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Gland Surgery Apr 2023In the past, it was conventionally thought that multiple ipsilateral breast cancer (MIBC) was a contraindication to breast conservation surgery, especially if... (Review)
Review
BACKGROUND AND OBJECTIVE
In the past, it was conventionally thought that multiple ipsilateral breast cancer (MIBC) was a contraindication to breast conservation surgery, especially if multicentric foci in different quadrants of the breast were present. However, over time, there has been a growing body of evidence in the literature demonstrating no survival detriment or poorer local control with breast conservation for MIBC. There is, however, a paucity of information integrating anatomy, pathology with surgical treatment of MIBC. Understanding mammary anatomy, pathology of the sick lobe hypothesis and molecular impact of field cancerisation contributes significantly to the understanding of the role of surgical treatment of MIBC. The purpose of this narrative overview is to review the paradigm shifts over time in the use of breast conservation treatment (BCT) for MIBC, and how the concepts of the sick lobe hypothesis and field cancerisation interact with this therapeutic strategy. A secondary objective is to explore the feasibility of surgical de-escalation for BCT in the presence of MIBC.
METHODS
A PubMed search was performed for articles relating to BCT, multifocal, multicentric and MIBC. A separate literature search was performed for sick lobe hypothesis and field cancerisation and their interaction for surgical treatment for breast cancer. The available data was then analysed and synergised into a coherent summary of how the molecular and histologic aspects of MIBC interact with surgical therapy.
KEY CONTENT AND FINDINGS
There is a growing body of evidence supporting the use of BCT for MIBC. However, there is scant data connecting the basic science aspects of breast cancer in terms of pathology and genetics to adequacy of surgical extirpation of breast malignancies. This review bridges this gap by demonstrating how information on basic sciences available in contemporary literature can be extrapolated for use in artificial intelligence (AI) systems to assist in BCT for MIBC.
CONCLUSIONS
This narrative review connects several aspects of the surgical treatment for MIBC: historical perspectives of therapy compared with contemporary philosophy based on clinical evidence, anatomy/pathology (sick lobe hypothesis) and molecular findings (field cancerisation) as potential indicators of adequate surgical resection, and how current technology can be used to forge future AI applications in breast cancer surgery. These form the foundation for future research to safely de-escalate surgery for women with MIBC.
PubMed: 37200923
DOI: 10.21037/gs-22-609 -
Gland Surgery Dec 2018Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick... (Review)
Review
Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick lobe hypothesis, which states that cancer arises from genetically unstable cells through mutations acquired in utero, forms the basis of malignant transformation. These 'at risk' cells line the mammary ductal-lobular system of a single 'sick' lobe and when exposed to noxious events in the surrounding microenvironment, further genetic changes occur which completes conversion to malignancy, in certain defined patterns. This review explores how anatomy, pathology and genomics can merge, not only to guide optimum surgery, but also to provide a more comprehensive portal for precision medicine.
PubMed: 30687632
DOI: 10.21037/gs.2018.09.08 -
Journal of Biomedical Physics &... Feb 2021Breast cancer is the most common cancer among women. Considering the fact that a high dose is delivered in a single fraction of IORT, the evaluation of the dose at...
BACKGROUND
Breast cancer is the most common cancer among women. Considering the fact that a high dose is delivered in a single fraction of IORT, the evaluation of the dose at sensitive organs like thyroid is necessary.
OBJECTIVE
The current study has aimed to evaluate the received dose to thyroid lobes in the breast IORT technique.
MATERIAL AND METHODS
A total of 49 women with breast cancer undergoing IORT were enrolled in this cross-sectional study with census sampling. Immediately after tumor resection, a single dose of 20 Gray at the applicator surface was delivered using 50KV X-ray by an Intrabeam machine. The thyroid dose was detected using thermoluminescent detectors (TLD) 100 at the mid-thyroid line, left and right lobes.
RESULTS
The dose at the right and left lobes of the thyroid gland as well as the mid-thyroid line was found to be 40.18±35.44 mGy, 35.50±27.32 mGy, and 40.61±32.47 mGy, respectively. The right lobe received a significantly higher absorbed dose compared to the left lobe when the right breast was under IORT treatment. The same trend was seen with the left lobe and left breast under IORT treatment (P=0.0001 and P=0.018, respectively). The applicator size showed non-significant effects on the absorbed dose at the thyroid gland. Also, the applicator depth had a non-significant inverse effect on thyroid dose.
CONCLUSION
According to our findings, the absorbed dose at each thyroid lobe depends on the under-treatment side as well as the applicator size and depth (applicator upper surface distance from the skin).
PubMed: 33564640
DOI: 10.31661/jbpe.v0i0.2001-1046 -
Journal of Medical Ultrasonics (2001) Jul 2015Breast cancer is a lobar disease in the sense that, at the earliest stages, the cancer is structurally confined to a single sick lobe. The subgross morphology of breast... (Review)
Review
Breast cancer is a lobar disease in the sense that, at the earliest stages, the cancer is structurally confined to a single sick lobe. The subgross morphology of breast carcinoma is often complex, as multiple invasive foci are frequently present and the ductal system often contains an extensive in situ component. Adequate preoperative visualization of all of the malignant structures within the affected breast and preoperative mapping of the lesions in relation to the surrounding normal structures are essential for successful image-guided breast surgery and therefore are key factors in assuring adequate local control of the disease. We advocate use of the lobar approach in ultrasound imaging (ducto-radial echography) and breast-conserving surgery based on the lobar anatomy of the breast, the sick lobe theory, our extensive clinical experience with the approach, and favorable long-term patient outcomes. Despite abundant evidence demonstrating the advantages of the lobar approach, the number of breast centers using it in practice is still limited. In this review, we aim to call attention to the advantages of the lobar approach from the theoretical, imaging, and surgical points of view.
Topics: Breast; Breast Neoplasms; Female; Humans; Ultrasonography, Mammary
PubMed: 26576784
DOI: 10.1007/s10396-015-0625-5 -
International Journal of Surgical... Dec 2019
Topics: Adult; Carcinoma in Situ; Humans; Male; Orchiectomy; Seminoma; Testicular Neoplasms; Testis
PubMed: 30880534
DOI: 10.1177/1066896919835928 -
Medical Science Monitor : International... Aug 2006Although tumor size and grade are well-established prognostic parameters in unselected series or in advanced cases of invasive breast carcinoma, studying their... (Review)
Review
Although tumor size and grade are well-established prognostic parameters in unselected series or in advanced cases of invasive breast carcinoma, studying their prognostic value in small invasive carcinomas has generated variable results. The significance of these parameters was recently questioned in three large studies on invasive carcinomas less than 15 mm in size, in which neither grade nor size were found to be independent prognostic parameters. Two of these studies were carried out on material of our institution and evidenced the outstanding prognostic significance of a radiological parameter (presence of casting type microcalcifications) in these tumors, challenging the traditional approach in breast pathology in which conventional morphologic prognostic parameters are clearly insufficient to explain these results. In the present article we discuss the practical difficulties in measuring and grading invasive breast carcinomas to point out the disturbing lack of wide international consensus considering the optimal assessment of these parameters, contributing to discordant results in the reviewed studies. We also present the unifying concept of the theory of the sick lobe which, by shifting the focus from the debated details of measuring and grading towards the judgement of the pattern of tumoral growth, offers alternative morphologic prognostic parameters which fulfill the needs of a modern interdisciplinary approach to diagnosing small breast carcinomas.
Topics: Breast Neoplasms; Carcinoma, Lobular; Female; Humans; Neoplasm Staging; Prognosis
PubMed: 16865079
DOI: No ID Found -
The British Journal of Radiology Apr 2022The aim of this study is to evaluate feasibility of salvage 4-week hypofractionated whole breast radiotherapy (WBRT) in patients with in-breast recurrence after...
OBJECTIVES
The aim of this study is to evaluate feasibility of salvage 4-week hypofractionated whole breast radiotherapy (WBRT) in patients with in-breast recurrence after receiving intraoperative radiotherapy with electrons (IOERT) for primary breast cancer (BC).
METHODS
BC patients who had repeated quadrantectomy underwent modified WBRT with intensity-modulated radiotherapy using Helical Tomotherapy to underdose the IOERT region. This approach, called POLO (Partially Omitted Lobe), excluded the IOERT volume from receiving the full prescription dose.
RESULTS
Nine patients were treated with this approach, receiving 45 Gy in 20 fractions. A simultaneous integrated boost of 2.5 Gy in 20 fractions was delivered in 6/9 patients. Dose constraints and planning objectives were reported. No severe toxicity was reported while local control and overall survival were 100%.
CONCLUSION
The POLO approach is technically feasible and capable to achieve a significant reduction of radiation dose delivered to the previous treated IOERT area.
ADVANCES IN KNOWLEDGE
The study demonstrates the technical and dosimetric feasibility of conservative salvage whole breast radiotherapy, while sparing the area already treated with IORT, in patients with in-breast recurrence.
Topics: Breast Neoplasms; Electrons; Female; Humans; Mastectomy, Segmental; Radiotherapy Dosage; Radiotherapy, Adjuvant; Radiotherapy, Intensity-Modulated
PubMed: 34919420
DOI: 10.1259/bjr.20210405 -
Acta Radiologica (Stockholm, Sweden :... Jun 2021According to sick lobe theory, one or more lobes of the breast are more prone to the development of carcinoma. However, the implications of this theory in breast...
BACKGROUND
According to sick lobe theory, one or more lobes of the breast are more prone to the development of carcinoma. However, the implications of this theory in breast magnetic resonance imaging (MRI) are unknown.
PURPOSE
To evaluate the MRI appearance of mass type (multifocal and multicentric diseases) and non-mass type (non-mass enhancements) sick lobe patterns, together with the histopathology results.
MATERIAL AND METHODS
MRI reports of 2015 patients in two tertiary breast imaging centers between June 2012 and June 2018 were retrospectively reviewed for multifocal-multicentric diseases and segmental, linear, and regional enhancements. A total of 113 patients were included. The specimens obtained by thick needle, vacuum, excisional biopsy/lumpectomy or mastectomy after breast MRI scans were pathologically assessed. The pathologic results were categorized as invasive carcinoma, precursor, and benign proliferative lesions according to the 2012 World Health Organization Classification of Tumors.
RESULTS
The percentage of underlying benign and precursor invasive lesions was significantly different in patients with mass and non-mass MRI patterns. While the pathology results of mass type patterns were premalignant and malignant in all cases, nearly half of the underlying histologies were benign proliferative subtypes in patients with non-mass type patterns.
CONCLUSION
In this study, the mass and non-mass patterns derived from sick lobe theory were related to different risks of malignancy in the pathological examinations.
Topics: Adult; Aged; Aged, 80 and over; Breast; Breast Neoplasms; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Retrospective Studies; Young Adult
PubMed: 32693609
DOI: 10.1177/0284185120941825 -
Polski Przeglad Chirurgiczny Nov 2019Breast cancer is the most common malignant neoplasm among women. Metastases to the thyroid are relatively rare. Those lesions annunciate neoplasm dissemination in most...
Breast cancer is the most common malignant neoplasm among women. Metastases to the thyroid are relatively rare. Those lesions annunciate neoplasm dissemination in most cases. Metastatic breast cancer of thyroid lobe regrowth hasn't been described yet. In the article the authors present a case of a 66-year old women with isolated, metachronous breast cancer metastasis in regrowth of the right thyroid lobe. Resection of the right lobe with metastatic tumor was performed with a purpose of total recovery. Despite surgery, multiple bone metastases were detected a few months after. In conclusion, regrowth of the thyroid is a potential site of recurrence and metastasis. Therefore, the thyroid bed cannot be omitted in routine examination during and after oncological treatment.
Topics: Aged; Breast Neoplasms; Female; Humans; Risk Factors; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy
PubMed: 32945782
DOI: 10.5604/01.3001.0013.5723 -
Breastfeeding Medicine : the Official... Dec 2009We sought to determine if different mammary lobes produce milk of varying composition. (Comparative Study)
Comparative Study
OBJECTIVE
We sought to determine if different mammary lobes produce milk of varying composition.
STUDY DESIGN
Seventeen mothers were enrolled in this study. Foremilk was obtained from three nipple openings on each breast. After the breastfeeding session, hindmilk was sampled in the same manner. We measured creamatocrit (CrCt) and analyzed the protein concentration. Data were analyzed with the paired t test and Wilcoxon signed-rank sum test where appropriate. Coefficient of variance (COV) was calculated to identify the variation of protein content among different mammary lobes.
RESULTS
The fat and protein contents of the foremilk and hindmilk from each milk duct differed despite being expressed from the same breast. When we compared the CrCt values and protein content obtained from three ducts, a greater than 5% difference between the maximum and minimum value was observed in 64 out of 68 breasts (94%) for CrCt and in 61 out of 68 breasts (91%) for protein content. The mean COV of protein content in each breast was 13.2 +/- 8.0 (range, 1.2-45.3).
CONCLUSIONS
These study results demonstrate that milk synthesis differs in each mammary lobe, even in the same breast. The degree of fullness in each mammary lobe seems to play the most important role in the fat content. The protein content in the milk from each mammary lobe is determined by other factors, presumably by the feedback inhibitor of lactation, accumulated in the corresponding mammary lobe.
Topics: Breast Feeding; Female; Humans; Lactation; Lipids; Mammary Glands, Human; Milk Proteins; Milk, Human
PubMed: 19366313
DOI: 10.1089/bfm.2008.0124