Robotic Versus Conventional or Endoscopic-assisted Nipple-sparing Mastectomy and Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Prospectively Designed Multicenter Trial Comparing Clinical Outcomes, Medical Cost, and Patient-reported Outcomes (RCENSM-P).

OBJECTIVE: To compare the clinical and patient-reported outcomes of minimal access and conventional nipple-sparing mastectomy (C-NSM). The secondary outcomes investigated included medical costs and oncological safety. BACKGROUND: Minimal-access NSM has been increasingly applied in the treatment of patients with breast cancer. However, prospective multicenter trials comparing robotic-assisted NSM (R-NSM) versus C-NSM or endoscopic-assisted NSM (E-NSM) are lacking. METHODS: A prospectively designed 3-arm multicenter, nonrandomized trial (NCT04037852) was conducted from October 1, 2019 to December 31, 2021, to compare R-NSM with C-NSM or E-NSM. RESULTS: A total of 73 R-NSM, 74 C-NSM, and 84 E-NSM procedures were enrolled. The median wound length and operation time of C-NSM was (9 cm, 175 minutes), (4 cm, and 195 minutes) in R-NSM, and (4 cm and 222 minutes) in E-NSM. Complications were comparable among the groups. Better wound healing was observed in the minimal-access NSM group. The R-NSM procedure was 4000 and 2600 United States Dollars more expensive than C-NSM and E-NSM, respectively. Wound/scar and postoperative acute pain evaluation favored the use of minimal access NSM over C-NSM. Quality of life in terms of chronic breast/chest pain, mobility, and range of motion of the upper extremity showed no significant differences. The preliminary oncologic results showed no differences among the 3 groups. CONCLUSIONS: R-NSM or E-NSM is a safe alternative if compared with C-NSM in terms of perioperative morbidities, especially with better wound healing. The advantage of minimal access groups was higher wound-related satisfaction. Higher costs remain one of the major limiting factors in the widespread adoption of R-NSM.

Ochratoxin A detoxification potentials of basil, chan, and chia seeds.

The most toxic of the ochratoxins is ochratoxin A (OTA), which is primarily produced by species of Aspergillus and Penicillium that can be found in maize, wheat, coffee, red wine, and various grains. OTA induces immunotoxicity, nephrotoxicity, hepatotoxicity, teratogenicity, and carcinogenicity in both animals and humans. Thus, there is a need to identify mycotoxin detoxification agents that can effectively decontaminate OTA. Seeds of basil (Ocimum basilicum L.), chan (Hyptis suaveolens L.), and chia (Salvia hispanica L.) are functional foods capable of eliminating harmful substances. Despite this potential, the impact of these seeds on OTA detoxification remains unclear. This study reveals that milled basil, chan, and chia seeds adsorb significant levels of OTA, with chia demonstrating the highest adsorption capacity, followed by chan and basil seeds showing the least efficiency. Furthermore, milled basil, chan, and chia seeds effectively reduced OTA residues in artificial gastric and intestinal fluids, where they achieved up to 93% OTA adsorption in the former. In addition, these milled seeds were able to remove OTAs from canned, drip, and instant coffee. This study is the first to report the OTA elimination potential of basil, chan, and chia seeds.

Tumor characteristics of breast cancer in predicting axillary lymph node metastasis.

BACKGROUND: Tumor characteristics was sought to be related to axillary lymph node metastasis (ALNM), the paramount prognostic factor in patients with invasive breast cancer. This study was aimed to identify the ALNM-associated tumor characteristics and to determine the predictive clinical pathway. MATERIAL AND METHODS: Data from 1325 patients diagnosed with invasive breast cancer between January 2004 and January 2010 were retrospectively reviewed. The structure equation model (SEM) was used to build the predictive clinical pathway. RESULTS: Among the factors found in the final model, the status of human epidermal growth factor receptor 2 is the primary influence on ALNM through histology grade (ß=0.18), followed by tumor size (ß=0.16). Tumor size was highly relevant to lymphovascular invasion (LVI) and influenced ALNM through LVI (ß=0.26), the strongest predictor of ALNM in the final model (ß=0.46) and the highest risk of ALNM (odds ratio=9.282; 95% confidence interval: 7.218-11.936). CONCLUSIONS: The structure equation model presented the relation of these important predictors, and might help physicians to assess axillary nodal condition and appropriate surgical procedures.

Prediction of axillary lymph node metastases in breast cancer patients based on pathologic information of the primary tumor.

BACKGROUND: Axillary lymph nodes (ALN) are the most commonly involved site of disease in breast cancer that has spread outside the primary lesion. Although sentinel node biopsy is a reliable way to manage ALN, there are still no good methods of predicting ALN status before surgery. Since morbidity in breast cancer surgery is predominantly related to ALN dissection, predictive models for lymph node involvement may provide a way to alert the surgeon in subgroups of patients. MATERIAL AND METHODS: A total of 1325 invasive breast cancer patients were analyzed using tumor biological parameters that included age, tumor size, grade, estrogen receptor, progesterone receptor, lymphovascular invasion, and HER2, to test their ability to predict ALN involvement. A support vector machine (SVM) was used as a classification model. The SVM is a machine-learning system developed using statistical learning theories to classify data points into 2 classes. Notably, SVM models have been applied in bioinformatics. RESULTS: The SVM model correctly predicted ALN metastases in 74.7% of patients using tumor biological parameters. The predictive ability of luminal A, luminal B, triple negative, and HER2 subtypes using subgroup analysis showed no difference, and this predictive performance was inferior, with only 60% accuracy. CONCLUSIONS: With an SVM model based on clinical pathologic parameters obtained in the primary tumor, it is possible to predict ALN status in order to alert the surgeon about breast cancer counseling and in decision-making for ALN management.

Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel.

BACKGROUND: Electrocautery applications in surgical operations produce evasive odorous smoke in the cleanest operation rooms. Because of the incomplete combustion of electrical current in the tissues and blood vessels during electrocautery applications, electrocautery smoke (ES) containing significant unknown chemicals and biological forms is released. The potential hazards and cancer risk should be further investigated from the perspective of the occupational health of surgical staff. METHODS: The particle number concentration and the concentration of polycyclic aromatic hydrocarbons (PAHs) in ES were thoroughly investigated in 10 mastectomies to estimate the cancer risk for surgical staff. The particle number concentration and gaseous/particle PAHs at the surgeons' and anesthetic technologists' (AT) breathing heights were measured with a particle counter and filter/adsorbent samplers. PAHs were soxhlet-extracted, cleaned, and analyzed by gas chromatography/mass spectrometry. RESULTS: Abundant submicron particles and high PAH concentrations were found in ES during regular surgical mastectomies. Most particles in ES were in the size range of 0.3 to 0.5 µm, which may potentially penetrate through the medical masks into human respiration. The average particle/gaseous phase PAH concentrations at the surgeon's breathing height were 131 and 1,415 ng/m³, respectively, which is 20 to 30 times higher than those in regular outdoor environments. By using a toxicity equivalency factor, the cancer risk for the surgeons and anesthetic technologists was calculated to be 117 × 10(-6) and 270 × 10(-6), respectively; the higher cancer risk for anesthetic technologists arises due to the longer working hours in operation rooms. CONCLUSIONS: The carcinogenic effects of PAHs in ES on the occupational health of surgical staff should not be neglected. The use of an effective ES evacuator or smoke removal apparatus is strongly suggested to diminish the ES hazards to surgical staff.

Pure mucinous carcinoma of the breast: clinicopathologic characteristics and long-term outcome among Taiwanese women.

BACKGROUND: Pure mucinous carcinoma (MC) is found in about 3.5% of all newly diagnosed breast cancer patients in Taiwan. MC is a relatively rare malignancy of breast cancer, and its nature, behaviors, treatment pattern and long-term follow-up are not well understood. The study aimed to investigate the incidence rate, treatment patterns, and prognostic factors of MC of the breast and the clinical long-term outcomes compared with infiltrating ductal carcinoma not otherwise specified (IDC) in the middle and south Taiwanese women. METHODS: Data from 93 patients with breast MC were retrospectively reviewed and the clinicopathologic characteristics and survival status were compared with those of 2,674 patients with IDC. RESULTS: The expression of hormonal receptor was higher in MC than those in IDC (P <0.001). MC also demonstrated lower Her2/neu gene over-expression (P = 0.023), less axillary lymph node involvement (P <0.0001), lymphovascular invasion (P <0.0001) and higher 10-year overall survival rate (P = 0.042), when compared with those of IDC. CONCLUSION: Our data confirm the less aggressive behavior of MC compared to IDC. MC showed favorable clinicopathologic characteristics in tumor grade, hormone receptor status and lymph node involvement in the middle and south Taiwanese women.

Speckle reduction imaging of breast ultrasound does not improve the diagnostic performance of morphology-based CAD System.

PURPOSE: Speckle reduction imaging (SRI) is a newly developed technique in ultrasound examination. This study aimed to compare the diagnostic performance of SRI and non-SRI breast ultrasound examinations by using a morphology-based computer-aided diagnostic system. METHODS: One hundred ten patients with pathologically proven breast lesions were enrolled consecutively from April 2008 to October 2008. SRI and non-SRI ultrasound images were both obtained at the same examination for each patient. The regions of interest were manually sketched by an experienced physician without histological information. Nineteen practical morphologic features from the extracted contour were calculated and a support vector machine classifier identified the breast tumor as benign or malignant. Conventional binomial receiver operating characteristics curve analysis was used to represent the diagnostic performance of both SRI and non-SRI. RESULTS: Between SRI and non-SRI methods, there were no significant differences in the area under the receiver operating characteristics curve (Az value: 0.82 versus 0.81), the sensitivity (78.9% versus 84.2%), and the specificity (73.6% versus 70.8%). CONCLUSIONS: Based on the morphology study, the performance of breast ultrasound in characterizing the solid breast mass as benign or malignant was not significantly improved with SRI.

Correlation of histologic grade with other clinicopathological parameters, intrinsic subtype, and patients' clinical outcome in Taiwanese women.

OBJECTIVE: This study aimed to reveal the relationships between histologic grade and other clinicopathologic parameters including intrinsic subtype in Taiwanese women with breast cancer. METHODS: There were 1302 women diagnosed with breast cancer recruited for this study. Histologic grade was scored according to the Nottingham-modified Bloom-Richardson grading system. RESULTS: Higher tumor grade was associated with larger tumor size (P = 0.021), a larger number of lymph node metastases (P = 0.001), advanced clinical stage (P = 0.010), higher human epithelial growth receptor-2 positivity (P < 0.001), negative estrogen receptor and progesterone receptor (P < 0.0001) status. Triple negative breast cancer (56.6%) and human epithelial growth receptor-2 (44.3%) subtypes were associated with more Grade III breast cancer in contrast to luminal A (22.3%) and B (29.9%) breast cancer. In multivariate Cox regression analysis for cancer-specific survival, histologic grade (hazard ratio = 1.78) was a significant prognostic factor. CONCLUSIONS: This study demonstrated that histologic grade is highly correlated with some valuable biomarkers and confirmed the significance of histologic grade in Taiwanese female breast cancers.

Glutathione S-Transferase P1 (GSTP1) gene polymorphism increases age-related susceptibility to hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most frequent malignant neoplasms in the world. Genetic polymorphism has been reported to be a factor increasing the risk of HCC. Phase II enzymes such as glutathione s-transferases (GSTP1, GSTA1) play important roles in protecting cells against damage induced by carcinogens. The aim of this study was to estimate the relationship of the GSTP1 and GSTA1 gene polymorphisms to HCC risk and clinico-pathological status. METHODS: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to measure GSTP1 (A-->G) and GSTA1 (C-->T) gene polymorphisms in 386 healthy controls and 177 patients with HCC. RESULTS: Neither gene polymorphism was associated with the clinico-pathological status of HCC and serum expression of liver-related clinico-pathological markers. No association between the GSTA1 gene polymorphism and HCC susceptibility was found. However, in the younger group, aged < or = 57 years, individuals with AG or GG alleles of GSTP1 had a 2.18-fold (95%CI = 1.09-4.36; p = 0.02) and 5.64-fold (95%CI = 1.02-31.18; p = 0.04) risk, respectively, of developing HCC compared to individuals with AA alleles, after adjusting for other confounders. CONCLUSION: AG and GG alleles of GSTP1 gene polymorphisms may be considered as factors increasing the susceptibility to and risk of HCC in Taiwanese aged < or = 57 years.

Aloe-Emodin Enhances Tamoxifen Cytotoxicity by Suppressing Ras/ERK and PI3K/mTOR in Breast Cancer Cells.

Aloe-emodin (AE) is derived from Aloe vera and rhubarb (Rheum palmatum) and exhibits anticancer activities via multiple regulatory mechanisms in various cancers. AE can also enhance the anticancer efficacy of cisplatin, doxorubicin, docetaxel, and 5-fluorouracil; however, its effects remain poorly characterized. MCF-7, MDA-MB-231, MDA-MB-468, BT-474, and HCC-1954 breast cancer cell lines were treated with the indicated conditions of AE, and cell viability assays were performed. The expression levels of signaling proteins were determined by western blot analysis, intracellular reactive oxygen species (ROS), cell cycle distributions, and rates of apoptosis as estimated by flow cytometry. In comparison with other cells, MCF-7 cells were more sensitive to AE treatment; AE enhanced the cytotoxicity of 9[Formula: see text][Formula: see text]g/ml tamoxifen by reducing EGFR, ER[Formula: see text], Ras, ERK, c-Myc, and mTOR protein expression and blocking PI3K and mTOR activation. Finally, although co-treatment of AE with tamoxifen increased intracellular ROS, there were no effects on cell cycle progression. Besides facilitating tamoxifen-induced cell death, AE also enhanced the antiproliferative activity of tamoxifen by blocking Ras/ERK and PI3K/mTOR pathways in breast cancer cells, thus demonstrating the chemosensitizing potential of AE.

Expression of glucose transporter-1 in Taiwanese patients with breast carcinoma--a preliminary report.

Malignant cells show increased glucose uptake in vitro and in vivo. High expression of the glucose transporter-1 gene (GLUT1) has been found in many human tumor tissues. The aim of this study was to investigate the correlation between GLUT1 expression in breast carcinomas of Taiwanese patients and clinical prognostic parameters. Twenty-eight (71.8%) of the 39 breast carcinomas analyzed showed positive GLUT1 expression with different intensities: 1+, 19 cases (48.7%); 2+, 6 cases (15.4%), 3+, 3 cases (7.7%). No significant correlation was seen between GLUT1 expression and clinical prognostic parameters such as tumor size (p = 0.085), age (p = 0.4528), axillary lymph node metastasis (p = 0.9562), nuclear grade (p = 0.6895), estrogen receptor-positive (p = 1.0000), and progesterone receptor-positive (p = 0.9689).

Differences in accuracy and underestimation rates for 14- versus 16-gauge core needle biopsies in ultrasound-detectable breast lesions.

BACKGROUND/OBJECTIVE: Core needle biopsy (CNB) was widely used in the diagnosis of ultrasound-detectable breast lesions. We aimed at assessing the diagnostic performance differences between 14- and 16-gauge ultrasound-guided core biopsies. METHODS: This retrospective study enrolled patients receiving CNB from January 2001 to December 2007. The results of 14- and 16-gauge breast CNBs were compared with pathology reports of open surgical biopsy (OSB). RESULTS: A total of 1024 paired CNB and OSB results were obtained from 1732 CNB procedures in 1630 patients.Those CNB results reached 92.9% sensitivity, 99.7% specificity, 5.96% underestimation, and 94.8% accuracy rates. There was no difference in sensitivity (p=0.17) or specificity (p=0.38) between 14- and 16-gauge needles. However, better overall accuracy (p=0.02), less underestimation (p<0.001), and lower false-negative (p=0.02) rates were found for the 14-gauge CNB. CONCLUSION: Regarding accuracy and underestimation rates, a 14-gauge needle is preferred to a 16-gauge one in ultrasound-guided biopsies.

Survival benefit of tamoxifen in estrogen receptor-negative and progesterone receptor-positive low grade breast cancer patients.

PURPOSE: This study aimed to analyze the efficacy and prognostic significance of adjuvant tamoxifen in breast cancer patients with various hormone receptor statuses. METHODS: Typically, 1,260 female breast cancer patients were recruited in this study. The correlation between estrogen receptor (ER)/progesterone receptor (PR) phenotypes and clinical characteristics was investigated, and the survival rate was assessed after 5-year follow-up. RESULTS: The 5-year overall survival (85%) was better in women under the age of 50 years. Patients with ER+/PR+ tumors had a better 5-year survival rate (94%); those with ER-/PR- tumors experienced the worst outcome (74% survival rate); whereas single-positive cases were in between. In 97 out of 128 patients with ER-/PR+ tumors, tamoxifen was given as adjuvant hormonal therapy, and it increased the survival benefit in the lower grade group in terms of overall survival and disease-free survival (p=0.01 and p=0.03, respectively). CONCLUSION: For high-grade tumors with ER-/PR+, adjuvant tamoxifen therapy may have no survival benefit, whereas for the patients with low-grade ER-/PR+ tumors, adjuvant tamoxifen therapy is highly suggestive.

Vascular morphologic information of three-dimensional power Doppler ultrasound is valuable in the classification of breast lesions.

Doppler ultrasound imaging provides vascular information that could characterize benign and malignant breast masses in many previous publications. In this study, we applied vascular quantification and morphology features derived from three-dimensional power Doppler ultrasound as classifiers based on support vector machine. An Az value under the receiver operating characteristic (ROC) curve was used to measure the significance of each vascularization feature. Sixty solid breast tumors were assessed. According to the Az value for the ROC curve of the selected features, the classification performance of the proposed method was 0.8423, indicating that vascular morphologic information is valuable in the classification of breast lesions.

Acupuncture-related rapid dermal spread of breast cancer: a rare case.

Many ethnic Chinese patients seek second or adjuvant alternative therapies after breast cancer is diagnosed. Chinese herbs and acupuncture are the most popular methods in East Asia. We present a case of acupuncture manipulation-related cutaneous spread that no literature reported before. Post-acupuncture cutaneous spread was noted in a 54-year-old woman with left neck lymph node recurrence after complete surgery, chemotherapy and radiotherapy treatment. The results of chest computed tomography and skin biopsy showed the metastatic breast cancer in the dermis. Six courses of paclitaxel and gemcitabine followed by trastuzumab were given as therapeutic chemotherapy. The neck mass and cutaneous lesions subsided after 2 courses of chemotherapy. Direct puncture of a metastatic lymph node might increase the incidence of tumor spread on the skin. Therefore, despite the efficacy of complementary and alternative medicine, its safety and possible side effects should be more emphasized.

Neuroendocrine Carcinoma of the Breast: Case Report and Literature Review.

BACKGROUND: Neuroendocrine carcinoma of the breast is a rare disease. CASE REPORT: We present a 65-yearold female patient with an enlarged breast mass within 2 months. Solid neuroendocrine carcinoma of the breast was diagnosed by excision biopsy and histopathological analysis. A lumpectomy with the right axillary sentinel lymph node biopsy was performed, and the mass was completely resected. The literature on neuroendocrine carcinoma of the breast is reviewed. CONCLUSION: Due to the diversity of imaging findings from primary breast neuroendocrine carcinomas, the diagnosis is based on immunohistochemical staining of neuroendocrine markers. Surgery has turned out to be the first-line treatment and subsequently radiation may play a role in palliative treatment.

HINTERGRUND: Neuroendokrine Mammakarzinome sind eine seltene Krankheit. FALLBERICHT: Wir stellen eine 65 Jahre alte Frau mit einem innerhalb von 2 Monaten vergrößerten Tumor vor. Ein solides neuroendokrines Karzinom der Brust wurde mittels Exzisionsbiopsie und histopathologischer Analyse diagnostiziert. Eine Lumpektomie wurde mit einer Sentinel-Lymphknotenbiopsie in der rechten Achsel durchgeführt und die Wucherung komplett entfernt. Die Literatur zum neuroendokrinen Mammakarzinom wird dargestellt. SCHLUSSFOLGERUNG: Aufgrund der Vielfältigkeit der Ergebnisse bei der Bildgebung des primären neuroendokrinen Mammakarzinoms basiert die Diagnose auf immunohistochemischer Färbung von neuroendokrinen Markern. Die chirurgische Entfernung hat sich als First-line-Behandlung herausgestellt und nachfolgend kann Bestrahlung eine Rolle in der palliativen Behandlung einnehmen.

Computer-aided diagnosis for breast tumors by using vascularization of 3-D power Doppler ultrasound.

This study assessed the accuracy of three-dimensional (3-D) power Doppler ultrasound in differentiating between benign and malignant breast tumors by using a support vector machine (SVM). A 3-D power Doppler ultrasonography was performed on 164 patients with 86 benign and 78 malignant breast tumors. The volume-of-interest (VOI) in 3-D ultrasound images was automatically generated from three rectangular regions-of-interest (ROI). The vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) on 3-D power-Doppler ultrasound images were evaluated for the entire volume area, computer extracted VOI area and the area outside the VOI. Furthermore, patient's age and VOI volume were also applied for breast tumor classifications. Each ultrasonography in this study was classified as benign or malignant based on the features using the SVM model. All the tumors were sampled using k-fold cross-validation (k=10) to evaluate the diagnostic performance with receiver operating characteristic (ROC) curves. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of SVM for classifying malignancies were 94%, 69%, 73%, 92% and 81%, respectively. The classification performance in terms of Az value for the ROC curve of the features derived from 3-D power Doppler is 0.91. This study indicates that combining 3-D power Doppler vascularity with patient's age and tumor size offers a good method for differentiating benign and malignant breast tumors.

Comparative analysis of logistic regression, support vector machine and artificial neural network for the differential diagnosis of benign and malignant solid breast tumors by the use of three-dimensional power Doppler imaging.

OBJECTIVE: Logistic regression analysis (LRA), Support Vector Machine (SVM) and a neural network (NN) are commonly used statistical models in computer-aided diagnostic (CAD) systems for breast ultrasonography (US). The aim of this study was to clarify the diagnostic ability of the use of these statistical models for future applications of CAD systems, such as three-dimensional (3D) power Doppler imaging, vascularity evaluation and the differentiation of a solid mass. MATERIALS AND METHODS: A database that contained 3D power Doppler imaging pairs of non-harmonic and tissue harmonic images for 97 benign and 86 malignant solid tumors was utilized. The virtual organ computer-aided analysis-imaging program was used to analyze the stored volumes of the 183 solid breast tumors. LRA, an SVM and NN were employed in comparative analyses for the characterization of benign and malignant solid breast masses from the database. RESULTS: The values of area under receiver operating characteristic (ROC) curve, referred to as Az values for the use of non-harmonic 3D power Doppler US with LRA, SVM and NN were 0.9341, 0.9185 and 0.9086, respectively. The Az values for the use of harmonic 3D power Doppler US with LRA, SVM and NN were 0.9286, 0.8979 and 0.9009, respectively. The Az values of six ROC curves for the use of LRA, SVM and NN for non-harmonic or harmonic 3D power Doppler imaging were similar. CONCLUSION: The diagnostic performances of these three models (LRA, SVM and NN) are not different as demonstrated by ROC curve analysis. Depending on user emphasis for the use of ROC curve findings, the use of LRA appears to provide better sensitivity as compared to the other statistical models.