Surgery In Breast Cancer Patients Research Articles

Evolving Role of Lymphedema Surgery on Breast Reconstruction: A Systematic Review and Multi-Institutional Algorithmic Approach

Background/Objectives: Recent advancements in breast cancer treatment have led to increased survival rates, prompting a shift towards addressing breast cancer-related lymphedema (BCRL). Despite the evolving role of lymphatic surgery in breast reconstruction, there is limited literature evaluating the current role of lymphatic surgery in breast reconstruction. This review aims to evaluate the state of lymphatic surgery in breast reconstruction, analyzing surgical techniques and proposing a multi-institutional algorithmic approach. Methods: Through a search and screening of literature, data regarding the study type, type of operation (bypass, pLVB/ILR/LYMPHA, VLNT, or a combination of treatments), and clinical outcomes were collected. Results: The systematic review included 184 studies. Overall, the number of publications on lymphatic surgery increased from 4.4 per year (2010–2016) to 21.1 per year since 2017. The most published procedure was vascularized lymph node transfer (34.6%), followed by preventive lymphatic surgery (31.4%), therapeutic lymphovenous bypass (23.3%), and combined breast and lymphatic reconstruction (10.7%). While VLNT was the most published procedure, preventive surgery has been the most published topic since 2020, with 11.7 articles per year since. Similarly, there has been an increase in studies on combined lymphatic surgery and breast reconstruction in the last five years, with 16 articles published. Conclusions: The role of lymphatic surgery in breast cancer patients is evolving, with an increasing emphasis on preventive procedures and combined reconstructive approaches. However, our study shows that the current literature is predominantly based on lower-level evidence, highlighting the need for more randomized controlled trials to establish stronger clinical recommendations.

Serum Exosomes Expressing CD9, CD63 and HER2 From Breast-Cancer Patients Decreased After Surgery of the Primary Tumor: A Potential Biomarker of Tumor Burden.

Exosomes are extracellular vesicles produced by both normal and cancer cells. Previous research has demonstrated that circulating exosomes derived from cancer cells may create a niche for future metastasis, distant from the primary tumor. In the present report, circulating exosomes were captured and quantified based on exosome-surface proteins in pre- and post-operative serum of breast cancer patients, focusing on the exosome markers CD9 and CD63, as well as HER2, a therapeutic target for breast cancer. Eight breast cancer patients were recruited, and their pre- and post-operative serum samples were analyzed for CD63 and CD9; or CD9 and human epidermal growth factor receptor-2 (HER2), double-positive exosomes. An ExoCounter with antibody-conjugated beads was used to capture serum-derived exosomes. Sera from patients with tumors larger than 10 mm were used for analysis. The resected breast cancer was also histopathologically analyzed for the presence of HER2. CD63 and CD9 double-positive serum exosomes and CD9 and HER2 double-positive serum exosomes decreased after surgery in breast-cancer patients whose tumors expressed HER2, as determined by histopathological analysis. Serum exosomes expressing CD9, CD63 and HER2 are candidate biomarkers of tumor burden in HER2-positive breast-cancer patients.

Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients.

We evaluate the impact of frailty and malnutrition on breast cancer surgery outcomes in older adults using the ACS 5-factor modified frailty index (MFI) and Global Leadership Initiative on Malnutrition (GLIM) definition. Single institution retrospective review of a prospective database of the older adult (>60 years old) breast cancer surgery patients (2000-2016); cases stratified into groups as per MFI (0-2) and GLIM. Characteristics, 90-day post-op events, and 5-year follow-up data were analyzed to report survival and complication outcomes. Among 436 patients at diagnosis, 213 (48.9%) were >80 years old. 377 (86.5%) were alive at 5 years. 274 (62.8%) had MFI > 0, and 69 (15.8%) had malnutrition. Patients ≥ 80, MFI > 0, and PR-negative tumors had worse 5-year survival. There was no survival difference in patients >80 with/without malnutrition (HR = 1.01, p = 0.971), and there was no difference in mastectomy or lumpectomy (p = 0.560) between patients ≥ 80 or patients younger than 80; however, 94% of immediate reconstruction were in pts < 80. On multivariate regression, complications were associated with age < 80, readmission, MFI > 0, and history of HTN; serious complications were associated with age < 80, readmission, anticoagulation, and not receiving endocrine therapy. MFI showed a significant predictive value for 5-year survival for patients ≥ 80 and should be part of the preoperative evaluation.

Prediction model for individualized precision surgery in breast cancer patients with complete response on MRI and residual calcifications on mammography after neoadjuvant chemotherapy.

Identifying whether there is residual carcinoma in remaining suspicious calcifications after neoadjuvant chemotherapy (NAC) in breast cancer patients can provide crucial information for surgeons in determining the most appropriate surgical approach. Therefore, we investigated factors predicting calcifications without residual carcinoma (ypCalc_0) or with residual carcinoma (ypCalc_ca) and aimed to develop a prediction model for patients exhibiting residual suspicious calcifications on mammography but complete response on MRI after NAC. This retrospective study included breast cancer patients undergoing NAC, showing residual suspicious mammographic calcifications but complete response on MRI between January 2019 and December 2020 (development set) and between January 2021 and December 2022 (validation set). Multivariable logistic regression analysis identified significant factors associated with ypCalc_0. The prediction model, developed using a decision tree and factors from logistic regression analysis, was validated in the validation set. The development set included 134 women (mean age, 50.6 years; 91 with ypCalc_0 and 43 with ypCalc_ca) and validation set included 146 women (mean age, 51.0 years; 108 with ypCalc_0 and 38 with ypCalc_ca). Molecular subtype (P = .0002) and high Ki-67 (P = .02) emerged as significant independent factors associated with ypCalc_0 in the development set. The prediction model, incorporating hormone receptor (HR)-/human epidermal growth factor receptor 2 (HER2)+ with high Ki-67 as ypCalc_0 predictors, and HR+/HER2- cancers or HR+/HER2+ or triple-negative (TN) cancers with low Ki-67, as ypCalc_ca predictors, achieved an area under receiver operating characteristic curve of 0.844 (95% CI 0.774-0.914) in the validation set. Minimized surgery may be considered for managing residual calcifications in HR-/HER2+ with high Ki-67 cancers, while complete excision is recommended for HR+/HER2- breast cancers or for HR+/HER2+or TN breast cancers with low Ki-67.

Estradiol and testosterone associated with risk of breast cancer: a meta-analysis

Background: To investigate the correlation between estradiol and testosterone in patients with breast cancer. Methods: The literatures on the correlation between estradiol and testosterone on the risk of breast cancer were searched and collected. The time limit is that each database is established until December 2023. After screening, the modified Jadad scale was used to evaluate the quality of the research literature. NoteExpress 3.2 was used for literature management, and Excel 2003 was used for data collection and extraction. Statistical analysis was performed using RevMan 5.4.1 software to determine whether there was heterogeneity in the study according to the size of Q test (P-value), and then the OR value of combined effects was calculated using fixed or random effects models and forest maps were drawn. At the same time, the literatures with the greatest weight were excluded for sensitivity analysis, and the literature bias was evaluated by drawing funnel plot. Results: A total of 628 literatures were retrieved, and 11 case-control trials met the criteria for inclusion. Meta-analysis results showed that the level of E2 in breast cancer patients was higher than that in non-breast cancer control group, but the difference was not statistically significant (OR=121.56, 95%CI (-3.32-264.44), P=0.06). The level of E2 in premenopausal patients with breast cancer was higher than that in non-breast cancer control group, but the difference was not statistically significant (OR=8.26, 95%CI (-2.83-19.34), P=0.14). The level of E2 in postmenopausal patients with breast cancer was higher than that in non-breast cancer control group, and the difference was statistically significant (OR=20.36, 95%CI (7.04-33.68), P=0.003). Preoperative T level was higher in patients with breast cancer than in non-breast cancer control group, but the difference was not statistically significant (OR=14.77, 95%CI (-14.11-43.65), P=0.32). The T level before and after surgery in breast cancer patients was higher than that in non-breast cancer control group, and the difference was statistically significant (OR=12.91, 95%CI (4.43-21.39), P=0.003). Sensitivity analysis showed that the combined effect size results were stable and reliable OR (95%CI) was 24.41 (10.21~38.61), P=0.0007. Funnel plot results showed publication bias. Conclusion There is a positive correlation between the levels of estradiol and testosterone and the occurrence and development of breast cancer after menopause.

71794 - Breast reduction surgery in breast cancer patients - a retrospective cohort study regarding surgical, cosmetic and patient-reported outcomes

71794 - Breast reduction surgery in breast cancer patients - a retrospective cohort study regarding surgical, cosmetic and patient-reported outcomes

Long-Term Oncologic Outcomes of Omitting Axillary Surgery in Breast Cancer Patients with Chest Wall Recurrence after Mastectomy.

The management of the axilla in breast cancer patients with isolated chest wall recurrence (CWR) after mastectomy remains controversial. Although sentinel lymph node biopsy (SLNB) for restaging is feasible, its role is unclear. We aimed to determine if the omission of axillary restaging surgery in female patients with operable presumably isolated CWRs could result in an increased risk of second recurrences. In this retrospective multicentre study, patients who developed CWRs were reviewed. We excluded patients with suspected or concomitant regional/distant metastases, bilateral cancers and patients without CWR surgery. Patients' demographics, pathological data and subsequent recurrences were collected from a prospective database and were compared between patients with axillary lymph node dissection (ALND) and/or SLNB versus no axillary operation at CWR. A total of 194 patients with CWRs were eligible. The median age at CWR was 56.0 (IQR 47.0-67.0) years old. At recurrence, 8 (4.1%), 5 (2.6%) and 181 (93.3%) patients had ALND, SLNB and no axillary operation, respectively. Patients with no axillary surgery during CWR were associated with, at primary cancer, a lower incidence of ductal carcinoma in situ as diagnosis (p = 0.007) and older age (p = 0.022). Subsequent ipsilateral axillary (p = 0.768) and second recurrences (p = 0.061) were not statistically different between patients with and without axillary surgery at CWR on median follow-up of 59.5 (IQR 27.3-105) months. In patients without evidence of concomitant regional or distant metastasis at CWR diagnosis, omission of axillary restaging surgery was not associated with an increased ipsilateral axillary or second recurrences on long-term follow-up.

Comparing and Analyzing the Physical and Functional Concerns of Post Breast Cancer Surgery Patients Who Received Physical Therapy for Lymphedema After Surgery to Those Who Did Not Receive Physical Therapy After Surgery

Objective: This pilot research project examined the physical and functional concerns of patients who had breast cancer surgery followed by receiving skilled physical therapy or lymphedema therapy services for more than or less than three months. Methods: This research study utilized the Qualtrics system to create a survey for the participants to complete. After completing the survey, the researchers divided the participants into two groups. The researchers analyzed the data using SPSS to run independent sample t-tests. Results: The study results show no significant difference in limb size and self-care activities between the two groups who received physical therapy.

The Effects of Preoperative Video-Assisted Education on Anxiety and Comfort After Breast Cancer Surgery: Nonrandomized Controlled Study

PurposeThis study aimed to determine the effects of video-assisted education given before breast cancer surgery on patients' anxiety and comfort. DesignA non-randomized, controlled, quasi-experimental model was designed. MethodsThe study was conducted in the general surgery clinic of a public hospital. Seventy patients voluntarily participated in the study, 35 of them were in the Control (CG) and 35 of them were in the Experimental Group (EG). While routine treatment and care were given to CG, besides this a video-assisted education was provided to EG. The data was collected using the Personal Information Form, State-Trait Anxiety Inventory (STAI), and General Comfort Questionnaire (GCQ). The patients in both groups filled in the STAI and GCQ on the first day preoperatively, STAI-S and GCS on the second postoperative day and STAI-S on the tenth day after surgery. P<0.05 was accepted as a statistical significance value. FindingsThe groups were similar in terms of descriptive features and preoperative anxiety scores (p>0.05). Postoperative second and tenth day anxiety scores were significantly higher in CG (43.97±9.42 and 39.45±3.88) compared to EG (33.29±4.94 and 33.31±3.01) (p<0.05). In terms of the mean scores of the GCQ and its subscales of comfort, preoperative comfort was found to be lower than postoperative comfort level (p<0.05). ConclusionIt was determined that the preoperative video-assisted education decreased the anxiety level and increased the comfort level in EG. It was concluded that the use of video-assisted education in reducing anxiety and increasing the perception of comfort in breast cancer surgery patients would be beneficial.

Assessing breast cancer-related lymphedema screening and treatment gaps in a safety-net hospital.

We evaluated the unmet breast cancer-related lymphedema(BCRL) treatment and education needs at New England's largest safety-net hospital serving a diverse population by assessing prevalence, risk factors, and treatment. This was a retrospective cohort study examining breast cancer surgery patients from September 2016 to September 2021. The primary outcome was BCRL diagnosis. Secondary outcomes included BCRL risk factors, and physical and occupational therapy (PT/OT)referral frequency and completion. Of 639 patients, 17% of patients had documented BCRL, which was significantly associated with axillary lymph node dissection (ALND).There were no racial, insurance, breast radiation, or BMI category differences between patients with and without a BCRL diagnosis. Of those with BCRL, 58% received a PT/OTreferral, and 56% completed their referral. There were no racial, insurance, or BMI category differences between those who received a PT/OTreferral and those who did not. In our high-risk population, rates of documented BCRL were higher than expected, approaching rates of ALND, despite the majority undergoing sentinel lymph node biopsy (SLNB).PT/OTreferral and completion rates were low, concerning for an unmet BCRL treatment and education need. No disparities in care delivery were seen, but a program that addresses treatment gaps and ensures accessible and patient-centered BCRL care is urgently needed.

A novel 3D-printed scaffold for patient-specific partial breast reconstruction: A prospective, single-arm clinical trial.

e23227 Background: The current scarcity of appropriate breast fillers restricts the availability of breast-conserving surgery for breast cancer patients. The advent of 3D printing technology has introduced novel possibilities for breast reconstruction by fabricating the patient-specific and custom-designed medical products in three dimensions. Methods: We performed a prospective, single-arm clinical trial. The trial population included woman aged between 18 and 60 years with histologically confirmed breast cancer. (Primary) tumors with a size greater than 1.0 cm and less than 8.0 cm, or those presenting as multiple diffuse lesions limited to a single quadrant, preclude the feasibility of traditional breast-conserving surgery. Patients were assigned to receive the patient-specific 3D-printed scaffolds transplantation surgery. Degradation of 3D-printed scaffold, cosmetic outcomes, complications, satisfaction of patients was assessed. Results: Between August of 2016 and August of 2023, 26 patients received partial breast reconstruction using 3D-printed patient-specific scaffolds. The median follow-up was 58.9 months (range, 29 to 88 months). Patients who received partial breast reconstruction with 3D-printed scaffolds have natural-looking and symmetrical breasts after surgery. One year after operation, mild depression at the implantation site was observed in four patients (15.4%). This number increased to seven (26.9%) after two years of surgery. No flap necrosis or ischemia was observed in the nipple and areola area in all patients. Hematoxylin &amp; Eosin showed that fibrous connective tissue, fibroblast cells and blood vessels were observed inside/around the scaffold after one year of surgery. The average degradation rate of 3D-printed scaffolds is 54.07% at 12 months, 74.48% at 24 months, 86.94% at 36 months,87.36% at 48 months, and 92.76% at 60 months. The breast satisfaction score rating by Breast-q scale is 68.5±15.7 at 6 months, 65.4±14.2 at 12 months, and 62.8±15.9 at 24 months. Conclusions: This is the first report of 3D-printed biodegradable scaffolds for breast reconstruction. Partial breast reconstruction using a 3D-printed scaffold presents a viable alternative for breast cancer patients who are not suitable candidates for conventional breast-conserving surgery, yielding promising outcomes. Clinical trial information: NCT03348293 .

Simultaneous integrated boost intensity-modulated radiotherapy post breast-conserving surgery: clinical efficacy, adverse effects, and cosmetic outcomes in breast cancer patients

BackgroundSimultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) is an innovative technique delivering a higher dose to the tumor bed while irradiating the entire breast. This study aims to assess the clinical outcomes, adverse effects, and cosmetic results of SIB-IMRT following breast-conserving surgery in breast cancer patients.MethodsWe conducted a retrospective analysis of 308 patients with stage 0–III breast cancer who underwent breast-conserving surgery and SIB-IMRT from January 2016 to December 2020. The prescribed doses included 1.85 Gy/27 fractions to the whole breast and 2.22 Gy/27 fractions or 2.20 Gy/27 fractions to the tumor bed. Primary endpoints included overall survival (OS), local–regional control (LRC), distant metastasis-free survival (DMFS), acute and late toxicities, and cosmetic outcomes.ResultsThe median follow-up time was 36 months. The 3-year OS, LRC, and DMFS rates were 100%, 99.6%, and 99.2%, respectively. Five patients (1.8%) experienced local recurrence or distant metastasis, and one patient succumbed to distant metastasis. The most common acute toxicity was grade 1–2 skin reactions (91.6%). The most common late toxicity was grade 0–1 skin and subcutaneous tissue reactions (96.7%). Five patients (1.8%) developed grade 1–2 upper limb lymphedema, and three patients (1.1%) had grade 1 radiation pneumonitis. Among the 262 patients evaluated for cosmetic outcomes at least 2 years post-radiotherapy, 96.9% achieved excellent or good results, while 3.1% had fair or poor outcomes.ConclusionsSIB-IMRT after breast-conserving surgery in breast cancer patients demonstrated excellent clinical efficacy, mild acute and late toxicities, and satisfactory cosmetic outcomes in our study. SIB-IMRT appears to be a feasible and effective option for breast cancer patients suitable for breast-conserving surgery.

Abstract PO1-23-05: Exploratory clinical trial of preoperative non-invasive localization before surgery in breast cancer patients using augmented reality technology

Abstract Purpose: A single-center, randomized, prospective exploratory clinical trial to assess the clinical efficacy of augmented reality(AR)-based breast cancer localization medical imaging solution in patients with breast cancer Methods: This prospective exploratory clinical trial enrolled 20 women who were diagnosed with invasive breast cancer between the ages of 19 and 70, had a single lesion or multifocal lesion with a lesion size of 5mm or more and 30mm or less, had no metastasis to other organs, and had not received prior chemotherapy. All patients underwent mammography, ultrasound, CT, and MRI for preoperative assessment. Patients were randomly assigned to US-guided skin marking (control) and SKIA-breast (AR localization) groups of 10 each. Result: Two surgeons performed breast-conserving surgery on twenty patients. Pathologic evaluation of all patients confirmed negative margins. Two independent pathologists evaluated marginal distance, and neither the two reader's estimates (R1, 6.20±4.37 vs. 5.04±3.47, p=0.519; R2, 5.10±4.31 vs. 4.10±2.38, p= 0.970) nor the two reader's average values (5.65±4.19 vs. 4.57±2.84, p= 0.509) showed any difference between the two groups. In comparing the tumor plane area ratio, there was no statistically significant difference between the two groups for the two readers (R1, 15.90±9.52 vs. 19.38±14.05, p=0.525; R2, 15.32±9.48 vs. 20.83±12.85, p=0.290) and the two reader's mean values (15.56±9.11 vs. 20.09±13.38, p=0.388). Based on the two surgeons' responses, convenience, safety, satisfaction, and reusability were all superior in the AR localization group (p=0.000). Conclusion: AR localization is an acceptable alternative to US-guided skin marking with no significant differences in surgical outcomes. Citation Format: Minah Lee, Jun Woo Lee, Woosung Lim, Joohyun Woo, Hyun-Goo Kim, Se Hyun Paek, SangHui Park, Ji Min Kim, Jin Chung, Jee Eun Lee, Jeoung Hyun Kim. Exploratory clinical trial of preoperative non-invasive localization before surgery in breast cancer patients using augmented reality technology [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-23-05.

Preoperative magnetic resonance imaging identify feasibility of breast-conserving surgery for breast cancer patients

Preoperative magnetic resonance imaging identify feasibility of breast-conserving surgery for breast cancer patients

Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis.

Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy. Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1. Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant. We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating the feasibility and acceptability of an adapted fencing intervention in breast cancer surgery post-operative care: the RIPOSTE pilot randomized trial.

Adapted physical activity programs have shown promising results in reducing the physical, social and psychological side effects associated with breast cancer, but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the framework to guide the planning and evaluation of programs according to the 5 following keys: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing). This program is an innovative intervention focused on improving the quality of life (QoL) of breast cancer surgery patients through fencing. A convergent mixed methods pilot study was conducted to preliminary evaluate the different RE-AIM dimension of the pilot program. Twenty-four participants who have just undergone surgery for invasive breast cancer were randomly allocated in two groups: one group started immediately after their inclusion (Early RIPOSTE group) and the other started 3 months following their inclusion (Delayed RIPOSTE group). Participants answered a questionnaire at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and physical activity. RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of QoL, shoulder functional capacity, fatigue and anxiety-depression state, even without any significant differences between the Early RIPOSTE group and the Delayed RIPOSTE group. The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during school vacations were the main barriers. The intervention was moderately well implemented and adherence to the protocol was suitable. RIPOSTE is an acceptable and effective program for involving breast cancer survivors in physical activity, that needs to be tested at a larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide.

A radiogenomic multimodal and whole-transcriptome sequencing for preoperative prediction of axillary lymph node metastasis and drug therapeutic response in breast cancer: a retrospective, machine learning and international multicohort study.

Axillary lymph nodes (ALN) status serves as a crucial prognostic indicator in breast cancer (BC). The aim of this study was to construct a radiogenomic multimodal model, based on machine learning and whole-transcriptome sequencing (WTS), to accurately evaluate the risk of ALN metastasis (ALNM), drug therapeutic response and avoid unnecessary axillary surgery in BC patients. In this study, conducted a retrospective analysis of 1078 BC patients from The Cancer Genome Atlas (TCGA), The Cancer Imaging Archive (TCIA), and Foshan cohort. These patients were divided into the TCIA cohort ( N =103), TCIA validation cohort ( N =51), Duke cohort ( N =138), Foshan cohort ( N =106), and TCGA cohort ( N =680). Radiological features were extracted from BC radiological images and differentially expressed gene expression was calibrated using technology. A support vector machine model was employed to screen radiological and genetic features, and a multimodal model was established based on radiogenomic and clinical pathological features to predict ALNM. The accuracy of the model predictions was assessed using the area under the curve (AUC) and the clinical benefit was measured using decision curve analysis. Risk stratification analysis of BC patients was performed by gene set enrichment analysis, differential comparison of immune checkpoint gene expression, and drug sensitivity testing. For the prediction of ALNM, rad-score was able to significantly differentiate between ALN- and ALN+ patients in both the Duke and Foshan cohorts ( P <0.05). Similarly, the gene-score was able to significantly differentiate between ALN- and ALN+ patients in the TCGA cohort ( P <0.05). The radiogenomic multimodal nomogram demonstrated satisfactory performance in the TCIA cohort (AUC 0.82, 95% CI: 0.74-0.91) and the TCIA validation cohort (AUC 0.77, 95% CI: 0.63-0.91). In the risk sub-stratification analysis, there were significant differences in gene pathway enrichment between high and low-risk groups ( P <0.05). Additionally, different risk groups may exhibit varying treatment responses ( P <0.05). Overall, the radiogenomic multimodal model employs multimodal data, including radiological images, genetic, and clinicopathological typing. The radiogenomic multimodal nomogram can precisely predict ALNM and drug therapeutic response in BC patients.

The impact of ultrasound-guided erector spinae plane block on hemodynamic stability and postoperative pain in patients undergoing modified radical mastectomy for breast cancer.

Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia. Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points. Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001). Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.

69 (PB-069) Poster - Prehabilitation and rehabilitation in breast cancer surgery patients – a pilot study

69 (PB-069) Poster - Prehabilitation and rehabilitation in breast cancer surgery patients – a pilot study

Machine learning determined risk factors associated with non-adherence to timely surgery for breast cancer patients

Guillaume Labilloy, Bharti Jasra, Jason Widrich, Lauren Edgar, Carmen Smotherman, Leigh Neumayer, Brian G. Celso