The presence of extranodal extension (ENE) in sentinel lymph nodes (SLNs) can predict non-SLN metastases in breast cancer (BC) patients; however, the prognostic relevance of its extent remains ...controversial. The purpose of this study was to examine the predictive role of ENE in SLNs measured by its widest dimension (WD), highest dimension (HD), and the WD/HD ratio for non-SLN involvement, overall, and disease-free survival (OS, DFS) in cT1-2N0 BC patients with positive SLNs.
A total of 511 women with cT1-2N0 BC and positive SLNs undergoing axillary lymph node dissection were retrospectively enrolled. The associations of ENE's WD, HD, and WD/HD ratio with non-SLN metastases, 5-year OS, and DFS were established through a multivariable modeling approach.
SLNs were ENE-positive in 149 (29.16%) participants, and 133 (26.03%) had non-SLN metastases. During the median 60 (16-60)-month follow-up, 69 (13.50%) patients experienced recurrences, and 62 (12.13%) died. The numbers of SLNs, non-SLNs, and total axillary LNs involved differed between the ENE-negative and ENE-positive groups, as well as between the WD/HD ≤ 1.2 and WD/HD > 1.2 subgroups (all P-values were < .001). Multivariable analyses showed significant associations of the WD/HD ratio > 1.2 with non-SLN involvement, OS, and DFS (P-values were .003, < .001, and .005, respectively).
Despite no predictive value of ENE's WD and HD, the WD/HD ratio > 1.2 was an independent predictor of non-SLN involvement, mortality, and recurrence.
ENE's WD/HD ratio could be a valuable indicator for cT1-2N0 BC individuals with positive SLNs for whom further axillary treatment may be beneficial.
In breast cancer (BC), the prognostic relevance of extranodal extension (ENE) size in sentinel nodes (SLNs) is controversial. All cT1-2N0 BC participants had SLN macrometastases; 29.16% had ENE-positive SLNs. As an independent predictor of non-SLN metastases and survival, ENE's widest dimension (WD) to highest dimension (HD) ratio > 1.2 could indicate Z011-eligible BC patients who may benefit from further axillary treatment.
Purpose
Based on the risk of locoregional recurrence (LRR), postmastectomy radiotherapy (PMRT) is recommended in T1-T2pN1 breast carcinoma (BC). We aimed to elucidate our institutional strategies ...underlying selection of these patients for PMRT. In the no-PMRT subset, we compared various lymph node (LN) staging systems’ abilities to predict 5‑year overall and locoregional-free survival (OS/LRFS).
Methods
We retrospectively enrolled 548 women with T1-T2pN1 BC undergoing mastectomy and axillary LN dissection. Depending on PMRT delivery, the participants were divided into the PMRT and no-PMRT groups. Predictors of OS/LRFS were calculated for the no-PMRT group only. Based on Cox regression modelling, the number of positive LNs (PLN), negative LNs (NLN), LN ratio (LNR), log odds of PLN (LODDS), and modified LNR (mLNR) were modelled, each respectively, with OS model covariates (age, grade III, lymphovascular invasion LVI, tumor size, hormone receptor HR status) and LRFS model covariates (age, grade III, LVI). The C‑statistic, Akaike information criterion, and likelihood ratio χ
2
of the models were compared.
Results
Median follow-up was 60.5 (18–82), 61 (28–82), and 60 (18–80) months for the entire cohort, PMRT, and no-PMRT group, respectively. The PMRT and no-PMRT groups had comparable OS (
p
= 0.235). LRFS was better (
p
= 0.030) in the PMRT group comprising 105 subjects (19.16%) who were younger, more likely to have a higher-grade, HR−, HER2+ tumors, more PLNs, fewer NLNs, Ki-67 ≥ 20%, LVI, and extranodal extension (
p
≤
0.001). In the no-PMRT group, LNR-based OS/LRFS models exhibited superior prognostic performance.
Conclusion
In early-stage BC patients undergoing mastectomies, LN dissections and no PMRT, we propose LNR-based multivariable models to predict OS/LRFS with superior accuracy.
Introduction: Breast cancer is the most commonly diagnosed malignancy in women and the leading cause of cancer death in women. Tumor size is a critical factor in determining the type and extent of ...surgical and oncologic treatment. It is accurately determined by imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI), which provide a more reliable determination of tumor size. The aim of our study was to investigate the impact of preoperative breast magnetic resonance imaging on surgical treatment of newly diagnosed breast cancer. Material and Methods: The study retrospectively reviewed the records of 241 participants with newly diagnosed breast cancer who underwent preoperative mammography, breast ultrasound, and MRI between 2016 and 2020 at University Hospital Centre Rijeka. Patients were diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, ductal carcinoma in situ, or a combination of the types. Surgical treatment included one of the following procedures: simple quadrantectomy, quadrantectomy and sentinel lymph node biopsy, quadrantectomy and axillary lymph node dissection, mastectomy and sentinel biopsy, or mastectomy and axillary dissection. Results: Compared with histopathologic tumor size, breast MRI overestimated size in 10% of patients. T stage was underestimated in 5% of patients (p>0.050). In comparison, breast ultrasound overestimated tumor size in 12% and underestimated it in 48% (p<0.001). Similarly, mammography overestimated tumor size in 14% and underestimated it in 62% (p<0.001). Conclusion: In patients with newly diagnosed breast cancer, the use of preoperative breast MRI as an adjunct to mammography and ultrasound for locoregional staging significantly alters subsequent surgical treatment.
Glycoprotein 96 (gp96) is a member of the heat shock protein 90 family, which is an ubiquitous family of molecular chaperones that are involved in the regulation of protein folding and other ...essential cellular activities. Residing in the lumen of the endoplasmic reticulum, gp96 plays a key role in maintaining protein homeostasis, from assemblage to degradation. However, exposure to stressful conditions that disturb cellular homeostasis may translocate gp96 to the cell surface, which implies its additional functions, such as the regulation of intracellular signalling, proliferation, and apoptosis, as well as the modulation of the immune response. Besides its roles under physiological conditions, gp96 is also included in different stages of oncogenesis. In this review, we summarised available data on the structure, physiological, and pathophysiological roles of gp96, particularly in breast cancer oncogenesis.
Glikoprotein 96 (gp96) član je obitelji proteina toplinskog šoka 90 koja je inače sveprisutna obitelj molekularnih šaperona uključenih u regulaciju sinteze proteina, ali i drugih esencijalnih staničnih procesa. Gp96 je smješten u lumenu endoplazmatskog retikula stanice gdje igra ključnu ulogu u homeostazi proteina, od njihove sinteze do razlaganja. Međutim, uslijed izloženosti stresornim čimbenicima koji dovode do narušavanja stanične ravnoteže, može doći do premještanja gp96 na staničnu membranu pri čemu se aktiviraju njegove dodatne funkcije, kao što su regulacija unutarstanične signalizacije, proliferacije, apoptoze te modulacija imunološkog odgovora. Pored njegove uloge u fiziološkim uvjetima, gp96 također ima i aktivnu ulogu u različitim fazama onkogeneze. U ovom preglednom članku objedinili smo dostupna saznanja o strukturi, fiziološkim te patofiziološkim ulogama gp96, prvenstveno onima u onkogenezi kod karcinoma dojke.
Breast cancer (BC) is the most common malignancy to affect females. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. Throughout history, the management of BC ...has evolved from extensive radical mastectomy towards less invasive treatments. Radical mastectomy was introduced by W.S. Halsted in 1894, involving the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite its mutiloperative lymphatic mapping and the concept of sentinel lymph node (SLN) biopsy (SLNB) have been developed. SLNB has replaced axillary lymph node dissection (ALND) to be the standard procedure for axillary staging in patients with clinically node-negative BC. Many women have since been spared ALND, including those with negative SLNB or with SLNs involved with micrometastases (0.2-2 mm in size). In the last decade, evidence gathered from new clinical trials suggests that ALND may be safely omitted even in BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy is delivered.ating effect, it had been the main surgical approach to BC patients until 1948, when Patey and Dyson proposed its modified form that conserved pectoralis major and minor and the level III of axillary lymph nodes. The latter was associated with less postoperative morbidity and improved quality of life. The idea of limited breast tissue resection was introduced in the 1970s by Umberto Veronesi and led to further minimizations of surgery in BC patients until breast conservation became the standard of care for early-stage disease. In the 1990s, intra
Karcinom dojke je najčešći maligni tumor u žena. Prvi zapisi o karcinomu dojke i njegovom liječenje datiraju iz drevnog Egipta 1500-1600 godina pr.n.e. Terapijski pristup bolesti mijenjao se kroz povijest te je nekadašnji invazivni, kao npr. radikalna mastektomija, s vremenom zamijenjen manje invazivnim kirurškim metodama. W.S. Halsted 1894. godine predstavlja metodu radikalne mastektomije. Ona uključuje potpunu resekciju dojke, regionalnih limfnih čvorova te velikog i malog pektoralnog mišića. Unatoč čestim postoperacijskim komplikacijama, zauzimala je glavno mjesto među kirurškim modalitetima liječenja karcinoma dojke sve do 1948. godine kada su Patey and Dyson predstavili modificiranu radikalnu mastektomiju kojom su se, za razliku od radikalne, sačuvali pektoralni mišići te pazušni limfni čvorovi lože III, te postoperacijske komplikacije smanjene, uz poboljšanje kvalitete života bolesnica. Ideju ograničene resekcije tkiva dojke predstavlja Veronesi 70-ih godina 20. stoljeća, nakon čega je i dalje nastavljeno smanjenje opsega i radikalnosti kiruških zahvata. Konačno, poštedna operacija dojke postaje standard u liječenju žena s ranim stadijem karcinoma dojke. Koncept biopsije limfnog čvora čuvara kod karcinoma dojke nailazi na svekoliku prihvaćenost, a njegovim usvajanjem mnoge su bolesnice pošteđene radikalnih disekcija aksilarnih limfnih čvorova, od onih čiji je nalaz biopsije limfnog čvora čuvara bio negativan, do onih s mikrometastazom u istome (malim tumorskim depozitom veličine 0.2-2 mm), dok zaključci novijih studija iz posljednjih deset godina, sugeriraju da i u žena kojima su biopsijom utvrđena metastaza u jednome do dva limfna čvora čuvara disekcija aksilarnih limfnih čvorova može se također izbjeći bez štetnih posljedica, uz primjenu adjuvantne radioterapije.
Karcinom dojke najčešći je maligni tumor u žena. Prvi zapisi o karcinomu dojke i njegovu liječenje datiraju iz drevnog Egipta 1500 - 1600 godina pr. n. e. Terapijski pristup bolesti mijenjao se kroz ...povijest te je nekadašnji invazivni, kao npr. radikal-na mastektomija, s vremenom zamijenjen manje invazivnim kirurškim metodama. W. S. Halsted 1894. predstavlja metodu radikalne mastektomije koja uključuje potpunu resekciju dojke, regionalnih limfnih čvorova te velikog i malog pektoralnog mišića. Unatoč čestim postoperacijskim komplikacijama, zauzimala je glavno mjesto među kirurškim moda-litetima liječenja karcinoma dojke sve do 1948. kada su Patey and Dyson predstavili modifici-ranu radikalnu mastektomiju kojom su se, za razliku od radikalne, sačuvali pektoralni mišići te pazušni limfni čvorovi lože III, a postoperacijske su komplikacije smanjene, uz poboljšanje kvalitete života bolesnica. Ideju ograničene resekcije tkiva dojke predstavlja Veronesi 70-ih godina 20. stoljeća, nakon čega je i dalje nastavljeno smanjenje opsega i radikalnosti kiruških zahvata. Konačno, poštedna operacija dojke postaje standard u liječenju žena s ranim sta-dijem karcinoma dojke. Koncept biopsije limfnog čvora čuvara kod karcinoma dojke nailazi na svekoliku prihvaćenost, a njegovim usvajanjem mnoge su bolesnice pošteđene radikalnih disekcija aksilarnih limfnih čvorova, od onih čiji je nalaz biopsije limfnog čvora čuvara bio negativan do onih s mikrometastazom u istome (malim tumorskim depozitom veličine 0,2-2 mm), dok zaključci novijih studija iz posljednjih deset godina sugeriraju da se i u žena kojima je biopsijom utvrđena metastaza u jednome do dva limfna čvora čuvara disekcija aksilarnih limfnih čvorova može izbjeći bez štetnih posljedica, uz primjenu adjuvantne radioterapije.
The authors have provided an in-depth review of the history of saline and silicone gel-filled breast implants. In the history of medicine, no devices have been more scrutinized and thoroughly studied ...than breast implants. Although we as plastic surgeons recognize and appreciate the benefits that our patients derive from these devices, society as a whole continues to remain skeptical. The reasons for this are complex and multifactorial but appear to be fueled by the media, oppositional organizations, and several trial lawyers. Prior to 1990, when the silicone gel implant controversy began, there were only eight indexed publications that dealt with the issue of silicone gel breast implants. Since 1990, there have been more than 500 indexed publications dealing with silicone gel implants. At the time of the moratorium in 1992, we as plastic surgeons did not have a leg to stand on because there was a paucity of scientific evidence to support our observations that silicone breast implants were safe and effective devices.
Background: In the follow-up of patients with inflammatory bowel disease (IBD), Tc-99m-HMPAO labelled leukocytes scintigraphy (leukocyte scan; LS) has long been established as a valuable diagnostic ...tool. The aim of this study was to estimate the relationship between scintigraphic results, inflammatory markers (IM) (including white blood cells (WBCs) and C-reactive protein (CRP)), clinical parameters and clinical indices of the disease activity (CI), in order to determine clinical settings in which LS is indicated. Materials and methods: A total of 147 patients who underwent LS, (79 males, 68 females, median age 36), were examined from April 2010 until December 2017 at the University Hospital Centre Zagreb, Croatia. Among these, 126 (86%) had Crohn's disease (CD) and 21 (14%) had ulcerative colitis (UC). Either increased IM (either WBCs ≥10x109/L and/or CRP ≥7.4 mg/L) and/or CI, Crohn's disease activity index (CDAI) score ≥220 points, Harvey-Bradshaw index (HBI) score ≥8 points, and severe colitis defined according to Truelove and Witts' criteria (TWC) for UC, respectively, were considered consistent with active disease. Results: Eighty-two patients (56%) had negative scans, while in 65 (44%) the scans were positive. Positive correlations were found between LS and all of the 3 parameters, WBCs, CRP and CI. When combined, the 3 parameters demonstrated even stronger positive correlation with the LS results with the correlation coefficient 0.76 (p<0.0001, 95% CI 0.68-0.82). Using endoscopy and histological study findings of the obtained specimens as a composite reference standard, the overall sensitivity, specificity, positive predictive value and negative predictive value of IM and CI for LS were determined, being 91%, 85%, 83%, and 92%, respectively. IM and CI were both negative in 76 (52%) out of the total subjects. Of these, 70 had negative LS as well. Conclusion: In the presence of normal IM with CI pointing to no active or mildly active disease, LS is not necessarily indicated,
Uvod: Rak dojke je najčešće dijagnosticirana zloćudna bolest u žena i vodeći uzrok smrti od raka u žena. Veličina tumora je ključan čimbenik u određivanju vrste i opsega kirurškog i onkološkog ...liječenja. Točno se utvrđuje slikovnim modalitetima poput mamografije, ultrazvuka i magnetske rezonancije (MRI) koja omogućuje najpouzdanije određivanje veličine tumora. Cilj našeg istraživanja bio je istražiti utjecaj preoperativne magnetske rezonancije dojke na kirurško liječenje novodijagnosticiranog raka dojke.
Materijal i metode: U studiju su bile retrospektivno uključene 241 bolesnice s novodijagnosticiranim karcinomom dojke koje su podvrgnute preoperativnoj mamografiji, ultrazvuku dojke i magnetskoj rezonanci između 2016. i 2020. godine u KBC-u Rijeka. Pacijentima je dijagnosticiran invazivni duktalni karcinom, invazivni lobularni karcinom, duktalni karcinom in situ ili kombinacija tipova. Kirurško liječenje uključivalo je jedan od sljedećih zahvata: kvadrantektomiju, kvadrantektomiju i biopsiju sentinel limfnog čvora, kvadrantektomiju i disekciju pazuha, mastektomiju i sentinel biopsiju ili mastektomiju i disekciju pazuha.
Rezultati: U usporedbi s histopatološkom veličinom tumora, MRI dojke je precijenio veličinu u 10% bolesnica. T stadij je podcijenjen u 5% bolesnica (p>0,050). Za usporedbu, ultrazvuk dojke precijenio je veličinu tumora u 12%, a podcijenio u 48% slučajeva (p<0,001). Slično, mamografija je precijenila veličinu tumora u 14%, a podcijenila u 62% slučajeva (p<0,001).
Zaključak: U bolesnica s novodijagnosticiranim rakom dojke, primjena preoperativne MRI dojke kao dopune mamografiji i ultrazvuku za lokoregionalno određivanje stadija značajno mijenja naknadno odluku kirurškog liječenja raka dojke.
Breast cancer (BC) is the most common malignancy to affect females. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. Throughout history, the management of BC ...has evolved from extensive radical mastectomy towards less invasive treatments. Radical mastectomy was introduced by W.S. Halsted in 1894, involving the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite its mutilating effect, it had been the main surgical approach to BC patients until 1948, when Patey and Dyson proposed its modified form that conserved pectoralis major and minor and the level III of axillary lymph nodes. The latter was associated with less postoperative morbidity and improved quality of life. The idea of limited breast tissue resection was introduced in the 1970s by Umberto Veronesi and led to further minimizations of surgery in BC patients until breast conservation became the standard of care for early-stage disease. In the 1990s, intraoperative lymphatic mapping and the concept of sentinel lymph node (SLN) biopsy (SLNB) have been developed. SLNB has replaced axillary lymph node dissection (ALND) to be the standard procedure for axillary staging in patients with clinically node-negative BC. Many women have since been spared ALND, including those with negative SLNB or with SLNs involved with micrometastases (0.2-2 mm in size). In the last decade, evidence gathered from new clinical trials suggests that ALND may be safely omitted even in BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy is delivered.
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