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Breast (Edinburgh, Scotland) Jun 2023To assess real-world outcomes and prognostic factors of non-metastatic inflammatory breast cancer according to immunohistochemistry (IHC)-based subtype and treatment...
AIM
To assess real-world outcomes and prognostic factors of non-metastatic inflammatory breast cancer according to immunohistochemistry (IHC)-based subtype and treatment regimen.
METHODS
An institutional retrospective analysis of patients treated with neoadjuvant systemic treatment (NAST) for stage III inflammatory breast cancer diagnosed between 2001 and 2018 was performed. The survival outcomes in relation to patient characteristics, tumour characteristics, treatment modality and response to NAST were analyzed.
RESULTS
225 patients fulfilled the inclusion criteria, 90% of patients were node-positive. IHC-based subtypes: 39.1% were HR+/HER2-, 19.1% HR+/HER2+, 23.1% HR-/HER2+ and 18.7% HR-/HER2-. Treatment was multimodal: NAST (100%), surgery (94.2%) and radiotherapy (94.2%). 53.3% of patients received adjuvant endocrine therapy, 34.3% (neo)adjuvant trastuzumab. Tri-modality therapy was applied in 89.3% of patients. Following NAST, a pathologic complete remission (pCR) in the breast was found in 16.9%, in the axilla in 29.7% and in both the breast and axilla in 10.3% of patients. The axillary pCR rate was significantly higher in HR- subtypes. Median overall survival (OS) was 8.9, 7.2, 5.8 and 2.3 years (p < 0.001) for HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- subtype, respectively. On multivariate analysis, IHC-based subtype, age and axillary pCR were found as independent prognostic factors for RFS and OS. pCR rate and median OS improved over time, 5.8% vs 14.7% and 4.7 vs 10.0 years (2001-2009 vs. 2010-2018), respectively.
CONCLUSIONS
Axillary pCR and the non-triple-negative IHC-based subtype are favourable prognostic factors for RFS and OS in inflammatory breast cancer. Introduction of taxanes and antiHER2 drugs contributed to improved pCR rate and OS.
Topics: Humans; Female; Inflammatory Breast Neoplasms; Breast Neoplasms; Prognosis; Treatment Outcome; Retrospective Studies; Axilla; Chemotherapy, Adjuvant; Neoadjuvant Therapy; Receptor, ErbB-2
PubMed: 36740512
DOI: 10.1016/j.breast.2023.01.011 -
BMJ (Clinical Research Ed.) Apr 2000To evaluate the agreement between temperature measured at the axilla and rectum in children and young people. (Review)
Review
OBJECTIVE
To evaluate the agreement between temperature measured at the axilla and rectum in children and young people.
DESIGN
A systematic review of studies comparing temperature measured at the axilla (test site) with temperature measured at the rectum (reference site) using the same type of measuring device at both sites in each patient. Devices were mercury or electronic thermometers or indwelling thermocouple probes.
STUDIES REVIEWED
40 studies including 5528 children and young people from birth to 18 years.
DATA EXTRACTION
Difference in temperature readings at the axilla and rectum.
RESULTS
20 studies (n=3201 (58%) participants) had sufficient data to be included in a meta-analysis. There was significant residual heterogeneity in both mean differences and sample standard deviations within the groups using different devices and within age groups. The pooled (random effects) mean temperature difference (rectal minus axillary temperature) for mercury thermometers was 0.25 degrees C (95% limits of agreement -0.15 degrees C to 0.65 degrees C) and for electronic thermometers was 0. 85 degrees C (-0.19 degrees C to 1.90 degrees C). The pooled (random effects) mean temperature difference (rectal minus axillary temperature) for neonates was 0.17 degrees C (-0.15 degrees C to 0. 50 degrees C) and for older children and young people was 0.92 degrees C (-0.15 degrees C to 1.98 degrees C).
CONCLUSIONS
The difference between temperature readings at the axilla and rectum using either mercury or electronic thermometers showed wide variation across studies. This has implications for clinical situations where temperature needs to be measured with precision.
Topics: Adolescent; Axilla; Body Temperature; Child; Child, Preschool; Data Collection; Humans; Infant; Infant, Newborn; Rectum; Thermometers
PubMed: 10784539
DOI: 10.1136/bmj.320.7243.1174 -
Current Problems in Diagnostic Radiology 1995Magnetic resonance imaging of the shoulder is routinely used, especially in the evaluation of rotator cuff disease and glenohumeral instability. More recent studies have... (Review)
Review
Magnetic resonance imaging of the shoulder is routinely used, especially in the evaluation of rotator cuff disease and glenohumeral instability. More recent studies have provided a more sophisticated understanding of what represents a pathologic rotator cuff. Similarly, there has been an increased focus on the role of the glenohumeral ligaments and their labral attachment sites in maintaining glenohumeral stability. There have been technical advances as well, including the increased use of magnetic resonance arthrography. In addition, newer studies have shed light on the pathophysiology of the long bicipital tendon and compression neuropathies involving the suprascapular and axillary nerves.
Topics: Arthrography; Axilla; Humans; Joint Instability; Ligaments, Articular; Magnetic Resonance Imaging; Nerve Compression Syndromes; Rotator Cuff; Shoulder Dislocation; Shoulder Joint
PubMed: 8556861
DOI: No ID Found -
Breast (Edinburgh, Scotland) Mar 2022The role of axillary surgery has evolved over the last three decades from routine axillary lymph node dissection (ALND) to sentinel lymph node biopsy to omission of...
The role of axillary surgery has evolved over the last three decades from routine axillary lymph node dissection (ALND) to sentinel lymph node biopsy to omission of axillary surgery altogether in select patients. This evolution has been achieved through the design and conduct of multiple clinical trials demonstrating that ALND does not impact survival and is not necessary for local control in patients with early-stage breast cancer and limited nodal involvement. Importantly, this practice-changing shift mirrored the trend towards earlier stage at diagnosis and the recognition of the interplay between local and systemic therapies in maintaining local control. There are numerous clinical scenarios today in which axillary staging can be safely avoided, including (1) DCIS treated with lumpectomy, (2) at the time of contralateral prophylactic mastectomy, and (3) in elderly patients with early-stage, HR+/HER2-clinically node-negative (cN0) disease. Ongoing clinical trials seek to expand the cohorts in which surgical nodal staging can be omitted. These populations include a broader range of early-stage, cN0 patients undergoing upfront surgery, as seen in the SOUND, INSEMA, BOOG 2013-08, SOAPET and NAUTILUS trials. Omission of axillary surgery in cN0 patients with HER2+ or triple-negative disease treated with neoadjuvant chemotherapy is also being tested in the ASICS and EUBREAST-01 trials. Continued advances in imaging and the growing role of genomic assays in selecting patients for systemic therapy are likely to further minimize the need for axillary surgery; thereby further reducing the morbidity of local therapy for women with breast cancer.
Topics: Aged; Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Mastectomy; Mastectomy, Segmental; Neoplasm Staging; Sentinel Lymph Node Biopsy
PubMed: 34949533
DOI: 10.1016/j.breast.2021.11.018 -
Tidsskrift For Den Norske Laegeforening... Sep 2023
Topics: Humans; Axilla; Exanthema
PubMed: 37753761
DOI: 10.4045/tidsskr.23.0287 -
PloS One 2023Lasers of different wavelengths have been developed for use in permanent hair reduction. An increase in the manufacturing of home-use laser hair removal devices allows...
BACKGROUND
Lasers of different wavelengths have been developed for use in permanent hair reduction. An increase in the manufacturing of home-use laser hair removal devices allows for these treatments to be performed in the comfort of your own home at an affordable cost.
OBJECTIVE
To evaluate the effectiveness of permanent hair reduction using a Diode laser in comparison to the Silk'n™ Flash and Go Lux (475-1200 nm) home-use laser.
METHODS
Fifteen females received six axillae laser hair removal treatments at two to four-week intervals using either a professional laser or home-use laser device. Photographs and hair counts were taken before each treatment and at a three week follow up. A T-test was used to evaluate statistical significance, and regression analysis to determine a difference in the effects. Pain scores and side effects were recorded by a visual analogue scale in a satisfaction questionnaire.
RESULTS
The professional laser showed an overall hair reduction of 85% on the right axilla and 88% on the left axilla. The home-use laser showed an overall reduction of 52% on the right axilla and 46,3% on the left axilla. Mild side effects were experienced for both laser devices. There were no serious adverse effects reported, safety features are effective to a certain extent.
CONCLUSION
The Flash & Go Lux home-use laser can effectively reduce hair at a slower rate than the Diode laser. The home-use laser device offers protection against accidental exposure to light and use on darker skin types. Risks of retinal damage due to long-term exposure to home-use laser light are still cause for concern.
Topics: Female; Humans; Lasers, Semiconductor; Hair; Hair Removal; Intense Pulsed Light Therapy; Axilla; Treatment Outcome
PubMed: 37235570
DOI: 10.1371/journal.pone.0286162 -
Journal of Feline Medicine and Surgery Apr 2023Axillary wounds most often occur in outdoor cats that wear a collar, typically after having been missing. These wounds are commonly chronic and indolent in nature, and... (Review)
Review
PRACTICAL RELEVANCE
Axillary wounds most often occur in outdoor cats that wear a collar, typically after having been missing. These wounds are commonly chronic and indolent in nature, and although there is so far no consensus on an explanation for this, it is likely that there are several factors involved.
CLINICAL CHALLENGES
Axillary wounds are often difficult to manage due to the frequent presence of infection, their histopathological characteristics and their location, where there is excessive tension and movement of the axillary tissues. Initial surgical treatment has a high reported incidence of failure and complications in the literature, with wound breakdown reported most commonly. Giving due consideration to the difficulties of managing these wounds, however, will help practitioners to decrease the occurrence of complications and the need for multiple procedures, and therefore improve the outcome.
EQUIPMENT
Initial approach and surgical management can be achieved using standard medical equipment and surgical kit available to general practitioners.
EVIDENCE BASE
This review discusses the surgical techniques reported in the literature to have successfully treated chronic axillary wounds and recommendations are also provided based on the authors' clinical experience.
Topics: Animals; Cats; Wounds and Injuries; Axilla
PubMed: 37038310
DOI: 10.1177/1098612X231162880 -
BMC Cancer Sep 2022Laterality in breast cancer means an increased frequency of left-sided breast cancers compared to right-sided breast cancers ranging between 1.05 and 1.26. It was first...
BACKGROUND
Laterality in breast cancer means an increased frequency of left-sided breast cancers compared to right-sided breast cancers ranging between 1.05 and 1.26. It was first described in 1935 by Fellenberg, Sweden. The explanation of this phenomenon is not clear, but the association with other factors was found. This study aimed to explore the laterality of breast cancer in Bahrain as a model for Arabian countries. The association of laterality with the clinicopathological characteristics of the tumor was also analyzed to explore any applied clinical value.
METHODS
This is a cross-sectional, retrospective review of a particular ethnic population to study laterality of breast cancer versus a number of clinicopathological factors, as well as prognosis. The study analyzed 228 breast cancer patients treated in Arabian Gulf University facilities in Bahrain between 1999 and 2020. Three bilateral breast cancer and two malignant phyllodes patients were excluded. The following variables were analyzed: laterality ratio (Lt/Rt) and the association between laterality and clinicopathological characteristics (age at diagnosis, family history of malignancy, size of the tumor, tumor grade, histological type, hormonal receptors and HER2, axillary lymph node status, tumor stage, five-year survival rate, nulliparity, and multifocality).
RESULTS
The laterality ratio (Lt/Rt) was 1.06 and was 0.97 for patients below 50 years of age, and 1.19 for patients 50 years of age and above. Analysis of our data showed a statistically significant association between laterality and tumor stage (p. value =0.025) at presentation, and laterality and family history of malignancy (p. value =0.052). Right-sided breast cancer was associated with a higher positive family history of malignancy and an increased ratio of locally advanced and metastatic disease, and a reduced 5-year survival in relation to size and stage. Left-sided breast cancer was associated with higher early tumor stage.
CONCLUSION
This is the first study exploring the issue of breast cancer laterality in a defined Arabian population. The laterality ratio in this study was 1.06, which is consistent with the globally published range (1.05 to 1.26) and is increasing with increasing age. The association between breast cancer laterality, and the hormonal and HER2 is still not widely addressed in the available literature, although other clinicopathological characteristics were extensively analyzed.
Topics: Axilla; Bahrain; Breast Neoplasms; Cross-Sectional Studies; Female; Humans; Infant; Unilateral Breast Neoplasms
PubMed: 36088284
DOI: 10.1186/s12885-022-10063-y -
Folia Morphologica 2019The present study aims to summarise the accessory muscles of the anterior thoracic wall and axilla that can be encountered during breast and axillary surgery and record...
BACKGROUND
The present study aims to summarise the accessory muscles of the anterior thoracic wall and axilla that can be encountered during breast and axillary surgery and record their incidence and clinical significance. Moreover, the laterality of the atypical muscles is highlighted and possible gender dimorphism is referred. Accessory anterior thoracic wall muscles include: Langer's axillary arch, sternalis muscle, chondrocoracoideus, chondroepitrochlearis, chondrofascialis, pectoralis minimus, pectoralis quartus and pectoralis intermedius.
MATERIALS AND METHODS
The anatomical, surgical and radiological literaturę has been reviewed and an anatomical study on 48 Greek adult cadavers was performed.
RESULTS
Literature review revealed the existence of accessory muscles of the anterior thoracic wall and axilla that have a significant incidence that can be considered high and may, therefore, have clinical significance. For the most common of these muscles, which are axillary arch (Langer's) and sternalis muscle, the cadaveric incidence is 10.30% and 7.67%, respectively. In the current cadaveric study, accessory thoracic wall muscles were identified in two cadavers; namely a bilateral sternalis muscle (incidence 2.08%) extending both to the anterior and posterior surface of the sternum and a left-sided chondrocoracoideus muscle (of Wood) (incidence 2.08%).
CONCLUSIONS
Despite the fact that accessory anterior thoracic wall and axillary muscles are considered to be rare, it is evident that the incidence of at least some of them is high enough to encounter them in clinical practice. Thus, clinicians' awareness of these anatomical structures is advisable.
Topics: Axilla; Breast; Cadaver; Female; Humans; Male; Muscle, Skeletal; Thoracic Wall
PubMed: 30664230
DOI: 10.5603/FM.a2019.0005 -
Breast (Edinburgh, Scotland) Mar 2022While systemic therapy for non-metastatic, invasive breast cancer is provided to minimize the risk of recurrence, neoadjuvant therapy (NAT) is given prior to surgery to...
While systemic therapy for non-metastatic, invasive breast cancer is provided to minimize the risk of recurrence, neoadjuvant therapy (NAT) is given prior to surgery to downstage the tumor and to evaluate treatment response. Downstaging the tumor may allow for less invasive surgery on the breast and axilla, thus avoiding the need for breast reconstruction, improving cosmetic outcomes, and reducing postoperative complications. With the rising number of NAT candidates, it is becoming increasingly important to standardize how tumor response is assessed after surgery. In the post-NAT setting, macroscopic assessment of surgical samples, extent of sampling for histology, and microscopic analysis require a different approach than in the primary surgery setting. In the neo-adjuvant setting, the close collaboration of pathologists, oncologists, surgeons, and radiologists within the multidisciplinary team is essential to ensure the best possible management of breast cancer patients. Here, we provide an update on the suggested procedures for an accurate assessment of tumor response to NAT, including the evaluation of all relevant parameters that correlate with long-term prognosis and inform the subsequent adjuvant interventions.
Topics: Axilla; Breast; Breast Neoplasms; Female; Humans; Neoadjuvant Therapy; Neoplasm, Residual
PubMed: 34810049
DOI: 10.1016/j.breast.2021.11.009