Clinical Study on the Thoracodorsal Artery Perforator Flap in Breast-Conserving Reconstruction of T2 Breast Cancer.

BACKGROUND: Breast-conserving surgery combined with oncoplastic breast surgery has become the standard surgical treatment for early breast cancer. OBJECTIVE: The purpose of this study was to investigate the safety and efficacy of the thoracodorsal artery perforator flap (TDAPF) in breast-conserving reconstruction of T2 breast cancer. METHODS: Thirty patients with T2 breast cancer admitted to our hospital from January 2019 to December 2020 were enrolled to receive pedicled TDAPF for repairing breast defects after breast-conserving surgery. Intraoperative conditions, postoperative complications, and shape satisfaction after breast reconstruction were recorded. RESULTS: The operation was successfully completed in all 30 patients, with an operation time of 177.77 ± 24.39 min, bleeding of 44.17 ± 7.67 mL, and length of hospital stay of 5.23 ± .97 d. There was no deformity or seroma at the donor site. Breast shape recovered well after operation. After operation, one patient had fat liquefaction in the recipient site, which healed well after wound treatment. The incidence of postoperative complications was 3.33%. Postoperative follow-up lasted 16-28 months, with a median of 22 months. The Breast-Q score for breast satisfaction was 61.83 ± 12.87 at 6 months after operation, compared to 62.07 ± 11.78 before operation (P > .05). CONCLUSIONS: TDAPF, featuring a high survival rate, moderate flap area, fewer postoperative complications, and high satisfaction with breast shape after operation. For east asian women with moderate breast size, TDAPF is a safe, effective choice for repairing defects in breast-conserving surgery for T2 breast cancer.

Mammographic Density Reduction is Associated to the Prognosis in Asian Breast Cancer Patients Receiving Hormone Therapy.

INTRODUCTION: Using mammographic density as a significant biomarker for predicting prognosis in adjuvant hormone therapy patients is controversial due to the conflicting results of recent studies. This study aimed to evaluate hormone therapy-induced mammographic density reduction and its association with prognosis in Taiwanese patients. METHODS: In this retrospective study, 1941 patients with breast cancer were screened, and 399 patients with estrogen receptor-positive breast cancer who received adjuvant hormone therapy were enrolled. The mammographic density was measured using a fully automatic estimation procedure based on full-field digital mammography. The prognosis included relapse and metastasis during treatment follow-up. The Kaplan-Meier method and Cox proportional hazards model were used for disease-free survival analysis. RESULTS: A mammographic density reduction rate >20.8%, measured preoperatively and after receiving hormone therapy from 12-18 months, was a significant threshold for predicting prognosis in patients with breast cancer. The disease-free survival rate was significantly higher in patients whose mammographic density reduction rate was >20.8% (P = .048). CONCLUSION: This study's findings could help estimate the prognosis for patients with breast cancer and may improve the quality of adjuvant hormone therapy after enlarging the study cohort in the future.

Clinical study on single-port endoscopic resection via a gasless transaxillary approach in the treatment of breast fibroadenoma in adolescents.

BACKGROUND: Breast fibroadenoma is the most common benign breast tumour. This study aimed to investigate the advantages and disadvantages of endoscopic-assisted resection via a gas-less transaxillary single-port approach for breast fibroadenoma in adolescent patients, compared with a traditional approach. METHODS: The clinical data of 83 patients with breast fibroadenoma treated in our hospital from October 2019 to October 2021 were collected for retrospective analysis. These patients were divided into an endoscopic-assisted surgery (ES) group (n = 39) and a traditional open surgery (OS) group (n = 44) according to the surgical approach. The operative time, intraoperative blood loss, incision length, postoperative complications, and patient satisfaction were compared between the two groups. RESULTS: The surgical cost was (5.1 ± 0.6) thousand Yuan [(0.7 ± 0.1) thousand US dollars] in the ES group and (3.5 ± 2.7) thousand Yuan [(0.5 ± 0.4) thousand US dollars] in the OS group, showing a statistically significant difference (p < 0.001). There was no significant difference in surgical time, intraoperative blood loss, incision length, or the rate of postoperative complications between the two groups. Stratified analysis revealed that the ES group had a significantly shorter operative time [(57.00 ± 10.26) min vs. (78.27 ± 7.63)] (p < 0.001), a smaller incision length [(3.73 ± 0.34) cm vs. (4.42 ± 0.44) cm] (p < 0.001), and a lower complication incidence rate (11.1% vs. 63.6) (p = 0.011) than the OS group in the cases with a nodule number ≥ 3. The satisfaction score using the BREAST-Q scale indicated that psychosocial well-being and patient satisfaction with the breast in the ES group were significantly superior to those in the OS group [(91.18 ± 3.12) points vs. (87.00 ± 4.45) points and (91.03 ± 6.80) points vs. (84.45 ± 6.06) points, respectively] (p < 0.001). CONCLUSION: ES is a safe and effective method for the treatment of fibroadenoma. In patients with multiple fibroadenomas (≥ 3 tumours), ES has a shorter operative time and fewer postoperative complications. ES demonstrates a significant, prominent advantage in cosmetic appearance. However, it should be noted that ES is associated with higher costs than OS.

Midterm follow-up results of a novel technique: Contralateral breast overlapped reconstruction after mastectomy for unilateral breast cancer.

BACKGROUND: The breasts of Oriental women are characterized by an obvious scar constitution and a relatively small mammary gland volume. Thus, plastic surgery, which is now popular in the West, is not suitable for most patients in China, and Chinese surgeons are searching for symmetrical plastic surgery options that are suitable for patients with breast tumors, unilateral breast implants and an obvious scar constitution. METHODS: Between January 2016 and December 2019, 15 patients underwent contralateral breast overlapped reconstruction (COBOR) at the Affiliated Hospital of Putian University. We assessed their clinicopathological data, complications, cosmetic satisfaction and quality of life. RESULTS: The mean age was 41.6 years (range, 31-54 years), the average BMI was 24.36 kg/m2 (range, 20.3-28.4 kg/m2), the most common tumor location was the upper outer quadrant (n = 9), the mean preoperative tumor size was 21.11 mm (range, 7-42 mm), and 4 patients underwent neoadjuvant chemotherapy. The cancer grades and histological types were as follows: G3 nonspecial type (NST), 3 cases; G2 NST, 6 cases; G2 lobular carcinoma, 1 case; and ductal carcinoma in situ (DCIS), 5 cases. The nipple margin was negative in all of these cases. Among them, there was 1 case of poor wound healing caused by subcutaneous fat liquefaction around the incision. In another case, partial nipple necrosis occurred on the affected side due to an insufficient nipple blood supply after the operation and healed after debridement and dressing changes. There were no cases of tumor recurrence during the mean follow-up of 22.53 months (range, 11-47 months). The BREAST-Q scores showed that COBOR provided good patient satisfaction. CONCLUSION: For Oriental patients with small breasts, COBOR, which results in fewer scars, good symmetry and good satisfaction, is an effective and safe surgical method. However, larger studies with longer follow-up periods are needed to obtain more reliable postoperative results.

Classification of malignant tumours in breast ultrasound using unsupervised machine learning approaches.

Traditional computer-aided diagnosis (CAD) processes include feature extraction, selection, and classification. Effective feature extraction in CAD is important in improving the classification's performance. We introduce a machine-learning method and have designed an analysis procedure of benign and malignant breast tumour classification in ultrasound (US) images without a need for a priori tumour region-selection processing, thereby decreasing clinical diagnosis efforts while maintaining high classification performance. Our dataset constituted 677 US images (benign: 312, malignant: 365). Regarding two-dimensional US images, the oriented gradient descriptors' histogram pyramid was extracted and utilised to obtain feature vectors. The correlation-based feature selection method was used to evaluate and select significant feature sets for further classification. Sequential minimal optimisation-combining local weight learning-was utilised for classification and performance enhancement. The image dataset's classification performance showed an 81.64% sensitivity and 87.76% specificity for malignant images (area under the curve = 0.847). The positive and negative predictive values were 84.1 and 85.8%, respectively. Here, a new workflow, utilising machine learning to recognise malignant US images was proposed. Comparison of physician diagnoses and the automatic classifications made using machine learning yielded similar outcomes. This indicates the potential applicability of machine learning in clinical diagnoses.

Indocyanine green fluorescence method for sentinel lymph node biopsy in breast cancer.

BACKGROUND/OBJECTIVE: Breast biopsy and analysis of sentinel lymph nodes (SLNs) accurately predict tumor status in the affected basin and help in avoiding unnecessary axillary lymph node dissection, which is associated with remarkable morbidity risk. Blue dye and radioisotope are the most widely used mapping agents, but non-radioactive tracers of comparable accuracy warrant further investigation. This study aimed to investigate utilization of indocyanine green (ICG) fluorescence in sentinel node localization compared with blue dye and to assess the incremental value of ICG. METHODS: A total of 39 consecutive patients underwent sentinel lymph node biopsy (SLNB) (40 cases: 38 unilateral and 1 bilateral) with combined blue dye and ICG for localization. The obtained fluorescence images of the lymphatic system were investigated. RESULTS: All 84 lymph nodes removed in 40 procedures were identified by ICG, but only 37 were identified by blue dye. The ICG method identified an average of 2.1 SLNs in 39 of 40 cases with a detection rate of 97.5%, but only 0.93 SLN per case with blue dye. Subcutaneous lymphatic channel patterns were also detected by fluorescent imaging in 37 procedures, which all revealed lymphatic drainage toward the axilla except in one case with internal mammary pathway. CONCLUSION: This study demonstrated the accuracy and safety of ICG for SLNB and its superiority to blue dye method in SLN localization. Therefore, ICG fluorescence method is safe and effective addition in breast clinical settings, wherein blue dye alone is used.

Mammographic Density Distribution of Healthy Taiwanese Women and its Naturally Decreasing Trend with Age.

We analysed typical mammographic density (MD) distributions of healthy Taiwanese women to augment existing knowledge, clarify cancer risks, and focus public health efforts. From January 2011 to December 2015, 88,193 digital mammograms were obtained from 69,330 healthy Taiwanese women (average, 1.27 mammograms each). MD measurements included dense volume (DV) and volumetric density percentage (VPD) and were quantified by fully automated volumetric density estimation and Box-Cox normalization. Prediction of the declining MD trend was estimated using curve fitting and a rational model. Normalized DV and VPD Lowess curves demonstrated similar but non-identical distributions. In high-density grade participants, the VPD increased from 12.45% in the 35-39-year group to 13.29% in the 65-69-year group but only from 5.21% to 8.47% in low-density participants. Regarding the decreased cumulative VPD percentage, the mean MD declined from 12.79% to 19.31% in the 45-50-year group versus the 50-55-year group. The large MD decrease in the fifth decade in this present study was similar to previous observations of Western women. Obtaining an MD distribution model with age improves the understanding of breast density trends and age variations and provides a reference for future studies on associations between MD and cancer risk.

Albumin and hemoglobin adducts of estrogen quinone as biomarkers for early detection of breast cancer.

Cumulative estrogen concentration is an important determinant of the risk of developing breast cancer. Estrogen carcinogenesis is attributed to the combination of receptor-driven mitogenesis and DNA damage induced by quinonoid metabolites of estrogen. The present study was focused on developing an improved breast cancer prediction model using estrogen quinone-protein adduct concentrations. Blood samples from 152 breast cancer patients and 71 healthy women were collected, and albumin (Alb) and hemoglobin (Hb) adducts of estrogen-3,4-quinone and estrogen-2,3-quinone were extracted and evaluated as potential biomarkers of breast cancer. A multilayer perceptron (MLP) was used as the predictor model and the resultant prediction of breast cancer was more accurate than other existing detection methods. A MLP using the logarithm of the concentrations of the estrogen quinone-derived adducts (four input nodes, 10 hidden nodes, and one output node) was used to predict breast cancer risk with accuracy close to 100% and area under curve (AUC) close to one. The AUC value of one showed that both data sets were separable. We conclude that Alb and Hb adducts of estrogen quinones are promising biomarkers for the early detection of breast cancer.