Is Body Appreciation a Moderator of Women's Satisfaction and Distress with the Body Changes that Occur after Breast Cancer Surgery? A One-Year Longitudinal Study.

Women with breast cancer show dissatisfaction with their appearance, a perception of loss of femininity and bodily integrity, and dissatisfaction with the outcome of the surgery. Body Appreciation (BA) is defined as positive attitudes toward one's body, beyond satisfaction and dissatisfaction with one's appearance. Although studies about the protective role of BA have increased, to the best of our knowledge, there are no published studies on the association between BA, body dissatisfaction, and distress in participants with breast cancer. The aims of this study are: (a) To analyze whether BA is a moderator of satisfaction with the body from before breast surgery to the one-year follow-up; and (b) to analyze whether BA is a moderator of distress from before breast surgery to the one-year follow-up. The sample consisted of 115 women diagnosed with breast cancer. Several hierarchical regression analyses were conducted. The results indicated that BA moderated the association between the appearance evaluation before the surgery and the appearance evaluation 12 months after the surgery. Although BA was a significative predictor of distress, it was not a moderator of distress from the moment before breast surgery to the one-year follow-up. This study highlights the importance of evaluating the construct of BA in participants with breast cancer using longitudinal designs and developing psychological interventions that focus on increasing BA.

Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial.

Importance: Sentinel lymph node biopsy (SLNB) is the standard of care for axillary node staging of patients with early breast cancer (BC), but its necessity can be questioned since surgery for examination of axillary nodes is not performed with curative intent. Objective: To determine whether the omission of axillary surgery is noninferior to SLNB in patients with small BC and a negative result on preoperative axillary lymph node ultrasonography. Design, Setting, and Participants: The SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound) trial was a prospective noninferiority phase 3 randomized clinical trial conducted in Italy, Switzerland, Spain, and Chile. A total of 1463 women of any age with BC up to 2 cm and a negative preoperative axillary ultrasonography result were enrolled and randomized between February 6, 2012, and June 30, 2017. Of those, 1405 were included in the intention-to-treat analysis. Data were analyzed from October 10, 2022, to January 13, 2023. Intervention: Eligible patients were randomized on a 1:1 ratio to receive SLNB (SLNB group) or no axillary surgery (no axillary surgery group). Main Outcomes and Measures: The primary end point of the study was distant disease-free survival (DDFS) at 5 years, analyzed as intention to treat. Secondary end points were the cumulative incidence of distant recurrences, the cumulative incidence of axillary recurrences, DFS, overall survival (OS), and the adjuvant treatment recommendations. Results: Among 1405 women (median [IQR] age, 60 [52-68] years) included in the intention-to-treat analysis, 708 were randomized to the SLNB group, and 697 were randomized to the no axillary surgery group. Overall, the median (IQR) tumor size was 1.1 (0.8-1.5) cm, and 1234 patients (87.8%) had estrogen receptor-positive ERBB2 (formerly HER2 or HER2/neu), nonoverexpressing BC. In the SLNB group, 97 patients (13.7%) had positive axillary nodes. The median (IQR) follow-up for disease assessment was 5.7 (5.0-6.8) years in the SLNB group and 5.7 (5.0-6.6) years in the no axillary surgery group. Five-year distant DDFS was 97.7% in the SLNB group and 98.0% in the no axillary surgery group (log-rank P = .67; hazard ratio, 0.84; 90% CI, 0.45-1.54; noninferiority P = .02). A total of 12 (1.7%) locoregional relapses, 13 (1.8%) distant metastases, and 21 (3.0%) deaths were observed in the SLNB group, and 11 (1.6%) locoregional relapses, 14 (2.0%) distant metastases, and 18 (2.6%) deaths were observed in the no axillary surgery group. Conclusions and Relevance: In this randomized clinical trial, omission of axillary surgery was noninferior to SLNB in patients with small BC and a negative result on ultrasonography of the axillary lymph nodes. These results suggest that patients with these features can be safely spared any axillary surgery whenever the lack of pathological information does not affect the postoperative treatment plan. Trial Registration: ClinicalTrials.gov Identifier: NCT02167490.

Clinical and cost outcomes of a polyethylene glycol (PEG)-coated patch versus drainage after axillary lymph node dissection in breast cancer: results from a multicentre randomized clinical trial.

BACKGROUND: The aim of this study was to compare the clinical outcomes between breast cancer patients who underwent axillary lymph node dissection with postoperative management using a polyethylene glycol-coated patch versus axillary drainage. The direct costs associated with both postoperative management strategies were also evaluated. METHODS: This was a multicentre RCT in women with breast cancer who underwent axillary lymph node dissection (ClinicalTrials.gov identifier: NCT04487561). Patients were randomly assigned (1 : 1) to receive either drainage or a polyethylene glycol-coated patch as postoperative management. The primary endpoints were the need for an emergency department visit for any event related to the surgery and the rate of seroma development. RESULTS: A total of 227 patients were included , 115 in the patch group (50.7 per cent) and 112 (29.4 per cent ) in the drainage group. The incidence of emergency department visits was significantly greater for patients with drainage versus a polyethylene glycol-coated patch (incidence rate difference 26.1 per cent, 95 per cent c.i. 14.5 to 37.7 per cent; P < 0.001). Conversely, the seroma rate was significantly higher in the polyethylene glycol-coated patch group (incidence rate difference 22.8 per cent, 95 per cent c.i. 6.7 to 38.9 per cent; P < 0.0055). Compared with drainage, using a polyethylene glycol-coated patch resulted in cost savings of €100.41 per patient. An incremental cost-effectiveness ratio analysis found that drainage was associated with an incremental cost-effectiveness ratio of €7594.4 for no need for hospital admission and €491.7 for no need for an emergency department visit. CONCLUSION: Compared with patients who received drainage after axillary lymph node dissection, the use of a polyethylene glycol-coated patch resulted in a higher rate of seroma, but a lower number of postoperative outpatient or emergency department visits and thus a reduction in overall costs.

Advances and controversies in management of breast ductal carcinoma in situ (DCIS).

Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer. It accounts for 25% of all breast cancers diagnosed, as a result of the expansion of breast cancer screening and is associated with a high survival rate. DCIS is particularly clinically challenging, due to its heterogeneous pathological and biological traits and its management is continually evolving towards more personalized and less aggressive therapies. This article suggests evidence-based guidelines for proper DCIS clinical management, which should be discussed within a multidisciplinary team in order to propose the most suitable approach in clinical practice, taking into account recent scientific studies. Here we include updated multidisciplinary treatment protocols and techniques in accordance with the most recent contributions published on this topic in the peer-reviewed medical literature, and we outline future perspectives.

Factors Associated With Increased Complications in Patients With BRCA Gene Mutations Undergoing Reconstructive Breast Surgery.

Reconstructive breast surgery after bilateral prophylactic mastectomy in patients who carry a mutation of the breast cancer (BRCA) gene has been increasing. Undergoing risk-reducing breast surgery can be of great benefit to young patients who have a high risk of developing breast cancer. There is little available evidence about the rate of complications in these patients and which factors are related to increased complications. The objective of this study was to identify predictors of complications in BRCA gene mutation carriers who underwent reconstructive breast surgery. A single-center, retrospective cohort study was conducted that included all patients with a mutation of the BRCA gene who underwent a breast reconstructive procedure, either immediate or delayed, between January 2013 and March 2019 and received a minimum of 6 months' follow-up. The results of our study showed that smoking is the most important modifiable risk factor associated with an increased complication rate for reconstructive breast surgery in patients with BRCA gene mutation. Smoking cessation will reduce the patient's risk for postoperative complications by 50%; therefore, it should be encouraged in all surgical patients and enforced in patients undergoing prophylactic procedures.

External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients.

BACKGROUND: A prognostic model based on the results of molecular analysis of sentinel lymph nodes (SLN) is needed to replace the information that staging the entire axilla provided. The aim of the study is to conduct an external validation of a previously developed model for the prediction of 5-year DFS in a group of breast cancer patients that had undergone SLN biopsy assessed by the One Step Nucleic Acid Amplification (OSNA) method. METHODS: We collected retrospective data of 889 patients with breast cancer, who had not received systemic treatment before surgery, and who underwent SLN biopsy and evaluation of all SLN by OSNA. The discrimination ability of the model was assessed by the area under the ROC curve (AUC ROC), and its calibration by comparing 5-years DFS Kaplan-Meier estimates in quartile groups of model predicted probabilities (MPP). RESULTS: The AUC ROC ranged from 0.78 (at 2 years) to 0.73 (at 5 years) in the training set, and from 0.78 to 0.71, respectively, in the validation set. The MPP allowed to distinguish four groups of patients with heterogeneous DFS (log-rank test p < 0.0001). In the highest risk group, the HR were 6.04 [95% CI 2.70, 13.48] in the training set and 4.79 [2.310, 9.93] in the validation set. CONCLUSIONS: The model for the prediction of 5-year DFS was successfully validated using the most stringent form of validation, in centers different from those involved in the development of the model. The external validation of the model confirms its utility for the prediction of 5-year DFS and the usefulness of the TTL value as a prognostic variable.

Association between sleep-disordered breathing and breast cancer aggressiveness.

BACKGROUND: Sleep-disordered breathing (SDB) has been associated with cancer aggressiveness, but studies focused on specific tumors are lacking. In this pilot study we investigated whether SDB is associated with breast cancer (BC) aggressiveness. METHODS: 83 consecutive women <65 years diagnosed with primary BC underwent a home respiratory polygraphy. Markers of SDB severity included the apnea-hypopnea index (AHI) and the 4% oxygen desaturation index (ODI4). The Ki67 proliferation index, lack of hormone receptors (HR-), Nottingham Histological Grade (NHG), and tumor stage were used as markers of BC aggressiveness. The association between SDB and molecular subtypes of BC was also assessed. RESULTS: The mean (SD) age was 48.8 (8.8) years and body mass index was 27.4 (5.4) Kg/m2. 42 women (50.6%) were post-menopausal. The median (IQR) AHI was 5.1 (2-9.4), and ODI4 was 1.5 (0.5-5.8). The median (IQR) AHI did not differ between the groups with Ki67>28% and Ki67<29% [5.1 (2.6-8.3) vs 5.0 (1.5-10), p = 0.89)], HR- and HR+ [5.7 (1.6-12.4) vs 4.9 (2-9.4), p = 0.68], NHG (Grade3, Grade2, and Grade1; p = 0.86), tumor stage (stage III-IV, stage II, and stage I; p = 0.62), or molecular subtypes (Luminal A, Luminal B, HER2, and triple negative; p = 0.90). The prevalence of an AHI≥5 did not differ between the groups with Ki67>28% and Ki67<29% (51.2% vs 52.3%, p = 0.90), HR- and HR+ (58.3% vs 49.1%, p = 0.47), NHG categories (p = 0.89), different tumor stages (p = 0.71), or molecular subtypes (p = 0.73). These results did not change when the ODI4 was used instead of the AHI. CONCLUSION: Our results do not support an association between the presence or severity of SDB and BC aggressiveness.

Tríada de Rosen: carcinoma lobulillar in situ, lesiones de células columnares y carcinoma tubular. A propósito de un caso / Rosen's triad: Lobular carcinoma in situ, columnar cell lesions and tubular carcinoma. A case report

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Periareolar augmentation mastopexy: A new approach dealing with the cases as tuberous breasts.

BACKGROUND: Periareolar augmentation mastopexy is one of the most demanded operations at Plastic Surgery clinics. Nevertheless, it is one of the leads of malpractice claims in United States caused by the high patient expectations and the standard surgical techniques which may result in common complications. The aim of this report is to present a new surgical approach to solve these complications. METHODS: After establishing a working hypothesis, we performed a revision study of our patients and we came to the following conclusion: in order to perform a periareolar mastopexy for ptosis correction, breast has to be tuberous at any level and to have abnormally short inferior pole. These findings may explain the main complications from periareolar augmentation mastopexy with the standard surgical techniques. Consequently, we started a prospective observational study including 56 patients following a new surgical technique which deals the cases as tuberous breasts. RESULTS: During three years, fifty-six periareolar mastopexies were performed with this new surgical approach with one year follow-up. No major complications were observed and 40 of the patients (71%) described the results as very positive. CONCLUSION: "If a periareolar mastopexy can be performed, then it must be a tuberous breast". According to this, a new surgical technique for periareolar augmentation mastopexy has been developed obtaining an improvement in our surgical results and achieving a totally different view on this pathology, which has not been reported in literature yet.

Mastopatía diabética. Estudio de 8 casos / Diabetic mastopathy. Report of 8 cases

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Leiomioma perineal grande en gestante de 9 semanas / Giant perineal leiomyoma in the 9th week of pregnancy

Los leiomiomas perineales son tumores infrecuentes de origen mesenquimal clasificados en somáticos y retroperitoneales. Los retroperitoneales son los que afectan sobre todo a las mujeres durante el período perimenopáusico. El diagnóstico va dirigido a diferenciarlos de los leiomiosarcomas y de los tumores estromales gastrointestinales. Presentamos el caso de una mujer de 30 años de edad, gestante de 9 semanas. Consulta por una tumoración de crecimiento progresivo en espacio isquiorrectal derecho que coincide con el embarazo, pero paucisintomático. Se abordó por vía perineal y se practicó una resección en bloque de un tumor de 9 cm (AU)

Perineal leiomyoma are rare mesenchymal tumours classified as somatic or retroperitoneal. The retroperitoneal variety are mainly related to women during the peri-menopausal phase. Diagnosis is directed at differentiating them from leiomyosarcomas and gastrointestinal stromal tumours. We report on a case of a 30-year-old and 9-week pregnant woman. She consulted due to a progressive growing mass in the right ischiorrectal fossa coinciding with pregnancy, but with sparse symptoms. Surgery was performed through a perineal access with a complete resection of a 9 cm tumour (AU)

Cáncer de vesícula biliar en un hospital comarcal / Gallbladder cancer in a regional hospital

Objetivo Evaluar el tratamiento del cáncer de vesícula biliar (CVB) en nuestro medio. Material y métodos De 372 pacientes a los que se les realizó colecistectomía (enero de 2003 a febrero de 2007), 6 presentaron un CVB. Resultados En 4 casos el carcinoma fue incidental, en un paciente se tuvo sospecha diagnóstica antes de la colecistectomía, y un paciente comenzó con ictericia obstructiva secundaria a neoplasia avanzada. Incidencia: 2 casos por 100.000 habitantes por año; cáncer incidental en el 1,1% de las colecistectomías. La ecografía mostró multilitiasis en 2 pacientes, barro biliar y neoplasia en un paciente, litiasis mayor de 3cm en 2 pacientes y sólo masa tumoral en un paciente. Grados T: un caso T0 (in situ), un caso T1, 3 casos T2 y un caso T4. En los T2 incidentales se practicó ampliación quirúrgica: en 2, linfadenectomía, y en uno, segmentectomía IVb-V con linfadenectomía. En la sospecha preoperatoria se practicó colecistectomía, linfadenectomía y resección del lecho vesicular. Conclusiones El CVB presenta baja incidencia pero es un hallazgo incidental en el 1% de las colecistectomías. No existe tratamiento adyuvante, por lo que la cirugía basada en el grado T es la única oportunidad de curación. No es infrecuente que tumores supuestamente T2 sean luego T3 al existir células malignas en el lecho vesicular hepático. Su extirpación mantiene la oportunidad de curación. La creación de una base de datos nacional de cáncer de vesícula ayudaría a establecer recomendaciones terapéuticas propias para esta enfermedad (AU)

Objectives To assess the management of gallbladder cancer (GBC) in our region. Material and methods Data on 372 patients who underwent cholecystectomy were identified from our database (January 2003 to February 2008) and 6 patients were found to have GBC. Results Four patients had incidental carcinoma, one case was preoperatively suspected, and one patient presented with jaundice and locally advanced neoplasia. The incidence was 2 per 100,000 inhabitants per year; incidental carcinoma in 1.1% of cholecystecomies. The ultrasonography showed multilithiasis in 2 patients, sludge and neoplasia in 1, gallstones more than 3cm in 2, and tumor mass only in 1 case. T stage: 1 case of T0 (in situ), 1 of T1, 2 of T2 and one T4. Incidental carcinomas were reoperated on when a T2 was established: 2 underwent lymphadenectomy and cystic stump resection, 1 segmentectomy IVb-V and lymphadenectomy. In the preoperative suspected neoplasia a cholecystectomy, lymphadenectomy, and partial hepatic gallbladder bed resection was initially performed. Conclusions GBC has a low incidence but it will be found in 1% of cholecystectomies. There is no adjuvant treatment and T-based surgical treatment is the is the only opportunity to reach cure in those patients. A national GBC database would be helpful in the publication of national guidelines for this disease (AU)

[Gallbladder cancer in a regional hospital]. / Cáncer de vesícula biliar en un hospital comarcal.

OBJECTIVES: To assess the management of gallbladder cancer (GBC) in our region. MATERIAL AND METHODS: Data on 372 patients who underwent cholecystectomy were identified from our database (January 2003 to February 2008) and 6 patients were found to have GBC. RESULTS: Four patients had incidental carcinoma, one case was preoperatively suspected, and one patient presented with jaundice and locally advanced neoplasia. The incidence was 2 per 100,000 inhabitants per year; incidental carcinoma in 1.1% of cholecystecomies. The ultrasonography showed multilithiasis in 2 patients, sludge and neoplasia in 1, gallstones more than 3cm in 2, and tumor mass only in 1 case. T stage: 1 case of T0 (in situ), 1 of T1, 2 of T2 and one T4. Incidental carcinomas were reoperated on when a T2 was established: 2 underwent lymphadenectomy and cystic stump resection, 1 segmentectomy IVb-V and lymphadenectomy. In the preoperative suspected neoplasia a cholecystectomy, lymphadenectomy, and partial hepatic gallbladder bed resection was initially performed. CONCLUSIONS: GBC has a low incidence but it will be found in 1% of cholecystectomies. There is no adjuvant treatment and T-based surgical treatment is the is the only opportunity to reach cure in those patients. A national GBC database would be helpful in the publication of national guidelines for this disease.

[Decrease of serum cholinesterase in colorectal cancer]. / Disminución de la colinesterasa sérica en el cáncer colorrectal.

BACKGROUND AND OBJECTIVE: Cholinesterase is an enzyme with an unknown physiologic function. Some situations are related to a decreased serum cholinesterase activity but those situations are not well defined and the responsible mechanisms are unknown. Malignancy is one of these situations. The aim of the study was to compare the cholinesterase activity between patients with and without colorectal cancer. PATIENTS AND METHOD: Case-control study of patients with colorectal cancer who underwent surgery in our hospital from March 05 to January 07. RESULTS: Patients from the cancer group had a significant decreased serum cholinesterase activity. CONCLUSIONS: Investigation of cholinesterase function in humans may result in new research lines in oncology treatment.