1,720,985 research outputs found
No Ink on Ductal Carcinoma in Situ: A Single Centre Experience
No full textAbstract
Introduction: The incidence of ductal carcinoma in situ (DCIS) of the breast has greatly increased thanks to the widespread use of screening mammography. The primary aim of surgery is to prevent local recurrence by achieving a clear margin of resection although its extent still represents a controversial issue. Hence, a retrospective analysis of patients undergoing surgery for DCIS was performed in order to assess the association of margin widths of < 1 mm, 1 to 2 mm, and > 2 mm with ipsilateral breast tumor recurrence (IBTR) considering also the potential role of host-, tumor- and treatment-related factors.
Methods: From 2000 to 2016, 388 patients diagnosed with pure DICS undergoing BCS with or without post-operative RT at the Breast Unit of “Ospedale Policlinico San Martino” in Genoa were selected. The pathologic analysis was always performed according to a standardized protocol including the measure of the microscopic distance to the nearest radial margin: positive margins were those with DCIS present at the inked margin; close margins were considered to have tumor between 0.1 to 0.9 mm, or 1 to 1.9 mm, and negative margins were > 2 mm.
Results: At a median follow-up of 90 months there were 26 IBTR (10 invasive and 16 DCIS). In univariate analysis there was a significant difference in IBTR by comparing positive versus close/negative margins of excision (P = 0.05) and the number of re-operations (P = 0.000). On multivariate analysis, both the margin status (P = 0.002) and the number of re-operations (P < 0.001) were still significantly associated with IBTR. The actuarial IBTR rates were significantly different in patients with a positive margin of excision at the primary operation as compared to patients with close/negative margins (log-rank test, P = 0,042) while the stratification by the margin width (0.1-0.9 mm; 1.0-1.9 mm; > 2 mm) was not significant (log-rank test, P = 0,243).
Conclusions: The policy of “no ink on the tumor” that is well accepted for invasive breast cancer can be translated to DCIS, because the actuarial IBTR rates were significantly different only in patients with a positive margin of excision as compared to patients with close/negative margins
Tumor size-driven dose of intraoperative radiotherapy for breast cancer: 18 Gy versus 21 Gy
No full textAim: To test whether a reduced total single dose of 18 Gy of intraoperative radiotherapy with electrons (IORT) may be tailored to safely treat patients in comparison with the standard dose of 21 Gy. (NCT01276938). Patients and Methods: From October 2009 to December 2011, 199 females affected by breast cancer were treated with conservative surgery and IORT with two different exclusive doses, 18 or 21 Gy. Results: The median follow-up was 91 months (16-104 months). Sixty-five patients (pT1a, pN0mic, pMx, G1-G3) received 18 Gy and 134 patients (pT1c, pN0mic, pMx, G1-G3) received 21 Gy. No significant difference in local recurrence-free survival or overall survival was detected in the 18 Gy-treated arm versus that treated with 21 Gy: 96.9% vs. 96.3%, p=0.72, and 96.9% vs. 95.5%, p=0.82, respectively at 5 years. Conclusion: The lower dose of 18 Gy achieved excellent results in terms of local toxicity and local control in early breast cancer
Gender-specific aspects related to type of fertility preservation strategies and access to fertility care
No full textAxillary ultrasound and Fine-Needle Aspiration Cytology in the preoperative staging of axillary node metastasis in breast cancer patients
No full textObjective A prospective observational clinical study was undertaken to assess the accuracy of preoperative Axillary Ultrasound (AUS) plus Fine-Needle Aspiration Cytology (FNAC) as well as and its clinical utility, that is the capacity of the information supplied by the test to guide the clinical decision-making. Materials and methods from January 2013 to August 2015, 400 female patients with pT1-3 cN0 operable breast cancer underwent AUS with FNAC at the Breast Unit of the “IRCCS San Martino-IST” in Genoa (Italy). Results 127 out of 400 patients (31.7%) had axillary lymph node metastases; in 69 out of 127 node-positive patients (54.3%) AUS detected at least one abnormal lymph node, and in 56 out of 127 patients (44.1%) the abnormal sonographic pattern of the lymph node was coupled with a positive FNAC finding. No false-positive finding by both AUS-alone or combined AUS/FNAC was observed. AUS-alone had sensitivity of 54.3% (69/127), specificity of 100% (273/273), PPV of 100% (69/69), NPV of 82.5% (273/331), and accuracy of 85.5% (342/400). Combined AUS/FNAC had sensitivity of 44.1% (56/127), specificity of 100% (273/273), PPV of 100% (56/56), NPV of 79.4% (273/344), and accuracy of 82.2% (329/400). Conclusions AUS-alone or combined AUS/FNAC had a high accuracy rate coupled with a more than satisfactory efficiency due to their low costs and easy access for the preoperative staging of the axilla. Notably, AUS-alone might be suggested for the preoperative staging of patients with early stage breast cancer because FNAC did not increased the specificity but reduced the sensitivity of the technique. Patients with negative findings might undergo either SLNB or close observation while waiting for the definitive results of ongoing SOUND randomized clinical trial
No Axillary Lymph Node Dissection in Breast Cancer Patients with Sentinel Lymph Node Micrometastasis
No full textFollow-up data of a series of 75 breast cancer patients with sentinel node (SN) micrometastases only (between 0.2 and 2 mm) and favorable histopathological features of the primary tumor (well-differentiated, T1 tumors without lymphovascular invasion) who refused completion axillary lymph node dissection (ALND) or who were unsuitable for surgery were assessed in order to detect the rate of axillary recurrence after an adjuvant chemoand/or hormonal adjuvant treatment was given. The great majority of patients (81.3%) did not undergo ALND due to the existence of favorable histopathologic factors while the rest were equally distributed among over 75-year-old women (10.6%) and patients at a high surgical risk due to comorbid conditions (9.3%). Sixty-six patients (88%) underwent conservative treatment (lumpectomy followed by adjuvant breast radiotherapy) while the remaining nine patients (12%) had total mastectomy; 72 out of 75 patients (96%) received some forms of adjuvant chemo- and/or hormone-therapy. After a median follow-up of 38 months (range 12 - 84 months), nine out of 75 patients (12%) had a disease relapse, only one of them (1.3%) being affected by an axillary recurrence in the untreated axilla three years after primary surgery. On these grounds, completion ALND could be safely omitted in patients with SN micrometastasis and favorable histopathological characteristics of the primary neoplasm due to the very low rate of axillary recurrence with no detrimental effect on survival
Trastuzumab emtansine (T-DM1) as adjuvant treatment of HER2-positive early breast cancer: safety and efficacy
No full textIntroduction: The prognosis of patients with HER2-positive early breast cancer has radically improved after the introduction of (neo)adjuvant anti-HER2 targeted therapy. Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate combining the anticancer properties of the anti-HER2 agent trastuzumab and the antineoplastic cytotoxic drug DM1. After demonstrating to be an effective and safe treatment for patients with HER2-positive advanced breast cancer, the development of T-DM1 has moved to the early setting. Areas covered: The aim of this review is to explore the current role of T-DM1 in the treatment landscape of HER2-positive early breast cancer, focusing specifically on the efficacy and safety data available in the adjuvant setting. Expert opinion: T-DM1 is an effective and safe treatment option in the adjuvant setting for patients with HER2-positive breast cancer without pathologic complete response after standard neoadjuvant chemotherapy plus anti-HER2 targeted therapy. With the availability of more effective anti-HER2 targeted agents, including T-DM1, there is an urgent need for more chemotherapy de-escalation research efforts in the early setting
Clinical decision-making in atypical and suspicious categories in fine-needle aspiration cytology of the breast
No full textBackgroud: Fine-needle aspiration cytology (FNAC) is a simple and reliable technique to assess breast lesions, although a definitive differential diagnosis (benignity vs. cancer) is achieved approximately in 60-70% of cases because an inadequate (C1), atypical (C3) or suspicious (C4) category is otherwise reported. Patients and Methods: A retrospective analysis of 763 cases with C3 or C4 reports was performed to define their positive predictive value (PPV), as well as the practical implications of clinical and imaging findings as for clinical decision-making. FNACs were collected from January 2003 to September 2012 at the Breast Unit of IRCCS "A.O.U. San Martino-IST" Genoa, with each being received later to definitive histology. The PPV for cancer of C3/C4 categories were computed to measure the accuracy of FNAC; moreover, the PPV was also stratified according to clinical, mammography and sono graphy data alone or by their combination. Resuls: The PPV of C3 and C4 was 21.1% (80/380) and 84.1% (322/383), respectively. Within each C3/C4 category, a significant direct correlation (p<0.001) between the suspicion index of clinical, mammography and sonography data and cancer detection rate was always observed. The PPV of C3/C4 stratified by the combination of clinical and imaging findings showed satisfactory values in the C3 category only when there was an agreement between clinical and imaging findings, whereas the PPV of the C4 category was always remarkably high (ranging from 92.3% to 100%). Conclusion: the diagnostic work-up in C4 reports or in patients with a C3 report but with an high suspicion index at clinical or imaging exami nation should be preferably implemented by means of a core biopsy to optimize the therapeutic planning; given a C3 report with dubious clinical and/or imaging findings, an excisional biopsy (or in alternative vacuum-assisted breast biopsy with complete removal of the nodule) should be preferably performed in order to reach a definitive histological dia gnosis with no further delay
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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