Is the Number or Proximity of Margins Less than 2 mm Associated with an Increased Mastectomy Rate in Patients Attempting Breast Conservation Therapy for Ductal Carcinoma In Situ?

BACKGROUND: Consensus guidelines recommend ≥ 2 mm margins in patients undergoing partial mastectomy (PM) for ductal carcinoma in situ (DCIS). It is unknown whether the number or proximity of margins less than 2 mm is associated with an increased mastectomy rate in patients attempting breast conservation therapy (BCT) for DCIS. The aim of this study is to examine this relationship. PATIENTS AND METHODS: An institutional database review identified 208 patients with DCIS who underwent PM at a tertiary referral center and community hospitals from July 2020 to June 2023. Patients with a history of breast cancer, previous surgery for breast cancer, ipsilateral invasive carcinoma, papillary carcinoma, Paget's disease, more lobular carcinoma in situ (LCIS) than DCIS present, initial mastectomy, no DCIS present, routine shave margins (of all vectors), and ≥ 2 mm margins of all six vectors were excluded. Selective intraoperative margin re-excisions were included. RESULTS: A total of 208 patients who met inclusion criteria were retrospectively reviewed. 122 (25%) had one close/positive (< 2 mm) margin and 86 (18%) had two or more close/positive margins. Of the patients with one close/positive margin, 7% (9/122) eventually underwent mastectomy. Of the patients with two or more close/positive margins, 20% (17/86) eventually underwent mastectomy. Overall, no patients with opposing margins underwent mastectomy. CONCLUSIONS: Patients undergoing PM for DCIS have a mastectomy rate that is increased threefold, with two or more close/positive margins at initial PM, when compared with those with only one close/positive margin. The presence of opposing close/positive margins at initial PM did not increase the mastectomy rate and most were cleared with re-excision.

Assessment of Radiation Induced Pneumonitis and Pericarditis in Patients Undergoing Breast Conservative Treatment Using Hypofractionated Simultaneous Integrated Boost Technique.

INTRODUCTION: To determine the proportion of radiationinduced pneumonitis and pericarditis in patients who have received Hypo-fractionated Radiation along with simultaneous integrated boost technique after breast conservative surgery using a prospective observational study from a tertiary hospital. MATERIALS & METHODS: The incidence of radiationinduced pneumonitis and pericarditis was evaluated in all adult patients with biopsy-proven early-stage unilateral breast cancer who underwent breast-conserving surgery followed by hypo-fractionated radiation with a simultaneous integrated boost technique. Baseline assessments including a six-minute walk test, highresolution computed tomography (HRCT), pulmonary function tests (PFTs), electrocardiography (ECG) and echocardiography (ECHO) were performed. At three months post-radiation treatment, patients underwent follow-up assessments with a six-minute walk test, ECG and ECHO. At six months post-radiation treatment, patients underwent further assessments with a six-minute walk test, ECG, ECHO, PFTs, and HRCT of the thorax. Data analysis was performed using SPSS version 19. RESULTS: Our study investigated the incidence of acute radiation-induced pneumonitis and pericarditis in patients treated with hypofractionated VMAT-SIB technique in 20 eligible early breast cancer patients. The study found that the technique is feasible and achieves encouraging dosimetric parameters, including well achieved ipsilateral lung and heart doses. The reduced treatment time of 3-4 weeks compared to the previous 6-7 weeks with sequential boost was also found to be desirable in resource-constrained settings. The incidence of acute radiation pneumonitis and pericarditis was acceptable and comparable to existing data, with 90% of patients experiencing grade 1 radiation pneumonitis according to CTCAE v5.0. Post-treatment pulmonary function tests showed significant changes, particularly in patients who had received neoadjuvant chemotherapy and nodal irradiation. The six-minute walk test and Borg scale also showed a significant positive correlation with pulmonary function tests. There was no significant pericarditis during the follow-up. The study proposes that the hypofractionated radiotherapy using VMAT-SIB is a suitable alternative to conventional fractionation, with acceptable acute toxicities, but longer follow-up is required to assess the impact on late toxicities. CONCLUSION: Our research has shown that hypofractionated adjuvant radiotherapy with SIB is a safe and feasible treatment for patients with early breast cancer. This treatment method doesn't pose any significant short-term risks to the lungs or heart, and the SIB technique provides better coverage, conformity and sparing of organs at risk. Additionally, patients have reported positive cosmetic outcomes with this treatment. However, to make more accurate conclusions, we need to conduct further studies with larger sample sizes and longer follow-up periods to evaluate the potential longterm side effects of this treatment using VMAT in whole breast radiation.

Axillary Lymphadenectomy: Safe Dissection Through a Correct Technique.

The primary treatment of breast cancer in sentinel-positive ganglia includes axillary lymphatic nodal dissection. The LAD (lymphatic axillary dissection) has decreased in overall numbers but due to the increasing incidence of breast cancer, it is practised on a daily basis, even though there is a myriad of complications such as numbness of the upper limb and chest wall, movement restriction of the upper limb, and chronic pain which appear due to trauma to the nerves which pass through the axilla. However, the utility in the overall survival or DFS (disease-free survival) of the patient is unquestionable.  In our study, through the dissection of cadavers, we exposed the vital structures and the anatomical relations of this region. We aimed to offer a map or technique for the surgeon to follow to decrease the overall morbidity of this procedure.

Breast Conservation Therapy for Primary Squamous Cell Carcinoma of the Breast in an Elderly Woman: A Case Report.

This case report details a rare instance of primary squamous cell carcinoma (PSCC) of the breast in an octogenarian, emphasizing the unique diagnostic and treatment challenges posed by this malignancy in an elderly patient and adding to the scientific literature on PSCC managed with breast conservation therapy (BCT). An 80-year-old woman with medical comorbidities presented with a focal asymmetry in the right breast's retroareolar plane, detected during routine screening mammography. Diagnostic evaluations raised high suspicion for malignancy, confirmed as PSCC by ultrasound-guided biopsy. Histopathological analysis showed atypical keratinizing squamous epithelial nests and cysts. The patient underwent lumpectomy and re-excision of close surgical margins with a sentinel lymph node biopsy, which showed well-differentiated invasive squamous cell carcinoma with no residual carcinoma or nodal involvement. She was treated with adjuvant hypofractionated radiation therapy, experiencing minimal side effects. This case highlights the importance of considering individualized, nuanced approaches to adjuvant therapies in the treatment of PSCC in older patients. It demonstrates that BCT, coupled with carefully selected adjuvant therapy, can be a successful treatment strategy for PSCC in the elderly, contributing valuable insights into the management of this rare condition.

Mobile app for patient education about breast cancer surgical treatment / Aplicativo móvel para a educação de pacientes sobre o tratamento cirúrgico do câncer de mama

Abstract Introduction: Breast cancer is a relevant public health problem with high incidence, morbidity and mortality. Patients experience a feeling of uncertain future, low self-esteem, fear of death and mutilation. In this situation, the rational absorption of information is compromised and technology can help. Objective: To develop and validate a mobile application (app) for patient education on the surgical treatment of breast cancer. Patient education in breast cancer helps set patients' preoperative expec-tations and satisfaction with the surgical experience and outcomes. Methods: The app was created in five stages: 1. analysis - situational diagnosis and integrative literature review; 2. design - planning and creation of didactic content; 3. development - definition of the app navigation; 4. implementation - configuration of tools and creation of an environment to download the app from the internet; 5. testing - application of usability, performance, compatibility, and functional tests. The developed app was validated by 13 doctors experienced in the treatment of breast cancer and 19 female breast cancer patients, using the Delphi technique. Results: Consensus was achieved, with an excellent overall content validity index of 1.00, both among the doctors and the patients in the first round of consultation. Conclusion: The app, named OncoMasto Cirurgia App, was developed after an integrative literature review, tested and validated for content by specialist doctors and by breast cancer patients, showing great agreement among the study participants.

Resumo Introdução: O câncer de mama é um relevante problema de saúde pública com alta incidência, morbidade e mortalidade. Os pacientes experimentam uma sensação de futuro incerto, baixa autoestima, medo da morte e mutilação. Nessa situação, a absorção racional de informações fica comprometida e a tecnologia pode ajudar. Objetivo: Desenvolver e validar um aplicativo móvel (app) para a educação de pacientes sobre o tratamento cirúrgico do câncer de mama. A educação do paciente em câncer de mama ajuda a definir as expectativas pré-operatórias e a satisfação dos pacientes com a experiência e os resultados cirúrgicos. Métodos: O app foi elaborado em cinco etapas: 1. análise - diagnóstico situacional e revisão integrativa da literatura; 2. design - planejamento e criação de conteúdo didático; 3. desenvolvimento - definição da navegação do aplicativo; 4. implantação - configuração de ferramentas e criação de ambiente para download do aplicativo pela internet; 5. testes - aplicação de testes de usabilidade, desempenho, compatibilidade e funcionais. O aplicativo desenvolvido foi validado por 13 médicos com experiência no tratamento do câncer de mama e 19 mulheres diagnosticadas com a doença, utilizando a técnica Delphi. Resultados: O consenso foi alcançado, com um excelente índice de validade de conteúdo geral de 1,00, tanto entre os médicos quanto entre as pacientes, na primeira rodada de consulta. Conclusão: O app, denominado OncoMasto Cirurgia App, foi desenvolvido após revisão integrativa da literatura, testado e validado quanto ao conteúdo por médicos especialistas e por pacientes com câncer de mama, apresentando ótima concordância entre os participantes do estudo.