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Brain Connectivity May 2022Patients with breast cancer frequently report cognitive impairment both during and after completion of therapy. Evidence suggests that cancer-related cognitive...
Patients with breast cancer frequently report cognitive impairment both during and after completion of therapy. Evidence suggests that cancer-related cognitive impairments are related to widespread neural network dysfunction. The default mode network (DMN) is a large conserved network that plays a critical role in integrating the functions of various neural systems. Disruption of the network may play a key role in the development of cognitive impairment. We compared neuroimaging and neurocognitive data from 43 newly diagnosed primary breast cancer patients (mean age = 48, standard deviation [SD] = 8.9 years) and 50 frequency-matched healthy female controls (mean age = 50, SD = 10 years) before treatment and 1 year after treatment completion. Functional and effective connectivity measures of the DMN were obtained using graph theory and Bayesian network analysis methods, respectively. Compared with healthy females, the breast cancer group displayed higher global efficiency and path length post-treatment ( < 0.03, corrected). Breast cancer survivors showed significantly lower performance on measures of verbal memory, attention, and verbal fluency ( < 0.05) at both time points. Within the DMN, local brain network organization, as measured by edge-betweenness centralities, was significantly altered in the breast cancer group compared with controls at both time points ( < 0.0001, corrected), with several connections showing a significant group-by-time effect ( < 0.003, corrected). Effective connectivity demonstrated significantly altered patterns of neuronal coupling in patients with breast cancer ( < 0.05). Significant correlations were seen between hormone blockade therapy, radiation therapy, chemotherapy cycles, memory, and verbal fluency test and edge-betweenness centralities. This pattern of altered network organization in the default mode is believed to result in reduced network efficiency and disrupted communication. Subregions of the DMN, the orbital prefrontal cortex and posterior memory network, appear to be at the center of this disruption and this could inform future interventions. Impact statement This prospective study is the first to investigate how post-treatment changes in functional and effective connectivity in the regions of default mode network are related to cancer therapy and measures of memory and verbal learning in breast cancer patients. We demonstrate that the interactions between treatment, brain connectivity, and neurocognitive outcomes coalesce around a subgroup of brain structures in the orbital frontal and parietal lobe. This would suggest that interventions that target these regions may improve neurocognitive outcomes in breast cancer survivors.
Topics: Bayes Theorem; Brain; Brain Mapping; Breast Neoplasms; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Neural Pathways; Prospective Studies
PubMed: 34210168
DOI: 10.1089/brain.2021.0049 -
Case Reports in Pulmonology 2015Lung cancer is one of the most common cancers in America. Frequent sites of metastasis include the Hilar lymph nodes, adrenal glands, liver, brain, and bone. The...
Lung cancer is one of the most common cancers in America. Frequent sites of metastasis include the Hilar lymph nodes, adrenal glands, liver, brain, and bone. The following case report is of a primary lung cancer with metastases to the breast and skin. Case. A 48-year-old African American male with a past medical history of poorly differentiated left breast cancer status after modified radical mastectomy (MRM), chronic obstructive pulmonary disease, and smoking (20 pack-years) presents to the ER with progressive shortness of breath on exertion, upper back pain, and weight loss for 2 months in duration. On physical examination he is found to have a MRM scar on his left breast and a left periumbilical cutaneous mass. Chest X-ray and chest CT reveal a right upper lobe mass and biopsies from the breast, lung, and the periumbilical mass indicate a poorly differentiated carcinoma of unclear etiology; all tumor markers are negative. The patient is male and a chronic smoker; therefore the diagnosis is made as lung carcinoma with metastases to the breast and skin. Conclusion. A high index of suspicion for cutaneous metastases should be cast when investigating cutaneous pathologies in patients at risk for primary lung malignancy.
PubMed: 25861506
DOI: 10.1155/2015/136970 -
Annals of Medicine and Surgery (2012) Oct 2020The non-technical skills for surgeons (NOTSS) system was developed as a tool to assess surgical skills for patient safety during surgery. This study aimed to develop a...
BACKGROUND
The non-technical skills for surgeons (NOTSS) system was developed as a tool to assess surgical skills for patient safety during surgery. This study aimed to develop a NOTSS-based training system for surgical trainees to acquire non-technical skills using a chest surgery scenario in a wet lab.
MATERIALS AND METHODS
Trainees were categorized into three subgroups according to the years of experience as follows: Level A: 6 years or more; Level B: 3-5 years; and Level C: 1-2 years. Three stages of surgical procedure were designed: 1. chest wall resection and right upper lobe lobectomy, 2. right middle lobe sleeve lobectomy, and 3. right lower lobe lobectomy. One instructor was assigned to each operation table, who evaluated each participant's NOTSS scores consisting of 16 elements.
RESULTS
When comparing average NOTSS score of all the three procedures, significant differences were observed between Level A, B, and C trainees. As an example of varying elements by procedure, Level A trainees demonstrated differences in Situation Awareness, and a significant difference was observed in Level C trainees regarding the elements of Decision Making. On the contrary, no significant difference was observed among Level B trainees. In the comparison between first-time and experienced participants, a significant improvement was observed in some elements in Level B and C trainees.
CONCLUSION
This study highlights the usefulness and feasibility of the NOTSS scoring system for surgeons with different experiences and the effectiveness of providing feedback to trainees during intraoperative handoffs in a wet lab.
PubMed: 32994981
DOI: 10.1016/j.amsu.2020.07.062 -
Turkish Journal of Surgery Jun 2021Endoscopic parathyroid and thyroid surgery is becoming increasingly common. In this study, we present the results of patients who underwent Endo- scopic parathyroid via...
Endoscopic parathyroid and thyroid surgery is becoming increasingly common. In this study, we present the results of patients who underwent Endo- scopic parathyroid via unilateral axillo-breast approach (EP via UABA). Three patients underwent EP via UABA. Patients were discharged on the next day after surgery, while at one month follow up all of them reported no further symptoms. Operation performed via two axiller and one areolar trochar. As different from open surgery, the strap muscles don't pulled laterally and not entered into the thyroid lobe from the midline. In this technique, the strap muscles are separated from the middle part of the strap muscles and the thyroid gland is reached from the middle of the strap muscles. In this way, N. laryngeal recurrence and parathyroid gland that usually located in the posterior aspect of the thyroid gland can be revealed clearly by reducing the risk of complications. EP via UABA can be performed safe effective procedure via good cosmetic results.
PubMed: 37275189
DOI: 10.47717/turkjsurg.2021.4755 -
Neuro-oncology Advances 2022While it has been suspected that different primary cancers have varying predilections for metastasis in certain brain regions, recent advances in neuroimaging and... (Review)
Review
BACKGROUND
While it has been suspected that different primary cancers have varying predilections for metastasis in certain brain regions, recent advances in neuroimaging and spatial modeling analytics have facilitated further exploration into this field.
METHODS
A systematic electronic database search for studies analyzing the distribution of brain metastases (BMs) from any primary systematic cancer published between January 1990 and July 2020 was conducted using PRISMA guidelines.
RESULTS
Two authors independently reviewed 1957 abstracts, 46 of which underwent full-text analysis. A third author arbitrated both lists; 13 studies met inclusion/exclusion criteria. All were retrospective single- or multi-institution database reviews analyzing over 8227 BMs from 2599 patients with breast (8 studies), lung (7 studies), melanoma (5 studies), gastrointestinal (4 studies), renal (3 studies), and prostate (1 study) cancers. Breast, lung, and colorectal cancers tended to metastasize to more posterior/caudal topographic and vascular neuroanatomical regions, particularly the cerebellum, with notable differences based on subtype and receptor expression. HER-2-positive breast cancers were less likely to arise in the frontal lobes or subcortical region, while ER-positive and PR-positive breast metastases were less likely to arise in the occipital lobe or cerebellum. BM from lung adenocarcinoma tended to arise in the frontal lobes and squamous cell carcinoma in the cerebellum. Melanoma metastasized more to the frontal and temporal lobes.
CONCLUSION
The observed topographical distribution of BM likely develops based on primary cancer type, molecular subtype, and genetic profile. Further studies analyzing this association and relationships to vascular distribution are merited to potentially improve patient treatment and outcomes.
PubMed: 35024611
DOI: 10.1093/noajnl/vdab170 -
International Journal of Breast Cancer 2011Breast carcinoma has a complex subgross morphology in the majority of cases. The malignant transformation usually involves a single breast lobe and may demonstrate...
Breast carcinoma has a complex subgross morphology in the majority of cases. The malignant transformation usually involves a single breast lobe and may demonstrate peripheral, segmental, or lobar growth patterns in the in situ phase. During the invasive phase, the tumor may grow beyond the borders of the affected lobe. The dimensions of the involved lobe and the pattern of its involvement determine the extent of the disease in the early phase, with the size, type, and position of the invasive foci being additional determinants in more advanced cases. Breast carcinomas of limited extent (occupying a tissue area <40 mm) are proper candidates for breast-conserving surgery. In other cases, careful individual preoperative assessment of disease extent is necessary in making decisions about the most appropriate surgical approach, taking into account the position of the lesion(s) within the breast, the dimensions of the breast, and patient preference.
PubMed: 22295230
DOI: 10.4061/2011/634021 -
World Journal of Clinical Cases May 2022Metaplastic breast cancer (MBC) is a rare subtype of breast cancer. They constitute less than 1% of breast cancer cases and are much rarer in males. There are few...
BACKGROUND
Metaplastic breast cancer (MBC) is a rare subtype of breast cancer. They constitute less than 1% of breast cancer cases and are much rarer in males. There are few reports of MBC because of its rarity. MBC, an aggressive type of cancer, is refractory to common treatment modalities of breast cancer and has a poor prognosis.
CASE SUMMARY
We report a case of MBC in a 78-year-old man. He visited our clinic with a palpable mass on the left breast with no masses in the axillary areas. He had previously undergone robot-assisted laparoscopic radical prostatectomy for prostate cancer, but there was no family history of malignancy. The breast mass was visible on ultrasonography, mammography, and magnetic resonance imaging, and chest computed tomography revealed a lung mass in the posterior basal segment of the right lower lobe. The patient was diagnosed with metaplastic carcinoma on core needle biopsy with lung metastasis. Total mastectomy with sentinel lymph node biopsy and video-assisted segmentectomy of the right lung was performed. However, multiple metastases appeared 3 mo after surgery in the brain, chest, and abdomen, and the patient died 5 mo after the initial diagnosis.
CONCLUSION
MBC is an aggressive and extremely rare breast cancer type. Further case reports are needed to determine the optimal treatment.
PubMed: 35801042
DOI: 10.12998/wjcc.v10.i15.4964 -
Romanian Journal of Morphology and... 2021The incidence of brain metastases (BMs) originating in breast cancer (BC) is increasing due to advances in imaging techniques, which can detect such events early, and...
The incidence of brain metastases (BMs) originating in breast cancer (BC) is increasing due to advances in imaging techniques, which can detect such events early, and due to new therapies that can ensure longer survival. We performed a retrospective study on patients with BMs originating in BC and receiving surgical treatment in Neurosurgery Clinics of Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, from January 2018 to December 2019. We identified 10 consecutive patients who underwent a craniotomy for a BMs originating in a BC (either for diagnostic purpose or with therapeutic intent). Clinicopathological data were collected from the electronic medical record and included the patient demographics (age at diagnosis of their BM), morphological characteristics of BM [location, cytopathological features, histopathological (HP) subtype, and immunohistochemical features, i.e., cytokeratin 5∕6 (CK5∕6), mammaglobin, estrogen receptor (ER), progesterone receptor (PR), and Ki67 labeling index (LI)], and time from BC diagnosis to BM diagnosis. Ninety percent of patients were in their sixth and seventh decades of life, with a median age of 57.9 years (47-65 years). Median time from BC diagnosis to BM was 34.42 months. Fifty percent of BMs were located in the parietal lobes, and 70% of all cases have multiple (≥2) BMs. All cases (100%) had a cytopathological examination, showing a hypercellular pattern, with poorly cohesive clusters of mild or pleomorphic cells, with nuclei with homogeneously distributed fine granular chromatin membrane, and with small or enlarged and irregular nucleoli. The dominant histopathology was invasive breast carcinoma of no special type (IBC-NST) (70%), but we also identified specific subtypes, i.e., tubular carcinoma (TC) (20%) and invasive micropapillary carcinoma (IMPC) (10%). Correlating location with HP subtypes of BMs from BC, IBC-NST and IMPC were located mostly in parietal lobes, and TC developed only in the occipital lobe. We found three patterns of immunostaining: (i) CK5∕6 +∕-, mammaglobin+, ER+, PR-, which was much more characteristic for IBC-NST; (ii) CK5∕6-, mammaglobin+, ER-, PR-, being identified in tubular breast carcinoma; (iii) CK5∕6 +∕-, mammaglobin-, ER-, PR-, which were revealed by invasive micropapillary breast carcinoma. Our study revealed the fact that BMs originating in BC show heterogeneity of hormone receptor status, although morphologically there is not so much diversity. We also found a very variable Ki67 LI, which correlated especially with the morphological subtype.
Topics: Brain Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Receptor, ErbB-2; Receptors, Estrogen; Receptors, Progesterone; Retrospective Studies
PubMed: 35024731
DOI: 10.47162/RJME.62.2.09 -
Journal of Cancer Research and... Dec 2022In this case report, we aimed to present the findings of a follicular thyroid carcinoma patient with breast metastasis, which is rarely reported in the literature. A...
In this case report, we aimed to present the findings of a follicular thyroid carcinoma patient with breast metastasis, which is rarely reported in the literature. A 33-year-old female who had been operated for thyroid cancer 17 years ago, but whose pathology report could not be reached was suspected of recurrence in the left lobe region of the thyroid gland. Fine-needle aspiration biopsy was done in this region, and the biopsy result was reported as thyroid follicular carcinoma. F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) was performed for re-staging before surgery. In the PET/CT, it was found that there was residual thyroid tissue in the right and left lobe region and superior to these lesions in the left side, there were lesions which destruct to the hyoid bone, and there were multiple nodular lesions in both lungs which measured with maximum 15 mm × 12 mm, and all these lesions have increased F-FDG uptake. In addition to these lesions, a nodular lesion with the size of ~11 mm ×10 mm in the upper-middle quadrant of the right breast, and it was showing increased F-FDG uptake (maximum standardized uptake value: 3). Pathology results of the left neck region operation materials were reported as papillary and follicular carcinoma of the thyroid gland. Right lumpectomy was performed for the lesion in the right breast during the same session with thyroid operation. The pathology result of this lesion was also reported as metastasis of thyroid follicular cancer. Posttreatment iodine-131 whole-body scan after surgery was reported as there was abnormal accumulation in residual thyroid tissues on the right side of the neck and lung metastases. In patients with thyroid cancer, the possibility of metastasis of the breasts should be considered when there is a lesion in the breast tissue.
Topics: Female; Humans; Adult; Positron Emission Tomography Computed Tomography; Adenocarcinoma, Follicular; Fluorodeoxyglucose F18; Thyroid Neoplasms; Neoplasms, Second Primary; Positron-Emission Tomography; Radiopharmaceuticals; Melanoma, Cutaneous Malignant
PubMed: 36511011
DOI: 10.4103/jcrt.JCRT_957_20 -
Journal of Personalized Medicine Oct 2021Breast cancer is the most common female cancer worldwide, and breast cancer accounts for 30% of female cancers. Of all the treatment modalities, breast cancer survivors...
Breast cancer is the most common female cancer worldwide, and breast cancer accounts for 30% of female cancers. Of all the treatment modalities, breast cancer survivors who have undergone chemotherapy might complain about cognitive impairment during and after cancer treatment. This phenomenon, chemo-brain, is used to describe the alterations in cognitive functions after receiving systemic chemotherapy. Few reports detect the chemotherapy-induced cognitive impairment (CICI) by performing functional MRI (fMRI) and a deep learning analysis. In this study, we recruited 55 postchemotherapy breast cancer survivors (C+ group) and 65 healthy controls (HC group) and extracted mean fractional amplitudes of low-frequency fluctuations (mfALFF) from resting-state fMRI as our input feature. Two state-of-the-art deep learning architectures, ResNet-50 and DenseNet-121, were transformed to 3D, embedded with squeeze and excitation (SE) blocks and then trained to differentiate cerebral alterations based on the effect of chemotherapy. An integrated gradient was applied to visualize the pattern that was recognized by our model. The average performance of SE-ResNet-50 models was an accuracy of 80%, precision of 78% and recall of 70%; on the other hand, the SE-DenseNet-121 model reached identical results with an average of 80% accuracy, 86% precision and 80% recall. The regions with the greatest contributions highlighted by the integrated gradients algorithm for differentiating chemo-brain were the frontal, temporal, parietal and occipital lobe. These regions were consistent with other studies and strongly associated with the default mode and dorsal attention networks. We constructed two volumetric state-of-the-art models and visualized the patterns that are critical for identifying chemo-brains from normal brains. We hope that these results will be helpful in clinically tracking chemo-brain in the future.
PubMed: 34683166
DOI: 10.3390/jpm11101025