Routine Breast Research Articles

A comparative study on the features of breast sclerosing adenosis and invasive ductal carcinoma via ultrasound and establishment of a predictive nomogram.

To analyze the clinical and ultrasonic characteristics of breast sclerosing adenosis (SA) and invasive ductal carcinoma (IDC), and construct a predictive nomogram for SA. A total of 865 patients were recruited at the Second Hospital of Shandong University from January 2016 to November 2022. All patients underwent routine breast ultrasound examinations before surgery, and the diagnosis was confirmed by histopathological examination following the operation. Ultrasonic features were recorded using the Breast Imaging Data and Reporting System (BI-RADS). Of the 865 patients, 203 (252 nodules) were diagnosed as SA and 662 (731 nodules) as IDC. They were randomly divided into a training set and a validation set at a ratio of 6:4. Lastly, the difference in clinical characteristics and ultrasonic features were comparatively analyzed. There was a statistically significant difference in multiple clinical and ultrasonic features between SA and IDC (P<0.05). As age and lesion size increased, the probability of SA significantly decreased, with a cut-off value of 36 years old and 10 mm, respectively. In the logistic regression analysis of the training set, age, nodule size, menopausal status, clinical symptoms, palpability of lesions, margins, internal echo, color Doppler flow imaging (CDFI) grading, and resistance index (RI) were statistically significant (P<0.05). These indicators were included in the static and dynamic nomogram model, which showed high predictive performance, calibration and clinical value in both the training and validation sets. SA should be suspected in asymptomatic young women, especially those younger than 36 years of age, who present with small-size lesions (especially less than 10 mm) with distinct margins, homogeneous internal echo, and lack of blood supply. The nomogram model can provide a more convenient tool for clinicians.

Analysis Of The Relationship Of Factors Triggering Breast Disorders With The Results Of Ultrasound Image Expectation In The Implementation Of The Mammae Organ Scanning Protocol

This study aims to determine the relationship between trigger factors for breast abnormalities with the results of ultrasound image observation. This study is an analytical observational study with a retrospective approach. The research design used was a control case design. Data collection will be carried out from April to June 2023 at the MCU Clinic in the Jabodetabek area. The study data were analyzed using bivariate and multivariate analysis. The results of the bivariate analysis showed p values = 0.000 &lt; 0.005 for each of the internal and external trigger factor variables. The conclusion in this study is that there is a significant relationship between the history of BSE, history of childbirth, history of breastfeeding, history of hormonal birth control use, genetic history, history of alcohol consumption, history of smoking, history of menarche, history of menopause, history of consumption of junk food, and history of consumption of soft drinks (p-value = 0.000) with observation of ultrasound images on the breast organ scanning protocol. Higher Diagnostic Accuracy through consideration of the triggering factors of breast disorders in ultrasound image results. Guide to the Development of Scanning Protocols that are More Effective in detecting breast disorders. Identify Risk Factors that allow special attention in the management of breast health. Increased Public Awareness of the importance of routine breast exams. Direction for Advanced Research to understand more deeply the relationship between trigger factors and ultrasound image outcomes. Potential Improvement of Clinical Practice and Guidelines by considering research findings.

The outstanding diagnostic value of DKI in multimodal magnetic resonance imaging for benign and malignant breast tumors: A diagnostic accuracy study.

To explore the value of applying different magnetic resonance imaging MRI sequences in the differential diagnosis of benign and malignant breast tumors. Routine breast magnetic resonance scans (T1-weighted image, T1WI; T2-weighted image, T2WI), dynamically enhanced scans, diffusion-weighted Imaging, and diffusion kurtosis imaging (DKI) scans were performed on 63 female patients with breast-occupying lesions. The benign and malignant lesions were confirmed by biopsy, excision-histopathology reports. There are 70 lesions, of which 46 are benign and 24 are malignant. Analyze the primary conditions, such as the shape, size, and boundary of the lesion, and determine the apparent diffusion coefficient (ADC), mean kurtosis (MK), and mean diffusion (MD) values. The receiver operating characteristic curve was used to evaluate the value and difference in differentiating benign and malignant lesions. In this study, the results of the 2 testers both showed that the MK of malignant lesions was significantly higher than that of benign lesions (P < .001), and the MD of benign lesions was higher than that of malignant lesions (P < .05). The ADC of benign lesions was higher than that of malignant lesions (P < .05). For MK, the area under the curve of the 2 testers was 0.855/0.869, respectively. When the best cutoff value of MK for tester 1 was 0.515, the sensitivity and specificity of MK for diagnosing malignant tumors were 83.3%/87.0%, respectively. For the 2 testers MD, and ADC, the area under the curve was < 0.5, and the diagnostic value was low. The MK value obtained by DKI has a specific value in the differential diagnosis of benign and malignant breast lesions. DKI is helpful in the identification of benign and malignant breast tumors. The diagnostic value is outstanding, and its importance to the changes in the microstructure of the organization needs to be further explored.

Knowledge and Practice of Breast Self Examination among Female Students of Tertiary Institutions in Abia State, Nigeria

Background: Early detection and diagnosis of illnesses by screening is a key public health premise. Breast self-examination is a cheap and convenient method of early detection of cancer of the breast, especially in resource poor countries; Women who frequently perform breast self-examinations (BSE) look for any lumps or abnormal changes in order to seek immediate medical assistance. There is increasing incidence of detection of breast cancer among young women, this has been attributed to a lack of knowledge and practice of breast self-examination (BSE).&#x0D; Aim: To determine the knowledge, and practice of routine breast self-examination among the female students of tertiary institutions in Abia State, Nigeria.&#x0D; Materials and Methods: This was a cross-sectional study conducted among 609 female students from five tertiary institutions in Abia State, Nigeria. Research instruments were structured, self-administered and pretested questionnaires. Data collected were analyzed using Statistical Package for Social Sciences (SPSS Version 25). &#x0D; Results: Majority of the participants were between the ages of 18-22 years. Majority of the respondents had heard of BSE (88.8%) mostly from social media (37.7%). A good number knew the steps involved in BSE (72.7%); while 467(76.7%) of respondents, had practiced BSE before. However, frequency of practice was low, and majority who didn’t practice frequently cited forgetfulness (38.5%) as their major reason. Most respondents agreed that BSE was very relevant (72.4%), and that families needed to be taught BSE (98.4%). Most respondents (81.3%) had no family history of breast lump while 87.8% had no family history of breast cancer. Occupation of respondents’ father was associated with knowledge of BSE and this was statistically significant; p&lt; 0.05.&#x0D; Conclusion: This study demonstrates good knowledge, and good practice, however frequency of practice was low.

Feasibility of implementing patient-reported outcome measures into routine breast cancer care delivery using a novel collection and reporting platform.

imPROVE is a new Health Information Technology platform that enables systematic patient-reported outcome measure (PROM) collection through a mobile phone application. The purpose of this study is to describe our initial experience and approach to implementing imPROVE among breast cancer patients treated in breast and plastic surgery clinics. We describe our initial implementation in 4 phases between June 2021 and February 2022: preimplementation, followed by 3 consecutive implementation periods (P1, P2, P3). The Standards for Reporting Implementation Studies statement guided this study. Iterative Plan-Do-Study-Act (PDSA) cycles supported implementation, and success was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Qualitative interviews conducted during the preimplementation phase elicited 4 perceived implementation barriers. Further feedback collected during each phase of implementation resulted in the development of brochures, posters in clinic spaces, and scripts for clinic staff to streamline discussions with patients, and the resolution of technical issues concerning patient login capabilities, such as compatibility with cell phone software and barriers to downloading imPROVE. Feedback also generated ideas for facilitating provider interpretation of PROM results. By the end of P3, 2961 patients were eligible, 1375 (46.4%) downloaded imPROVE, and 1070 (36.1% of those eligible, 78% of those who downloaded) completed at least 1 PROM. Implementation efforts across 2 surgical departments at 2 academic teaching hospitals enabled collaboration across clinical specialties and longitudinal PROM reporting for patients receiving breast cancer care; the implementation effort also highlighted patient difficulties with mobile app-based PROM collection, particularly around initial engagement.

Ultrasonic spectroscopy at 20–80 MHz to evaluate lymph node status during breast conserving surgery

High-frequency (20–80 MHz) ultrasound was used to evaluate 77 lymph nodes from 38 patients to identify metastatic breast cancer. Lymph nodes were resected during routine breast conserving surgery. Through-transmission point measurements were collected from the resected nodes immediately following surgery using two single-element transducers (50-MHz center frequency, 6.35-mm diameter), a high-frequency ultrasonic pulser-receiver,and a 1-GHz digital oscilloscope. Attenuation and two spectral parameters—peak density and tortuosity—were calculated from the ultrasonic waveforms and power spectra, respectively. Fisher’s exact test was used to optimize the sensitivity and specificity for each parameter separately and for multivariate analyses. A multivariate analysis of peak density versus tortuosity with a cube-root decision boundary produced the most significant results, with an 89.6% accuracy, 100% sensitivity, 88.4% specificity, and p-value of 6.12 × 10−7. Computer simulations and phantom experiments showed that the sensitivity of the spectral parameters to tissue malignancy arises from ultrasonic Mie scattering from cell nuclei and nuclear pleomorphism. The results demonstrate that ultrasonic spectroscopy at 20–80 MHz provides high sensitivity and specificity for malignant lymph nodes in the breast, and has promise as a rapid, intraoperative, and potentially in vivo diagnostic tool for surgeons and a wide range of soft tissue cancers.

A comparison of breast screening performance based on a standardised test, during and outside of the COVID-19 lockdown period

PurposeIn the UK, the COVID-19 pandemicand the resulting lockdown significantly impacted routine breast screening and led to reduced case volumes for breast screening readers. The aim of the study was to evaluate whether breast screening performance on a test-set based assessment scheme (PERFORMS) varied over time, in association with the lockdown period. MethodIn this retrospective study, performance data were obtained for all breast cancer screening readers in England who completed the PERFORMS schemes based on digital mammography (from 2015 to 2022). Cancer detection (sensitivity), correct return to screen (specificity) and the difference between the sensitivity and specificity were calculated for each breast screener in each PERFORMS scheme. ResultsDuring the study period, 4906 readers participated in eight PERFORMS schemes. Both the cancer detection (H(7) = 775.56, p <.00001) and correct return to screen rate (H(7) = 401.13, p <.00001) varied significantly by scheme. The difference between cancer detection and correct return to screen rate in the scheme administered during the lockdown period was significantly higher than in all other schemes (p <.05, Bonferroni correction applied). ConclusionsThe performance of breast screeners on the PERFORMS test-set based assessment scheme which was administered during the lockdown period, was characterised by markedly high sensitivity and low specificity when compared to their performance on other tests taken pre-COVID and following the lockdown.

Routine breast milk monitoring using automated molecular assay system reduced postnatal CMV infection in preterm infants.

Human cytomegalovirus (CMV) transmitted through breast milk poses fatal risks to preterm infants. However, current molecular assay systems often do not accommodate breast milk samples. In this study, we evaluated the analytical and clinical performance of the measurement procedure of CMV load in breast milk utilizing the Cobas CMV test on the Cobas 6,800 system. This was enabled by incorporating a simple independent sample preparation procedure before the application of samples on the automated assay system. Clinical data from electronic medical records were retrospectively analyzed. Breast milk samples from mothers of preterm infants born before 33 weeks of gestation were screened for CMV using the automated assay system. CMV positivity rates in breast milk and neonatal samples and the CMV transmission rate were calculated. Furthermore, to validate the analytical accuracy of the overall measurement procedure with newly obtained residual breast milk samples, the linearity of the measurement procedure was assessed, and a simplified sample preparation method was validated against a conventional method. The CMV positivity rates in maternal breast milk and neonatal samples were 57.8 and 5.2%, respectively. The CMV transmission rate through breast milk was 7.7%. No significant differences in gestational age or birth weight were found between the CMV-negative and CMV-positive neonates. The linearity of the procedure was observed within a range of 1.87-4.73 log IU/mL. The simplified sample preparation method had an equivalent or even improved CMV detection sensitivity than the conventional method. Incorporating a simple independent sample preparation procedure effectively resolved any potential issues regarding the application of breast milk on the automated assay system. Our approach contributed to reduced vertical transmission of CMV by providing a convenient and reliable method for the monitoring of breast milk CMV positivity for clinicians.

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.

Transcriptional intra-tumour heterogeneity predicted by deep learning in routine breast histopathology slides provides independent prognostic information

BackgroundIntra-tumour heterogeneity (ITH) causes diagnostic challenges and increases the risk for disease recurrence. Quantification of ITH is challenging and has not been demonstrated in large studies. It has previously been shown that deep learning can enable spatially resolved prediction of molecular phenotypes from digital histopathology whole slide images (WSIs). Here we propose a novel method (Deep-ITH) to predict and measure ITH, and we evaluate its prognostic performance in breast cancer. MethodsDeep convolutional neural networks were used to spatially predict gene-expression (PAM50 set) from WSIs. For each predicted transcript, 12 measures of heterogeneity were extracted in the training data set (N = 931). A prognostic score to dichotomise patients into Deep-ITH low- and high-risk groups was established using an elastic-net regularised Cox proportional hazards model (recurrence-free survival). Prognostic performance was evaluated in two independent data sets: SöS-BC-1 (N = 1358) and SCAN-B-Lund (N = 1262). ResultsWe observed an increase in risk of recurrence in the high-risk group with hazard ratio (HR) 2.11 (95%CI:1.22–3.60; p = 0.007) using nested cross-validation. Subgroup analyses confirmed the prognostic performance in oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, grade 3, and large tumour subgroups. The prognostic value was confirmed in the independent SöS-BC-1 cohort (HR=1.84; 95%CI:1.03–3.3; p = 3.99 ×10−2). In the other external cohort, significant HR was observed in the subgroup of histological grade 2 patients, as well as in the subgroup of patients with small tumours (<20 mm). ConclusionWe developed a novel method for an automated, scalable, and cost-efficient measure of ITH from WSIs that provides independent prognostic value for breast cancer. SignificanceTranscriptional ITH predicted by deep learning models enables prediction of patient survival from routine histopathology WSIs in breast cancer.

SYSTEMATIC REVIEW: ANAPLASTIC LARGE CELL LYMPHOMA FOLLOWING BREAST IMPLANT SURGERY

Highlights: BIA-ALCL, a T-cell lymphoma associated with breast implants, is posing a growing medical challenge due to the increasing use of implants for cosmetic and reconstructive purposes The majority of BIA-ALCL cases were associated with cosmetic reasons for breast implants, and textured implants were predominantly implicated. Abstract: Introduction: BIA-ALCL, a T-cell lymphoma associated with breast implants, poses a growing medical challenge despite its relatively low occurrence, due to the increasing use of implants for cosmetic and reconstructive purposes. Our objective is to review the incidence, characteristics of patients, implant types, management, and outcome of BIA-ALCL. Methods: Pubmed and Science Direct databases were searched to identify case series and observational research. A systematic review was conducted by looking up the keywords “breast implant” and “anaplastic large cell lymphoma”. Result: 11 relevant articles were assessed. A total of 353 BIA-ALCL cases have been reported. The mean age at diagnosis was 59.6 years. More than half (53.26%) of the reasons for the breast implants in BIA-ALCL patients were cosmetic. The mean time from breast implant placement to diagnosis was 9.99 years. The majority (71.39%) of documented BIA-ALCL cases have been associated with textured devices. BIA-ALCL patients mainly presented with seroma (54.67%). Outcomes included remission (71%), death because of the disease (4.25%), and recurrence (3.96%) with a mean time of duration of follow-up was 2.53 years. Conclusion: BIA-ALCL is rare cancer in some patients with breast implants but is increasing in incidence largely due to consistent and long-term follow-up. It is important for physicians involved in the care of patients with breast implants to be aware of BIA-ALCL and do routine breast exams.

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial.

To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening. Single-site, double-blinded randomised controlled trial. Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program. Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5February - 27 August 2021. Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes). lifestyle health promotion only. Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure). The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40-87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18-97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8-8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm. A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle-aged and older women and evidence that even very light alcohol consumption increases breast cancer risk. ClinicalTrials.gov, NCT04715516 (prospective; 20January 2021).

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Human Connections

Measuring Sarcopenia on MRI among Turkish Female Breast Cancer Patients

Background: Since the presence of sarcopenia in breast cancer patients is associated with increased postoperative complications, it is crucial to know its frequency in the prechemoteraphy period. It has been suggested that there are many factors associated with sarcopenia. This study focused on the frequency of sarcopenia over the pectoralis muscle area obtained in routine breast MRI among Turkish females who were newly diagnosed with breast cancer. Methods: In a prospective study, pectoralis muscle was manually contoured bilaterally, and the cross-sectional area on breast MRI was calculated in newly diagnosed breast cancer patients. The 'Core slices' program was used while calculating SMI. We accepted 7.4 kg/m2 as the threshold value for sarcopenia. Results: Overall, 17 patients (17 %) were sarcopenic. The analysis regarding the detection of sarcopenia in the patient groups &lt; 65 and ≥ 65 years of age was not statistically significant (P&lt;0.156). The relationship between the groups with BMI &lt; 25 and ≥ 25 sarcopenia was statistically significant (P&lt;0.001). Sarcopenia was found significantly more frequently in patients with metastasis (P&lt;0,0001). Conclusion: This study recruited Turkish females who were newly diagnosed breast cancer. It is the first study in the literature to include the same race, gender, and malignancy in which sarcopenia was investigated. It was shown that breast MRI which is radiation-free can be used in the evaluation of sarcopenia in patients with breast cancer. This result is important for being prepared for possible complications before treatment.

The Characteristics of female students in Allied Health Sciences Institution who performed routine breast self-examination (BSE) in Indonesia and Pakistan

Breast cancer is a major public health concern worldwide. The incidence of breast cancer remains high. The mortality rate and prognosis for breast cancer can be improved with early diagnosis and therapy. Self-examination of the breasts is a common method of early diagnosis for women's health issues. This study aimed to explore the characteristics of female students in Allied Health Sciences Institution who performed regular breast self-examination in Indonesia and Pakistan. After institutional ethics review board approval and informed consent, a quantitative survey recruited 430 female students from Allied Health Sciences institutions in Indonesia and Pakistan. This study strictly followed the highest level of ethical standards proposed by Helsinki Declaration (Revised 2013). A closed and open-ended questionnaire was used to collect data on their demographics and characteristics. The questionnaire was distributed online using a google form. Data were analyzed using descriptive analytics . The findings of this study showed that n=395(91.86%) were aged 18-35 years, and 51% were from rural. 49% from urban areas. The majority of participants were single or never married (88%). Most participants were undergraduate students (95.35%). Almost half participants did routine BSE once a month (48.6%). Only 16% were very confident about doing a breast self-examination. Nearly half respondents had never seen a doctor (47%). A positive attitude was seen among all the students. Additionally, most students performed a weekly breast examination. Evidently, more than half of the participants lacked self-assurance when it came to performing a breast assessment. We found a significant percentage who had never been to a doctor for medical attention. Public campaigns to raise awareness and urge female student in allied health science to regularly see their doctors and engage in BSE are so crucial

Knowledge regarding breast self-examination among middle aged women of Uttarakhand

Background: Breast self-examination involves the women herself looking at the mirror and feeling each breast for possible lumps and distortion or swelling. It is seen that more than 10% to 20% breast cancer is detected by breast self-examination. Methods: A descriptive cross-sectional study was conducted to assess knowledge regarding breast self-examination among middle aged women in a selected community setting of Uttarakhand. A total of 62 samples were selected through systematic randomized sampling technique. A structured knowledge questionnaire was administered through interview technique to assess the knowledge. Results: Most of the (49%) women had poor knowledge regarding breast self-examination. There was significant association between age of the samples, education status, family income and previous information regarding breast self-examination with knowledge score. Conclusions: The study concluded that there was inadequate knowledge regarding breast self-examination among middle aged women in Uttarakhand. There is a need for educational programs to create awareness and improve knowledge regarding routine breast self-examination.

Abstract P5-07-04: Evaluation of Treatment Choices at Baseline Among Breast Cancer Patients Based on the Frailty Status of the Patients

Abstract Background: Previous studies have shown that the frailty scores aid in better patient assessment and in advising treatment strategies. The objective of this study is to evaluate the impact of frailty status on the treatment choices among breast cancer patients. Methods: Patient Reported Outcomes Mobile Platform (PROmpt®), an application for remote patient reporting, was used by breast cancer patients for completing surveys between September 2020 and April 2021. Out of 317 breast cancer patients, there were 84 women for whom frailty assessment was done at baseline based on age, Activities of Daily living (ADLS), Instrumental Activities of Daily living (IADLS) and comorbidities. Frailty status was stratified based on frailty score into fit (score=0), intermediate fit (score = 1) and frail (score &amp;gt;=2). Treatment choices at baseline were stratified into targeted and cytotoxic monotherapy, hormone therapy, and systemic combined therapy. Role of chemotherapy treatment as adjuvant or neoadjuvant therapy was also assessed. Descriptive analysis was performed to assess the association of frailty status on the treatment choices at baseline. Results: Around 24% of breast cancer patients were below 50 years of age and 76% patients were at least 50 years of age or older. The majority of the study population was White (84.15%) and non-Hispanic and Latino’s (63.09%). Around 61% of patients had early-stage breast cancer and around 36% of the patients had late-stage breast cancer. The majority of fit patients (70.59%) and intermediate fit patients (81.82%) receive systemic combined therapy at baseline. Out of fit patients, 67.80 % patients received adjuvant or neoadjuvant therapy, while 44.44 % of the intermediate fit patients received adjuvant or neoadjuvant therapy. Discussion/Conclusion: Results demonstrate the feasibility of gathering fitness and frailty data as part of routine breast cancer care. Overall, the treatment choices among fit, intermediate fit and frail groups of patients appear consistent, although adjuvant/neoadjuvant therapy is directionally higher in fit patients. This similarity in regimen choice may be due to sample size, as the number of frail and intermediate fit patients is relatively small when compared to the fit patients. Further exploration related to treatment choices is recommended in a study population with higher levels of patients assessed as frail for comparative evaluation. Frailty Assessment and Treatment Choice Citation Format: Jasmeen Kaur, Aaron Galaznik. Evaluation of Treatment Choices at Baseline Among Breast Cancer Patients Based on the Frailty Status of the Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-04.

High rate of postoperative upstaging of ductal carcinoma in situ when prioritizing ultrasound evaluation of mammography-detected lesions: a single-center retrospective cohort study

BackgroundThe initial diagnosis of ductal carcinoma in situ (DCIS) can be upstaged to invasive cancer after definitive surgery. This study aimed to identify risk factors for DCIS upstaging using routine breast ultrasonography and mammography (MG) and to propose a prediction model.MethodsIn this single-center retrospective study, patients initially diagnosed with DCIS (January 2016–December 2017) were enrolled (final sample size = 272 lesions). Diagnostic modalities included ultrasound-guided core needle biopsy (US-CNB), MG-guided vacuum-assisted breast biopsy, and wire-localized surgical biopsy. Breast ultrasonography was routinely performed for all patients. US-CNB was prioritized for lesions visible on ultrasound. Lesions initially diagnosed as DCIS on biopsy with a final diagnosis of invasive cancer at definitive surgery were defined as “upstaged.”ResultsThe postoperative upstaging rates were 70.5%, 9.7%, and 4.8% in the US-CNB, MG-guided vacuum-assisted breast biopsy, and wire-localized surgical biopsy groups, respectively. US-CNB, ultrasonographic lesion size, and high-grade DCIS were independent predictive factors for postoperative upstaging, which were used to construct a logistic regression model. Receiver operating characteristic analysis showed good internal validation (area under the curve = 0.88).ConclusionsSupplemental screening breast ultrasonography possibly contributes to lesion stratification. The low upstaging rate for ultrasound-invisible DCIS diagnosed by MG-guided procedures suggests that it is unnecessary to perform sentinel lymph node biopsy for lesions invisible on ultrasound. Case-by-case evaluation of DCIS detected by US-CNB can help surgeons determine if repeating biopsy with vacuum-assisted breast biopsy is necessary or if sentinel lymph node biopsy should accompany breast-preserving surgery.Trial registrationThis single-center retrospective cohort study was conducted with the approval of the institutional review board of our hospital (approval number 201610005RIND). As this was a retrospective review of clinical data, it was not registered prospectively.

Unexpected breast cancer mimicking benign lesions on ultrasound-guided vacuum-assisted excision biopsy: A retrospective cross-sectional study over a 20-year period.

This study investigated the occurrence rate of unexpected breast cancer (UEBC) mimicking benign lesions [Breast Imaging Reporting and Data System (BI-RADS) category 3 or 4a] using ultrasound-guided vacuum-assisted excision biopsy (US-VAEB), and explored the factors responsible for late diagnosis of T2 stage UEBC. We collected clinicopathologic data and preoperative US imaging features within 3 months before US-VAEB of patients who were diagnosed with UEBC from January 2002 to September 2022. The UEBC were divided into T1 and T2 stageUEBC. The US imaging features as well as clinical and pathological information of T1 and T2 stage UEBC were compared to explore the factors responsible for late diagnosis of T2 stage UEBC. Breast cancer was diagnosed in 91 of 19306 patients who underwent US-VAEB. We excluded eight patients with breast cancer assigned to BI-RADS 4b category by preoperative US, and two for whom US imaging records were unavailable. Finally, we enrolled 81 patients. The occurrence rate of UEBC after US-VAEB was 0.42%(81/19296). Of the 81 cases of UEBC, 22 were at T2 stage. The ratio of T2 stage UEBC was 27.2%. The differences in risk factor of breast cancer and routine breast US screening between T1 and T2 stage UEBC were significant[96.6% (57/59) vs 81.8% (18/22), 44.1% (26/59) vs 13.6% (3/22), respectively, P<0.05). UEBC was rarely detected by US-VAEB. Most cases of T2 stage UEBC were diagnosed late because of the absence of routine US screening and risk factors for breast cancer. Stricter clinical management regulations for breast lesions and performing regular US screening may be helpful to reduce T2 stage UEBC.

HUBUNGAN TINGKAT PENDIDIKAN TERHADAP PENGGUNAAN LAKTAGOGUM

Lactagogum is a drug that can increase or facilitate the production of milk. Synthetic lactagogums are not widely known and relatively expensive. This causes the need for alternative laktagogum drugs. Efforts to increase breast milk production can be done by carrying out early and routine breast care, improving breastfeeding techniques, or by consuming foods that can affect breast milk production. One of the reasons for the failure of exclusive breastfeeding is the perception of insufficient breast milk, which can be caused by physiological and psychological factors. Education is a very important factor in this life, which is why education is a very important business of all time. Increasing breast milk production can be done in various ways, one of which is increasing the intake of lactagogum. Lactagogum is a drug that can increase or facilitate the production of milk. The sample in this study were breastfeeding mothers who had babies ranging in age from 3 to 6 months spread throughout Indonesia. This study was conducted by distributing a questionnaire to assess education and the use of Lactagogue as a food to increase breast milk production. Dissemination of questionnaires can be done manually or via Google Drive links which are distributed to several regions in Indonesia. The purpose of this study was to determine the relationship between education and the use of laktagogums. The research results are there is a relationship between education and the use of Lactagogum. It is hoped that mothers who are in the process of breastfeeding can make efforts to increase milk production, one of which is by consuming Lactagogum.