected cases are subjected to radiotherapy or systemic therapy with Imatinib. Due to the rare presentation, we report a similar case of DFSP on the left breast in a 42-year-old woman, who was initially diagnosed with benign phyllodes tumor of the left breast and final histopathology report of the wide local excision specimen diagnosed DFSP of the breast.