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1.
Cancer Commun (Lond) ; 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34738326

RESUMO

BACKGROUND: To date, there is no approved blood-based biomarker for breast cancer detection. Herein, we aimed to assess semaphorin 4C (SEMA4C), a pivotal protein involved in breast cancer progression, as a serum diagnostic biomarker. METHODS: We included 6,213 consecutive inpatients from Tongji Hospital, Qilu Hospital, and Hubei Cancer Hospital. Training cohort and two validation cohorts were introduced for diagnostic exploration and validation. A pan-cancer cohort was used to independently explore the diagnostic potential of SEMA4C among solid tumors. Breast cancer patients who underwent mass excision prior to modified radical mastectomy were also analyzed. We hypothesized that increased pre-treatment serum SEMA4C levels, measured using optimized in-house enzyme-linked immunosorbent assay kits, could detect breast cancer. The endpoints were diagnostic performance, including area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Post-surgery pathological diagnosis was the reference standard and breast cancer staging followed the TNM classification. There was no restriction on disease stage for eligibilities. RESULTS: We included 2667 inpatients with breast lesions, 2378 patients with other solid tumors, and 1168 healthy participants. Specifically, 118 patients with breast cancer were diagnosed with stage 0 (5.71%), 620 with stage I (30.00%), 966 with stage II (46.73%), 217 with stage III (10.50%), and 8 with stage IV (0.39%). Patients with breast cancer had significantly higher serum SEMA4C levels than benign breast tumor patients and normal controls (P < 0.001). Elevated serum SEMA4C levels had AUC of 0.920 (95% confidence interval [CI]: 0.900-0.941) and 0.932 (95%CI: 0.911-0.953) for breast cancer detection in the two validation cohorts. The AUCs for detecting early-stage breast cancer (n = 366) and ductal carcinoma in situ (n = 85) were 0.931 (95%CI: 0.916-0.946) and 0.879 (95%CI: 0.832-0.925), respectively. Serum SEMA4C levels significantly decreased after surgery, and the reduction was more striking after modified radical mastectomy, compared with mass excision (P < 0.001). The positive rate of enhanced serum SEMA4C levels was 84.77% for breast cancer and below 20.75% for the other 14 solid tumors. CONCLUSIONS: Serum SEMA4C demonstrated promising potential as a candidate biomarker for breast cancer diagnosis. However, validation in prospective settings and by other study groups is warranted.

2.
Clin Imaging ; 68: 36-44, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32563723

RESUMO

OBJECTIVES: A targeted surgical approach which accurately determines axillary status after neoadjuvant chemotherapy (NAC) may allow appropriate de-escalation of surgical treatment. It is postulated that the combined use of a particular marker clip, ULTRACOR®TWIRL™ (Bard, Inc.), and specific ultrasound settings for its identification, may overcome the challenges of pre-operative localisation with size diminution of nodes following NAC. Hence, this feasibility study was performed. METHODS: Three patients with locally advanced breast cancer (LABC), who had the Twirl marker clip placed in biopsy-proven metastatic axillary lymph nodes and completed treatment were included in this preliminary study. Preoperative sonographic identification of the clip and associated node was done on the day of surgery, confirmed by eliciting the 'twinkle' artifact, followed by hookwire localisation and resection. The 'twinkle' artifact was demonstrated within each specimen after resection. RESULTS: All three patients who completed treatment for LABC had successful identification and resection of clipped node aided by the 'twinkle artifact'. CONCLUSION: The 'twinkle' artifact is a novel and useful aid in identifying the Twirl™ clip marking a lymph node in the post-NAC setting, with the potential to be used intraoperatively.


Assuntos
Neoplasias da Mama , Terapia Neoadjuvante , Protocolos de Quimioterapia Combinada Antineoplásica , Artefatos , Axila/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela , Instrumentos Cirúrgicos
4.
Breast ; 49: 201, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31865283
6.
ANZ J Surg ; 89(5): 529-535, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30972960

RESUMO

BACKGROUND: Published data indicate that 20-40% of patients undergo breast conservation treatment (BCT) in Asia, which is below an indicative benchmark of 50%. With an increasing body of evidence suggesting that BCT might be associated with improved survival outcomes, it is exigent to increase BCT utilization. This study was therefore undertaken to evaluate BCT rates for women presenting with symptomatic breast cancer and potential for de-escalation of surgical treatment. METHODS: All patients who presented with symptomatic tumours and underwent surgical treatment at the authors' healthcare facility between January 2009 and December 2011 were included in this retrospective study. Standard wide excision was performed to achieve clear margins and reasonable cosmetic outcomes for BCT-eligible patients. Oncoplastic techniques such as therapeutic mammoplasty or volume replacement with flaps were not employed. RESULTS: A total of 116 women presented with symptomatic breast cancer. The majority (92.2%) were Asian. Mean age at diagnosis was 48.3 years and mean tumour size was 23.4 mm. Ninety-five patients (81.9%) underwent BCT. Of the 22 patients, 13 (59%) who underwent neoadjuvant chemotherapy had sufficient tumour size downstaging to successfully undergo BCT instead of mastectomy. CONCLUSION: It is possible for more than 80% of Asian women with symptomatic breast malignancies to undergo BCT, with the appropriate use of neoadjuvant medical therapy and surgical techniques. As increasing data indicate improved survival with BCT, this should be offered as the treatment of choice.


Assuntos
Neoplasias da Mama/terapia , Margens de Excisão , Mastectomia Segmentar/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Estudos Retrospectivos , Singapura/epidemiologia , Taxa de Sobrevida/tendências
8.
Breast ; 38: 136-143, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29324302

RESUMO

Breast conservation therapy (BCT) was established as the preferred modality of surgical treatment for early stage breast cancer in the early 1990's. Yet, rising mastectomy rates have been observed over the last decade. This increase is a cause for concern as recent large population-based studies have consistently reported improved breast cancer-specific survival and local control rates with BCT, in comparison with mastectomy. There is a pressing need to formulate strategies to effectively inform both patients and practitioners about current data, in the hope of reversing rising mastectomy rates to optimise survival outcomes. Based on the available evidence relating to the motivators for a mastectomy, a format for presenting data to bridge the existing knowledge deficit for effective patient counselling is proposed in this review.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Segmentar/mortalidade , Mastectomia/mortalidade , Adulto , Neoplasias da Mama/mortalidade , Comunicação , Aconselhamento , Tomada de Decisões , Feminino , Humanos , Mastectomia/tendências , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/tendências
9.
Gland Surg ; 7(6): 501-505, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30687623
10.
Gland Surg ; 7(6): 611-618, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30687632

RESUMO

Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick lobe hypothesis, which states that cancer arises from genetically unstable cells through mutations acquired in utero, forms the basis of malignant transformation. These 'at risk' cells line the mammary ductal-lobular system of a single 'sick' lobe and when exposed to noxious events in the surrounding microenvironment, further genetic changes occur which completes conversion to malignancy, in certain defined patterns. This review explores how anatomy, pathology and genomics can merge, not only to guide optimum surgery, but also to provide a more comprehensive portal for precision medicine.

13.
Gland Surg ; 6(4): 399-409, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28861382

RESUMO

Contemporary data suggests that breast conservation treatment (BCT) may confer a survival advantage when compared to mastectomy. Hence, it would be logical to adopt strategies which increase eligibility of successful BCT without compromising oncologic principles or cosmetic outcome. With respect to achieving good aesthetics, inferiorly sited breast cancers pose a particular technical challenge. A vast array of techniques, collectively referred to as oncoplastic breast surgery (OBS) have been developed to minimise post treatment distortion. The purported advantages of these approaches are the acquisition of wider margins and reduced re-excision rates. However, to date, there is a lack of data demonstrating significant reduction in local recurrence and overall survival when compared with less extensive procedures. In this review, "minimalist" procedures are described where strict oncologic criteria of clear margins are fulfilled and acceptable cosmesis are simultaneously achieved. These techniques offer less tissue loss, less extensive parenchymal mobilisation and shorter operating times without compromising margin status and aesthetics. They involve the combination of innovative incision designs and certain parenchymal resection patterns. Incision designs include the boomerang, golf-tee, anchor and arrowhead incisions which have been previously described but not widely used. Parenchymal resection patterns follow the "sick lobe hypothesis". These techniques, termed "reductionist", or "minimalist" comprising approaches where breast conserving surgery is condensed to its irreducible elements, offer alternatives which align with contemporary objectives of surgery where optimal survival outcomes are achieved through individualised procedures resulting in reduced iatrogenic impact. This logically allows scope for de-escalation of surgical therapy for breast cancer.

14.
Breast J ; 23(6): 663-669, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28833864

RESUMO

The sick lobe hypothesis provides the basis for a lobar approach in radiology, pathology, and surgical treatment of breast cancer. This approach aims to remove the tumor together with the surrounding field of genetic aberrations. Detailed preoperative lobar imaging that properly maps the disease and assesses its extent guides the parenchymal resection. Integration of our knowledge of breast anatomy and pathology with the results of preoperative radiological mapping is critical in assessing the eligibility of patients with multifocal and/or multicentric breast cancer for breast conservation treatment. Through an appropriately selected incision, a multisegment resection of the diseased lobe(s) is performed, which leaves the residual parenchyma in a formation that allows dovetailing of one part into the other, like the way pieces of a jigsaw puzzle fit together. Detailed pathologic analysis of the surgical specimen provides valuable feedback to the radiologist, establishes the completeness of surgical intervention, and generates predictive information for therapeutic decisions. Our approach is a step in continuous search for ideal tailored therapy to avoid under or over-treatment of breast cancer patients.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia Segmentar , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Cuidados Pré-Operatórios
17.
Arch Plast Surg ; 44(1): 85-86, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28194354
19.
ANZ J Surg ; 87(6): E5-E10, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25475622

RESUMO

BACKGROUND: Breast conservation treatment (BCT) is an established option in the treatment of early breast cancer, but women with small breast volume (SVB) are considered poor candidates for BCT. Multifocal and multicentric breast cancers (MFMCBC) are conventionally considered a relative contraindication to BCT. These arguments form the basis of limited eligibility for BCT for a woman with SVB and MFMCBC. This study was performed to investigate this syllogism. METHODS: Consecutive patients with breast malignancies treated from 2009 to 2011 were included. Patients were deemed to have successful BCT if they had pathologically clear margins and had completed all recommended adjuvant treatment. Those who had MFMCBC based on clinical, imaging and pathological data were selected for detailed evaluation. Comparisons were made with unifocal breast cancer. RESULTS: Data from a total of 160 patients who underwent treatment during the study period were analysed. The mean age was 48.8 years. One hundred and six patients (66.3%) were of Chinese ethnicity, 36 (22.5%) were of other Asian ethnicity and 18 were Caucasian (11.2%). Forty-one (25.6%) patients had clinical evidence of MFMCBC. Of these patients, 35 (85.4%) underwent BCT. After a mean follow-up of 45 months, none of the patients with MFMCBC developed a local recurrence. Two patients with MFMCBC, one who underwent mastectomy and one with BCT, succumbed to cancer from distant disease. CONCLUSION: BCT is feasible in women with MFMCBC in a predominantly Chinese community where majority are expected to have SVB. Further investigation is warranted to confirm the findings.


Assuntos
Neoplasias da Mama/cirurgia , Mama/anatomia & histologia , Mastectomia Segmentar/métodos , Adulto , Idoso , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/etnologia , Neoplasias da Mama/patologia , Feminino , Humanos , Margens de Excisão , Mastectomia/métodos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Gradação de Tumores , Invasividade Neoplásica , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
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