Breast Area Research Articles

Exploring bilateral breast size and density asymmetry: Insights from the saudi screening population

Background/objectivesThe swift appearance of asymmetry in breast size and density has been associated with an increased risk of breast cancer and other pathological changes. However, the occurrence of breast asymmetry and the factors influencing it have not been extensively studied among healthy, screened women in the Saudi population. Thus, this study aims to explore bilateral breast asymmetry in breast size and density among healthy, screened Saudi women and factors affecting the asymmetry. MethodsData of 1048 out of 1173 eligible women screened between 2012 and 2018 were extracted from Sheikh Mohammed Hussien AL-Amoudi Center of Excellence in Breast Cancer. The Laboratory for Individualized Radiodensity Assessment (LIBRA) software was used to measure percent density, dense area, and total area of breast from mammograms. Paired t-test was used to examine asymmetry between right and left breasts, and stratified analysis was performed to investigate the factors associated with breast asymmetry. ResultsNo significant differences were observed between the right and left breasts in percent density, dense area, and total breast area (p ≥ 0.2). However, for participants who never breastfed, the right breast area was slightly larger (average: 207.9 cm2) than the left breast (average: 202.8 cm2); p = 0.008. ConclusionThere were no significant differences found in the density, and size of the right and left breasts. However, women who breastfed tended to have slightly larger right breasts.

Association between Radiological and First-Order Statistical Features of the Mammogram, and the Tumor Phenotype in Breast Cancer Patients

Background: Breast cancer is among the most prevalent cancers which can effectively be screened by mammography. The spatial distribution of grey levels of the mammogram known as first-order statistical features (FOSFs) contain higher dimensional data which describe the breast composition. We aim to test these basic measures to differentiate density categories in breast cancer patients, and use them as covariates to investigate the relationship between radiologic and pathologic features of the tumor. Methods: Data from Eighty-five breast cancer subjects, their BI-RADS breast density category (a to d), percentage density (PD), and FOSFs of the mammogram including median, mean, interquartile range, kurtosis, maximum, minimum, standard deviation, skewness, and energy, were extracted. The tumor grade and the percentage of Ki67, ER, PR, and Her2 status were recorded. A linear discriminant analysis, and a support vector machine (SVM) were used to discriminate each density category from others. Then, the relation between variables were investigated using ANCOVA and regression analysis. Results: Density categories a and d were classified by SVM with high accuracy. The key feature of a and d were interquartile range and maximum intensities respectively. Reported tumor margins were related to Her2 overexpression and PR positivity. Spiculated tumor margin predicted percentage of PR expression, with a cumulative odds ratio of 7.85 (CI 2.5- 24.78), when adjusted for age, area of breast, density, and FOSFs, (p=0.0004). Conclusion: The findings of this study suggest that FOSFs can be incorporated in computer-aided systems to adjust for differences in breast composition and to refine risk profiles.

Descripción de un caso: ¿es factible realizar una biopsia selectiva de ganglio centinela en tumores de mama originados en el tejido ectópico axilar?

Breast cancer on axillary ectopic breast tissue is very rare, representing 0.3-0.6% of malignant breast cancers. Therefore, its early diagnosis is a real challenge. In this case, we describe a breast cancer on left axillary ectopic tissue in a 36-year-old female patient, who underwent local surgery with excision of the tissue. When approaching the nodal study of this patient, the possibility of selective study of the sentinel lymph node was considered. The absence of validated clinical guidelines in these cases and the exhaustive review of the literature led the multidisciplinary tumour committee of our hospital, the Hospital Clínico de Santiago de Compostela, to adopt the decision to attempt to perform this technique, adapting it, however, to this particular case. A double tracer was used, injecting technetium-99m in the periareolar area of the left breast and patent blue in the intratumoral area of the axillary ectopic tissue to determine whether both the breast and the tumour had the same lymphatic drainage pathways.Finally, 7 sentinel nodes and 1 palpable non-sentinel node were detected, of which the first was marked with both technetium-99m and patent blue, 4 with the radioisotope only, and 2 stained with patent blue. Two macrometastases were detected intraoperatively in the sentinel nodes, stained only with patent blue, while the rest were negative. The tumour committee took the decision to treat the axilla with radiotherapy. It is therefore concluded that in these cases the periareolar lymphatic drainage and that of the tumour itself may be different, so it would be advisable to use the double tracer injected in different areas to correctly identify the sentinel lymph node. The literature available for this type of situation is scanty and there are no approved clinical guidelines to support our therapeutic decisions, so it would be essential to study breast cancer in infrequent locations, in depth, in order to achieve protocols standardised by international societies that would serve as a benchmark for the management of these cases.

Reductions in Chronic Postsurgical Neuropathic Pain and Mechanical Allodynia in Breast Cancer Patients Treated With Laser Acupuncture: A Retrospective Observational Study

IntroductionChronic postsurgical neuropathic pain (CPSNP) and related static mechanical allodynia (SMA) is recognised as a significant long-term complication after breast cancer surgery (BCS). This study investigates the effectiveness of a novel laser acupuncture technique in treating CPSNP and SMA post-BCS whilst patients underwent standard cancer treatments. MethodsThirty patients with significant breast area CPSNP and SMA (DN4 ≥ 4) were treated with 60Milliwatt, 658nm laser acupuncture at Austin Hospital between January 2021 and 2024. Patient data was analysed retrospectively: 29 with CPSNP, 22 with SMA. The cohort had exposures to pain aggravating cancer therapies (e.g. chemotherapy, radiotherapy and antihormonal medications). An online patient questionnaire assessed treatment outcomes qualitatively. ResultsPatients received an average of 6·4 treatments and their average CPSNP showed significant reduction from 6·86 to 1.29 (P < .001), with a mean 5.57 point decrease (95% CI, 4.90-6.24). Average SMA showed significant reduction from an average of 6.77-1.75 (P < .001), with a mean 5.02-point decrease (95% CI, 4.09-5.96). Pain reductions occurred despite NP aggravating treatment and ongoing usage by 40% of the cohort. 92% of patients reported acute reductions in SMA in the online questionnaire. ConclusionThe significant pain reductions observed may indicate effectiveness of laser acupuncture in reducing both CPSNP and SMA in breast cancer patients post-BCS.

Real-time thermography for breast cancer detection with deep learning

In this study, we propose a framework that enhances breast cancer classification accuracy by preserving spatial features and leveraging in situ cooling support. The framework utilizes real-time thermography video streaming for early breast cancer detection using Deep Learning models. Inception v3, Inception v4, and a modified Inception Mv4 were developed using MATLAB 2019. However, the thermal camera was connected to a mobile phone to capture images of the breast area for classification of normal and abnormal breast. This study’s training dataset included 1000 thermal images, where a FLIR One Pro thermal camera connected to a mobile device was used for the imaging process. Of the 1000 images obtained, 700 images were considered for the normal breast thermography class while the 300 images were suitable for the abnormal class. We evaluate Deep Convolutional Neural Network models, such as Inception v3, Inception v4, and a modified Inception Mv4. Our results demonstrate that Inception Mv4, with real-time video streaming, efficiently detects even the slightest temperature contrast in breast tissue sequences achieving a 99.748% accuracy in comparison to a 99.712% and 96.8% for Inception v4 and v3, respectively. The use of in situ cooling gel further enhances image acquisition efficiency and detection accuracy. Interestingly, increasing the tumor surface temperature by 0.1% leads to an average 7% improvement in detection and classification accuracy. Our findings support the effectiveness of Inception Mv4 for real-time breast cancer detection, especially when combined with in situ cooling gel and varying tumor temperatures. In conclusion, future research directions should focus on incorporating thermal video clips into the thermal images database, utilizing high-quality thermal cameras, and exploring alternative Deep Learning models for improved breast cancer detection.

Capability and reliability of deep learning models to make density predictions on low-dose mammograms.

Breast density is associated with the risk of developing cancer and can be automatically estimated using deep learning models from digital mammograms. Our aim is to evaluate the capacity and reliability of such models to predict density from low-dose mammograms taken to enable risk estimates for younger women. We trained deep learning models on standard-dose and simulated low-dose mammograms. The models were then tested on a mammography dataset with paired standard- and low-dose images. The effect of different factors (including age, density, and dose ratio) on the differences between predictions on standard and low doses is analyzed. Methods to improve performance are assessed, and factors that reduce the model quality are demonstrated. We showed that, although many factors have no significant effect on the quality of low-dose density prediction, both density and breast area have an impact. The correlation between density predictions on low- and standard-dose images of breasts with the largest breast area is 0.985 (0.949 to 0.995), whereas that with the smallest is 0.882 (0.697 to 0.961). We also demonstrated that averaging across craniocaudal-mediolateral oblique (CC-MLO) images and across repeatedly trained models can improve predictive performance. Low-dose mammography can be used to produce density and risk estimates that are comparable to standard-dose images. Averaging across CC-MLO and model predictions should improve this performance. The model quality is reduced when making predictions on denser and smaller breasts.

Breast segmentation in infrared thermography from characteristical inframammary shape.

Infrared thermography is gaining relevance in breast cancer assessment. For this purpose, breast segmentation in thermograms is an important task for performing automatic image analysis and detecting possible temperature changes that indicate the presence of malignancy. However, it is not a simple task since the breast limit borders, especially the top borders, often have low contrast, making it difficult to isolate the breast area. Several algorithms have been proposed for breast segmentation, but these highly depend on the contrast at the lower breast borders and on filtering algorithms to remove false edges. This work focuses on taking advantage of the distinctive inframammary shape to simplify the definition of the lower breast border, regardless of the contrast level, which indeed also provides a strong anatomical reference to support the definition of the poorly marked upper boundary of the breasts, which has been one of the major challenges in the literature. In order to demonstrate viability of the proposed technique for an automatic breast segmentation, we applied it to a database with 180 thermograms and compared their results with those reported by others in the literature. We found that our approach achieved a high performance, in terms of Intersection over Union of 0.934, even higher than that reported by artificial intelligence algorithms. The performance is invariant to breast sizes and thermal contrast of the images.

Detection of invasive ductal carcinoma in quadrant breast areas by electrical impedance tomography implemented with gaussian relaxation-time distribution (EIT-GRTD)

Invasive ductal carcinoma (IDC) in breast specimens has been detected in the quadrant breast area: (I) upper outer, (II) upper inner, (III) lower inner, and (IV) lower outer areas by electrical impedance tomography implemented with Gaussian relaxation-time distribution (EIT-GRTD). The EIT-GRTD consists of two steps which are (1) the optimum frequency fopt selection and (2) the time constant enhancement of breast imaging reconstruction. fopt is characterized by a peak in the majority measurement pair of the relaxation-time distribution function γ, which indicates the presence of IDC. γ represents the inverse of conductivity and indicates the response of breast tissues to electrical currents across varying frequencies based on the Voigt circuit model. The EIT-GRTD is quantitatively evaluated by multi-physics simulations using a hemisphere container of mimic breast, consisting of IDC and adipose tissues as normal breast tissue under one condition with known IDC in quadrant breast area II. The simulation results show that EIT-GRTD is able to detect the IDC in four layers at fopt = 30, 170 Hz. EIT-GRTD is applied in the real breast by employed six mastectomy specimens from IDC patients. The placement of the mastectomy specimens in a hemisphere container is an important factor in the success of quadrant breast area reconstruction. In order to perform the evaluation, EIT-GRTD reconstruction images are compared to the CT scan images. The experimental results demonstrate that EIS-GRTD exhibits proficiency in the detection of the IDC in quadrant breast areas while compared qualitatively to CT scan images.

Evaluation of cosmetic outcomes in breast reconstruction patients undergoing radiotherapy using an anomaly generative adversarial network model

Considering the rising prevalence of breast reconstruction followed by radiotherapy (RT), evaluating the cosmetic impact of RT is crucial. Currently, there are limited tools for objectively assessing cosmetic outcomes in patients who have undergone reconstruction. Therefore, we validated the cosmetic outcome using a previously developed anomaly Generative Adversarial Network (GAN)-based model and evaluated its utility. Between January 2016 and December 2020, we collected computed tomography (CT) images from 82 breast cancer patients who underwent immediate reconstruction surgery followed by radiotherapy. Among these patients, 38 received immediate implant insertion, while 44 underwent autologous breast reconstruction. Anomaly scores (AS) were estimated using an anomaly GAN model at pre-RT, 1st follow-up, 1-year (Post-1Y) and 2-year (Post-2Y) after RT. Subsequently, the scores were analyzed in a time-series manner, considering reconstruction types (implant versus autologous), RT techniques, and the incidence of major complications. The median age of the patients was 46 years (range 29–62). The AS between Post-1Y and Post-2Y demonstrated a positive relationship (coefficient 0.515, P < 0.001). The AS was significantly associated with objective cosmetic indices, namely Breast Contour Difference (P = 0.009) and Breast Area Difference (P = 0.004), at both Post-1Y and Post-2Y. Subgroup analysis stratified by type of breast reconstruction revealed significantly higher AS values in patients who underwent prosthetic implant insertion compared to those with autologous reconstruction at all follow-up time points (1st follow-up, P = 0.001; Post-1Y, P < 0.001; and Post-2Y, P < 0.001). A threshold AS of ≥ 1.9 was associated with a 10% predicted risk of developing major complications. The feasibility of an AS generated by a GAN model for predicting both cosmetic outcomes and the likelihood of complications following RT has been successfully validated. Further investigation involving a larger patient cohort is warranted.

Will the white blood cells tell? A potential novel tool to assess broiler chicken welfare.

This study assessed qualitative and quantitative leukocyte evaluation as potential broiler chicken welfare indicators, contributing to the limited literature on white blood cell (WBC) morphology as a diagnostic tool for welfare. Broiler chicken welfare within four poultry houses (PH) 1 to 4, each on a different farm, was assessed using on-field indicators of affective states and health, and WBC morphology was examined. Affective states were evaluated using the Qualitative Behavior Assessment (QBA), with 25 behavioral expressions scored on a visual analogue scale (VAS) and grouped into two categories. Health indicators included assessments of lameness, footpad dermatitis, dermatitis on the breast and abdominal areas, hock burn, and feather cleaning. Blood samples were collected, differential leukocyte counts were performed, and a cell score was created for the recognition, classification, and interpretation of morphologic diversity of heterophils and lymphocytes. The heterophil to lymphocyte ratio (H/L) was also determined. Descriptive statistics and generalized linear models for binomial responses were used to analyze the results. PH4 differed from the other farms, showing a higher frequency of birds within QBA group 1 ('Attentive'to 'Desperate'), while birds in PH1, PH2, and PH3 were more frequent in QBA group 2 ('Relaxed' to 'Positively occupied'). Elevated proportions of heterophils in birds from PH4 (0.61, CI95%: 0.58; 0.64) and PH3 (0.60, CI95%: 0.57; 0.63) suggested higher stress levels and inflammatory responses. Birds in PH2 and PH4 exhibited higher frequencies of health issues such as dermatitis and lameness, and higher proportions of abnormalities in WBC number and morphology. PH3 and PH4 exhibited higher H/L ratios of 3.03 and 2.58, respectively, consistent with the on-field health and behavioral indicators. Blood samples from birds in PH2 and PH4 showed a proportion of 90% toxic change in heterophils, while in PH1 and PH3 it was 70%, indicating high levels of abnormal WBC morphology across all PHs. The findings emphasize the multifactorial nature of welfare impairments, including environmental conditions, health, and affective states. This highlights the need for indicators that reflect multiple welfare impacts, such as WBC counts and morphological alterations, which can serve as powerful tools in the complex task of assessing animal welfare.

Development of a Subtraction Processing Technology for Assistance in the Comparative Interpretation of Mammograms.

A comparative interpretation of mammograms has become increasingly important, and it is crucial to develop subtraction processing and registration methods for mammograms. However, nonrigid image registration has seldom been applied to subjects constructed with soft tissue only, such as mammograms. We examined whether subtraction processing for the comparative interpretation of mammograms can be performed using nonrigid image registration. As a preliminary study, we evaluated the results of subtraction processing by applying nonrigid image registration to normal mammograms, assuming a comparative interpretation between the left and right breasts. Mediolateral-oblique-view mammograms were taken from noncancer patients and divided into 1000 cases for training, 100 cases for validation, and 500 cases for testing. Nonrigid image registration was applied to align the horizontally flipped left-breast mammogram with the right one. We compared the sum of absolute differences (SAD) of the difference of bilateral images (Difference Image) with and without the application of nonrigid image registration. Statistically, the average SAD was significantly lower with the application of nonrigid image registration than without it (without: 0.0692; with: 0.0549 (p < 0.001)). In four subgroups using the breast area, breast density, compressed breast thickness, and Difference Image without nonrigid image registration, the average SAD of the Difference Image was also significantly lower with nonrigid image registration than without it (p < 0.001). Nonrigid image registration was found to be sufficiently useful in aligning bilateral mammograms, and it is expected to be an important tool in the development of a support system for the comparative interpretation of mammograms.

Laparoscopically harvested omental flap for immediate breast reconstruction: a retrospective single-center study of 300 cases

BackgroundThe laparoscopically harvested omental flap (LHOF) has been used in partial or total breast reconstruction, but most studies on LHOF were case reports or small case series. However, the clinical feasibility and oncological safety of LHOF in oncoplastic breast surgery remains controversial. This study reported our experience applying LHOF for immediate breast reconstruction.MethodsBetween June 2018 and March 2022, 300 patients underwent oncoplastic breast surgery using LHOF at our institution. Their clinicopathological data, complications, cosmetic outcomes, and oncologic outcomes were evaluated.ResultsAll patients underwent total breast reconstruction using LHOF after nipple-sparing mastectomy. The median operation time was 230 min (ranging from 155 to 375 min). The median operation time for harvesting the omental flap was 55 min (ranging from 40 to 105 min). The success rate of the laparoscopically harvested pedicled omental flap was over 99.0%. Median blood loss was 70 ml, ranging from 40 to 150 ml. The volume of the flap was insufficient in 102 patients (34.0%). The overall complication rate was 12.3%. Subcutaneous fluid in the breast area (7%) was the most common reconstruction-associated complication, but most cases were relieved spontaneously. The incidence rate of omental flap necrosis was 3.3%. LHOF-associated complications occurred in two cases, including one case of incisional hernia and one case of vascular injury. Cosmetic outcomes were satisfactory in 95.1% of patients on a four-point scale by three-panel assessment and 97.2% using the BCCT.core software. Two local and one systemic recurrence were observed during a median follow-up period of 32 months.ConclusionsThe LHOF for immediate breast reconstruction is a safe and feasible method that involves minimal donor-site morbidity, satisfactory cosmetic outcomes, and promising oncologic safety.

Acceptance of peer physical examination in medical students in Wuhan, China: A cross-sectional study.

Peer physical examination (PPE) is an essential part of the education of medical students. This study aimed to assess the acceptance level ofPPEin Chinese society as well as other related factors. While there have been numerous studies on PPE acceptance in Western societies, there have been relatively few studies on this topic in China. A questionnaire was distributed via social media to clinical-year medical students in China. With 1890 students participating overall, the response rate was 86.9%. The questionnaire collected demographic information and previous experience with PPE, and utilized a 5-point Likert scale to assess acceptance of PPE and factors influencing it. One thousand six hundred and forty-four percent of Chinese medical students accepted PPE, with 13% rejecting it and 19% neutral. Males were more accepting of PPE than females, and females were less accepting of being examined by someone of the opposite gender. The groin/thigh and breast areas were the most rejected for examination. There were no significant differences in acceptance rates between universities or academic performance groups. However, society had a significant impact on the acceptance of PPE. With a 67% acceptance rate of PPE among Chinese medical students, it could be considered a viable alternative to absent life models in Chinses universities. However, implementing PPE may come with its own set of difficulties, so it is recommended that a supervisor is present and that single-gender groups are formed, with friends paired together if possible.

Effectiveness of SCAR-Q for assessment of incisional SCAR after implant-based reconstruction in breast cancer patients: Can it be a tool for incision selection?

Incisional scarring is a factor of cosmetic appearance evaluated after breast reconstruction, along with the shape, position, and size of the breast. This study aimed to examine the effect of the incision scar location on patient satisfaction after breast reconstruction. Using the Japanese version of the SCAR-Q, we assessed the scar appearance, symptoms and psychosocial effects. Plastic surgeons performed assessments using the Manchester Scar Scale. The patients were divided into two groups: those with scars on the margins of the breast (MB group) and those with scars in the breast area (IB group). The results revealed that patients in the MB group reported significantly higher satisfaction with the scar appearance and psychological impact than those in the IB group. However, assessments using the Manchester Scar Scale did not reveal any significant differences between the two groups. In conclusion, this study underscores the importance of patient-reported outcomes in the evaluation of scar satisfaction after breast reconstruction. Patients tend to prefer and have higher satisfaction with scars along the breast margin, which offers valuable insights into surgical decisions. Further studies with larger and more diverse sample sizes are required for validation.

Different views of the pathway's impact on Chemoresistance and Relapse Advanced Breast Cancer and type 2 Diabetes Mellitus

Advanced breast cancer (ABC) with type 2 diabetes mellitus could be an uncommon, however profoundly forceful frame of breast cancer, which accounts for less than 5% of all locally progressed introductions. The clinical introduction of advanced breast cancer regularly contrasts altogether from that of non-advanced breast cancer; immunohistochemistry uncovers a few recognizing highlights. The more forceful triple-negative and HER2-positive breast cancer subtypes are overrepresented in advanced breast cancer compared to non-advanced breast cancer, with a poorer guess in reaction to routine treatments and plasma glucose level control with hyperglucosemia modification. Current understanding of breast tumor chemoresistance - breast cancers localized at essential breast areas and treated early can still relapse because of the presence of cancer cells and the change of cancer cells into a moderately forceful phenotype. This audit summarizes the current proof recommending that inflammatory signaling pathways are up-regulated, which may give a road for novel therapeutics against the background of diabetes. The part of the tumor microenvironment, through tumor-associated macrophages and infiltrating lymphocytes, is additionally examined, recommending that these tumors' outward variables may offer assistance in accounting for the contrasts in behavior between advanced breast cancer with high plasma glucose levels and non-advanced breast cancer. There are different novel treatment techniques currently underway in clinical trials; they require encouraging the improvement of preclinical models of this uncommon but forceful disease is vital.

Translation and psychometric assessment of the mastectomy module of the BREAST-Q questionnaire for use in Nigeria

BackgroundThe majority of non-metastatic breast cancer patients in sub-Saharan Africa are recommended to have mastectomy. The impact of mastectomy on a predominantly young African patient population requires evaluation. The BREAST-Q is a validated patient-reported outcome measure of quality-of-life following breast surgery that has been translated into 30 languages-none in Africa. This study aimed to translate and assess the psychometric properties of the mastectomy module of the BREAST-Q for use in Nigeria.MethodsThe BREAST-Q mastectomy module was translated from English to Yoruba and its psychometric properties assessed using best practice guidelines. Translation was performed in 4 steps: forward translation (x2), back translation, back translation review, and cognitive interviews with post-mastectomy patients. The translated BREAST-Q instrument was administered to post-mastectomy patients (n = 21) alongside the EORTC-QLQ BR23 to evaluate construct validity. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC); surveys were re-administered 4 weeks apart.ResultsThe translation process identified English phrases not amenable to direct translation, including “emotionally healthy” and descriptions of pain (“nagging,” “throbbing,” “sharp”). Translations were amended to reflect local context and question intent. During cognitive interviews, patients provided suggestions to simplify complex phrases, e.g. “discomfort in your breast area.”. Internal consistency within scales was over 0.70 for psychosocial wellbeing (α = 0.84–0.87), sexual wellbeing (α = 0.98–0.99), physical wellbeing in chest (α = 0.84–0.86), and satisfaction with care (α = 0.89–0.93). ICC for test-retest reliability was moderate (0.46–0.63).ConclusionsThe Yoruba version of the BREAST-Q mastectomy module presents a unique opportunity to adequately capture the experiences of Nigerian women post mastectomy. This instrument is being used in a pilot study of Nigerian patients to identify targets for intervention to improve the patient experience and compliance with breast cancer surgery.

Local Flaps in Breast-Conserving Surgery in Early Breast Cancer Patients: Armamentarium for Breast Surgeon.

To describe the technique and outcome of local perforator arteries advancement flap in breast-conserving surgeries (BCS) in patient of early breast cancer as our initial experience and review of literature on it. Patients who underwent (BCS) with local perforator artery flap reconstruction were reviewed in terms of their clinical, surgical, and post-operative follow-up details after taking written and informed consent. We have described 4 patients of early breast cancer out of which one patient was post-NACT while 3 were for upfront BCS. We have performed LICAP in 2 patients, AICAP in 1 patient, and IMAP in one patient, depending on the location of primary tumors. None of the patients had any major or minor surgical complications in the post-operative period and drains were removed on post-operative day 2. All patients received post-operative radiotherapy and tolerated well without any loco-regional complications. Patients are in routine follow-up with cosmetic satisfaction without any local recurrence over 1year. The main advantages of pedicled perforator flaps are well-vascularized tissue, spares underlying muscle leading to lesser donor site morbidity like muscle function and seroma formation, easily reach the breast area with good match in terms of skin and subcutaneous tissue, faster recovery, and shorter learning curve in comparison to free flaps. Knowledge and skill about these flaps will help surgeon to give better surgical outcomes and satisfaction to patients.

Effect and mechanism of Yueju Pills on breast cancer induced by DMBA in rats

This paper aims to explore the inhibitory effect of Yueju Pills on breast cancer and decipher the underlying mechanism. A total of 92 SPF-grade SD female rats were involved in this study, and 14 of them were randomly selected into control group. The remaining 78 rats were administrated with 7,12-dimethylbenzanthracene(DMBA) by gavage to establish the breast cancer model. The modeled rats were randomized into model, tamoxifen(1.9 mg·kg~(-1)·d~(-1)), and low-and high-dose(17, 34 g·kg~(-1)·d~(-1)) Yueju Pills groups. The mental state, food intake, and activities of the rats were observed daily, and the body weight was measured on alternate days. After 12 weeks of administration, the rats were sacrificed and the tumor weight was measured. The serum estrogen and progeste-rone levels were determined by enzyme-linked immunosorbent assay. The histopathological changes of the breast and tumor were observed by hematoxylin-eosin staining. Western blot was employed to measure the protein levels of glucose transporter 1(GLUT1), lactate dehydrogenase A(LDHA), phosphofructokinase muscle(PFKM), pyruvate kinase isozyme type M2(PKM2), hexokinase 2(HK2), nuclear factor-kappaB(NF-κB), and phosphorylated NF-κB. The intestinal microbiome was examined by 16S rRNA high-throughput sequencing. The results showed that compared with the model group, high and low-dose Yueju Pills showed the tumor inhibition rate of 15.8% and 64.5%, respectively, and the low dose group had stronger inhibitory effect. Compared with the control group, the model group presented elevated the levels of estrogen and progesterone in serum. The administration of Yueju Pills lowered such ele-vation, and the low-dose group showed stronger lowering effect(P&lt;0.05). Compared with the model group, Yueju Pills reduced the glands with increased breast tissue, the degree of breast duct expansion, the number and area of acinar cavity, the secretions, and the layers of mammary epithelial cells. Furthermore, Yueju Pills down-regulated the expression of GLUT1, LDHA, PFKM, PKM2, HK2, and NF-κB(P&lt;0.05) and altered the diversity, composition, structure, and abundance of intestinal flora. The results showed that Yueju Pills could inhibit breast cancer by regulating the secretion of estrogen and progesterone, glycolysis, inflammatory cytokines, and intestinal flora.

Breast tumor detection using empirical mode decomposition features

Breast cancer is the second leading cause of cancer deaths among women worldwide. Microwave-based breast cancer detection has attracted increasing attention over the past two decades. Rather than recovering the image of the breast area and accurately determining the tumor location, machine-learningbased algorithms concentrate on detecting the existence of a tumor. Feature extraction is a key step in machine learning, and this step strongly impacts the final detection accuracy. Principal component analysis (PCA) is one of the most widely used feature extraction methods; however, PCA is negatively impacted by signal misalignment. This paper presents an empirical mode decomposition (EMD)-based feature extraction method that is more robust to signal misalignment. The statistical features are extracted from the decomposed subbands of the original signal. The experimental results obtained from clinical data indicate that the detection accuracy is improved by the combination of features from EMD and PCA.

A before and after evaluation of patient reported outcomes assessed by Breast Q following LICAP turnover flap in breast conservative therapy.

Chest-wall perforator-based techniques to replace volume for breast conservative therapy allow excision of large breast areas with minimal sequalae, such as the nipple-areolar complex displacement, parenchymal indentation or contour deformity. Furthermore, chest wall perforator flaps facilitate the maintenance of breast symmetry, hence decreasing the need for contralateral surgery. Lateral intercostal flap was described in numerous variants among which the most famous are the propeller flap and the turnover version. The turnover version is the easiest and fastest version that allows the replacement of large amount of volume. In this paper, we evaluate patients reported outcomes, before and after surgery, collected through the Breast Q. This study was conducted on 21 patients who were admitted to the plastic surgery department. A prospectively maintained database was used to identify the patients and their records were assessed retrospectively. The pre/post operative patients data were collected. The Breast-Q questionnaire was administered before the surgery and at least 1year after. No major surgical complications were reported. Mean Breast-Q scores were evaluated at least 1year after surgery and radiotherapy and compared with pre-surgical scores. Among all the modules, no significant differences between the pre-surgical and post-surgical Breast-Q scores were observed. Until now, the lateral intercostal artery perforator flap has not been widely used, due to a difficult dissection and a challenging preoperative planning. According to the reported surgical technique, the execution is easy. This technique provides the same breast-related quality of life compared to preoperative values, reduces the mastectomy rate and increases the overall survival.