Resection Of Breast Cancer Research Articles

Rescue of outflow block of the remnant left liver after extended right hemihepatectomy for resection of a tumor in the caudate lobe.

Outflow block of the liver is a life-threatening event after living donor liver transplantation. Herein, we rescued a patient suffering from the outflow block of the remnant left hemiliver caused by bending of the left hepatic vein (LHV) after right hemihepatectomy plus caudate lobectomy combined with resection of the middle hepatic vein (MHV). A metastatic tumor sized 6 cm in the caudate lobe of the liver involving the root of the MHV was found in a 50's year old patient after resection of a right breast cancer eight years ago. Right hemihepatectomy and caudate lobectomy combined with resection of the MHV was performed using a two-stage hepatectomy (partial TIPE ALPPS). On day 1, the total bilirubin value increased to 4.5 mg/dL, and a dynamic computed tomography (CT) scan showed the bent LHV. On the diagnosis of outflow block of the left liver, a self-expandable metallic stent was placed in the LHV using an interventional approach, and the pressure in the LHV decreased from 27 cmH2O to 12 cmH2O. The bilirubin value decreased to 1.2 mg/dL on day 3. Outflow block of the LHV can happen after extended right hemihepatectomy with resection of the MHV. Early diagnosis and interventional stenting treatment can rescue the patient from congestive liver failure.

Association of surgeon's sex, and surgeon-patient dyad with financial outcomes among patients undergoing cancer surgery.

Surgeon sex has been associated with perioperative clinical outcomes among patients undergoing oncologic surgery. There may be variations in financial outcomes relative to the surgeon-patient dyad. We sought to define the association of surgeon's sex with perioperative financial outcomes following cancer surgery. Patients who underwent resection of lung, breast, hepato-pancreato-biliary (HPB), or colorectal cancer between 2014 and 2021 were identified from the Medicare Standard Analytic Files. A generalized linear model with gamma regression was utilized to characterize the association between sex concordance and expenditures. Among 207,935 Medicare beneficiaries (breast: n = 14,753, 7.1%, lung: n = 59,644, 28.7%, HPB: n = 23,400, 11.3%, colorectal: n = 110,118, 53.0%), 87.8% (n = 182,643) and 12.2% (n = 25,292) of patients were treated by male and female surgeons, respectively. On multivariable analysis, female surgeon sex was associated with slightly reduced index expenditures (mean difference -$353, 95%CI -$580, -$126; p = 0.003). However, there were no differences in 90-day post-discharge inpatient (mean difference -$-225, 95%CI -$570, -$121; p = 0.205) and total expenditures (mean difference $133, 95%CI -$279, $545; p = 0.525). There was minor risk-adjusted variation in perioperative expenditures relative to surgeon sex. To improve perioperative financial outcomes, a diverse surgical workforce with respect to patient and surgeon sex is warranted.

Effectiveness of WeChat-assisted preoperative education to reduce perioperative anxiety in breast cancer patients: a prospective randomized controlled study protocol

BackgroundBreast cancer is the most prevalent cancer among women globally, and surgical procedures continue to be the primary treatment. However, over 50% of patients experience preoperative anxiety due to the unknown and fear associated with surgery. Although drug therapy is commonly used to address this anxiety, its side effects have led to a heated debate regarding its effectiveness. Consequently, non-pharmacological therapies, such as preoperative education, have emerged as an alternative approach to alleviate anxiety. WeChat, a widely popular social media platform, offers a public platform that can potentially be utilized for effective preoperative education. This study aims to evaluate the use of WeChat public platform as a tool for preoperative education in patients undergoing breast surgery.MethodsThis is a prospective, randomized, and controlled trial will involve 392 adult women scheduled for breast cancer resection. Participants will be randomly assigned to either the WeChat education group or the regular group. In addition to regular preoperative visits, the WeChat education group will also watch science videos through the WeChat public platform. The regular group will only receive education from ward nurses during preoperative visits. The primary outcome measure will be the incidence of preoperative anxiety, defined by scores of the State Anxiety Inventory (SAI) exceeding 40 points. Secondary outcome measures include the incidence of severe anxiety (SAI > 44) on the day before surgery, incidence of anxiety 72 h after surgery, incidence of severe anxiety 72 h after surgery, NRS scores for pain at rest and during activity 24, 48, and 72 h after surgery, incidence of nausea and vomiting within 24 h after surgery, subjective sleep score at 1 week postoperatively, quality of life QoR-15 scores at 1 and 3 months postoperatively, incidence of chronic pain at 3 months postoperatively, bowel function recovery, length of hospital stay, and hospitalization expenses.DiscussionThis is the first clinical trial to investigate the use of WeChat public platform for delivering preoperative education on perioperative anxiety in breast cancer patients. By utilizing the renowned WeChat public platform, our study aims to improve patient outcomes by providing video education that explains the disease, surgery, and anesthesia in a more accessible manner, thereby reducing the incidence of perioperative anxiety. If our hypothesis is confirmed, this non-pharmacological approach can be universally acknowledged as a cost-effective and practical method in clinical care. Its application can also be extended to other medical fields beyond breast cancer.Trial registrationClinicalTrials.gov, NCT05291494. Registered on 29 December 2021.

Intraoperative Near-infrared Spectroscopy Can Predict Skin Flap Necrosis.

The study aimed to validate the previously identified capacity of near-infrared spectroscopy (NIRS) to detect clinically relevant differences in tissue perfusion intraoperatively. Consecutive patients undergoing oncologic resection requiring flap reconstruction were analyzed. Clinicians were blinded to tissue oxygen saturation (StO2) measurements taken intraoperatively. Measurements were taken at (1) control areas not affected by the procedure, (2) areas at risk of necrosis based on distal location, and (3) areas of skin flap necrosis (SFN) identified during the follow-up period. Mean StO2 values were compared using a single-sample t test and analysis of variance (ANOVA) to determine differences in oxygenation. There were 102 patients included from April 2018 to May 2019. Reconstruction was undertaken following resection for breast cancer (46), melanoma (35), sarcoma (9), and other cutaneous malignancies (12). Breast reconstruction involved 38 alloplastic reconstructions and eight autologous free flaps. Other skin flap reconstruction involved 42 local/regional skin flaps, 13 pedicled flaps, and one free flap. Eighteen patients (17.6%) developed SFN. Mean intraoperative StO2 measurements for control areas, areas at risk, and areas of SFN were 74.8%, 70.9%, and 54.3%, respectively. StO2 values equal to or less than 60% were highly specific (96%) for SFN, whereas StO2 values above 85% were highly sensitive (96%) to rule out SFN. These results further support the use of NIRS to objectively assess variations in skin flap oxygenation and tissue perfusion that are correlated with the development of postoperative SFN.

Abstract PR10: Mammary epithelial architecture modulates field cancerization

Abstract The architecture of the human breast undergoes extensive remodelling throughout puberty, the menstrual cycle, pregnancy, and involution with a risk of accumulating genetic alterations and tissue changes. Cells with mutations in cancer driver genes are abundant in tissues of healthy individuals, but rarely develop into tumors. However, the underlying mechanisms that prevent tumor formation are largely unknown. We utilized tissue clearing and imaged 15 disease-free human breasts and cancer resections with subcellular resolution to unravel the 3D architecture of thousands of mammary ducts per individual. Surprisingly, our analysis revealed that disease-free breasts carry a high burden of microscopic tissue lesions indicating widespread abnormal cell behaviour. Distinct mammary trees from the same breast differed in the kind and frequency of lesions, which coevolved scattered along the ductal routes. Combining 3D imaging of FFPE archived breast cancer resections with spatial CNV-seq revealed that, in half the cases, disease-free ductal segments neighbouring early cancer lesions contain molecular alterations. To resolve the mechanisms that regulate mutation spread, we compared the clonal behavior of cells with oncogenic mutations and neutral mutations in the mouse mammary gland epithelium. From the analysis of the clonal dynamics, we find that local tissue remodeling during the estrous cycle leads to the elimination of the majority of mutant clones, while accelerating the expansion of surviving clones. Thus, oncogenic mutations can spread along entire ducts before signs of transformation become apparent. Our data provides understanding of the earliest stages of epithelial evolution preceding disease. Citation Format: Hendrik A Messal, Cindy Cleyp0ol, Catrin Lutz, Stefan Hutten, Esther Lips, Jos Jonkers, Jelle Wesseling, Ronald Bleys, Ben Simons, Colinda Scheele, Jacco van Rheenen. Mammary epithelial architecture modulates field cancerization [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr PR10.

Current status and reflection on minimal access breast surgery

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

Ultrasonic elastography for the prevention of breast implant rupture: Detection of an increase with stiffness over implantation time

Breast implants are widely used after breast cancer resection and must be changed regularly to avoid a rupture. To date, there are no quantitative criteria to help this decision. The mechanical evolution of the gels and membranes of the implants is still underinvestigated, although it can lead to early rupture. In this study, 35 breast explants having been implanted in patients for up to 17 years were characterized by ex vivo measurements of their mechanical properties. Using Acoustic Radiation Force Impulse (ARFI) ultrasound elastography, an imaging method for non-destructive mechanical characterization, an increase in the stiffness of the explants has been observed. This increase was correlated with the implantation duration, primarily after 8 years of implantation. With an increase of the shear modulus of up to a factor of nearly 3, the loss of flexibility of the implants is likely to lead to a significant increase of their risk of rupture. A complementary analysis of the gel from the explants by mass spectrometry imaging (MSI) and liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS) confirms the presence of metabolites of cholesterol originating from the breast tissues, which most likely crossed the membrane of the implants and most likely degrades the gel. By observing the consequences of the physical–chemical mechanisms at work within patients, this study shows that ultrasound elastography could be used in vivoas a quantitative indicator of the risk of breast implant rupture and help diagnose their replacement.

Impact and value of olanzapine as part of a 4-drug regimen in patients receiving high emetic risk chemotherapy.

293 Background: The Michigan Oncology Quality Consortium, MOQC, has increased the use of olanzapine as part of a 4-drug antiemetic regimen for high emetic risk chemotherapy in many of its 50 practices across Michigan. The purpose of this project was to estimate the impact of olanzapine prescribing on health care utilization and subsequent savings in healthcare utilization payments in patients with breast cancer on (neo)adjuvant doxorubicin and cyclophosphamide (AC) for breast cancer. Methods: Multipayer claims data were used from the Michigan Value Collaborative (MVC), a collaborative quality initiative of over 100 hospitals and 40 physician organizations with the goal of improving healthcare value. We identified a cohort of female patients with a 90-day episode of care for breast cancer resection between 2016-2021 who received chemotherapy with AC as (neo)adjuvant chemotherapy. Patients were covered by Blue Cross Blue Shield of Michigan insurance plans or Medicare. Each patient was attributed to one practice using National Provider Identifiers on professional claims. Facility claims were used to identify inpatient admissions and emergency department (ED) visits across the patient’s course of chemotherapy, up to 21 days following final chemotherapy. Practice-level use of olanzapine abstracted by MOQC as part of ASCO’s Quality Oncology Practice Initiative (QOPI™) data collection was used to determine whether each patient's chemotherapy treatment began when the practice had “high” (≥25%) or “low” (<25%) rates of olanzapine use for high emetic risk chemotherapy. We compared healthcare utilization among patients treated by high- vs. low-prescriber practices and calculated the estimated differences in price-standardized payments attributed to olanzapine use. Results: We identified 1,891 total patients attributed to 45 MOQC practices; 922 patients were attributed to 15 practices that eventually became high prescribers. Patients treated by a high olanzapine prescribing practice had significantly lower hospitalization rates (10%) during chemotherapy compared to patients treated when their attributed practice was a low olanzapine prescriber (15%, p=0.02). There was no difference in the proportion of patients visiting the ED. The mean per-patient price-standardized insurance payment for inpatient hospitalization for this cohort was $12,007. Increased use of olanzapine led to an estimated payment savings of $334,095 in prevented hospitalizations among 525 patients treated when their attributed practice had a high olanzapine prescribing rate. Conclusions: In this patient sample, practice use of olanzapine in ≥ 25% of patients on high emetic risk chemotherapy was associated with significant reductions in the risk of hospitalization. As the proportion of patients receiving olanzapine increases, we expect even greater reductions in the risk of hospitalization and greater cost savings.

Prophylactic Salpingo-Oophorectomy and Survival After BRCA1/2 Breast Cancer Resection

Few studies have investigated whether prophylactic salpingo-oophorectomy (PSO) for patients with previously resected breast cancer who carry pathogenic germline BRCA1 or BRCA2 variants is associated with a reduced risk of cancer-specific death. To assess the association of PSO and prophylactic mastectomy (PM) with prognosis after quadrantectomy or mastectomy as primary treatment for patients with BRCA1 or BRCA2 breast cancer. This retrospective cohort study was performed in a single-institution, tertiary referral center. Consecutive patients with invasive breast cancer treated surgically between 1972 and 2019 were recruited and followed up prospectively after they were found to carry the BRCA1 or BRCA2 gene variant. The data analysis was performed between April 2022 and July 2023. Following breast surgery, some patients underwent PSO, PM, or both, whereas others did not. The primary study end point was overall survival as measured by the Kaplan-Meier method. Secondary end points were crude cumulative incidence of breast cancer-specific mortality, ipsilateral breast tumor recurrence (IBTR), contralateral breast cancer, ovarian cancer, and ovarian cancer-specific mortality. Of 480 patients included in the cohort (median age at initial surgery, 40.0 years; IQR, 34.0-46.0 years), PSO was associated with a significantly reduced risk of death (hazard ratio [HR], 0.40; 95% CI, 0.25-0.64; P < .001). This reduction was most evident for patients carrying the BRCA1 variant (HR, 0.35; 95% CI, 0.20-0.63; P = .001), those with triple-negative disease (HR, 0.21; 95% CI, 0.09-0.46; P = .002), and those with invasive ductal carcinoma (HR, 0.51; 95% CI, 0.31-0.84; P = .008). Prophylactic salpingo-oophorectomy was not associated with risk of contralateral breast cancer or IBTR. Initial or delayed PM was associated with a reduced risk of IBTR but not with overall survival or breast cancer-specific mortality. The study findings suggest that PSO should be offered to all patients with BRCA1/2 breast cancer who undergo surgery with curative intent to reduce risk of death. In particular, PSO should be offered to patients with the BRCA1 variant at the time of breast surgery.

Novel model based on ultrasound predict axillary lymph node metastasis in breast cancer

BackgroundWhether there is axillary lymph node metastasis is crucial for formulating the treatment plan for breast cancer. Currently, invasive methods are still used for preoperative evaluation of lymph nodes. If non-invasive preoperative evaluation can be achieved, it will effectively improve the treatment plan.ObjectiveConstructed a predict model based on ultrasound examination, which forest axillary lymph node metastasis in breast cancer, and validated this model.MethodPatients admitted to Xiamen First Hospital from April 2018 to August 2021 with complete case data were included in this study. Patients who had undergone breast cancer resection and axillary lymph node dissection or sentinel lymph node biopsy were divided into a training and validation cohort in a 7:3 ratio. In the training cohort, patients were divided into metastatic and non-metastatic groups based on whether axillary lymph nodes had metastasis. The parameters of the two groups were compared, and statistically significant parameters were included in multivariate analysis. Then, a Nomogram model was constructed, named Lymph metastasis predict model (LMPM). Calibration curves, receiver operating curve (ROC), and decision curve analysis (DCA) were plotted between the training and validation cohort, calculate the risk score of each patient, identify the optimal cutoff value, and test the predictive efficacy of LMPM.ResultTwo hundred seventy-three patients were enrolled in final study, the average age 49.7 ± 8.7, training cohort included 191 patients, the diameter of breast cancer, the lymph node peak systolic flow velocity (LNPS) and the cortex area hilum ratio (CH) of lymph node were exist significant difference in metastatic and non-metastatic group. Multivariate analysis showed cancer diameter, LNPS and CH included in LMPM, the cutoff value was 95, the calibration curve, ROC, DCA in training and validation cohort show satisfactory result.ConclusionThe predict model-LMPM, can predict axillary lymph node metastasis in breast cancer, which is useful for developing personalized treatment plans. However, further validation of the model is required by incorporating a larger number of patients.

Factors associated with unsatisfactory cosmetic results in oncoplastic surgery.

Oncoplastic surgery (OS) has expanded the indications for breast-conserving surgery associated with an adequate aesthetic result. However, few studies have described the factors associated with unsatisfactory cosmetic outcomes from this surgical modality. This is a cross-sectional prospective study that included patients undergoing breast-conserving surgery (BCS) with or without OS. The patients self-evaluated the cosmetic results of the breasts posttreatment and had them photographed. The photos were analyzed by BCCT.core. Individual and treatment factors (local and systemic) for all patients were evaluated. These factors were dichotomized according to the use of OS and to the cosmetic result (satisfactory and unsatisfactory). Categorical variables were tested for association with surgical outcome using the chi-square test while numerical variables using the Mann-Whitney U test. Variables with p <0,2 were selected for multivariate analysis. Of the 300 patients evaluated, 72 (24,0%) underwent OS. According to the patient self-evaluations, an unsatisfactory cosmetic result from OS was significantly associated with younger age at diagnosis, higher body mass index (BMI) at the time of evaluation, larger tumor size and greater weight of the surgical specimen. According to the BCCT.core, only the laterality of the tumor (left) was significantly associated with an unsatisfactory cosmetic result. In logistic regression, considering OS as a control variable, the risk of an unsatisfactory outcome according to patient self-evaluation was related to the tumor ≥ T2 odds ratio (OR) 1,85 (1,027-3,34) and age at diagnosis < 40 [OR 5,0 (1,84-13,95)]. However, according to the software, the variables were associated with an increased risk of an unsatisfactory outcome were the time interval between surgery and evaluation [OR 1,27 (1,16-1,39)], the presence of lymphedema [OR 2,97 (1,36-6,46)], surgical wound infection [OR 3,6 (1,22-11,16)], tumor location on the left side [OR 3,06 (1,69-5,53)], overweight [OR 2,93 (1,48-5,8)] and obesity [OR 2,52 (1,2-5,31)]. There is no standard methodology for breast cosmesis evaluation, which influences the factors associated with unsatisfactory results. Younger patients and those with increased BMI, left breast cancer and extensive resections tend to present with unsatisfactory cosmetic results when OS is performed.

A step ahead to enhancing routine breast cancer resection: Spheroid and hen's egg chorioallantoic membrane models to assess the photodynamic diagnosis efficiency of ALA and PSI-ALA-hex.

Aminolevulinic acid (ALA) and its derivatives have been used in the diagnosis of several diseases through topical, intravesical, and oral administration. However, their intravenous use for the theranostics of cancers has not raised interest despite its potential advantages. In this study, we compared the efficacy of ALA, its hexyl ester ALA-Hex, and our new derivative PSI-ALA-Hex to induce a fluorescent protoporphyrin IX (PpIX) overproduction in breast cancers. First, we tested the drugs on four subtypes of breast cancer spheroids in vitro. Our results demonstrated the capacity of ALA-Hex and PSI-ALA-Hex to produce PpIX in all breast spheroids, although ALA struggled in half of the models. We applied the chick embryo in vivo model to investigate the intravenous administration route of ALA and PSI-ALA-Hex, ALA-Hex being toxic. We engrafted breast cancer nodules having various hormonal profiles onto the chorioallantoic membrane of the eggs. They were all detected by fluorescence imaging with mild efficacy using PSI-ALA-Hex, which displayed a maximum selectivity of 2.2 to 2.9, whereas ALA showed a higher selectivity from 3.2 to 5.1 at 300μmol/kg. PSI-ALA-Hex was less appropriate for the diagnosis of breast cancer by intravenous administration. We show for the first time, to the best of our knowledge, the photodetection and imaging of a wide range of breast tumors in vivo upon intravenous treatment with ALA.

Utility of radiotherapy for the management of local tumor progression in patients with early breast cancer

The generally accepted standard in early breast cancer surgery today is breast-conserving surgery with external beam radiation therapy, which is comparable in results to previously widely performed radical mastectomy and even has an advantage in terms of overall survival and control. Until now, there are areas of discussion and a number of questions remain related to the methodology of irradiation of patients with breast cancer, namely: is it advisable to irradiate the axillary zone after radical resection for early breast cancer? Does irradiation of axillary lymph nodes provide regional control comparable to lymphadenectomy, and whether it can be an alternative to lymph node dissection? Whether provides an irradiation of axillary lymph nodes comparable with regional lymph node dissection the control over patients with a positive sentry lymph node? A lot of studies have been published so far, answers to questions derived from what we present in this work.

Multicenter study to evaluate the efficacy and standardize radiofrequency ablation therapy for early breast cancer.

e12570 Background: Early-stage breast cancer is increasingly detected by screening mammography, and we aim to establish radiofrequency ablation therapy (RFA) as a minimally invasive, cost-efficient, and cosmetically acceptable local treatment. In our Phase I study, localized tumors with a maximum diameter of 2 cm, preoperatively diagnosed by imaging and histopathology, were treated with RFA. A 90% complete ablation rate was confirmed histopathologically. Our phase II multicenter study of RFA without resection for early breast cancer will evaluate the long-term safety and efficacy of RFA as well as its cosmetic results, which are a perceived advantage of this technique. Methods: From Nov. 2009 to Nov. 2012, 58 patients with early-stage breast cancer received non-surgical RFA therapy. Patients had localized solitary N0 tumors with a maximum diameter of 1 cm. In our experimental therapy, a radiofrequency electrode needle is inserted through the skin into the breast lesion under imaging guidance, followed by thermal ablation with radiofrequency waves. RFA will be conducted under general anesthesia. The Cool-tip™ RF Ablation Single Electrode Kit (Medtronic, CO, USA) will be used to standardize the evaluation of the ablation effect. They underwent RFA and SNB under general anesthesia and adjuvant therapy and breast radiation. Follow-up evaluation for residual tumor at 3, 6, and 12 months after RFA included clinical examination, diagnostic imagings and vacuum-assisted biopsy. Surgical resection was recommended for patients with suspected residual disease or incomplete ablation. The primary endpoint was the frequency of adverse events. Secondary endpoints included the complete ablation rate and ipsilateral breast relapse-free rate. Results: The follow-up period ranged from 15 to 109 months (median, 85 months). The 57 patients completed the non-surgical RFA procedure and underwent diagnostic imaging and needle biopsy after 3 months. Seven patients with suspected incomplete ablation underwent surgical resection; incomplete ablation was confirmed in 5 (8.6%, 2 with invasive and 3 with non-invasive ductal carcinoma). During subsequent follow-up, 1 patient each was diagnosed with contralateral breast cancer and ipsilateral breast tumor relapse. No distant recurrence was documented. Cosmetic results were excellent in 94% of patients. Conclusions: Our phase II multicenter study of RFA without resection for early breast cancer will evaluate the long-term safety and efficacy of RFA as well as its cosmetic results, which are a perceived advantage of this technique. Clinical trial information: UMIN000008675 .

Serum fatty acid profiles in breast cancer patients following treatment

BackgroundBreast cancer is associated with alterations in lipid metabolism. The treatment of breast cancer can also affect serum lipid composition. The purpose of this study was the examination of serum fatty acids (FAs) profiles in breast cancer survivors to assess if the FA levels normalize.MethodsSerum levels of FAs were determined by gas chromatography–mass spectrometry in a group of breast cancer patients at baseline (before treatment, n = 28), at two follow-up visits at 12 months (n = 27) and 24 months (n = 19) after the breast cancer resection, and in the group of healthy controls (n = 25). Multivariate analysis was performed to assess how FA serum profile changes following treatment.ResultsBreast cancer patients’ serum FA profiles at follow-ups did not normalize to the levels of control group. The greatest differences were found for levels of branched-chain (BCFA), odd-chain (OCFA) and polyunsaturated (PUFAs) FAs, all of which were significantly increased 12 months after the surgery.ConclusionsAfter treatment for breast cancer, the patients’ serum FA profile differs from the profile before treatment and from controls, especially 12 months after treatment. Some changes may be beneficial – increased BCFA and OCFA levels, and improved n-6/n-3 PUFA ratio. This may reflect lifestyle changes in breast cancer survivors and have an impact on the risk of recurrence.

Diagnostic Value of FDG PET/CT in Surveillance after Curative Resection of Breast Cancer.

With increasing incidence of breast cancer and improvement in treatment, the concern about surveillance management also has increased. This retrospective study was designed to evaluate the diagnostic value of routine surveillance FDG PET/CT in patients with breast cancer. The diagnostic performance of surveillance PET/CT was analyzed regarding sensitivity, specificity, positive predictive value, negative predictive value and accuracy. The diagnostic accuracy was defined as the ability to differentiate recurrence and no-disease correctly and the proportion of true results, either true positive or true negative, in the population. Findings from pathologic examination; other imaging modalities such as CT, MRI and bone scan; or clinical follow-up were used as the reference standard. In this study of 1681 consecutive patients with breast cancer who underwent curative surgery, surveillance fluorodeoxyglucose PET/CT showed good diagnostic performance in the detection of clinically unexpected recurrent breast cancer or other malignancy, with a sensitivity of 100%, specificity of 98.5%, positive predictive value of 70.5%, negative predictive value of 100% and accuracy of 98.5%. In conclusion, surveillance fluorodeoxyglucose PET/CT showed good diagnostic performance in the detection of clinically unexpected recurrent breast cancer after curative surgery.

Cryo-assisted resection of primary breast cancer en bloc and tumor cryoablation connected with local drug delivery and targeting of tumor fluids. Experimental and clinical studies

Objective — to use cryosurgery in combination with simultaneous peritumoral and intratumoral tracer injections of blue dye for further lymphatic mapping in the treatment of primary breast tumors. The effectiveness of intraoperative cryoprobe‑assisted injection of blue dye and cytotoxic‑tracer mixture for locoregional drug targeting in the VX2 tumor model as well as its translational significance for cryo‑assisted breast tumor surgery with blue dye alone were evaluated. Sentinel lymph node mapping, pathological determination of the tumor, and resection margins were achievable.&#x0D; Materials and methods. Thirty‑nine patients with primary breast cancer in stages I to IV, aged 52,4 (±19) years (mean, standard deviation (SD) years), were randomly selected, treated at the Rudolfinerhaus Private Clinic in Vienna, Austria, and included in this preliminary clinical study. Under computed tomography guidance, we injected 2 ml of cytotoxic‑tracer mixture in five aliquots into the margins of 16 frozen or normothermic VX2 tumors. We evaluated the intraoperative and post‑operative drug targeting and therapeutic efficacy at the tumor‑host interface by means of computer tomography, gross examination, and histopathology. In thirty‑four T1 to T4 primary breast cancers, we performed an ultrasound‑guided cryoprobe‑assisted tumor freezing‑thawing cycle, blue dye‑guided lymphatic mapping, and surgery. We examined an intraoperative and freshly resected specimen and the blue dye distribution pattern in the tumor‑host interface, lymph node(s), breast parenchyma, and resection cavity. &#x0D; Results. 29 of the 38 patients had localized primary breast cancer, which was estimated to be resectable without neoadjuvant chemotherapy. 87% of patients had one to twelve stained axillary lymph nodes, while 72% of patients had another quadrant and resection cavity stained. Fluid‑impervious frozen VX2 or breast tumors transported drug(s) in an arc‑like pattern at the tumor‑host interface regardless of freeze dose, number of freeze‑thaw cycles, drug dose fractionation, tumor characteristics, or tumor dimensions. During melting, the cytotoxic‑tracer mixture spread within 50% of the VX2 tumor and mirrored that of the tumor‑host interface; it was massive in normothermia. In VX2, the CT gap corresponded to 20% of the focal margin necrosis in pathology. In both studies, blue dye dose‑staining spread linearly in the tumor‑host interface and tumor.&#x0D; Conclusions. The study paves the way for intraoperative cryo‑assisted cure options for primary breast cancer. We have shown that our cryosurgical technique of repeatedly freezing deep tumors for en bloc resection or for in situ ablation of primary breast cancer, facilitated by IOUS monitoring, can be coupled with the simultaneous injection of dye tracers during conventional surgery, which then allows for lymphatic mapping. Intraoperative freezing‑assisted drug delivery and targeting techniques during cryoablation of the VX2 tumor translate successfully to locoregional blue dye targeting and lymphatic mapping during cryo‑assisted surgery of breast cancer. We explored the ability of our strategy to prevent tumor cell migration, but not that of injected tracers, to the lymphovascular drainage during conventional resection of frozen breast malignancies.&#x0D;

Abstract 192: A novel and rapid patient-derived organoid breast cancer platform for precision medicine

Abstract An increasing number of studies performing correlative drug screens on patient-derived organoids (PDO) are revealing enormous potential for these models in predicting patient response to therapy. Despite this, their future use in a clinical setting is hindered by intrinsic limitations of PDO models, namely low success rates in establishing growing cell cultures from tumor tissue samples and long return times for drug response data that fall outside timescales of clinical actionability. To address these limitations, we leveraged technological advances in emulsion-based microfluidics and droplet generators to develop MicroOrganoSpheres (MOS) - microscale environments containing tumorspheres that retain structural, cellular, and genetic properties of an individual patient’s diseased tissue. Here, we focused on generating MOS from breast cancer tissue biopsies and resections across different subtypes of breast cancer. We established over 30 unique patients’ breast MOS samples at an average of 80% success, with the majority of these samples being hormone receptor positive (ER+/PR+) - the most clinically lethal and challenging subtype to establish. We evaluated MOS dose-responses across several first line standard of care chemotherapies for breast cancer. For this, we created a semi-automated workflow paired with high-content imaging for quantifying dose responses and tracking longitudinal cell dynamics during dosing. We generated dose response data for MOS samples, being able to move from primary tissue samples to MOS to drug dosing data within a clinically relevant timescale of 2-3 weeks. We conclude that our platform demonstrates the feasibility of 1) efficiently establishing MOS from breast cancer patient tumor samples from different subtypes and 2) performing drug dosing studies on these samples with improved turnaround times that enable clinical actionability for the patient. Together, these findings provide a foundation for evaluating this technology as a diagnostic tool in future clinical settings. Citation Format: David M. Graham, Gabrielle Rupprecht, Eric D. Bankaitis, Jeremy M. Force, Wylie Watlington, Steven W. Metzger, Xiling Shen, David Hsu. A novel and rapid patient-derived organoid breast cancer platform for precision medicine [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 192.

Positional advantages of supine MRI for diagnosis prior to breast‑conserving surgery.

The present study aimed to evaluate the rate of positive surgical margins for magnetic resonance imaging (MRI) performed in the supine position prior to breast-conserving surgery (BCS). The rate of positive surgical margins and the clinicopathological factors were examined in consecutive patients with BCS who underwent preoperative MRI performed in the supine position at Sapporo Medical University Hospital (Sapporo, Japan) and related hospitals and clinics between January 2012 and December 2013. Of 1,175 eligible patients, 1,150 were included after excluding 25 patients with either bilateral breast cancer or stage IV disease. Positive margin was defined as no cancer seen on the resected margin. The primary endpoint was the rate of positive surgical margins when preoperative MRI was performed in the supine position and the secondary endpoint was identification of the factors that predict positive margins. Of the 1,150 female patients (median age, 55 years; range, 29-97 years) who underwent BCS for breast cancer following MRI performed in the supine position, 215 (18.8%) had positive margins, which is similar to the rate with MRI in the prone position, and 930 (81.2%) had negative margins. The rate of positive surgical margins in patients of the human epidermal growth factor receptor 2 (HER2) type was significantly higher than that in the non-HER2 type group (6.5 and 2.9%; χ2 P=0.0103). There was no increase in the rate of positive margins in breast cancers with a diameter of >T2. The rate of positive surgical margins following MRI performed in the supine position was 18.8%. Supine MRI appears to be suitable for informing on the extent of resection of breast cancer.

BCR-Net: A deep learning framework to predict breast cancer recurrence from histopathology images.

Breast cancer is the most common malignancy in women, with over 40,000 deaths annually in the United States alone. Clinicians often rely on the breast cancer recurrence score, Oncotype DX (ODX), for risk stratification of breast cancer patients, by using ODX as a guide for personalized therapy. However, ODX and similar gene assays are expensive, time-consuming, and tissue destructive. Therefore, developing an AI-based ODX prediction model that identifies patients who will benefit from chemotherapy in the same way that ODX does would give a low-cost alternative to the genomic test. To overcome this problem, we developed a deep learning framework, Breast Cancer Recurrence Network (BCR-Net), which automatically predicts ODX recurrence risk from histopathology slides. Our proposed framework has two steps. First, it intelligently samples discriminative features from whole-slide histopathology images of breast cancer patients. Then, it automatically weights all features through a multiple instance learning model to predict the recurrence score at the slide level. On a dataset of H&E and Ki67 breast cancer resection whole slides images (WSIs) from 99 anonymized patients, the proposed framework achieved an overall AUC of 0.775 (68.9% and 71.1% accuracies for low and high risk) on H&E WSIs and overall AUC of 0.811 (80.8% and 79.2% accuracies for low and high risk) on Ki67 WSIs of breast cancer patients. Our findings provide strong evidence for automatically risk-stratify patients with a high degree of confidence. Our experiments reveal that the BCR-Net outperforms the state-of-the-art WSI classification models. Moreover, BCR-Net is highly efficient with low computational needs, making it practical to deploy in limited computational settings.