In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,acc...In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.展开更多
Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second s...Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second surgical operation, so many breast surgeons have started to depend on intraoperative frozen sections to ensure free safety margins. Aim of work: To assess our policy that we prefer to depend on intraoperative frozen section analysis to get free safety margin in breast conserving surgery from the 1st surgery, and its oncologic outcome. Patients and Methods: This is a retrospective study conducted in Oncology Center—Mansoura University (OCMU), where the data of 219 patients with breast cancer, who were managed by breast conserving surgery with intraoperative frozen section analysis of the safety margins, was analyzed. Results: The intraoperative frozen section analysis of safety margin was negative from the start in 183 (83.6%) patients, while it was positive in 36 patients (16.4%). Intraoperative decision of margin re-excision was applied for 29 patients (13.2%) in order to reach negative margin, modified radical mastectomy was offered for 4 patients (1.8%), while nipple sparing mastectomy with immediate breast reconstruction using latissimus dorsi flap was offered for 3 patients (1.4%). The postoperative paraffin results were typical with intraoperative frozen section analysis results in 216 patients (98.6%) and different results were obtained in only 3 patients (1.4%) who were managed by modified radical mastectomy in a second operation. Only 4 patients had local recurrence (1.8%) during the period of follow-up duration which was ranged from 1 to 86 months with mean ± SD (22.3 ± 14.1). Conclusion: The intraoperative frozen section analysis of safety margins in breast conserving surgery has very high-rate typical results with the paraffin section analysis and it is very helpful in decreasing the rate of second surgical operation in cases of infiltrated margins. It should be used routinely in all cases of breast conserving surgery.展开更多
Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like sho...Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like short-term admission or for those not indicated for general anesthesia due to complications. This report presents the outcomes of breast conserving surgery and sentinel lymph node biopsy under local anesthesia. Patients and Methods: The study included 61 patients with breast cancer that were all definitely diagnosed before surgery. The indications were preoperatively diagnosed localized DCIS, invasive carcinoma measuring less than 3 cm in tumor diameter on ultrasound, and tumors with negative axillary lymph nodes. The surgical procedures included breast conserving surgery associated with sentinel lymph node navigation biopsy. Results: The surgery could be performed under local anesthesia in all 61 patients, and no patient was converted to general anesthesia. Four patients had sentinel lymph node metastasis. Surgical stumps were positive in 18 patients (29.5%). Ten Gy of boost irradiation of the tumor bed was added to the conventional breast irradiation for these patients. There were no serious complications associated with surgery. Conclusion: Breast conserving surgery and sentinel lymph node biopsy for early breast cancer can be performed safely under local anesthesia. This procedure contributes to shortening the length of hospitalization and thereby saving medical resources without deceasing the quality of treatment.展开更多
Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized...Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, "therapeutic mammoplasty" or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients(14%). Nine patients(15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.展开更多
Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publicatio</span><span style="font-family:Verd...Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publicatio</span><span style="font-family:Verdana;">n of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE,</span><span style="font-family:Verdana;"> Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma </span><i><span style="font-family:Verdana;">In Situ</span></i><span style="font-family:Verdana;"> (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS)</span></span></span><span style="font-family:Verdana;">.展开更多
Objective: To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage I and stage II breast cancer. Methods: 216 female patients with breast cancer underwe...Objective: To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage I and stage II breast cancer. Methods: 216 female patients with breast cancer underwent breast-conserv- ing therapy from December 1993 to October 2004. Their data were analyzed retrospectively. The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast, postoperative radiotherapy, chemotherapy and endocrine ther- apy. Of them, 209 patients underwent axillary lymph node dissection. Results: There were no operative complications. 216 patients were followed-up 3 to 147 months, the medial follow-up time was 78 months. The local recurrence rate was 1.85%. Two patients died and one of them was not related with breast cancer. Presence or absence of fibrosis, shape of breast, asymmetry, pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon. Breasts were scored cosmetically as excellent and good in 199 patients, the rate of satisfactory was 92.13%. Conclusion: Breast-conserving therapy for early breast cancer is a safe and effective therapy. It has less trauma and less complications and can also raise the quality of life in the patients. But we must obey the strict indications and reasonable techniques.展开更多
Objective To investigate the relationship between the expression of S100A7 protein and prediction of recurrence and prognosis of breast cancer in patients undergoing breast-conserving surgery combined with radiotherap...Objective To investigate the relationship between the expression of S100A7 protein and prediction of recurrence and prognosis of breast cancer in patients undergoing breast-conserving surgery combined with radiotherapy.Methods 349 samples of carcinoma tissue wax blocks were selected from January 2011 to January 2014 in Qingdao Central Hospital.All the patients had undergone breast-conserving surgery.We analyzed S100A7 expression in tumor tissue by immunohistochemical staining.Using univariate and multivariate analyses,we evaluated the relationship between S100A7 and clinical results,to explore independent risk factors for local regional recurrence(LRR).Results The positive expression of S100A7 in the recurrence group(66.7%)was significantly higher than in the non-recurrence group(38.4%),P=0.025.A log-rank test showed that high S100A7 expression was significantly correlated with 5-year regional recurrence free survival rate(RFS)(94.9%vs 89.5%,P=0.0408),distant metastasis free survival rate(DFS)(95.4%vs 83.5%,P<0.001),and overall survival rate(OS)(99.0%vs 92.5%,P=0.0011).Histological grade,vessel carcinoma embolus,lymph node metastasis,S100A7 expression,and tumor size were factors that influenced RFS.Multivariate analysis of the Cox proportional hazard model showed that high S100A7 expression was an independent risk factor that affected breast cancer RFS(HR=6.864,95%CI:1.575-29.915,P=0.01).Thus,we concluded that high S100A7 expression is associated with increased risk of LRR and distant metastasis of breast cancer after breast-conserving surgery and postoperative radiotherapy.S100A7 can be used as a molecular marker to screen for patients with high recurrence risk after breast-conserving surgery.展开更多
The incidence of multifocal(MF) and multicentric(MC) carcinomas varies widely among clinical studies,depending on definitions and methods for pathological sampling.Magnetic resonance imaging is increasingly used becau...The incidence of multifocal(MF) and multicentric(MC) carcinomas varies widely among clinical studies,depending on definitions and methods for pathological sampling.Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity.However,false positive lesions might incorrectly influence treatment decisions.Therefore,preoperative biopsies must be performed to avoid unnecessary surgery.Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors.However,the rate of local recurrences is usually low after breast conservative treatment(BCT) of MC/MF tumors.It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years,with small tumors and absence of extensive ductal carcinoma in situ.A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial.Surgery should achieve both acceptable cosmetic results and negative margins,which requires thorough preoperative radiological workup and localization of lesions.Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity,namely fibrosis.In conclusion,BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists,surgeons and radiotherapists.展开更多
BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment...BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.展开更多
Objective: To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT). Me...Objective: To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT). Methods: A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. Results: In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year). Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. Conclusions: The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.展开更多
Background:Adjuvant radiotherapy has increased disease-free and overall survival rates in breast cancer. Conventionally fractionated radiotherapy delivers 50 Gy over 5 weeks which is the standard approach. A shorter d...Background:Adjuvant radiotherapy has increased disease-free and overall survival rates in breast cancer. Conventionally fractionated radiotherapy delivers 50 Gy over 5 weeks which is the standard approach. A shorter duration of hypofractionated radiotherapy (HFRT) will be more convenient for patients and treatment providers if found safe and equally effective. Material and Methods: Fifty-four breast cancer patients who underwent breast conservative surgery (BCS) were enrolled in this study. The patients received 4005 cGy/15 fractions. A boost to the tumor bed was administered in all patients. In this study, radiotherapy induced toxicity was evaluated. Results: In this study, the median age of our patients was 48 years with age ranged from 28 to 69 years. Acute skin toxicity was assessed, and it was noted that grade 2 skin toxicity was shown in only 6 patients (11.1%) at the end of radiotherapy and disappeared after 6 weeks of treatment. Late skin toxicity (telangectasia, hyperpigmentation, and subcutaneous fibrosis) was assessed and showed that most patients had grade 0 toxicity with no grade 3 toxicity at all. Regarding pulmonary toxicity, 5 patients (9.3%) developed acute pneumonitis and as regards chronic lung toxicity, it was evident in only 3 patients, 2 patients (3.7%) were grade 1 and 1 patient (1.9%) was grade 2. Cardiac toxicity was evident in 2 patients (7.1%) of the left breast cancer patients. Regarding lymphoedema, most patients that showed lymphoedema were grade 1. Conclusion: The results confirm the safety and feasibility of adjuvant hypofractionated whole breast radiotherapy in breast cancer patients in terms of acute and late toxicity.展开更多
Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter radiation schedules offered the prom...Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter radiation schedules offered the promise of equivalent local control to standard radiation therapy by giving larger doses per fraction in shorter period of time. Methods: This study included 36 female patients with operable invasive stage I-II breast cancer. These patients underwent microscopic wide local excision of the primary tumor and lymph node dissection. They received adjuvant radiotherapy. The radiation dose was 40 Gy total dose in 15 fractions for whole breast and additional dose of 9 Gy in three consecutive fractions was delivered to tumour cavity simultaneously. Results: Mean age was 52 years (range: 30 - 67);most patients were of stage II disease and Grade II was the most common one. Invasive ductal carcinoma was reported in 94.4% and 72.2% of patients were hormone receptor positive. After median follow-up of 52 months, all patients were alive and ipsilateral local recurrence was reported in 1 case only. Grade IV radiation toxicity was not observed;moist desquamation was the most common acute reaction (61%) with grade III in 5.5% followed by dry desquamation in 55.6% of grade I only. Grade I erythema was recorded in 41.7% and grade II in 11%. Fibrosis was the most frequent late reaction (44.3%) with grade II in 11% followed by telengectesia then pigmentation (41.7%, 33.3% respectively). Conclusion: The regimen used in this study appears promising with acceptable acute toxicities and convenient for our patients and has the advantage of economic use of radiation facilities. However, larger number of patients and longer period of follow-up are needed for further evaluation.展开更多
Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis o...Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiologicalpathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.展开更多
Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer i...Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.展开更多
Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-select...Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m<sup>2</sup>. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.展开更多
文摘In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.
文摘Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second surgical operation, so many breast surgeons have started to depend on intraoperative frozen sections to ensure free safety margins. Aim of work: To assess our policy that we prefer to depend on intraoperative frozen section analysis to get free safety margin in breast conserving surgery from the 1st surgery, and its oncologic outcome. Patients and Methods: This is a retrospective study conducted in Oncology Center—Mansoura University (OCMU), where the data of 219 patients with breast cancer, who were managed by breast conserving surgery with intraoperative frozen section analysis of the safety margins, was analyzed. Results: The intraoperative frozen section analysis of safety margin was negative from the start in 183 (83.6%) patients, while it was positive in 36 patients (16.4%). Intraoperative decision of margin re-excision was applied for 29 patients (13.2%) in order to reach negative margin, modified radical mastectomy was offered for 4 patients (1.8%), while nipple sparing mastectomy with immediate breast reconstruction using latissimus dorsi flap was offered for 3 patients (1.4%). The postoperative paraffin results were typical with intraoperative frozen section analysis results in 216 patients (98.6%) and different results were obtained in only 3 patients (1.4%) who were managed by modified radical mastectomy in a second operation. Only 4 patients had local recurrence (1.8%) during the period of follow-up duration which was ranged from 1 to 86 months with mean ± SD (22.3 ± 14.1). Conclusion: The intraoperative frozen section analysis of safety margins in breast conserving surgery has very high-rate typical results with the paraffin section analysis and it is very helpful in decreasing the rate of second surgical operation in cases of infiltrated margins. It should be used routinely in all cases of breast conserving surgery.
文摘Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like short-term admission or for those not indicated for general anesthesia due to complications. This report presents the outcomes of breast conserving surgery and sentinel lymph node biopsy under local anesthesia. Patients and Methods: The study included 61 patients with breast cancer that were all definitely diagnosed before surgery. The indications were preoperatively diagnosed localized DCIS, invasive carcinoma measuring less than 3 cm in tumor diameter on ultrasound, and tumors with negative axillary lymph nodes. The surgical procedures included breast conserving surgery associated with sentinel lymph node navigation biopsy. Results: The surgery could be performed under local anesthesia in all 61 patients, and no patient was converted to general anesthesia. Four patients had sentinel lymph node metastasis. Surgical stumps were positive in 18 patients (29.5%). Ten Gy of boost irradiation of the tumor bed was added to the conventional breast irradiation for these patients. There were no serious complications associated with surgery. Conclusion: Breast conserving surgery and sentinel lymph node biopsy for early breast cancer can be performed safely under local anesthesia. This procedure contributes to shortening the length of hospitalization and thereby saving medical resources without deceasing the quality of treatment.
文摘Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, "therapeutic mammoplasty" or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients(14%). Nine patients(15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.
文摘Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publicatio</span><span style="font-family:Verdana;">n of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE,</span><span style="font-family:Verdana;"> Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma </span><i><span style="font-family:Verdana;">In Situ</span></i><span style="font-family:Verdana;"> (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS)</span></span></span><span style="font-family:Verdana;">.
文摘Objective: To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage I and stage II breast cancer. Methods: 216 female patients with breast cancer underwent breast-conserv- ing therapy from December 1993 to October 2004. Their data were analyzed retrospectively. The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast, postoperative radiotherapy, chemotherapy and endocrine ther- apy. Of them, 209 patients underwent axillary lymph node dissection. Results: There were no operative complications. 216 patients were followed-up 3 to 147 months, the medial follow-up time was 78 months. The local recurrence rate was 1.85%. Two patients died and one of them was not related with breast cancer. Presence or absence of fibrosis, shape of breast, asymmetry, pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon. Breasts were scored cosmetically as excellent and good in 199 patients, the rate of satisfactory was 92.13%. Conclusion: Breast-conserving therapy for early breast cancer is a safe and effective therapy. It has less trauma and less complications and can also raise the quality of life in the patients. But we must obey the strict indications and reasonable techniques.
基金Supported by a grant from The Medical Foundation of Wu Jieping(No.320.6750.16229)
文摘Objective To investigate the relationship between the expression of S100A7 protein and prediction of recurrence and prognosis of breast cancer in patients undergoing breast-conserving surgery combined with radiotherapy.Methods 349 samples of carcinoma tissue wax blocks were selected from January 2011 to January 2014 in Qingdao Central Hospital.All the patients had undergone breast-conserving surgery.We analyzed S100A7 expression in tumor tissue by immunohistochemical staining.Using univariate and multivariate analyses,we evaluated the relationship between S100A7 and clinical results,to explore independent risk factors for local regional recurrence(LRR).Results The positive expression of S100A7 in the recurrence group(66.7%)was significantly higher than in the non-recurrence group(38.4%),P=0.025.A log-rank test showed that high S100A7 expression was significantly correlated with 5-year regional recurrence free survival rate(RFS)(94.9%vs 89.5%,P=0.0408),distant metastasis free survival rate(DFS)(95.4%vs 83.5%,P<0.001),and overall survival rate(OS)(99.0%vs 92.5%,P=0.0011).Histological grade,vessel carcinoma embolus,lymph node metastasis,S100A7 expression,and tumor size were factors that influenced RFS.Multivariate analysis of the Cox proportional hazard model showed that high S100A7 expression was an independent risk factor that affected breast cancer RFS(HR=6.864,95%CI:1.575-29.915,P=0.01).Thus,we concluded that high S100A7 expression is associated with increased risk of LRR and distant metastasis of breast cancer after breast-conserving surgery and postoperative radiotherapy.S100A7 can be used as a molecular marker to screen for patients with high recurrence risk after breast-conserving surgery.
文摘The incidence of multifocal(MF) and multicentric(MC) carcinomas varies widely among clinical studies,depending on definitions and methods for pathological sampling.Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity.However,false positive lesions might incorrectly influence treatment decisions.Therefore,preoperative biopsies must be performed to avoid unnecessary surgery.Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors.However,the rate of local recurrences is usually low after breast conservative treatment(BCT) of MC/MF tumors.It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years,with small tumors and absence of extensive ductal carcinoma in situ.A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial.Surgery should achieve both acceptable cosmetic results and negative margins,which requires thorough preoperative radiological workup and localization of lesions.Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity,namely fibrosis.In conclusion,BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists,surgeons and radiotherapists.
文摘BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.
文摘Objective: To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT). Methods: A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. Results: In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year). Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. Conclusions: The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.
文摘Background:Adjuvant radiotherapy has increased disease-free and overall survival rates in breast cancer. Conventionally fractionated radiotherapy delivers 50 Gy over 5 weeks which is the standard approach. A shorter duration of hypofractionated radiotherapy (HFRT) will be more convenient for patients and treatment providers if found safe and equally effective. Material and Methods: Fifty-four breast cancer patients who underwent breast conservative surgery (BCS) were enrolled in this study. The patients received 4005 cGy/15 fractions. A boost to the tumor bed was administered in all patients. In this study, radiotherapy induced toxicity was evaluated. Results: In this study, the median age of our patients was 48 years with age ranged from 28 to 69 years. Acute skin toxicity was assessed, and it was noted that grade 2 skin toxicity was shown in only 6 patients (11.1%) at the end of radiotherapy and disappeared after 6 weeks of treatment. Late skin toxicity (telangectasia, hyperpigmentation, and subcutaneous fibrosis) was assessed and showed that most patients had grade 0 toxicity with no grade 3 toxicity at all. Regarding pulmonary toxicity, 5 patients (9.3%) developed acute pneumonitis and as regards chronic lung toxicity, it was evident in only 3 patients, 2 patients (3.7%) were grade 1 and 1 patient (1.9%) was grade 2. Cardiac toxicity was evident in 2 patients (7.1%) of the left breast cancer patients. Regarding lymphoedema, most patients that showed lymphoedema were grade 1. Conclusion: The results confirm the safety and feasibility of adjuvant hypofractionated whole breast radiotherapy in breast cancer patients in terms of acute and late toxicity.
文摘Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter radiation schedules offered the promise of equivalent local control to standard radiation therapy by giving larger doses per fraction in shorter period of time. Methods: This study included 36 female patients with operable invasive stage I-II breast cancer. These patients underwent microscopic wide local excision of the primary tumor and lymph node dissection. They received adjuvant radiotherapy. The radiation dose was 40 Gy total dose in 15 fractions for whole breast and additional dose of 9 Gy in three consecutive fractions was delivered to tumour cavity simultaneously. Results: Mean age was 52 years (range: 30 - 67);most patients were of stage II disease and Grade II was the most common one. Invasive ductal carcinoma was reported in 94.4% and 72.2% of patients were hormone receptor positive. After median follow-up of 52 months, all patients were alive and ipsilateral local recurrence was reported in 1 case only. Grade IV radiation toxicity was not observed;moist desquamation was the most common acute reaction (61%) with grade III in 5.5% followed by dry desquamation in 55.6% of grade I only. Grade I erythema was recorded in 41.7% and grade II in 11%. Fibrosis was the most frequent late reaction (44.3%) with grade II in 11% followed by telengectesia then pigmentation (41.7%, 33.3% respectively). Conclusion: The regimen used in this study appears promising with acceptable acute toxicities and convenient for our patients and has the advantage of economic use of radiation facilities. However, larger number of patients and longer period of follow-up are needed for further evaluation.
文摘Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiologicalpathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.
文摘Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.
文摘Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m<sup>2</sup>. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.