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1.
Technol Cancer Res Treat ; 23: 15330338241264843, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39238290

RESUMO

BACKGROUND: Radical mastectomy remains the cornerstone procedure for the treatment of breast cancer (BC). However, traditional radical surgeries often lead to complications such as local numbness, pulling sensations, and atrophy of the pectoralis major muscle. In contrast, BC radical surgeries that preserve more tissue have shown potential in reducing these complications. This retrospective study aims to analyze case data from our institution, focusing on the methods of surgeries that preserve more tissue and evaluating the safety and reliability of the follow-up results. METHODS: A retrospective observational study was conducted on cases diagnosed with BC between May 2018 and July 2019 at our institution. The cases were divided into three different surgical groups and followed up for a period of 5 years. The follow-up results were then discussed within each group. RESULTS: A total of 315 cases diagnosed with BC underwent regular follow-ups. The statistical analysis revealed an average age of 45 years and an average tumor size slightly over 2.2 cm, with early-stage BC (Stage I and II) accounting for 90.2% of the cases. The overall survival (OS) and disease-free survival times in the group undergoing total mastectomy with tissue preservation were comparable to those in the traditional radical mastectomy group and the breast-conserving plus radiotherapy group. Moreover, the complication rate, particularly the incidence of chest wall numbness and pulling sensations, was lower in the total mastectomy with tissue preservation group compared to the traditional radical mastectomy group. The overall average follow-up time was 64.4 months, with a recurrence and metastasis rate of 15.6% and an OS rate of 92.7%. CONCLUSION: Based on our follow-up results, total mastectomy with more tissue preservation demonstrates comparable efficacy to breast-conserving surgery and traditional radical mastectomy. It can reduce some complications associated with traditional radical mastectomy and is beneficial for subsequent immediate and delayed breast reconstruction. This approach may be suitable for most patients with early to mid-stage breast cancer who do not wish to undergo breast-conserving surgery.


Assuntos
Neoplasias da Mama , Recidiva Local de Neoplasia , Humanos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Adulto , Tela Subcutânea/patologia , Tela Subcutânea/cirurgia , Mastectomia/métodos , Seguimentos , Idoso , Estadiamento de Neoplasias
2.
Microsurgery ; 44(6): e31230, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39268882

RESUMO

BACKGROUND: The recipient vessel choice is very important when performing free-flap breast reconstructions. Usually, the concomitant vein of the recipient artery is anastomosed, and mismatches in the diameter are occasionally observed. We consider the thoracoepigastric vein (TEV) as a potential useful recipient vein. The use of the TEV is not a novel technique. It has been used by surgeons for free-flap anastomoses in the axillary region, but usually as an anastomotic site for the second vein. However, anatomical findings such as TEV diameter, its deficiency rate, and influence on mastectomy are not clear. In this study, computed tomography (CT) was performed to evaluate the use of the TEV as a recipient vein for breast reconstruction. METHODS: The medical records of patients who underwent breast reconstruction with free-flap transfer were retrospectively evaluated. In most cases, CT was performed using a tissue expander inserted after mastectomy. The TEV was considered suitable if its diameter on the mastectomy side was >1 mm and the vertical distance from the most distal slice level where the TEV could be seen at the third costal cartilage height of the parasternal region was <50 mm. RESULTS: Sixty-six sides of 33 patients were evaluated. The mean age of the patients was 49.3 ± 5.1 years. The TEV was used in five flaps. TEV diameters were not significantly different between the left and right sides (1.85 ± 0.53 vs. 1.82 ± 0.6, respectively, p = 0.836). On the mastectomy side, eight (25%) TEVs were injured, but only three (8.6%) were considered unavailable. On the healthy side, 96.4% TEVs were available. CONCLUSIONS: TEVs may be a good choice as vein anastomosis targets for breast reconstruction with a free flap because of their relatively large vessel diameter. TRIAL REGISTRATION: UMIN-CTR: R000061573.


Assuntos
Retalhos de Tecido Biológico , Mamoplastia , Mastectomia , Tomografia Computadorizada por Raios X , Humanos , Mamoplastia/métodos , Feminino , Pessoa de Meia-Idade , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Estudos Retrospectivos , Adulto , Tomografia Computadorizada por Raios X/métodos , Mastectomia/métodos , Anastomose Cirúrgica/métodos , Veias/diagnóstico por imagem , Veias/cirurgia , Veias/anatomia & histologia , Neoplasias da Mama/cirurgia
3.
Radiat Oncol ; 19(1): 120, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39272162

RESUMO

OBJECTIVE: To explore the high-risk factors affecting the prognosis of pT1 - 2N1M0 patients after mastectomy, establish a nomogram prediction model, and screen the radiotherapy benefit population. METHOD: The clinical data of 936 patients with pT1 - 2N1M0 who underwent mastectomy in the fourth hospital of Hebei Medical University from 2010 to 2016 were retrospectively analyzed. There were 583 patients received postmastectomy radiotherapy(PMRT), and 325 patients without PMRT. Group imbalances were mitigated using the propensity score matching (PSM) method, and the log-rank test was employed to compare overall survival (OS) and disease-free survival (DFS) between the cohorts. The efficacy of PMRT across various risk groups was evaluated using a nomogram model. RESULT: The median follow-up period was 98 months, Patients who received PMRT demonstrated significantly improved 5-year and 8-year OS and DFS compared to those who did not (P < 0.001). Multivariate analysis revealed that age, primary tumor site, positive lymph node, stage, and Ki-67 level independently influenced OS, while age, primary tumor site, and stage independently affected DFS. PMRT drastically enhanced OS in the high-risk group (P = 0.001), but did not confer benefits in the low-risk and intermediate risk groups (P = 0.057, P = 0.099). PMRT led to a significant improvement in disease-free survival (DFS) among patients in the intermediate and high-risk groups (P = 0.036, P = 0.001), whereas the low-risk group did not experience a significant benefit (P = 0.475). CONCLUSION: Age ≤ 40 years, tumor located in the inner quadrant or central area, T2 stage, 2-3 lymph nodes metastasis, and Ki67 > 30% were the high-risk factors affecting the prognosis of this cohort of patients. In OS nomogram, patients with a risk score of 149 or higher who received PMRT exhibited improved OS. Similarly, in DFS nomogram, patients with a risk score of 123 or higher who received PMRT demonstrated enhanced DFS.


Assuntos
Neoplasias da Mama , Mastectomia , Nomogramas , Humanos , Feminino , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Radioterapia Adjuvante , Adulto , Prognóstico , Idoso , Medição de Risco , Taxa de Sobrevida , Estadiamento de Neoplasias
5.
Int J Palliat Nurs ; 30(8): 451-463, 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-39276136

RESUMO

BACKGROUND: Breast cancer is the most common malignancy among women. Women with breast cancer need to adapt all aspects of their life following their diagnosis. AIM: To investigate how women with breast cancer make adaptations in their lives to cope with the condition. METHODS: A directed content analysis was used for this study and 23 participants were interviewed. The participants included women undergoing a mastectomy and their husbands, oncologists, oncology ward nurses and psychologists. Questions were asked regarding the participants' experiences of their adaptation to a mastectomy and cancer. RESULTS: Data analysis led to the emergence of four dimensions; the physical dimension, self-concept, role-playing and interdependence. These four dimensions consisted of 21 main categories, 59 subcategories and 111 codes. CONCLUSION: The present study showed that despite the emergence of different coping approaches, women undergoing mastectomy have had various physical and mental problems that lead to role disruption. It is recommended that solutions be adopted to increase the adaptation of these patients.


Assuntos
Adaptação Psicológica , Neoplasias da Mama , Islamismo , Mastectomia , Humanos , Feminino , Mastectomia/psicologia , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Adulto , Irã (Geográfico) , Idoso
6.
J Med Vasc ; 49(3-4): 135-140, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39278693

RESUMO

Upper limb lymphedema after breast cancer treatment including axillary dissection occurs in almost 20% of women. Its treatment consists of complete decongestive physiotherapy based on low-stretch bandage to reduce volume, followed by elastic compression to maintain it. In this article, we will detail recent data on lymphedema risk factors with possible genetic predisposition, prevention (surgical, compression), manual lymphatic drainage, physical activity, weight, advice, and treatments including gene therapy.


Assuntos
Linfedema Relacionado a Câncer de Mama , Humanos , Feminino , Fatores de Risco , Linfedema Relacionado a Câncer de Mama/terapia , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/diagnóstico , Resultado do Tratamento , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Excisão de Linfonodo/efeitos adversos , Drenagem Linfática Manual , Mastectomia/efeitos adversos , Predisposição Genética para Doença , Linfedema/terapia , Linfedema/etiologia , Terapia Genética , Exercício Físico
7.
Surg Oncol ; 56: 102128, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39241490

RESUMO

BACKGROUND/AIM: Ductal carcinoma in situ is considered a local disease with no metastatic potential, thus sentinel lymph node biopsy (SLNB) may be deemed an overtreatment. SLNB should be reserved for patients with invasive cancer, even though the risk of upstaging rises to 25 %. We aimed to identify clinicopathological predictors of post-operative upstaging in invasive carcinoma. METHODS: We retrospectively analyzed patients with a pre-operative diagnosis of DCIS subjected to breast surgery between January 2017 to December 2021, and evaluated at the Breast Unit of PTV (Policlinico Tor Vergata, Rome). RESULTS: Out of 267 patients diagnosed with DCIS, 33(12.4 %) received a diagnosis upstaging and 9(3.37 %) patients presented with sentinel lymph node (SLN) metastasis. In multivariate analysis, grade 3 tumor (OR 1.9; 95 % CI 1.2-5.6), dense nodule at mammography (OR 1.3; 95 % CI 1.1-2.6) and presence of a solid nodule at ultrasonography (OR 1.5; 95 % CI 1.2-2.6) were independent upstaging predictors. Differently, the independent predictors for SLNB metastasis were: upstaging (OR 2.1.; 95 % CI 1.2-4.6; p = 0.0079) and age between 40 and 60yrs (OR 1.4; 95 % CI 1.4-2.7; p = 0.027). All 9 patients with SLN metastasis received a diagnosis upstaging and were aged between 40 and 60 years old. CONCLUSION: We identified pre-operative independent predictors of upstaging to invasive ductal carcinoma. The combined use of different predictors in an algorithm for surgical treatments of DCIS could reduce the numbers of unnecessary SLNB.


Assuntos
Algoritmos , Neoplasias da Mama , Carcinoma Ductal de Mama , Carcinoma Intraductal não Infiltrante , Metástase Linfática , Humanos , Feminino , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos Retrospectivos , Pessoa de Meia-Idade , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/secundário , Carcinoma Ductal de Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/secundário , Adulto , Idoso , Biópsia de Linfonodo Sentinela/métodos , Prognóstico , Seguimentos , Mamografia , Mastectomia , Estadiamento de Neoplasias
8.
Artigo em Russo | MEDLINE | ID: mdl-39248586

RESUMO

Postmastectomy syndrome (PMS) is a complex neurovascular set of symptoms that develops in most patients after breast cancer (BC) treatment and significantly reduces the quality of life. One of the potential mechanisms of its occurrence is considered to be an endothelial dysfunction. The possible method of reducing manifestation of endothelial dysfunction is systematic aerobic dynamic training. OBJECTIVE: To evaluate the influence of 12-week aerobic dynamic training program of moderate intensity on the endothelial dysfunction laboratory markers and life quality in patients with PMS. MATERIAL AND METHODS: Single-center prospective randomized trial included 40 patients with PMS divided into study (20 patients) and comparative (20 patients) groups, as well as 20 healthy female volunteers. The expression level of soluble intercellular adhesion molecule-1 (ICAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) were evaluated in all participants at baseline by enzyme-linked immunosorbent assay method, and additionally psychological and physical component of health by SF-36 questionnaire were assessed in patients with PMS.Patients of study group received a course of 12-week partially controlled aerobic dynamic training of moderate intensity lasting 45 minutes with frequency equal 5 times per week. Patients with PMS were re-evaluated for ICAM-1 and PECAM-1, as well as for life quality. RESULTS: The group of patients with PMS after BC treatment had increased level of ICAM-1 in long-term period, that may indicate endothelial dysfunction. Statistically significant decrease of endothelial dysfunction laboratory markers was revealed in patients with PMS, who underwent the course of cardiorespiratory training. In the same time, the dynamics of changes in ICAM-1 was higher in the study group than in comparative group. Further, improvement of physical and psychological components of health by SF-36 questionnaire was found. CONCLUSIONS: The program of cardiorespiratory trainings of moderate intensity in patients, who had BC treatment a year ago, decreases intercellular adhesion molecules level that may show an improvement of endothelial dysfunction.


Assuntos
Molécula 1 de Adesão Intercelular , Mastectomia , Humanos , Feminino , Molécula 1 de Adesão Intercelular/sangue , Pessoa de Meia-Idade , Adulto , Molécula-1 de Adesão Celular Endotelial a Plaquetas/sangue , Qualidade de Vida , Estudos Prospectivos , Terapia por Exercício/métodos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/reabilitação
9.
BMJ Open ; 14(8): e078816, 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39214662

RESUMO

OBJECTIVE: Breast-conserving therapy (BCT) includes breast-conserving surgery (BCS) combined with radiation therapy (RT). RT plays a crucial role in improving the prognosis of patients who undergo BCS. However, obesity is a potential risk factor for resistance to radiation. The aim of this study was to evaluate any difference in the long-term prognosis of patients with early stage breast cancer and obesity treated with BCT or total mastectomy (TM). DESIGN, SETTING AND PARTICIPANTS: This was a retrospective cohort study involving 1125 patients diagnosed with early stage breast cancer and obesity at the Shanghai Cancer Center of Fudan University from 2013 to 2016. OUTCOME MEASURES: Obesity in the Chinese population was defined as a body mass index ≥28 kg/m2. Surgical options included BCT and TM. The primary survival outcomes were overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). Inverse probability of treatment weighting (IPTW) was used to control for the impact of confounding factors on prognosis. RESULTS: The median follow-up times in the BCT group and TM group without postoperative RT were 51.1 months (IQR of 40.6-68.1 months) and 61.8 months (IQR of 46.5-76.7 months), respectively. After IPTW, the baseline data were balanced. Compared with those in the TM cohort, patients in the whole IPTW cohort in the BCT cohort had worse DFS (HR 4.280, 95% CI 2.180 to 8.400; p<0.001), RFS (HR 4.380, 95% CI 2.370 to 8.120; p<0.001) and OS (HR 3.590, 95% CI 1.620 to 7.950; p=0.002). CONCLUSION: In patients with early stage breast cancer and obesity, TM is associated with better survival outcomes than BCT.


Assuntos
Neoplasias da Mama , Mastectomia Segmentar , Obesidade , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Estudos Retrospectivos , Obesidade/complicações , Pessoa de Meia-Idade , China/epidemiologia , Prognóstico , Adulto , Intervalo Livre de Doença , Estadiamento de Neoplasias , Idoso , Mastectomia , Índice de Massa Corporal , Mastectomia Simples
10.
BMC Surg ; 24(1): 245, 2024 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-39217330

RESUMO

BACKGROUND: The incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery. METHODS: A single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded. RESULTS: Only 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period. CONCLUSION: This study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.


Assuntos
Neoplasias da Mama , Mastectomia , Poliglactina 910 , Complicações Pós-Operatórias , Telas Cirúrgicas , Humanos , Feminino , Telas Cirúrgicas/economia , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Mama/cirurgia , Paquistão , Resultado do Tratamento , Implante Mamário/economia , Implante Mamário/métodos , Implante Mamário/instrumentação , Mamoplastia/economia , Mamoplastia/métodos , Implantes de Mama/economia , Países em Desenvolvimento
13.
BMC Womens Health ; 24(1): 443, 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39107751

RESUMO

BACKGROUND: Being diagnosed with Breast Cancer (BC) is a crisis that throws the patient's life out of balance. Cancer-related fatigue is a debilitating sign experienced by women during and after BC treatment. Regular physical exercise may help mitigate patients' fatigue, enhance coping abilities, improve their quality of life, and overall well-being. In parallel, psychological interventions are geared toward normalizing the lived painful experiences among oncology patients. OBJECTIVE: to examine the effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy. METHODS: A quasi-experimental study was conducted in the Oncology Surgical Department and chemotherapy unit at the Alexandria Main University Hospital, Egypt. A total of 60 women were randomly allocated to either to the study or the control groups. Women in the study group practiced seated exercises and psychological rehabilitation interventions, including mindfulness breathing, problem-solving training, cognitive reframing technique, and thought stopping while the control group received the routine care. RESULTS: The study revealed a significant decline in the fatigue mean scores among participants in the intervention group from 136.10 ± 27.76 to 98.43 ± 25.99 (p < 0.001). Similarly, there was a significant decrease in the patients' mean scores of maladaptive coping, helplessness/ hopelessness (p = 0.014), and anxious preoccupation (p = 0.008). In contrast, there is a noticeable increment in the scores of adaptive coping, such as fighting spirit (p = 0.012), cognitive avoidance (p = 0.002), and fatalism (p = 0.009). CONCLUSION: Bundling seated exercises and psychological rehabilitation interventions using the teach-back approach have been proven to be simple and inexpensive non-pharmacological methods of reducing cancer-related fatigue and improving coping skills among women post-mastectomy. TRIAL REGISTRATION NUMBER: NCT06360276, ClinicalTrails.gov, Retrospectively registered (April 8th, 2024), URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT06360276 .


Assuntos
Adaptação Psicológica , Neoplasias da Mama , Terapia por Exercício , Fadiga , Mastectomia , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Mastectomia/psicologia , Pessoa de Meia-Idade , Fadiga/psicologia , Adulto , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Qualidade de Vida/psicologia , Atenção Plena/métodos , Egito , Educação de Pacientes como Assunto/métodos , Empoderamento , Terapias Mente-Corpo/métodos , Exercício Físico/psicologia
15.
BMC Cancer ; 24(1): 973, 2024 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-39118042

RESUMO

BACKGROUND: Self-management is the key to control breast cancer related lymphedema (BCRL). This study aimed to develop a mobile application with nurse support for lymphedema self-management and evaluate its usability from the patients' points of view. METHODS: This applied developmental study was conducted on 87 women in a lymphedema clinic, Shiraz, Iran, May-November 2023. The study included three phases: development, distribution of the application and usability evaluation. In the development phase, the researchers developed application using the Java programming language. In distribution phase, the application was installed on the participants' phones. For usability evaluation, 87 patients completed the user satisfaction questionnaire after three months access to the application. Data was analyzed using descriptive and analytical statistics using SPSS software 22. P-value less than 0.05 was considered significant. RESULTS: We designed a self-management application specific to BCRL that included ten unique modules mainly related to patient education, interaction with peers and nurse, self-management support, and settings. The application mean usability score was 7.72 ± 1.08. The usability dimensions of "screen" (8.06 ± 1.02) and "terminology and systems information" (7.29 ± 1.62) received the highest and lowest mean scores, respectively. CONCLUSION: The application has new features to meet more patients' needs compared to what other existing lymphedema self-management applications already have addressed. The findings showed that the participants rated the application usability at the "good" level that is similar to some previous studies. Considering the unique nature of the application and its favorable usability, we recommend its use for BCRL self-management.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Aplicativos Móveis , Autogestão , Humanos , Feminino , Autogestão/métodos , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Sobreviventes de Câncer/psicologia , Irã (Geográfico) , Adulto , Inquéritos e Questionários , Linfedema Relacionado a Câncer de Mama/terapia , Mastectomia/efeitos adversos , Idoso , Linfedema/etiologia , Linfedema/terapia , Satisfação do Paciente
16.
Eur J Surg Oncol ; 50(9): 108534, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39163741

RESUMO

BACKGROUND: Phyllodes tumours of the breast are rare, and their treatment is still subject to discussion. They are classified as benign, borderline, or malignant based on histopathological characteristics of the stroma. This study demonstrates 10 years' experience in diagnosis and management of malignant phyllodes. METHODS: All patients referred for discussion at our sarcoma multidisciplinary team meeting from 2003 to 2013 with a diagnosis of malignant phyllodes were identified. Patient demographics, biopsy details, excision extent, final pathology, reconstruction, adjuvant treatment, recurrence and overall survival were assessed. RESULTS: Thirty patients were identified over the 10 year period. Eight (26.7 %) had their diagnosis upgraded to malignant phyllodes on completion excision, compared to initial biopsy. Nine (30 %) had breast surgery elsewhere as definitive treatment before referral to our service. Four of these (44.4 %) required more extensive excision and three developed metastases (33.3 %) and died. Twenty-one patients had primary surgery through our service and three (14.3 %) died from disease. Overall, 13 patients had radical mastectomy, 92.3 % with adequate margins (>1 cm histologically) and no local recurrence, 9 simple mastectomy 22.2 % with adequate margins and 1 local recurrence and 8 wide local excision with 37.5 % adequate margins and 1 local recurrence. CONCLUSION: For malignant phyllodes patients, the best chance to reduce recurrence and improve survival is adequate excision and radical mastectomy should be considered. For borderline lesions, consideration should be given for referral to a specialist centre and we recommend delayed reconstruction, because of the chance of histological upgrade to malignancy.


Assuntos
Neoplasias da Mama , Mastectomia , Recidiva Local de Neoplasia , Tumor Filoide , Humanos , Tumor Filoide/patologia , Tumor Filoide/cirurgia , Tumor Filoide/terapia , Feminino , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Pessoa de Meia-Idade , Adulto , Idoso , Estudos Retrospectivos , Mamoplastia , Margens de Excisão , Sarcoma/terapia , Sarcoma/patologia , Sarcoma/cirurgia , Taxa de Sobrevida , Adulto Jovem , Biópsia
17.
Lymphat Res Biol ; 22(4): 224-229, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39092500

RESUMO

Background: Lymphedema is a common complication after mastectomy in women with breast cancer. Several methods have been described to assess and diagnose lymphedema, one of the most studied being the perimeter and ultrasonography. However, the reliability of these methods and the correlation between them are still controversial. The aim of this study was to analyze the reliability of cytometry and ultrasound imaging in the assessment of lymphedema after mastectomy in women with breast cancer and to study the correlation between them. Methods and Results: A cross-sectional study was conducted in 29 women with mastectomy after breast cancer. Lymphedema in the arm was measured both with cytometry and ultrasonography. Reliability was calculated with intraclass correlation coefficient. The correlation between the two methods was carried out with the Pearson correlation coefficient. Both cytometry (M1: α = 0.999, ICC = 0.996; M2: = α = 0.998, ICC = 0.994) and ultrasonography (M1: α = 0.992, ICC = 0.976; M2: = α = 0.991, ICC = 0.973) are reliable methods to assess lymphedema in the arm. No significant correlation was found between them (p > 0.05). Conclusions: Cytometry and ultrasonography appear to be adequate for the measurement of edema in women with breast cancer after mastectomy. However, for an accurate measurement of lymphedema, these measurements should not be used interchangeably.


Assuntos
Neoplasias da Mama , Linfedema , Mastectomia , Ultrassonografia , Humanos , Feminino , Mastectomia/efeitos adversos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Pessoa de Meia-Idade , Estudos Transversais , Linfedema/etiologia , Linfedema/diagnóstico , Linfedema/diagnóstico por imagem , Linfedema/patologia , Adulto , Idoso , Reprodutibilidade dos Testes , Braço/patologia , Braço/diagnóstico por imagem , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/diagnóstico
18.
Acta Oncol ; 63: 620-635, 2024 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-39099323

RESUMO

BACKGROUND AND PURPOSE: Metaplastic breast carcinoma (BC-Mp) is an uncommon subtype that poses unique challenges. The limited information on patient prognosis and therapeutic strategies motivated our research initiative. We aimed to assess disease-free survival (DFS), overall survival (OS), and influential factors in patients with nonmetastatic BC-Mp. MATERIALS AND METHODS: In this multicenter retrospective cohort study, clinicopathological data for nonmetastatic BC-Mp patients treated at four oncology units in Poland (2012-2022) were gathered. RESULTS: Among 115 women (median age 61, range: 28-91), the median tumor size was 40 mm (range 20-130); 30% of patients exhibited positive local lymph nodes. The majority of patients presented with stage II (46%) and triple-negative breast cancer (TNBC) (84%). Radiotherapy was administered to 61% of patients. Surgical procedures included breast-conserving surgery in 31% of patients and mastectomy in 68%. Eighty-three per cent of patients received chemotherapy. The median estimated DFS and OS were 59 and 68 months, respectively. Multivariable analysis revealed that tumor size influenced DFS and OS (Hazard ratios [HR] = 1.02, 95%CI 0.01-0.03 for both endpoints) and taxanes application improved DFS (HR = 0.47, 95%CI 0.24-0.93), but other factors did not. For patients receiving neoadjuvant systemic therapy (N = 51), taxanes improved DFS and OS according to univariable analysis. INTERPRETATION: Our findings highlight poor DFS and OS regardless of receiving optimal treatment, emphasizing the need for tailored therapeutic strategies for BC-Mp patients. Taxanes appear promising in a neoadjuvant setting, particularly within the current standard of care for the TNBC subtype.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Idoso , Prognóstico , Neoplasias da Mama/terapia , Neoplasias da Mama/patologia , Neoplasias da Mama/mortalidade , Idoso de 80 Anos ou mais , Resultado do Tratamento , Intervalo Livre de Doença , Metaplasia/patologia , Metaplasia/terapia , Mastectomia , Neoplasias de Mama Triplo Negativas/patologia , Neoplasias de Mama Triplo Negativas/terapia , Neoplasias de Mama Triplo Negativas/mortalidade
20.
J Plast Reconstr Aesthet Surg ; 96: 242-253, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39106546

RESUMO

BACKGROUND: Pre-operative radiotherapy (PRT) and pre-operative chemoradiotherapy (PCRT) prior to mastectomy and immediate breast reconstruction for locally advanced breast cancer have the potential to reduce radiation late-effects and expedite oncologic treatment. Recent feasibility work indicates that PCRT is safe and technically possible. Here, we present a systematic review of currently available data on clinical, oncological, reconstructive and aesthetic outcomes. METHODS: A prospectively registered search of Medline (Ovid), EMBASE (Ovid), EMCARE (Ovid) and CINAHL (EBSCO) databases was performed in August 2023. Clinical, oncological, reconstructive and aesthetic outcomes were appraised with risk of bias (ROBINS-I) and methodological quality determined (STROBE checklist) for each study. RESULTS: Twenty-two published articles (19 journal articles and 3 abstracts) were identified reporting the outcomes of 1258 patients with median follow-up between 19.0-212.4 months. Patients received neoadjuvant chemotherapy in 20 studies. Rates of locoregional recurrence and overall survival ranged between 0-21.7% and 82.0%-98.3% respectively. Rates of flap loss or necrosis ranged from 0-7.6%. Rates of revisional procedures ranged between 1.9-35.3%. Patient-reported outcomes were reported in 7 studies and were mostly 'good' or 'excellent'. CONCLUSION: PRT and PCRT preceding mastectomy and breast reconstruction produce acceptable oncological outcomes with rates of surgical complication and reconstructive outcomes within normal limits, however, the majority of available studies are of low methodological quality and at high risk of bias. A pragmatic randomised trial comparing PRT versus PMRT in the setting of breast reconstruction is now urgently required to guide surgical practice.


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia , Humanos , Neoplasias da Mama/terapia , Neoplasias da Mama/cirurgia , Feminino , Mamoplastia/métodos , Estética , Quimiorradioterapia/métodos , Cuidados Pré-Operatórios/métodos , Terapia Neoadjuvante , Resultado do Tratamento
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