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Cureus May 2024To describe the histopathological pattern of different breast lesions among tissue specimens sent to our laboratory.
OBJECTIVE
To describe the histopathological pattern of different breast lesions among tissue specimens sent to our laboratory.
METHOD
A record-based study using a retrospective review of 255 histologically diagnosed breast biopsy reports in the histopathology department of authors from December 2016 to November 2021 was conducted. The specimens were collected from core biopsy, lumpectomy, and mastectomy. All data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) version 28 (IBM SPSS Statistics, Armonk, NY). Then, the findings were presented using text, tables, and charts.
RESULT
A total of 255 breast lesions were analyzed in this study. Most of the cases were benign (58.8%), followed by inflammatory lesions (21.6%), and malignant (19.6%). Fibroadenoma was the most prevalent benign lesion (36.7%), and most of the patients (70.9%) were in the age group of 20-39 years old. The most common inflammatory lesion was granulomatous mastitis (56.4%), and most of the cases were diagnosed in the age group of 30-39 years old. Invasive ductal carcinoma (IDC) was the most encountered histological type of carcinoma (62%). Of the malignant cases, 52% were diagnosed before the age of 50 years. Among these 50 cases, grade 2 was the most prevalent one (46%).
CONCLUSION
Benign breast lesions are more common than malignant breast lesions, and fibroadenoma is the most common benign subtype. Granulomatous mastitis is the most prevalent inflammatory breast lesion. About two-thirds of malignant cases are non-Arab. Invasive ductal carcinoma with no special type (NST) is the most common malignant subtype.
PubMed: 38883142
DOI: 10.7759/cureus.60408 -
Cureus May 2024Secretory breast carcinoma (SBC) is an extremely rare entity of breast cancer, which can affect all age groups. The diagnosis is based on the characteristic microscopic...
Secretory breast carcinoma (SBC) is an extremely rare entity of breast cancer, which can affect all age groups. The diagnosis is based on the characteristic microscopic appearance, and despite the triple negativity or low hormone receptor positivity, SBC is generally characterized by a favorable prognosis. Due to the rarity of the disease, no clear consensus on optimal treatment is available. Nevertheless, conservative surgery or mastectomy is the main therapeutic option. The efficacy of chemotherapy, radiotherapy, and hormone therapy in this pathology has not been rigorously explored. We report the case of a 65-year-old woman with SBC treated with surgery and adjuvant radiotherapy, with a review of the literature.
PubMed: 38883124
DOI: 10.7759/cureus.60430 -
Health Services Research Jun 2024To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage.
OBJECTIVE
To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage.
DATA SOURCES AND STUDY SETTING
Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals.
STUDY DESIGN
A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries.
DATA COLLECTION/EXTRACTION METHODS
We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described.
PRINCIPAL FINDINGS
Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (p = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (n = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (n = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate.
CONCLUSIONS
In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.
PubMed: 38881495
DOI: 10.1111/1475-6773.14338 -
Gan To Kagaku Ryoho. Cancer &... May 2024Pulmonary lymphangitis carcinomatosis is generally characterized by resistance to chemotherapy and is associated with a poor prognosis. Herein, we present a case of...
Pulmonary lymphangitis carcinomatosis is generally characterized by resistance to chemotherapy and is associated with a poor prognosis. Herein, we present a case of pulmonary lymphangitic carcinomatosis from recurrent breast cancer that responded well to trastuzumab deruxtecan(T-DXd). The patient was a 40-year-old woman with hormone receptor-positive, HER2-positive breast cancer. At the age of 31, she had undergone a left mastectomy with axillary lymph node dissection. She received adjuvant chemotherapy(5-fluorouracil-epirubicin-cyclophosphamide, docetaxel, and trastuzumab)followed by endocrine therapy(tamoxifen and LH-RHa). Three years after the surgery, pulmonary and bone metastases were detected and she was treated with trastuzumab, pertuzumab, and capecitabine. Liver metastases were detected, and she was treated with trastuzumab emtansine. Nine years after surgery, the patient developed dyspnea and was diagnosed with lymphangitis carcinomatosis. After initiating T-DXd, dyspnea rapidly improved, and ground glass opacity on CT scan disappeared. She responded well to the treatment, with prolonged, stable disease for 1 year and 2 months. Thus, T-DXd may be effective against pulmonary lymphangitis carcinomatosis, which is generally characterized by resistance to chemotherapy.
Topics: Humans; Female; Adult; Breast Neoplasms; Lymphangitis; Trastuzumab; Lung Neoplasms; Recurrence; Antineoplastic Combined Chemotherapy Protocols; Antineoplastic Agents, Immunological; Immunoconjugates; Camptothecin
PubMed: 38881071
DOI: No ID Found -
The Journal of Infection Jun 2024Implant-based reconstructions are increasingly utilized following mastectomy in the prevention and treatment of breast cancer. However, these implants are associated... (Review)
Review
Implant-based reconstructions are increasingly utilized following mastectomy in the prevention and treatment of breast cancer. However, these implants are associated with a high rate of infection, which is a major complication that can lead to implant removal, delay in adjuvant radiation and chemotherapy, and increase in health care costs. Early clinical signs and symptoms of infection, such as erythema, warmth, and tenderness, are challenging to discern from expected postsurgical responses. Furthermore, when atypical features are present or the patient's condition does not improve on adequate antimicrobials, the clinician should be prompted to consider an alternative noninfectious etiology. Herein we highlight the key elements of the preventive, diagnostic, and multidisciplinary therapeutic approach to salvaging the infected breast implant; review several infectious disease mimickers; and provide many pearls of wisdom that the practicing clinician must be familiar with and be able to manage in an effective and successful manner.
PubMed: 38879134
DOI: 10.1016/j.jinf.2024.106197 -
Precision dose prediction for breast cancer patients undergoing IMRT: The Swin-UMamba-Channel Model.Computerized Medical Imaging and... Jun 2024Radiation therapy is one of the crucial treatment modalities for cancer. An excellent radiation therapy plan relies heavily on an outstanding dose distribution map,...
BACKGROUND
Radiation therapy is one of the crucial treatment modalities for cancer. An excellent radiation therapy plan relies heavily on an outstanding dose distribution map, which is traditionally generated through repeated trials and adjustments by experienced physicists. However, this process is both time-consuming and labor-intensive, and it comes with a degree of subjectivity. Now, with the powerful capabilities of deep learning, we are able to predict dose distribution maps more accurately, effectively overcoming these challenges.
METHODS
In this study, we propose a novel Swin-UMamba-Channel prediction model specifically designed for predicting the dose distribution of patients with left breast cancer undergoing radiotherapy after total mastectomy. This model integrates anatomical position information of organs and ray angle information, significantly enhancing prediction accuracy. Through iterative training of the generator (Swin-UMamba) and discriminator, the model can generate images that closely match the actual dose, assisting physicists in quickly creating DVH curves and shortening the treatment planning cycle. Our model exhibits excellent performance in terms of prediction accuracy, computational efficiency, and practicality, and its effectiveness has been further verified through comparative experiments with similar networks.
RESULTS
The results of the study indicate that our model can accurately predict the clinical dose of breast cancer patients undergoing intensity-modulated radiation therapy (IMRT). The predicted dose range is from 0 to 50 Gy, and compared with actual data, it shows a high accuracy with an average Dice similarity coefficient of 0.86. Specifically, the average dose change rate for the planning target volume ranges from 0.28 % to 1.515 %, while the average dose change rates for the right and left lungs are 2.113 % and 0.508 %, respectively. Notably, due to their small sizes, the heart and spinal cord exhibit relatively higher average dose change rates, reaching 3.208 % and 1.490 %, respectively. In comparison with similar dose studies, our model demonstrates superior performance. Additionally, our model possesses fewer parameters, lower computational complexity, and shorter processing time, further enhancing its practicality and efficiency. These findings provide strong evidence for the accuracy and reliability of our model in predicting doses, offering significant technical support for IMRT in breast cancer patients.
CONCLUSION
This study presents a novel Swin-UMamba-Channel dose prediction model, and its results demonstrate its precise prediction of clinical doses for the target area of left breast cancer patients undergoing total mastectomy and IMRT. These remarkable achievements provide valuable reference data for subsequent plan optimization and quality control, paving a new path for the application of deep learning in the field of radiation therapy.
PubMed: 38878631
DOI: 10.1016/j.compmedimag.2024.102409 -
The British Journal of Surgery Jun 2024Oncoplastic breast-conserving surgery may allow women with early breast cancer to avoid a mastectomy, but many women undergo more extensive surgery, even when...
BACKGROUND
Oncoplastic breast-conserving surgery may allow women with early breast cancer to avoid a mastectomy, but many women undergo more extensive surgery, even when breast-conserving options are offered. The aim of the ANTHEM qualitative study was to explore factors influencing women's surgical decision-making for and against oncoplastic breast-conserving surgery.
METHODS
Semi-structured interviews were conducted with a purposive sample of women who had received either oncoplastic breast-conserving surgery or a mastectomy with or without immediate breast reconstruction to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically. Trial registration number: ISRCTN18238549.
RESULTS
A total of 27 women from 12 centres were interviewed. Out of these, 12 had chosen oncoplastic breast-conserving surgery and 15 had chosen a mastectomy with or without immediate breast reconstruction. Overwhelmingly, women's decisions were guided by their surgical teams. Decision-making for and against oncoplastic breast-conserving surgery was influenced by three key inter-related factors: perceptions of oncological safety; the importance of maintaining/restoring femininity and body image; and practical issues. Oncological safety was paramount. Women who reported feeling reassured that oncoplastic breast-conserving surgery was oncologically safe were happy to choose this option. Those who were not reassured were more likely to opt for a mastectomy, as a perceived 'safer' option. Most women wished to maintain/restore femininity, with the offer of immediate breast reconstruction essential to make a mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern.
CONCLUSION
Decision-making is complex and heavily influenced by the surgical team. High-quality, accurate information about surgical options, including appropriate reassurance about the short- and long-term oncological safety of oncoplastic breast-conserving surgery is vital if women are to make fully informed decisions.
Topics: Humans; Female; Breast Neoplasms; Mastectomy, Segmental; Middle Aged; Decision Making; Qualitative Research; Adult; Mammaplasty; Mastectomy; Aged; United Kingdom; Interviews as Topic
PubMed: 38877844
DOI: 10.1093/bjs/znae133 -
Journal of Transcultural Nursing :... Jun 2024Breast cancer is the most common cancer in Arabic women and is often diagnosed in advanced stages, resulting in an increased likelihood of requiring a mastectomy....
INTRODUCTION
Breast cancer is the most common cancer in Arabic women and is often diagnosed in advanced stages, resulting in an increased likelihood of requiring a mastectomy. Despite this, there is a lack of contemporary literature exploring Arabic women's experiences of breast cancer and its sequelae.
METHOD
Semi-structured interviews were conducted between 2019 and 2022 of Arabic women diagnosed with breast cancer. Data were analyzed using thematic analysis as described by Braun and Clark.
RESULTS
Two main themes were identified: (a) describes participants' experiences when diagnosed and (b) detailing their lack of decision-making autonomy and perceptions of support.
DISCUSSION
Arabic women believe in the concept of fate and faith, and their cultural conditioning is to prioritize family over themselves, often with limited support. They lack autonomy in decision-making due to the patriarchal society they live in.
PubMed: 38877748
DOI: 10.1177/10436596241259208 -
Breast Cancer Research and Treatment Jun 2024The purpose of this research was to examine the probability of ipsilateral breast cancer recurrence in individuals whose RT was delayed after the first chemotherapy and...
BACKGROUND
The purpose of this research was to examine the probability of ipsilateral breast cancer recurrence in individuals whose RT was delayed after the first chemotherapy and surgery.
PURPOSE
To analyze the effect of delaying RT for breast cancer patients (by more than 6 weeks after treatment).
METHODOLOGY
A retrospective analysis comprised 136 female breast cancer patients treated at the Baghdad Centre for Radiation Oncology and Nuclear Medicine from 2021 to May 2022. External beam radiation was started more than 6 weeks after chemotherapy was finished for all patients who also had surgery. Clinical examination and ultrasound were part of the follow-up process.
RESULTS
Patients' ages varied from 28 to 71, and the majority (83%) had a mastectomy. The majority of cases (95.5%) were diagnosed as invasive ductal carcinoma on histopathology, with 49.6% being at stage 2 and 42.6% being at stage 3. Seventy-six percent of patients tested positive for hormones. Although 10 patients (7.35%) acquired distant metastases within 5 years, only 2 (1.47%) had local recurrence because of the delay in RT. Specifically, 91.1% had complete local control with no evidence of disease spread.
CONCLUSION
Delaying RT by more than 6 weeks in patients with breast cancer did not substantially affect local control, according to the results of a new research, the first of its type in Iraq.
PubMed: 38877185
DOI: 10.1007/s10549-024-07385-9 -
Critical Reviews in Oncology/hematology Jun 2024Breast reconstruction (BR) after mastectomy is important to consider for a woman's body image enhancement and psychological well-being. Although post-mastectomy... (Review)
Review
Post-mastectomy radiation therapy after breast reconstruction: from historic dogmas to practical expert agreements based on a large literature review of surgical and radiation therapy considerations.
Breast reconstruction (BR) after mastectomy is important to consider for a woman's body image enhancement and psychological well-being. Although post-mastectomy radiation (PMRT) significantly improves the outcome of patients with high-risk breast cancer (BC), PMRT after BR may affect cosmetic outcomes and may compromise the original goal of improving quality of life (QoL). With the lack of practical guidelines, it seems essential to work on a consensus and provide some "expert agreements" to offer patients the best option for PMRT after BR. We report a global "expert agreement" that results from a critical review of the literature on BR and PMRT during the 6th international multidisciplinary breast conference in March 2023.
PubMed: 38876160
DOI: 10.1016/j.critrevonc.2024.104421