RESUMEN
INTRODUCTION: This study analyzes postoperative course of different immediate breast reconstruction techniques: deep inferior epigastric perforator flap (DIEP), gracilis, latissimus dorsi flap, expander implants and definitive implants. METHODS: All women operated on IBR between 2012 and 2017 in the CHU Strasbourg were included in this retrospective study. The main data collected were healing time, complications, surgical revisions and failure rates. These data were compared between the five IBR techniques to find a significant difference. Two groups were distinguished according to the surgical techniques: free flaps and implants. Data of those groups were compared too. RESULTS: One hundred and ninety three patients have had a breast surgical treatment between 2012 and 2017. Among them, 44 had a bilateral IBR (23%). Early and unserious complications, were less frequent in the implants group than in the free flaps group: 8.6% vs. 33.3% (P<0.01) for unilateral reconstructions and 10.9% vs. 38.9% (P<0.01) for bilateral reconstructions. No surgical failures were found in the free flaps group versus 6.2% for definitive implants and 3.6% for expander implants. Healing time was longer for the free flaps group than for the prothesis group: 5.6 weeks vs. 4.2weeks, (P<0.01). CONCLUSION: IBR with free flaps is associated with a higher risk for early and unserious complications as healing disorders, which extend the dressings time. However the failure rate is not higher with free flaps.
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Implantes de Mama/efectos adversos , Neoplasias de la Mama/cirugía , Colgajos Tisulares Libres/efectos adversos , Mamoplastia/métodos , Colgajo Perforante/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Terapia Combinada , Femenino , Colgajos Tisulares Libres/trasplante , Músculo Grácil/trasplante , Humanos , Tiempo de Internación , Mamoplastia/efectos adversos , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Dispositivos de Expansión Tisular , Cicatrización de HeridasRESUMEN
INTRODUCTION: The purpose of this study is to evaluate patients' satisfaction after immediate breast reconstruction (IBR) according to the surgical technique. METHODS: Included patients had an IBR between 2012 and 2017 and finished their reconstruction since a year. Patients were contacted by phone and their satisfaction was evaluated with the Breast Q questionnaire. According to the surgical technique, patients were divided into 5 groups: DIEP, gracilis, Latissimus Dorsi flap, definitive implant and expander implant. Techniques were grouped into two categories: free flaps and prothesis. Nipple reconstruction techniques were also evaluated: toe pulp grafting, nipple sharing and local flap. RESULTS: Nighty-five patients on the 103 who were eligible accepted to answer the questionnaire. Satisfaction with breasts was stastistically higher in the free flap group (72.6/100) than in the prothesis group (62.7/100) (P<0.01). Physical well-being (chest) was better for the free flap group than for the prothesis group (92.2/100 vs. 85.2/100, P=0.02). Nipple reconstructions with nipple sharing and free flap give a better satisfaction for patients than toe pulp grafting (75.3/100 and 73.5/100 vs. 47.8/100, P<0.01). CONCLUSION: IBR with free flap give, in a short time, a statistically higher satisfaction for breast than prothesis. Nipple reconstructions with free flap and nipple sharing give a better satisfaction too.
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Implantes de Mama/psicología , Neoplasias de la Mama/cirugía , Colgajos Tisulares Libres , Mamoplastia/métodos , Mamoplastia/psicología , Satisfacción del Paciente , Adulto , Neoplasias de la Mama/psicología , Femenino , Músculo Grácil/trasplante , Humanos , Mamoplastia/efectos adversos , Persona de Mediana Edad , Pezones/cirugía , Complicaciones Posoperatorias , Encuestas y CuestionariosRESUMEN
Breast reconstruction is an integral part of breast cancer treatment. It must be systematically mentioned when the disease is announced and proposed at an optimal time during cancer management. In case of ductal carcinoma in situ, reconstruction should be proposed at the same time as mastectomy, which generally preserves the skin. The conservation of the nipple-areolar complex should be further evaluated. In the case of invasive breast carcinoma, breast reconstruction is generally proposed at a distance from the oncological time, except for patients requiring neither chemotherapy nor postoperative radiotherapy for whom reconstruction can be immediate. Finally, in the case of prophylactic synchronous contralateral mastectomy, reconstruction should never delay the overall management of breast cancer.
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Mamoplastia , Mastectomía , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Femenino , HumanosRESUMEN
Oncoplastic surgery is to treat breast tumors with the help of plastic surgery. Efficiency of breast-conserving treatments (BCT) compared to mastectomies is equivalent. BCT is better accepted but can cause breast deformity, thus further operations. Oncoplastic surgery aims at conserving an acceptable shape to the breast. It ranges from simple remodeling to more complex techniques modifying the width of the breast. According to the quadrant to treat (inner upper, outer upper, inner lower, outer lower, union of quadrants, tumors of the nipple-areola complex, tumors of the inframammary fold), according to the proximity of the tumor to the nipple, and to the size of the breast and tumor, various techniques are displayed. Few touch ups are necessary. Symmetry is managed during the initial operation or after.
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Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Estética , Femenino , HumanosRESUMEN
INTRODUCTION: The objective of our study was to evaluate the risk of cancer after prophylactic nipple-sparing mastectomy (PNSM). MATERIAL AND METHODS: The PubMed database was consulted using the following key-words: "nipple-sparing mastectomy", "prophylactic", "locoregional recurrence", "oncological risk". Articles published between January 1995 and December 2016 were searched. RESULTS: Out of the 270 articles found, 19 were included. Overall, 15 studies were retrospective, 2 prospective, 2 prospective and retrospective and 3 were multicentric. All told, they involved 3890 patients corresponding to 6786 mastectomies, among which the total number of prophylactic nipple-sparing mastectomies was 3716. Average age of the patients was 44.4years and average follow-up was 38.4months (8-168months); 29.4% of them had a BRCA 1 or 2 mutation; 85 and 15% underwent prosthetic and autologous reconstructions, respectively. Average cancer rates exterior to and within the nipple areolar complex (NAC) were 0.2 and 0.004%, respectively. The overall average rate of histological pre-malignant lesions in the nipple areolar complex was 1.5%. The overall complication rate was 20.5%, and necrosis rates of the nipple areolar complex and the skin were 8.1 and 7.1%, respectively. CONCLUSION: In prophylactic breast surgery, conservation of the nipple areolar complex does not seem to increase the risk of cancer development. However, short follow-up time and the different methodologies applied in the different studies presently preclude generalization of the technique.
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Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Pezones , Tratamientos Conservadores del Órgano , Mastectomía Profiláctica/métodos , Femenino , Humanos , Medición de RiesgoRESUMEN
PURPOSE: Breast cancer is the most common malignancy in women in terms of incidence and mortality. Age is undoubtedly the biggest breast cancer risk factor. In this study we examined clinical, histological, and biological characteristics and mortality of breast cancer in elderly women along with their changes with advancing age. METHODS: We reviewed 63 original articles published between 2006 and 2016 concerning women over 70 years with breast cancer. RESULTS: Compared to patients 70-79 years, patients aged 80 and over had larger tumor size with fewer T1 (42.9% vs 57.7%, p < 0.01) and more T2 lesions (43.5% vs 33.0%, p < 0.01). Lymph nodes and distant metastases were more frequent, with more N + (49.5% vs 44.0%, p < 0.01) and more M1 (8.0% vs 5.9%, p < 0.01). Infiltrating mucinous carcinomas were more frequent (4.3% vs 3.7%, p < 0.01). Tumors had lower grades, with more grade 1 (23.2% vs 19.8%, p = 0.01) and fewer grade 3 (21.5% vs 25.5%, p < 0.01), and were more hormone-sensitive: PR was more often expressed (72.6% vs 67.3%, p < 0.01). Lympho-vascular invasion was less frequent in the 80 years and over (22.9% vs 29.7%, p = 0.01). Breast cancer-specific mortality was higher both at 5 years (25.8% vs 17.2%, p < 0.01) and 10 years (32.7% vs 26.6%, p < 0.01). CONCLUSION: Clinico-pathological characteristics, increased incidence, and mortality associated with aging can be explained on one hand by biological changes of the breast such as increased estrogen sensitivity, epithelial cell alterations, immune senescence, and tumor microenvironment modifications. However, sociologic factors such as increased life expectancy, under-treatment, late diagnosis, and insufficient individual screening, are also involved.
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Factores de Edad , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/metabolismo , Estrógenos/metabolismo , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Microambiente TumoralRESUMEN
OBJECTIVES: Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY: We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS: In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION: Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Neoplasias de la Mama , Trasplante de Órganos , Obtención de Tejidos y Órganos , Humanos , Femenino , Neoplasias de la Mama/epidemiología , Donantes de TejidosRESUMEN
BACKGROUND: Lipomodelling (LM) is an increasingly used technique to reconstruct or correct an aesthetic defect linked to a loss of substance. In France, the Haute Autorité de santé (HAS) published recommendations in 2015 and 2020 concerning the conditions of use of LM on the treated and contralateral breast. These appear to be inconsistently followed. METHODS: Twelve members of the Senology Commission of the Collège national des gynécologues-obstétriciens français (French College of Gynecologists and Obstetricians) reviewed the carcinological safety of LM and the clinical and radiological follow-up of patients after breast cancer surgery, based on French and international recommendations and a review of the literature. The bibliographic search was conducted via Medline from 2015 to 2022, selecting articles in French and English and applying PRISMA guidelines. RESULTS: A total of 14 studies on the oncological safety of LM, 5 studies on follow-up and 7 guidelines were retained. The 14 studies (6 retrospective, 2 prospective and 6 meta-analyses) had heterogeneous inclusion criteria and variable follow-up, ranging from 38 to 120 months. Most have shown no increased risk of locoregional or distant recurrence after LM. A retrospective case-control study (464 LMs and 3100 controls) showed, in patients who had no recurrence at 80 months, a subsequent reduction in recurrence-free survival after LM in cases of luminal A cancer, highlighting the number of lost to follow-up (more than 2/3 of luminal A cancers). About follow-up after LM, the 5 series showed the high frequency after LM of clinical mass and radiological images (in » of cases), most often corresponding to cytosteatonecrosis. Most of the guidelines highlighted the uncertainties concerning oncological safety of LM, due to the lack of prospective data and long-term follow-up. DISCUSSION AND PERSPECTIVES: The members of the Senology Commission agree with the conclusions of the HAS working group, in particular by advising against LM "without cautionary periods", excessively, or in cases of high risk of relapse, and recommend clear, detailed information to patients before undergoing LM, and the need for postoperative follow-up. The creation of a national registry could address most questions regarding both the oncological safety of this procedure and the modalities of patient follow-up.
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Neoplasias de la Mama , Mamoplastia , Humanos , Femenino , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Estudios Retrospectivos , Estudios de Casos y Controles , Estudios Prospectivos , Tejido AdiposoRESUMEN
OBJECTIVE: The uPA/PAI-1 assay and the EPClin® test are useful tools that add to clinico-anatomical characteristics to determine the indication of adjuvant chemotherapy in case of intermediate-prognosis invasive breast cancer. The principal purpose of our study was to analyze the concordance of uPA/PAI-1 and EPClin® in classification of patients into two groups: low and high risk of relapse. METHODS: We prospectively included 63 patients treated for intermediate-prognosis invasive breast cancer. All of these patients received a uPA/PAI-1 assay and an EPClin® test. RESULTS: The uPA/PAI-1 assay and EPClin® test were consistent for 56.2% and inconsistent for 43.8%. In the event of a discrepancy, the treatment decision was based in 95.2% of patients on the EPClin® test result. In total, 38 patients were selected for adjuvant chemotherapy after achievement of the two tests. The mean time to report results after surgery was 9 days for the uPA/PAI-1 assay and 35 days for the EPClin® test. No cases of recurrence or death were found, with an average follow-up of 32 months. CONCLUSION: The EPClin® test resulted in more chemotherapy prescriptions than indicated by uPA/PAI-1. However, we can't conclude to the superiority of one of these two tests, survival data and the effectiveness of our study being insufficient. In general, studies comparing different signatures useful to the therapeutic decision of intermediate prognosis breast cancers should be encouraged.
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Neoplasias de la Mama , Inhibidor 1 de Activador Plasminogénico , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Humanos , Recurrencia Local de Neoplasia , Inhibidor 1 de Activador Plasminogénico/uso terapéutico , Pronóstico , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéuticoRESUMEN
OBJECTIVE: The Carl Langer muscle is the main anatomical variation of the walls of the axillary area, its incidence being about 7%. The presence of this muscle crossing the anterior edge of the axillary vessels can induce difficulties of exposure, location and dissection during axillary surgery. In addition, it may be responsible for primary lymphedema of the upper limb, venous thrombosis of the axillary vein or thoracic outlet syndrome due to vascular or nervous compression. The objective of this work was to evaluate the state of knowledge on Carl Langer muscle of the gynecology-obstetrics medical residents of the French Eastern Region. MATERIAL AND METHODS: All the medical residents enrolled in the specialized diploma in gynecology-obstetrics in the 5 regions (Alsace, Bourgogne, Lorraine, Champagne-Ardenne and Franche-Comté) were questioned by means of a questionnaire sent by e-mail. RESULTS: From February to March 2021, 94 of the 160 medical residents interviewed answered to the questionnaire. Ninety-one of them (97%) did not know Carl Langer's muscle. Three medical residents thought they knew this muscle (3%) but their knowledge was imperfect. CONCLUSION: Our work has highlighted the general lack of knowledge of this anatomical variation, which is relatively frequent, among French gynecology-obstetrics medical residents who are required to examine or perform surgery on this area. This updated review of the literature should optimize the knowledge of the anatomy of the axillary area and consequently its surgery.
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Neoplasias de la Mama , Ginecología , Internado y Residencia , Obstetricia , Axila/cirugía , Femenino , Humanos , MúsculosRESUMEN
OBJECTIVE: Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation. DESIGN: The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS: The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities. RESULTS: The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±). CONCLUSION: There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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Mastectomía , Escolaridad , HumanosRESUMEN
INTRODUCTION: Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS: Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS: One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION: Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.
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Ansiedad , Neoplasias de la Mama , Ansiedad/diagnóstico , Ansiedad/psicología , Mama , Neoplasias de la Mama/diagnóstico , Femenino , Humanos , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
AIM: The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). MATERIALS AND METHODS: Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. SUMMARY RECOMMENDATIONS: The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).
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Terapia de Reemplazo de Estrógeno , Posmenopausia , Terapia de Reemplazo de Estrógeno/efectos adversos , Terapia de Reemplazo de Estrógeno/métodos , Estrógenos , Femenino , Humanos , Menopausia , Guías de Práctica Clínica como Asunto , Progestinas/efectos adversosRESUMEN
The association of polymyositis and cancer was first described in 1916, the most frequent cancers being mammary and gynecological for women, bronchopulmonary for men and digestive for both. This article reports a severe paraneoplastic polymyositis associated with breast cancer. The authors discuss its clinical, pathological and therapeutic particularities.
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Neoplasias de la Mama/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Polimiositis/diagnóstico , Neoplasias de la Mama/complicaciones , Carcinoma Ductal de Mama/complicaciones , Carcinoma Ductal de Mama/diagnóstico , Femenino , Humanos , Inflamación , Oncología Médica/métodos , Persona de Mediana Edad , Síndromes Paraneoplásicos/complicaciones , Polimiositis/complicaciones , Resultado del TratamientoRESUMEN
Breast pain is a concern in perimenopausal and postmenopausal women, quantifiable using validated tools, and may pre-exist or appear after initiation of a HRT. OBJECTIVES: A review of the literature was conducted to evaluate the frequency of breast pain, its evolution with age, its changes under HRT, its link with a possible risk of subsequent breast cancer, and the diagnostic (breast imaging) or therapeutic management modalities (pharmacological or other) in women taking HRT. METHOD: A review of the literature was carried out by consulting Medline, Cochrane Library data and international recommendations in French and English up to the end of 2019. RESULTS: Published data confirm the importance of breast pain in relation to breast cancer risk. Women with breast pain prior to or related to the use of HRT have a significantly increased risk of breast cancer compared to women without breast pain. The risk is increased in cases of moderate to severe breast pain. In the presence of diffuse breast pain without abnormalities on clinical examination, it is not recommended to change the usual indications for screening, whether organized or individual. For focal breast pain, breast imaging (mammography and possibly ultrasound) is recommended. In the absence of abnormalities on breast imaging, a reassuring dialogue has to take place. With regard to HRT, doses of estrogens should be reduced until the breast pain decreases, or even stop the HRT if this symptom persists despite the use of low doses. Wearing a bra brassiere-type can also reduce breast pain.
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Neoplasias de la Mama , Mastodinia , Neoplasias de la Mama/terapia , Femenino , Estudios de Seguimiento , Humanos , Mastodinia/diagnóstico , Mastodinia/terapia , Menopausia , Posmenopausia , Derivación y ConsultaRESUMEN
OBJECTIVE: The objective was to evaluate the diagnostic value of clinical examination and complementary imaging in the exploration of a breast lump or microcalcifications occurring in a postmenopausal woman taking hormonal replacement therapy (HRT), based on a systematic review of the literature in order to make recommendations for HRT management. METHODS: A literature review was conducted using Medline, Cochrane Library data and international recommendations in French and English until 2020. RESULTS: In the presence of a clinical breast mass in postmenopausal women, there is no clinical evidence to rule out cancer. A double evaluation by mammography and ultrasound is recommended and allows the imaging to be classified into 5 BI-RADS categories. The diagnostic management of masses classified BI-RADS 4 and 5 should be based on percutaneous sampling, with microbiopsy being the first step. A total of four situations may arise: 1. Clinical examination has detected a breast mass, but there is no imaging abnormality. In this case, the imaging NPV is high (>96%). If the clinical lesion increases in size, a tissue biopsy should be performed, while continued routine breast screening is recommended if the lesion remains stable and HRT can be continued. 2. Clinical examination, mammography, and ultrasound are in favour of a cyst. Simple cysts can be punctured if painful. There is no contraindication to continuing HRT in the case of simple cysts. Management options for complicated and complex cysts are no different from those offered to women without HRT. Continuation of HRT must consider their histological nature. 3. Clinical examination, mammography, and ultrasonography suggest a benign solid tumour. The management of these benign breast lesions (fibroadenoma ) is not different in women taking an HRT and there is no contraindication to continue the HRT. 4: Clinical examination, imaging and microbiopsy diagnose a malignant tumour. It is imperative that the HRT be stopped, whatever the hormonal dependence of the tumour and whether it is invasive or in situ. The management of the cancerous tumour must consider the updated breast cancer treatment guidelines. In the presence of microcalcifications, the course of action to be taken depends on the BI-RADS classification, established according to the morphology and arrangement of the calcifications. In case of suspicious microcalcifications (BI-RADS 4 or 5), a guided macrobiopsy should be performed. Diagnostic and therapeutic management in these patients is no different from that offered to women without HRT. Discontinuation of HRT is necessary in cases of malignancy (in situ or invasive cancer). CONCLUSION: A rigorous multidisciplinary approach is necessary for the exploration of a breast mass or microcalcifications in a postmenopausal woman.
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Neoplasias de la Mama , Calcinosis , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Calcinosis/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Posmenopausia , Derivación y ConsultaRESUMEN
OBJECTIVES: Breast cancer is the leading cancer in women worldwide with about 2 million new cases and 685,000 deaths each year. Mammography is the most widely used screening and diagnostic method. Currently, digital technologies advances facilitate the development of connected and portable devices. To overcome some of the disadvantages of mammography (breast compression, difficulty in analyzing dense breasts, radiation, limited accessibility in some countries, etc.), portable devices, conventionally known as connected bras (CB), have been created to offer an alternative method to mammography. The objective of our review was to list all the published CBs in order to know their main characteristics, their potential indications and their possible limitations. METHOD: A bibliographical search in the PUBMED database selecting only articles written in French or English, between 2011 and 2020, found 7 CBs under development. RESULTS: These CBs use thermal, ultrasonic and impedance sensors. Their advantages are an absence of irradiation, an absence of breast compression and a flexibility of use (outside an X-ray cabinet). Mammary gland analysis times vary, depending on the device, between 30min and 24h. They are all connected to data transmission systems and models that analyze the results. DISCUSSION AND CONCLUSION: These CBs are mostly still undergoing clinical validation (only [iTBra] has been evaluated in a clinical trial) and require evaluation steps that will eventually allow their future use for breast cancer detection in high-risk women, particularly in women with dense breasts and in women between screening waves.
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Neoplasias de la Mama , Mama , Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Mamografía/métodos , Tamizaje Masivo/métodosRESUMEN
PURPOSE: In breast cancer, radiotherapy is an essential component of the treatment. However, indications of irradiation of the internal mammary chain and axillary area are debatables. Axillary recurrence in patients with invasive breast carcinoma remains an issue. Currently, the substitution of axillary lymph node dissection by sentinel node biopsy leads to revisit the role of axillary irradiation. Breast irradiation including level I, II and III might decrease the risk of axillary recurrence. MATERIAL AND METHODS: A literature search was performed in PubMed and the Cochrane library to identify articles publishing data regarding dose-volume analysis of axillary levels in breast irradiation aiming to determine the potential therapeutic implications. RESULTS: Eleven articles were retained. A total of 375 treatment plans were analyzed. The results concerning the irradiation technique, initial dose prescribed to breast, delineated volumes and dose received at axillary levels were heterogeneous. The average dose delivered to axilla levels I-III with 3D-conformal radiotherapy using standard fields were between 24Gy and 43.5Gy, 3Gy and 32.5Gy and between 1.0Gy and 20.5Gy respectively. The average doses delivered to axilla levels I-III with 3D-conformal radiotherapy using high tangential fields were between 38Gy and 49.7Gy, 11Gy and 47.1Gy and 5Gy 38.7Gy, 32.1Gy and 5Gy (result available for only one study) respectively. Finally, the average doses delivered to axilla levels I-III with intensity modulated radiation therapy were between 14.5Gy and 42.6Gy, 3.4Gy and 35Gy and between 1.2Gy and 25.5Gy respectively. CONCLUSIONS: Incidental axillary dose seems insufficient to be therapeutic regardless of the irradiation technique. There are meaningful differences between intensity modulated radiation therapy and 3D-conformal radiotherapy.
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Neoplasias de la Mama/radioterapia , Irradiación Linfática/métodos , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/prevención & control , Recurrencia Local de Neoplasia/radioterapia , Dosificación Radioterapéutica , Radioterapia Conformacional/métodos , Radioterapia Conformacional/normas , Radioterapia de Intensidad Modulada/métodos , Radioterapia de Intensidad Modulada/normas , Biopsia del Ganglio Linfático CentinelaRESUMEN
INTRODUCTION: Carcinomas in situ represent more than 15 to 20% of breast cancers. Radiotherapy of whole breast is part of the therapeutic standard and follows surgery. However, the indication of tumor bed irradiation is still controversial and heterogeneous according to international practice even though it is a very frequent clinical situation. The aim of this study is to define the indications of tumor bed irradiation in the context of ductal carcinomas in situ and to discuss accelerated partial irradiation of the breast. METHOD: The selected papers were published between 2015 and 2020 and included as MeSH terms "ductal carcinoma in situ" and "boost" for the analysis of tumor bed irradiation, and "ductal carcinoma in situ" and "accelerated partial breast irradiation" for the analysis of accelerated partial irradiation. RESULTS: Boost was more often performed when risk factors for local recurrence were present, such as age less than 40 or 50 years old, clinical mode of detection, tumor size greater than 15 to 20mm, high nuclear grade, presence of necrosis, positive or insufficient surgical margins, associated atypical hyperplastic lesions, and lobular carcinoma in situ. Accelerated partial irradiation is an option for favorable or intermediate prognosis CCIS, further studies involving more patients are required. CONCLUSION: Radiotherapy of the mammary gland in the context of DCIS has shown its effectiveness in terms of local and locoregional control of the disease, thus reducing in situ and infiltrating recurrences. However, the indication of operating bed irradiation is still debated, and the practice is very heterogeneous depending on the country. Another possible alternative for patients with a favorable prognosis and a small tumor bed volume would be IPA.
Asunto(s)
Neoplasias de la Mama , Carcinoma Ductal , Carcinoma Intraductal no Infiltrante , Mama , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Carcinoma Intraductal no Infiltrante/radioterapia , Carcinoma Intraductal no Infiltrante/cirugía , Femenino , Humanos , Mastectomía Segmentaria , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
Of the 800 pesticides used worldwide, about 650 can affect the functioning of the endocrine system: endocrine disrupting pesticides (EDPs). Dietary or environmental exposure to EDPs is a concern, as their presence is currently demonstrated in most biological fluids. Some EDPs are prohibited, classified as carcinogenic, others are "probable" or "possible" carcinogens when there is limited evidence of their tumor effect. The impact of EDPs on breasts is not well known to date. However, since most EDPs have a long half-life and are lipophilic, breasts, composed mainly of adipose tissue, are a suitable site for their concentration. The objective of our review was to analyze the impact of EDPs related to our environmental exposure on breast cancer risk, through an analysis of recent literature, including epidemiological and biological data. Our review showed a positive association between the presence of EDPs and breast cancer, especially among women farmers or EDPs users but also in the general population. Studies on breast tumors have found a higher concentration of EDPs in estrogen-sensitive tumors. As for mortality, studies are contradictory, but confirm the dangerousness of some EDPs. The different series analyzed have several limitations, such as the low number of EDPs evaluated, small numbers and insufficient follow up. The potentiating effect of different EDPs used concomitantly and the window of exposure to these substances are parameters to be assessed.