Unilateral Breast Cancer Research Articles

Rate of Positive Family History in Iraqi Patients with Breast Cancer

Objective: The objective of this study was to understand the effect of positive family history as a risk factor between breast cancer patients depending on clinical and patiological features. Methods: This is a clinical survey study contained 507 Iraqi breast cancer patients from July 2022 to May 2023. The assessment of patients performed using histopathological examination of tissue samples from breast biopsy or surgical excision. Family history interviews recorded. Participants were recruited from various healthcare facilities. The questionnaire covered age, residency, family history, metastasis, and the specific site of breast cancer. A signed informed consent process ensured patient confidentiality. Results: This study examined the characteristics of breast cancer patients, including sex, age group, geographic distribution, and laterality. The sample consisted of 507 confirmed cases, 99.8% of which were females. Most patients were diagnosed on the left side, with 253 (49.9%) and 227 (44.77%) diagnosed on the right side. Unilateral breast cancer was predominant, with 53% of patients having bilateral breast cancer. Among the 507 patients, 31.76% had a positive family history of breast cancer, whereas 68% had a negative family history. Most patients had a first-degree relative to positive cancer, with 58 (36.02%) having a first-degree relative to positive cancer. The majority of cases did not show metastatic features, with the most metastatic cases being spread to the lymph nodes (6.7%). Conclusion: The majority of breast cancer cases were left-sided, with 31.7% having a positive family history and 68% having a negative one. Most cases had a second-degree relative to a positive cancer history, with most cases spreading to the lymph nodes.

Bilateral Breast Cancer.

This article is a review of the characteristics of bilateral breast cancer (BBC). Synchronous bilateral breast cancer (SBBC) and metachronous bilateral breast cancer (MBBC) account for 2.9-3.9% and 4.1-4.6% of all new breast cancer cases, respectively. The risk factors for SBBC include older patient age and lobular histology. On the other hand, younger age, lobular histology, and positive family history (or genetic factors) are the risk factors for MBBC. Contralateral prophylactic mastectomy in patients with mutations in the BRCA1/2 genes has been reported to increase survival rates. The prognosis of patients with SBBC is worse than the prognosis of patients with unilateral breast cancer (UBC). The prognosis of patients with MBBC compared to patients with UBC remains undetermined because the ages of patients and the intervals between the occurrence of two primary breast cancers appear to have a major impact on survival outcomes. The differences between SBBC and MBBC need clarification to increase our understanding of BBCs.

Decision Aid Interventions for Contralateral Prophylactic Mastectomy in Women of Average Risk: An Integrative Review.

The use of a decision aid (DA) for women facing the decision of contralateral prophylactic mastectomy (CPM) is limited. This article aimed to examine the literature for studies testing a DA for patients diagnosed with unilateral breast cancer considering CPM. A comprehensive search was conducted in CINAHL®, Ovid MEDLINE®, PubMed®, Web of Science, PsycINFO®, and Cochrane Library databases from 2017 to 2024. The studies were assessed for relevance in testing a patient DA for CPM in patients diagnosed with unilateral breast cancer. Studies were evaluated using the Mixed Methods Appraisal Tool, version 2018. Five studies met inclusion criteria. These studies included one pre-/postassessment cohort pilot study, one randomized controlled trial, two mixed-methods studies, and one qualitative study. Studies included 370 patients and 50 clinicians in the breast oncology setting. Oncology nurses can play a key role in advocating for shared decision-making for patients considering CPM. Additional testing of a DA for patients diagnosed with unilateral breast cancer considering CPM should be considered.

Assessing germline TP53 mutations in cancer patients: insights into Li-Fraumeni syndrome and genetic testing guidelines

BackgroundGermline TP53 gene variants are intricately linked to Li-Fraumeni syndrome, a rare and aggressive hereditary cancer syndrome. This study investigated the frequency and spectrum of TP53 pathogenic variants associated with Li-Fraumeni syndrome in a large cohort of mainly breast cancer patients from Russia.MethodsThe study analyzed 3,455 genomic DNA samples from cancer patients using next-generation sequencing panels and whole-genome sequencing. Clinically significant TP53 variants were identified and validated using Sanger sequencing. The clinical and family history characteristics of patients with TP53 variants were analyzed.ResultsThe analysis identified 13 (0.4%) individuals with clinically significant germline TP53 variants, all of whom were females with either unilateral breast cancer or breast cancer as part of multiple primary malignant neoplasms. The average age of breast cancer manifestation was 39.9 years, with a median of 36 years. Only 38.5% of the TP53 mutation carriers met the modified Chompret criteria for TP53 testing.ConclusionsThe findings underscore the necessity of thorough phenotype and family history analysis in genetic counseling to effectively diagnose LFS, and emphasize the importance of identifying TP53 variant carriers for developing treatment strategies, prognosis, and monitoring, as well as for identifying high-risk family members. The study also highlights that the current guidelines fail to identify over half of the TP53 mutation carriers, suggesting the need for a more comprehensive approach to genetic testing in suspected hereditary cancer cases.

Application of a Commercial Artificial Intelligence Software in Unilateral Mammography: Simulating Total Mastectomy Scenarios.

This study was to evaluate the performance of commercially available artificial intelligence (AI) software in unilateral mammograms simulating postmastectomy surveillance compared with AI software used in bilateral mammograms from the same women serving as controls. A retrospective database search identified consecutive women who underwent breast cancer surgery between January 2021 and December 2021. AI software was applied to the mammogram immediately preceding breast cancer diagnosis in two modes: bilateral (the standard bilateral mammography dataset) and unilateral analyses (each breast's craniocaudal and mediolateral oblique views), and their outputs were reviewed. The sensitivity, specificity, and number of marks per breast were compared between the bilateral and unilateral analyses with -5% non-inferiority margin for the difference in sensitivity and specificity between the two modes. A total of 694 women (mean age, 55.2 ± 10.8years) with unilateral or bilateral breast cancer contributed mammograms for analysis; each breast was then separately evaluated in the unilateral postmastectomy simulation (n = 1388), of which 730 had breast cancer (52.6%) (mean invasive size = 1.5cm) and compared with bilateral mammography analysis. The sensitivity of unilateral analysis was not inferior to that of bilateral analysis (78.6% vs. 76.7%), with a difference of 1.9%. The specificity of unilateral analysis was inferior to that in the bilateral analysis (81.5% vs. 91.9%), with a difference of -10.5% being lower than the non-inferiority margin. The average number of AI marks per breast was 0.94 (unilateral [1298/1388] and bilateral analyses [1306/1388], respectively). AI software performance in simulated unilateral mammography analysis demonstrated non-inferior sensitivity and inferior specificity compared to bilateral mammography.

Comparison of survival between unilateral and bilateral breast cancers using propensity score matching: a retrospective single-center analysis.

The characteristics of patients with bilateral and unilateral breast cancer at the time of diagnosis or during follow-up have been compared, focusing on the differences in disease-free survival and overall survival between these groups. A total of 1,947 patients diagnosed with invasive carcinoma were included in the study. 1876 ​​(96.4%) of our patients had unilateral and 71 (3.6%) had bilateral breast cancer. Among the bilateral breast cancer patients n = 47 were metachronous, while n = 24 were synchronous. SBBC, which had the lowest OS duration, showed a statistically significant difference compared to MBCC, similar to that observed in unilateral breast cancer (p = 0.027). The fact that SBBC has the lowest survival rate despite more aggressive treatments should be considered a poor prognostic factor for survival on its own.

The Comparative Frequency of Breast Cancer-Related Lymphedema Determined by Perometer and Circumferential Measurements: Relationship with Functional Status and Quality of Life.

Background: The aim of this study was to comparatively determine the frequency of breast cancer-related lymphedema (BCRL) by using prospective monitoring with perometer and circumferential measurements in a group of patients who underwent breast cancer surgery. We also aimed to evaluate the relationship between volume changes and functional status and quality of life (QoL) in patients with breast cancer-related subclinical lymphedema. Materials and Methods: Patients who had unilateral breast cancer surgery for breast were assessed with circumferential and perometer, respectively, for volumes at baseline, 3rd-month, 6th-month, 9th-month, and 12th-month by the same physiotherapist. Every patient was informed about lymphedema symptoms and prevention. The demographic and clinical properties were recorded. Functional status and QoL were evaluated by Q-DASH and the Lymphedema Quality of Life Questionnaire-Arm questionnaires. Results: A total of 101 female patients with a mean age of 49.02 + 10.59 years completed the 12-month follow-up. Most of the patients were overweight, had an axillary dissection in addition to breast surgery, and received radiotherapy. The frequency of subclinical and clinical BCRL at the end of 12 months was determined by 34.7% and 23.8% with circumferential measures and perometer, respectively. QoL and functional scores did not differ between patients with and without subclinical lymphedema. Conclusion: After the first 12 months after surgery, the frequency of BCRL assessed by circumferential measurements was higher than the frequency assessed by perometer. Periodic monitoring of women with breast cancer for the presence of BCRL, preferably by the same person together with patient education is suggested in order to allow early detection and timely intervention for BCRL.

From breast cancer diagnosis to survivorship: analyzing perioperative biopsychosocial phenotypes and their relationship to pain on long term.

From breast cancer diagnosis to survivorship: analyzing perioperative biopsychosocial phenotypes and their relationship to pain on long term.

Breast Cancer Susceptibility Gene Sequence Variations and Development of Contralateral Breast Cancer

Heterogeneity in development of estrogen receptor (ER)-specific first primary breast cancer exists due to deleterious germline variants in moderate- to high-penetrance breast cancer susceptibility genes, but it is unknown if these associations occur in ER-specific CBC. To determine the association of deleterious germline variants in breast cancer susceptibility genes with ER-specific CBC development and whether ER status of the first primary breast cancer modifies these associations. This case-control study included CBC cases and matched unilateral breast cancer controls from The Women's Environment, Cancer, and Radiation Epidemiology (WECARE) Study, a population-based case-control study. Eligible women were diagnosed between 1985 and 2000 with data and biospecimens collected from 2001 to 2004. Eligible participants were women younger than 55 years at first invasive breast cancer diagnosis. Participants were matched on age, diagnosis year, cancer registry region, and race and ethnicity, and countermatched on radiation treatment. For cases, CBC occurred 1 year or more following first breast cancer diagnosis. Analyses were performed from May to October 2024. CHEK2 1100delC and deleterious variants in ATM, BRCA1, and BRCA2. Development of CBC, measured as a rate ratio (RR). A total of 1290 women were included in analysis (median [IQR] age at first diagnosis, 47 [42-51] years). The ER-positive CBC rate for women with deleterious ATM variants was 4 times higher than for women without deleterious ATM variants (RR, 4.84; 95% CI, 1.11-21.08; P = .04); no women with ER-negative CBC carried deleterious ATM variants. The ER-positive CBC rates for women with deleterious variants in BRCA2 or CHEK2 1100delC were 5 to 6 times higher than for women without deleterious variants in BRCA2 or CHEK2 1100delC, respectively (BRCA2: RR, 5.88; 95% CI, 2.61-13.26, P < .001; CHEK2 1100delC: RR, 6.06; 95% CI, 1.26-29.04; P = .02). The ER-negative CBC rate for women with deleterious BRCA1 variants was 26 times higher than for women without deleterious BRCA1 variants (RR, 26.16; 95% CI, 8.01-85.44; P < .001). First primary breast cancer ER status did not modify associations between deleterious variants and ER-specific CBC development. In this case-control study of CBC, deleterious variants in breast cancer susceptibility genes were differentially associated with ER-specific CBC development. Germline variation profile may inform estimates of outcomes for ER-specific CBC subtypes.

Effects of mild cognitive impairment and sleep disorders on the minimum alveolar concentration value of sevoflurane

ObjectivesTo explore the effect of mild cognitive impairment (MCI) and MCI with sleep disorders on the potency of sevoflurane anesthesia in the elderly.DesignProspective study methods. Dixon up-and-down methods.SettingComprehensive public tertiary hospital, Cangzhou City, Hebei Province, China.Participants70 elderly patients scheduled for elective unilateral breast cancer surgery and finally analyzed 58 patients, including 30 patients with MCI (group M) and 28 patients with MCI with sleep disorders (group MS).Outcome measuresThe required minimum alveolar concentration (MAC) value of sevoflurane in the two groups was determined using the Dixon up-and-down method. The MAC value of sevoflurane and its 95% confidence interval (CI) were calculated using the logistic regression method. Serum melanin-concentrating hormone concentrations were determined by Elisa kits.ResultsThe MAC value of sevoflurane in group M was 1.43 (95% CI 1.05–1.61%), and the MAC value of sevoflurane in group MS was 1.93 (95% CI 1.78–2.08%), There were notable differences between the two groups (P < 0.0001). The level of melanin-concentrating hormone (MCH) in the MS group was significantly lower than that in the M group (21.52 ± 3.82 vs. 37.17 ± 3.66 pg/ml, P < 0.0001). There was a significant negative correlation between MCH levels and the probability of body movement during skin incision (OR = 0.844, 95% CI: 0.715–0.996, P = 0.045).ConclusionsPatients with MCI with sleep disorders required higher doses of sevoflurane than those with MCI alone. Changes in anesthetic requirements may be related to changes in MCH levels.

Shoulder Pain, Kinesiophobia, Emotional State and Muscle Strength in Breast Cancer Surgery Patients: A Cross-Sectional Study

Breast cancer is the most common type of cancer in women. The life expectancy of patients is increasing with advances in treatment. However, lymphovascular, musculoskeletal, and psychogenic complications are reported to be expected in the follow-up period after breast cancer surgery. Kinesiophobia is the behavior of avoiding movement for fear of increased pain. Research on the frequency and interrelationships of kinesiophobia and other complications in the follow-up period is limited. Aim: We aim to evaluate shoulder pain, kinesiophobia, emotional state and muscle strength in female patients who have undergone breast cancer surgery and are in the follow-up period and to examine the relationship between these factors. Materials and Methods: A total of 50 female patients who underwent unilateral breast cancer surgery and were using aromatase inhibitors were included in this cross-sectional descriptive study. Demographic data, details of the surgical procedure and medical treatment information were recorded from the patient files. Hand grip muscle strength was measured by hand dynamometer, the Beck Depression Scale assessed emotional state, and the Tampa Kinesiophobia Scale assessed fear of movement. A Beck Depression Scale score of 10 and above and a Tampa Kinesiophobia Scale of 37 and above were considered significant. Results: The mean age of 50 female patients was 59.31 ± 11.19 years. Sixty percent of the patients had undergone surgery on the right breast and 40% on the left breast. Shoulder pain (n:31) was present in 62%. There were statistically significant correlations between pain and the Tampa kinesiophobia scale and the Beck depression scale (p:0.042, p:0.038). Kinesiophobia was present in 74% of the patients, and 64% had moderate to severe depression. The mean of the Tampa Kinesiophobia scale was 42.86±8.81, and the mean of the Beck depression scale was 15.19±10.98. When the relationship between kinesiophobia and depression was evaluated, a statistically positive significant relationship was found between them (p=0.005, r=0.410). The hand grip strength was 22.16±5.00 kg on the right and 18.22±5.10 kg on the left in patients who underwent left-sided breast cancer surgery. A significant difference was found in the left- and right-hand grip strength of those who underwent left-sided surgery for breast cancer (p

Factors Associating with Bone-Only Metastasis in Chinese Breast Cancer Patients in the Absence of Anti-Human Epidermal Growth Factor Receptor 2-Targeted Therapy

Introduction: Bone-only metastasis (BOM) is a distinct clinical phenomenon in which cancer cells disseminate exclusively to the bones, without involvement of other distant organs. We investigated the factors associated with the BOM state versus other states of metastasis in breast cancer patients with bone metastasis (BM) at their first relapse. The results could help tailor the screening and preventive therapy strategies for BM in breast cancer. Methods: The study included 231 women who underwent mastectomy for primary unilateral non-metastatic breast cancer in 1997 or later and were subsequently diagnosed with BM at first relapse in 2008–2018 at the Fourth Hospital of Hebei Medical University in China. Factors such as patient age at primary breast cancer diagnosis, tumor clinicopathological characteristics, chemotherapy, radiotherapy, endocrine therapy (ET), time to progression (TTP), and others were analyzed. ET compliance was categorized from medication adherence. Multivariate logistic regressions were used to estimate the odds ratio (OR) and p value. Results: Only three (3.8%, 3/79) human epidermal growth factor receptor 2-positive (HER2+) breast cancer patients (n = 79) used anti-HER2-targeted agents in the adjuvant setting. After excluding them, the remaining 228 patients were analyzed. They had an average age of 47.3 years and median TTP 29.4 months at their first relapse. Overall, patients with BOM accounted for 26.8%. The BOM state was similarly presented in the hormone receptor-positive (HR+) patients (n = 182) and in the HR-negative (HR−) patients (n = 45) (28.6% vs. 17.8%, p = 0.142). However, it was significantly lower in the HER2+ patients (n = 76) than in the HER2-negative (HER2−) patients (n = 129) (13.2% vs. 31.8%, p = 0.003). Multivariate analyses showed that the BOM state was not associated with the HR+ (vs. HR−, OR 1.253, p = 0.723) and full ET compliance (vs. no/partial, OR 1.346, p = 0.545) status. Nonetheless, the BOM state was significantly associated with a lower chance in the HER2+ patients overall (OR 0.240, p = 0.008) and in the HR+ patients (OR 0.145, p = 0.005) but not in the HR− patients (OR 1.012, p = 0.991) than one in the HER2− patients. A lower chance of BOM state was also associated with TTP ≥24 months (p < 0.05). There were no other associated factors identified. Conclusion: Differently from HR status and other clinicopathological factors, the HER2+ status is associated with a lower chance of the BOM state in breast cancer patients with first BM. Such association appears to be reflected in HR+ patients only.

Clinical characteristics and prognostic analysis of metachronous bilateral breast carcinoma: a retrospective study based on propensity score matching.

To investigate clinical characteristics, treatment, outcomes, and prognostic risk factors of metachronous bilateral breast carcinoma (MBBC) and provide a theoretical basis for clinical management of MBBC. This was a retrospective study. From January 1, 2010 to March 31, 2022, a total of 23,010 patients with breast cancer underwent surgical treatment at the Breast Center of the Fourth Hospital of Hebei Medical University, including 386 patients with MBBC. Propensity score matching (PSM) was performed on MBBC patients and unilateral breast cancer (UBC) patients in a 1:1 ratio, and 210 UBC patients and 210 MBBC patients were finally matched. Clinical medical records of all patients were collected, including age of onset, family history of breast cancer, tumor size, lymph node status, TNM stage, mode of surgery, menstruation, pathological type, immunohistochemical (IHC) typing, treatment, disease-free survival (DFS), and overall survival (OS). The result showed that age of onset of the second primary cancer (SPC) was significantly older than that of the first primary cancer (FPC) (P = 0.024). Baseline data from MPPC patients showed that the tumor size of FPC was significantly larger than that of SPC (P = 0.043), and the proportion of PR ( +) in FPC is significantly higher than that in SPC (P = 0.045). Among MBBC patients with FPC for estrogen receptor (ER) or progesterone receptor (PR) ( +) and Her-2 (-), clinical characteristics and treatment results showed that the proportion of PR ( +) in the drug-resistant group was significantly lower than that in the non-drug-resistant group. The 2-year OS rate of SPC in the drug-resistant group was significantly shorter than those of the non-drug-resistant group (78.9% vs 100%, P < 0.05). The result of PSM-based comparison between MBBC patients and UBC patients showed significantly lower proportion of MBBC patients with SPC received chemotherapy compared to UBC patients (P = 0.026), and there was no significant difference in OS and DFS between SPC course of MBBC patients and UBC patients (P > 0.05). The univariate analysis showed that high TNM stage was a risk factor for death and disease progression in MBBC patients, with the risk of death in stage III MBBC patients being about 5 times higher than that in stage I MBBC patients (HR = 4.97, 95%CI = 1.42-17.31, P = 0.012), and the risk of disease recurrence being about 3.5 times higher than that in stage I MBBC patients (HR = 3.55, 95%CI = 1.07-11.81, P = 0.039). In summary, this study presented clinical characteristics, treatment options, and outcomes of MBBC patients and patients with MBBC who were resistant to endocrine therapy have a worse SPC survival prognosis. The course of SPC in MBBC patients was similar to that of UBC in terms of prognosis and survival, which suggested that SPC can be treated according to UBC treatment regimen. High TNM stage was a prognostic risk factor for SPC patients.

Emotional Reactivity and Regulation Relate to Surgical Treatment Decision Making Among Newly Diagnosed Women With Breast Cancer.

Despite bilateral mastectomy (BLM) for early-stage breast cancer (BC) showing no survival benefit and increased risk compared to breast conserving surgery, some patients still choose this treatment. This study examined whether emotion reactivity and regulation influence treatment decision making among newly diagnosed women with breast cancer. Cross-sectional survey data were analyzed as part of a larger study. Measures included the Contralateral Prophylactic Mastectomy (CPM) survey, PROMIS Anxiety scale, and Emotion Regulation Questionnaire (ERQ) Cognitive Reappraisal and Emotional Suppression subscales. Primary analysis included a logistic regression model predicting treatment choice (BLM vs. non-BLM). Participants (N = 137) with unilateral BC (Stages 0-III) were divided between BLM (n = 66) versus breast conserving surgery (i.e., non-BLM, n = 71) treatment groups. Compared to the non-BLM group, the BLM group was younger, more likely to be partnered, and had a higher household income. Women with high levels of BC-specific worry were 3.6 times more likely to choose BLM compared to women with low levels of worry (OR = 3.09, 95% CI: 1.07-0.8.93). Those who used cognitive reappraisal were 10% less likely to choose BLM compared to women who did not use cognitive reappraisal (OR = 0.90, 95% CI: 0.82-0.99). There were no group differences in levels of generalized anxiety (OR = 0.93, 95% CI: 0.87-0.99) or emotional suppression (OR = 1.02, 95% CI: 0.90-1.16). Findings suggest the choice of BLM may be due, in part, to negative emotional experiences after a BC diagnosis and lesser use of reappraisal to reframe cancer-related fears. These may be important targets of intervention to support women making BC treatment decisions.

Surgical resection and complex reconstruction of thoracic wall soft-tissue sarcoma following radio for unilateral breast cancer: a case report

Surgical resection and complex reconstruction of thoracic wall soft-tissue sarcoma following radio for unilateral breast cancer: a case report

Secondary Risk-Reducing Strategies for Contralateral Breast Cancer in BRCA1/2 Variant Carriers: A Systematic Review and Meta-analysis.

Breast cancer poses significant challenges, especially the increased risk of contralateral breast cancer (CBC) in BRCA1/2 variant carriers. This study systematically reviews and analyzes the effectiveness of secondary risk-reducing strategies for CBC in BRCA1/2 carriers. A systematic review and meta-analysis were conducted from January 2000 to December 2023, including RCTs, cohort, or case-control studies involving BRCA carriers with unilateral breast cancer. Random-effects models were used for odds ratios (ORs) on CBC incidence and hazard ratios (HRs) for overall survival (OS), with bias assessed via the Newcastle-Ottawa Scale. A total of 23,840 participants from 26 studies were included. Secondary risk-reducing interventions reduced CBC incidence by 38% [OR 0.62, 95% confidence interval (CI) 0.57-0.68] and improved OS by 45% (HR 0.55, 95% CI 0.46-0.67). Subgroup analyses showed differences by BRCA type, menopausal status, and treatment duration. For BRCA1 carriers, chemotherapy was most effective, while, for BRCA2, it was endocrine therapy. Postmenopausal interventions reduced CBC by 47% (OR 0.53, 95% CI 0.40-0.71), while premenopausal carriers saw a 34% reduction (OR 0.66, 95% CI 0.53-0.82). Tamoxifen's effect diminished over time. Secondary prophylaxis reduces CBC and improves OS in BRCA1/2 carriers, with variations by genetic and physiological factors. These findings underscore the need for personalized strategies, considering menopausal status and treatment duration.

Association between mammographic breast density and outcome in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy.

To analyze the relationship between mammographic breast density and tumor response and outcome at follow-up, in terms of overall survival (OS) and disease-free survival (DFS), in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy (NACT). A total of 228 women (mean age, 47.6years ± 10 [SD]; range: 24-74years) with invasive breast cancer who underwent NACT were included in this observational retrospective study. Clinical, radiological and histopatological data were retrieved. Categorization of breast density was performed by two radiologists in consensus on mammography acquired at the time of diagnosis according to BI-RADS categories. Association between density categories and tumor response was analyzed in the overall population and in subgroups defined by menopausal status, tumor phenotype and stage at diagnosis. Kaplan-Meier (KM) curves were used to estimate the OS and DFS probabilities. Subgroup analyses based on menopausal status and tumor phenotype were performed. A total of 30 patients (13.2%) achieved pathological complete response (pCR). No association between density categories and pCR was found (P = 0.973), even at subgroups analysis. The median follow-up time was 92months. Patients with dense breast showed the longest DFS (P = 0.0094), results confirmed in premenopausal patients (P = 0.0024) and in triple negative breast cancers (P = 0.0292). Density category did not show a statistically significant association with OS. Breast cancer patients receiving NACT with extremely dense breasts showed better DFS. No evidence of breast density as a predictive marker for complete pathological response or as a prognostic factor in terms of OS was found.

Comparison between ultrasound-guided intertransverse process and erector spinae plane blocks for breast cancer surgery: A randomised controlled trial.

Clinical comparisons between intertransverse process block (ITPB) and erector spinae plane block (ESPB) are lacking. This study aimed to compare their blocking profile and clinical efficacy in breast cancer surgery. Randomised, blinded, active-controlled superiority trial. A tertiary hospital in China from 20 February to 31 July 2023. Sixty-eight females undergoing unilateral breast cancer surgery. Patients were randomised to receive either ITPB performed at T2-6 (5 ml of 0.5% ropivacaine per level) or ESPB at T4 (25 ml of 0.5% ropivacaine). General anaesthesia and postoperative analgesia were standardised. The primary outcome was the number of blocked dermatomes at anterior T2-7, assessed 45 min after block completion, with a predefined superiority margin of 1.5 dermatomes. The important secondary outcome was the worst resting pain scores (11-point numerical rating scale) within 30 min in the recovery room, which was tested following a gatekeeping procedure. Other secondary outcomes included resting pain scores at various time points, use of rescue analgesics, opioid consumption, patient satisfaction, recovery quality score, and adverse effects within 24 h postoperatively. The ITPB group showed a median [q1, q3] of 5 [4, 6] blocked dermatomes at anterior T2-7, whereas the ESPB group had 1 [0, 4], with a median difference of 4 (95% confidence interval (CI), 3 to 4); the lower 95% CI limit exceeded the predefined superiority margin of 1.5 (superiority P < 0.001). Worst resting pain scores within 30 min in the recovery room in the ITPB group were 1 [0, 2] vs. 3 [1, 4] in the ESPB group, with a median difference of -1 (95% CI, -2 to 0; P = 0.004). Patients in the ITPB group required fewer rescue analgesics within 30 min in the recovery room than did those in the ESPB group. No other clinically relevant results were observed in the secondary outcomes. Although ITPB demonstrated more consistent anterior dermatomal spread and improved immediate postoperative analgesia compared to ESPB, no additional benefits were identified for breast cancer surgery. Future studies may investigate the potential of ITPB for surgical anaesthesia. www.chictr.org.cn (ChiCTR2300068454).

Effectiveness of U/S Guided Erector Spinea Plane Block for Post-Operative Pain Control in Breast Surgeries

Abstract Background Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related mortality among females in more than 100 countries. The traditional therapeutic approaches for breast cancer include surgery, radiation therapy, chemotherapy, Immunotherapy and endocrine therapy, surgical resection is still considered to be the primary and most effective therapy. Objective To evaluate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block in breast surgery postoperatively Methods This was randomized controlled clinical trial that was held in major operating theaters in el demerdash hospital, Ain Shams University, Cairo, Egypt for 6 months on females undergoing breast surgeries aged between 21 - 45 years. Results Our results reported that there was highly statistically significant difference found between Group I and Group II regarding Postoperative pain scores Immediately, Postoperative pain scores After 5min, Postoperative pain scores After 10 min, and there was no highly statistically significant difference found between Group I and Group II regarding Postoperative pain scores After 15min, Postoperative pain scores After 20min, Postoperative pain scores After 25min and Postoperative pain scores After 30min. There was highly statistically significant difference found between Group I and Group II regarding Total morphine consumption (mg) and Number of patients requiring morphine. Also, there was highly statistically significant difference found between Group I and Group II regarding Mean arterial blood pressure (mmHg) Immediately, and there was no highly statistically significant difference found between Group I and Group II regarding Mean arterial blood pressure (mmHg) After 5min, Mean arterial blood pressure (mmHg) After 10 min, Mean arterial blood pressure (mmHg) After 15 min, Mean arterial blood pressure (mmHg) After 20 min, Mean arterial blood pressure (mmHg) After 25 min and Mean arterial blood pressure (mmHg) After 30 min. Regarding Patients satisfaction, there was statistically significant difference found between Group I and Group II Conclusion Ultrasound-guided ESP block with general an aesthesia offers superior post-operativeanalgesia compared to general an aesthesia alone in patients undergoing unilateral non-reconstructive breast cancer surgeries and is associated with better patient satisfaction scores at discharge. There was no significant difference in intraoperative morphine consumption. The ultrasound-guided ESP block appears to be an effective block for postoperative analgesia in breast cancer surgery.

A Cost–Utility Analysis of the Use of −125 mm Hg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery

Background: Closed-incision negative pressure therapy (ciNPT) decreases the rate of wound complications in oncoplastic breast surgery (OBS) but at a fiscal cost. Our aim was to examine the cost-utility of ciNPT in OBS. Methods: A literature review was performed to obtain the probabilities and outcomes for the treatment of unilateral breast cancer with OBS with ciNPT versus without. Reported utility scores in the literature were used to calculate quality-adjusted life years (QALYs) for each health state. A decision analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost–utility ratio was calculated. Sensitivity analyses were performed. Results: OBS with ciNPT is associated with a higher clinical effectiveness (QALY) of 33.43 compared to without (33.42), and relative cost increase of $667.89. The resulting incremental cost-utility ratio of $57432.93/QALY favored ciNPT. In one-way sensitivity analysis, ciNPT was the more cost-effective strategy if the cost of ciNPT was less than $1347.02 or if the probability of wound dehiscence without was greater than 8.2%. Monte Carlo analysis showed a confidence of 75.39% that surgery with ciNPT is more cost effective. Conclusion: Despite the added cost, surgery with ciNPT is cost-effective. This finding is a direct result of decreased overall wound complications with ciNPT.