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Breast Cancer Research and Treatment Apr 2024This review summarizes the available data on the effectiveness of indocyanine green fluorescence imaging (ICG-FI) for real-time detection of breast cancer (BC) tumors... (Review)
Review
Fluorescence imaging for real-time detection of breast cancer tumors using IV injection of indocyanine green with non-conventional imaging: a systematic review of preclinical and clinical studies of perioperative imaging technologies.
BACKGROUND
This review summarizes the available data on the effectiveness of indocyanine green fluorescence imaging (ICG-FI) for real-time detection of breast cancer (BC) tumors with perioperative imaging technologies.
METHODS
PubMed and Scopus databases were exhaustively searched for publications on the use of the real-time ICG-FI evaluation of BC tumors with non-conventional breast imaging technologies.
RESULTS
Twenty-three studies were included in this review. ICG-FI has been used for BC tumor identification in 12 orthotopic animal tumor experiences, 4 studies on animal assessment, and for 7 human clinical applications. The BC tumor-to-background ratio (TBR) was 1.1-8.5 in orthotopic tumor models and 1.4-3.9 in animal experiences. The detection of primary human BC tumors varied from 40% to 100%. The mean TBR reported for human BC varied from 2.1 to 3.7. In two studies evaluating BC surgical margins, good sensitivity (93.3% and 100%) and specificity (60% and 96%) have been reported, with a negative predictive value of ICG-FI to predict margin involvement intraoperatively of 100% in one study.
CONCLUSIONS
The use of ICG-FI as a guiding tool for the real-time identification of BC tumors and for the assessment of tumor boundaries is promising. There is great variability between the studies with regard to timing and dose. Further evidence is needed to assess whether ICG-guided BC surgery may be implemented as a standard of care.
Topics: Humans; Animals; Female; Indocyanine Green; Breast Neoplasms; Predictive Value of Tests; Mastectomy; Mammary Neoplasms, Animal; Optical Imaging
PubMed: 38182824
DOI: 10.1007/s10549-023-07199-1 -
International Wound Journal Apr 2024This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation... (Meta-Analysis)
Meta-Analysis
Comparative efficacy of silver alginate dressings versus standard gauze in enhancing wound healing post-mastectomy for triple-negative breast cancer: A systematic review and meta-analysis.
This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation post-mastectomy in patients with triple-negative breast cancer. From an initial pool of 1245 articles, five studies met the inclusion criteria. The analysis revealed that SAD significantly improve early wound healing 1 week post-mastectomy, as indicated by lower Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scales (I = 85%; Random: SMD: -7.08, 95% CI: -8.26 to -5.98, p < 0.01), compared to SG. Additionally, long-term scar outcomes measured by the Manchester Scar Scale (MSS) 5 months post-mastectomy showed a notable reduction in scar formation (I = 95%; Random: SMD: -12.97, 95% CI: -16.20 to -9.75, p < 0.01)) in the silver alginate group. The findings support the use of SAD in post-mastectomy care for triple-negative breast cancer patients but highlight the need for further research on long-term safety and cost-effectiveness.
Topics: Humans; Alginates; Bandages; Burns; Cicatrix; Mastectomy; Silver; Triple Negative Breast Neoplasms; Wound Healing
PubMed: 38155417
DOI: 10.1111/iwj.14558 -
Frontiers in Oncology 2023The safety of mastectomy (MT) with immediate reconstruction (IR) in breast cancer patients who have completed neoadjuvant chemotherapy (NAC) is not apparent. This...
BACKGROUND
The safety of mastectomy (MT) with immediate reconstruction (IR) in breast cancer patients who have completed neoadjuvant chemotherapy (NAC) is not apparent. This meta-analysis aims to systematically evaluate the differences in surgical complications and postoperative survival rates between MT with IR (MT+IR) and MT alone in post-NAC breast cancer patients.
METHODS
The PubMed, Embase, Cochrane Library, WanFang Data, and CNKI databases were systematically searched, and cohort studies of post-NAC breast cancer patients with MT+IR or MT surgery were collected from databases inception to May 25, 2023. Two researchers independently executed literature screening, data extraction, and bias risk assessment, and meta-analysis was performed using Revman 5.3 software.
RESULTS
A total of 12 studies involving 7378 cases who have accepted NAC were collected for this study. The results showed that compared with the MT group, the relative risk of surgical complications in the MT+IR group was increased by 44%, with no statistical significant [RR=1.44, 95% CI (0.99, 2.09), P=0.06]. While among study subgroups with a median follow-up of less than one year, more surgical complications occurred in the MT+IR group by 23% [RR=1.23, 95% CI (1.00, 1.52), P=0.05]. There was no significant differences in overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival between the two groups.
CONCLUSIONS
Compared with the MT, MT+IR does not affect the postoperative survival rate in post-NAC breast cancer patients, accompanied by a mild increase in short-term surgical complications, but no significant difference in long-term complications.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero, identifier CRD42023421150.
PubMed: 38074648
DOI: 10.3389/fonc.2023.1288744 -
Oncotarget Dec 2023To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain,...
PURPOSE
To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations.
METHODS
A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment.
RESULTS
1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years.
CONCLUSIONS
The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.
Topics: Female; Humans; Arm; Breast Neoplasms; Lymph Node Excision; Mastectomy; Morbidity; Risk Factors
PubMed: 38039404
DOI: 10.18632/oncotarget.28539 -
Cureus Nov 2023Fat grafting has been described as a potential treatment for post-mastectomy pain syndrome (PMPS) following oncological breast surgery. The study's aim was to compare... (Review)
Review
Fat grafting has been described as a potential treatment for post-mastectomy pain syndrome (PMPS) following oncological breast surgery. The study's aim was to compare and contrast the current literature using a systematic review and meta-analysis to quantify the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Databases, including MEDLINE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched. Data synthesis was conducted using Review Manager 5.4 (Cochrane Collaboration, London, UK), with 95% confidence intervals. All randomised controlled trials (RCT) and observational studies comparing lipofilling for PMPS were included. A total of six studies met the inclusion criteria with five articles being used in data analysis for the mean percentage reduction in visual analogue scale (VAS) score. The primary outcome measure was the mean percentage reduction in the VAS pain score. Secondary outcomes included the Neuropathic Pain Symptom Inventory (NPSI) and the quality of life assessments post treatment. Overall, a total of 266 patients received fat transfer for PMPS, and 164 were in the control group. The mean percentage reduction in VAS score was 19.8 (10.82, 28.82; p < 0.0001). Secondary outcomes, including health-related quality of life, showed good outcomes post fat transfer. This involved breast softness, cosmesis, and psychosocial well-being. The results from this meta-analysis suggest that autologous fat grafting is an efficacious treatment for reducing pain caused by PMPS. The authors suggest more high-quality trials are needed to enhance the current evidence base.
PubMed: 38024082
DOI: 10.7759/cureus.49017 -
Gland Surgery Oct 2023Breast-conserving surgery and mastectomy are standard surgical options for breast cancer. However, some patients experience a local recurrence after the operation. Many...
BACKGROUND
Breast-conserving surgery and mastectomy are standard surgical options for breast cancer. However, some patients experience a local recurrence after the operation. Many factors have been identified as a risk of local recurrence. Extensive intraductal component (EIC) was found as one of the major risks of the recurrence. Nevertheless, there were neither any systematic reviews nor controlled trials focused on EIC. This study aims to identify the impact of EIC on the local recurrence of breast cancer.
METHODS
We searched all relevant studies published between the inception to December 2020. All electronic data from PubMed and Scopus databases were extracted for evaluation of EIC as a factor of the recurrence. Local recurrence was a primary outcome between EIC-positive group and EIC-negative group. Margin status and adjuvant radiation were focused as a subgroup analysis. The Newcastle Ottawa Scale was applied for quality assessment of included studies and RevMan 5.3 program was used to estimate the effect of the results. The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
RESULTS
A total of 32 studies, comprising 4,290 and 15,143 patients in the EIC-positive and EIC-negative groups respectively, were retrieved and met selection criteria. All included studies were at low to intermediate risk of bias. There was a statistically significant difference in local recurrence between EIC-positive patients and EIC-negative patients (OR =2.73; 95% CI: 2.42-3.07; P<0.00001). However, there was not any significant difference in patients who had negative margin (OR =1.97; 95% CI: 0.92-4.19; P=0.36) or received any adjuvant irradiation (OR =1.58; 95% CI: 0.55-4.54; P=0.24).
CONCLUSIONS
EIC increases the risk of local recurrence, especially in breast-conserving surgery patients. However, there are a limited number of populations to analyze in subgroup analysis, the rate of local recurrence between two groups is not different in patients who had negative margin or received postoperative irradiation.
PubMed: 38021199
DOI: 10.21037/gs-23-137 -
The British Journal of Surgery Jan 2024Different intraoperative techniques with varying levels of evidence are available to decrease positive surgical margins during breast conserving surgery. The aim of this...
INTRODUCTION
Different intraoperative techniques with varying levels of evidence are available to decrease positive surgical margins during breast conserving surgery. The aim of this review is to assess the effectiveness of the MarginProbe® device as an intraoperative adjunct tool in reducing positive surgical margins, and subsequently exploring the effect on patient re-excision rates.
METHODOLOGY
A systematic review of the available medical literature was conducted from 2007 to March 2022. A literature search of Cochrane, PubMed and Embase by two independent reviewers reviwers was performed to identify eligible articles looking at the primary outcome of percentage reduction in patient re-excision rates using MarginProbe®. Secondary outcomes analysed were comparison of tissue volume removed, absolute and relative reduction in re-excision rate, cosmetic outcome, as well as MarginProbe® sensitivity and specificity.
RESULTS
A total of 12 full text articles were identified. An independent samples t-test using a total of 2680 patients found a 54.68 per cent reduction in re-excision rate with the use of MarginProbe®, which was statistically significant with a large effect size (P < 0.001; d = 1.826). Secondary outcomes showed a relatively higher sensitivity of the MarginProbe® device, at the expense of decreased specificity, and no significant impact on cosmesis and volume of breast tissue excised.
CONCLUSION
MarginProbe® is an effective intraoperative adjunct in breast-conservation surgery that reduces patient re-excision rates, with no adverse effects relating to breast cosmesis or increase in volume of excised tissue.
Topics: Humans; Female; Mastectomy, Segmental; Margins of Excision; Intraoperative Care; Breast; Reoperation; Breast Neoplasms; Retrospective Studies
PubMed: 37991190
DOI: 10.1093/bjs/znad335 -
Translational Cancer Research Oct 2023We conducted a comprehensive systematic review of the literature and meta-analysis of the oncologic outcomes of breast reconstruction (BR) after mastectomy and...
BACKGROUND
We conducted a comprehensive systematic review of the literature and meta-analysis of the oncologic outcomes of breast reconstruction (BR) after mastectomy and mastectomy only. This study aimed to analyze the impact of BR on the prognosis of patients with breast cancer.
METHODS
A systematic search of MEDLINE and EMBASE databases was performed using the following keywords: breast cancer, mastectomy, and BR. Inclusion criteria were studies reporting the survival data of patients after mastectomy only and mastectomy with BR. Event-free survival (EFS), breast cancer-specific survival (BCSS), and overall survival (OS) were considered the indicators of oncological outcomes. As all the included studies were non-randomized trials, we used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. The effect of BR on survival was measured using the effect size of the hazard ratio (HR). Data from each study were analyzed using the Review Manager.
RESULTS
Fifteen studies with 20,948 cases of BR and 63,358 cases of mastectomy were included. The pooled HRs for EFS and BCSS were 1.07 [95% confidence interval (CI): 0.78-1.47, P=0.65] and 0.84 (95% CI: 0.64-1.11, P=0.22), respectively. The patients who underwent BR after mastectomy had similar EFS and BCSS scores. Furthermore, patients who received BR had better OS (HR =0.73; 95% CI: 0.61-0.88, P=0.001) than those who underwent mastectomy only.
CONCLUSIONS
The data showed that BR after mastectomy had similar EFS and BCSS and better OS than mastectomy alone. Our meta-analysis suggests that BR is a practicable and safe treatment option for patients with breast cancer.
PubMed: 37969403
DOI: 10.21037/tcr-23-706 -
Breast Cancer : Basic and Clinical... 2023Breast cancer is the most prominent cancer type to affect women. Surgical treatment of invasive breast cancers involves mastectomy. Due to mastectomy, women are... (Review)
Review
BACKGROUND
Breast cancer is the most prominent cancer type to affect women. Surgical treatment of invasive breast cancers involves mastectomy. Due to mastectomy, women are subjected to social, emotional, and cultural problems which need to be addressed.
OBJECTIVE
The objective of the study is to understand how women cope with body image-related issues, trauma, anxiety, and depression post-mastectomy.
DESIGN
A systematic literature review was conducted for understanding the coping in post-mastectomy patients. The methods for identifying the studies were based on Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines.
DATABASES
Medline/PubMed, PsycInfo, and Cochrane databases were used for searching relevant articles. A final of 19 studies were analyzed for the work.
METHODS
Search strings such as "coping strategies and post mastectomy," "body image coping and post mastectomy" and "anxiety coping and post mastectomy" were used for identification of references from databases. Eligibility criteria were used for finalizing the references.
RESULTS
Analysis of the 19 studies has clearly shown that women who undergo mastectomy suffer from anxiety, stress, and trauma. This study has observed that women have problems with their body image post-mastectomy along with bouts of depression. Self-coping has been observed in relatively few studies. Psychological interventions before surgery have been observed to be a better coping strategy. In most of the studies, women opted for breast reconstruction to overcome the trauma associated with mastectomy.
CONCLUSION
Mastectomy has a severe impact on women's appearance and psychology. Breast reconstruction and acceptance have played an important role in coping among these women. However, breast reconstruction is not accepted by many women due to a multitude of factors. Thus, it is essential to have proper intervention programs in place to ensure women can cope with this situation and can lead healthy lives.
REGISTRATION
Systematic literature review (SLR) is submitted to PROSPERO. The application confirmation number is 449135.Registration awaited from the database.
PubMed: 37954028
DOI: 10.1177/11782234231209126 -
Frontiers in Oncology 2023Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy...
INTRODUCTION
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and the factors predicting BIA-ALCL onset in patients with and without an implant replacement.
METHODS
A quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, and systematic review) published until April 2022 and searched in PubMed, Scopus, and Google-Scholar databases using "Breast-Implant" AND/OR "Associated" AND/OR "Anaplastic-Large-Cell-Lymphoma". The statistical significance was verified by Student's -test for continuous variables, while Fisher's exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL's onset time. The Kaplan-Meier model allowed the estimation of the probability of survival after therapy according to breast implant exposure time.
RESULTS
Overall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years old, with a mean time to disease onset from the first implant of 10.3 years. The hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (hazard ratio = 0.03; 95%CI: 0.005-0.19; -value < 0.01). Patients with implant replacement were significantly older than patients without previous replacement at diagnosis, having a median time to diagnosis since the first implant of 13 years (7 years in patients without replacement); anyway, the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years.
DISCUSSION
Our findings suggest that, in BIA-ALCL patients, the implant substitution and/or capsulectomy may delay the disease's onset. However, the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis, and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow-up after the implant substitution should be recommended.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023446726.
PubMed: 37927474
DOI: 10.3389/fonc.2023.1202733