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RESUMO Introdução: O câncer de mama é a segunda neoplasia mais comum entre as mulheres. A constante evolução científica tem permitido abordagens cirúrgicas cada vez menos invasivas, diminuindo a morbidade relacionada ao tratamento sem prejuízo oncológico. O objetivo deste artigo é mostrar os resultados cirúrgicos e a versatilidade da mamoplastia redutora com a técnica de Pitanguy modificada, para otimização da reconstrução imediata associada à cirurgia oncológica. Métodos: Apresentamos os casos de três pacientes submetidas à técnica proposta. A marcação da mama com diagnóstico de câncer é planejada seguindo os princípios da mamoplastia redutora descrita por Pitanguy. Porém, o triângulo de ressecção inferolateral é transposto para a área supratumoral. Ele pode ser posicionado da junção dos quadrantes laterais (JQL) até o quadrante superolateral (QSL) da mama oncológica. Resultados: As três pacientes foram submetidas à técnica descrita associada à mamoplastia de simetrização contralateral com a técnica de Pitanguy. Todas realizaram radioterapia adjuvante, associada ou não à quimioterapia. Duas pacientes evoluíram sem intercorrências e uma apresentou pequena necrose de 1x1cm na junção inferior dos retalhos na mama com câncer, que foi tratada de maneira conservadora sem atrasar o tratamento adjuvante. Todas seguem satisfeitas com o resultado estético. Conclusão: A técnica descrita mostrou-se uma boa alternativa para tumores localizados entre a JQL e o QSL da mama oncológica, proporcionando ressecções mais amplas e dessa forma ampliando a indicação de cirurgia conservadora e reduzindo a necessidade de cirurgia radical, com melhores resultados estéticos sem prejuízo do desfecho oncológico. ABSTRACT Introduction: Breast cancer is the second most common cancer among women. Constant scientific evolution has allowed increasingly less invasive surgical approaches, reducing treatment-related morbidity without cancer damage. The objective of this article is to show the surgical results and the versatility of reduction mammoplasty with the modified Pitanguy technique to optimize the immediate reconstruction associated with cancer surgery. Methods: We present the cases of three patients who underwent the proposed technique. Marking of the breast diagnosed with cancer is planned following the principles of reduction mammoplasty described by Pitanguy. However, the inferolateral resection triangle is transposed into the supratumoral area. It can be placed from the junction of the lateral quadrants (JLQ) to the superolateral quadrant (SLQ) of the oncological breast. Results: the three patients underwent the described technique associated with contralateral symmetrization mammoplasty with the Pitanguy technique. All were submitted to adjuvant radiation therapy, associated or not with chemotherapy. Two patients progressed without incident and one had a small necrosis of 1x1 cm at the flaps lower junction in the breast with cancer, which was treated conservatively without delaying the adjuvant treatment. All were satisfied with the aesthetic result. Conclusion: The described technique proved to be a good alternative for tumors located between the JLQ and the SLQ of the oncological breast. It provides broader resections and thus expands the indication for conservative surgery and reduces the need for radical surgery, with better aesthetic results without impairment of the cancer outcome

Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required. Resumo Objetivo A mastectomia poupadora do complexo areolo-mamilar (MPM) tem sido tradicionalmente utilizada em casos selecionados com distância tumor-mamilo > 2 cm e biópsia de congelação da base do mamilo negativa. Recomendar MPM em populações não selecionadas continua controverso. Este estudo avaliou os resultados oncológicos de pacientes submetidas à MPM em uma população não selecionada atendida em um único centro. Métodos Coorte retrospectivo incluindo pacientes não selecionadas com carcinoma invasivo ou carcinoma ductal in situ (CDIS) submetidas à MPM entre 2010 e 2020. Os desfechos incluíram: recorrência locorregional, sobrevida livre de doença (SLD) e sobrevida global (SG), independentemente do tamanho do tumor ou da distância tumor-mamilo. Resultados Setenta e seis pacientes (média: 46,1 anos de idade) (58 carcinomas invasivos/18 CDIS) foram incluídas. A maioria dos carcinomas invasivos era hormônio-positivo (60%) (superexpressão de HER2: 24%; triplo-negativo: 16%), enquanto 39% dos CDIS eram de alto grau histológico. Os carcinomas invasivos foram T2 em 66% dos casos, com metástases axilares em 38%. As margens cirúrgicas foram todas negativas. Todas as pacientes com carcinoma invasivo receberam tratamento sistêmico e 38% receberam radioterapia. Após um período médio de 34,8 meses, 3 pacientes com carcinoma invasivo (5,1%) e 1 com CDIS (5,5%) apresentaram recidiva local. Durante o acompanhamento, duas pacientes tiveram metástase à distância e vieram a óbito. As taxas de SG e SLD aos 5 anos para carcinoma invasivo foram de 98% e 83%, respectivamente. Conclusão Em casos não selecionados, os resultados oncológicos de 5 anos após MPM foram considerados aceitáveis e comparáveis a resultados anteriores. Estudos adicionais são necessários.

Age is a risk factor for breast cancer in females, and over 60% of female breast cancer deaths occur in those aged 65 and older. As the population in the United States continues to age, it is expected that there will be a commensurate increase in the number of women diagnosed with breast cancer, making understanding of effective treatment and management of breast cancer in the elderly essential. Here, we review the treatment and management of early breast cancer in the elderly. We report a case of invasive mucinous carcinoma in an 80-year-old female detected on routine clinical breast exam by her primary care physician. Mucinous carcinoma of the breast is a type of rare invasive neoplasm that generally carries an excellent prognosis. Following an ultrasound-guided core needle biopsy, a right breast needle localized segmental mastectomy was performed and the patient was prescribed an aromatase inhibitor for hormone-receptor positive tumor. After a follow-up of 8 years, the patient remains free of recurrence or metastasis and vibrantly living meaningful daily life.

We present a case of a 49-year Turkish woman who had synchronous renal leiomyoma and breast cancer. The patient was evaluated for a suspicious breast mass; and renal mass was detected incidentally by contrast-enhanced computed tomography (CT). Diagnostic tru-cut biopsy was performed for both masses. Breast mass biopsy was reported as invasive ductal carcinoma (IDC) while renal biopsy was described as benign mesenchymal tumour. According to the biopsy results, the renal mass was followed for six months. For breast cancer, segmental mastectomy and concomitant sentinel lymph node biopsy was performed. Histologically, the tumour was reported as IDC and low-grade cribriform ductal carcinoma in situ (less than 1%). Six months later, renal mass was excised by laparoscopic approach. Histopathological examination was consistent with renal leiomyoma. For both tumours, no recurrence within one year was found on follow-up. Key Words: Renal leiomyoma, Breast cancer, Laparoscopy.

Objective Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). Methods Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. Results Thepatientswere followedupfor amean time of132months since thefirst surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. Conclusion In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery.We demonstrated that NSMmay be considered after IBTR for patients who did not want to undergo total mastectomy. Resumo Objetivo Há poucos estudos sobre a segurança de se realizar adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) para tratamento de recidiva local. O objetivo deste estudo foi avaliar os resultados de pacientes com indicação para mastectomia que optaram por se submeter a NSM para o tratamento de recorrência local. Métodos Foram analisadas 24 pacientes submetidas a NSM para tratamento de recidiva local após tratamento conservador entre janeiro de 2001 e dezembro de 2018. Resultados As pacientes foramacompanhadas por um períodomédio de 132meses a partir da primeira cirurgia. Após a NSM, 5 (20,8%) pacientes foram diagnosticadas com recorrência local, e apenas 1 paciente foi a óbito. As pacientes apresentaram 4,8% de necrose parcial e 2,4% de necrose total do mamilo. Conclusão Em um longo período de acompanhamento desde a primeira cirurgia, foram observadas baixas taxas de complicação pós-operatória e boa sobrevida, porém, associadas comuma alta taxa de recorrência local em pacientes submetidas a NSM para tratamento de recidiva local após cirurgia conservadora. Neste estudo, demonstrou-se que a NSM pode ser considerada uma opção cirúrgica para pacientes que não querem se submeter a mastectomia total.

Amaç: Primer meme neoplazilerinin %0,3-1’ini oluşturan nadir görülen fibroepitelyal meme tümörü ’dür. Klinik, radyolojik ve histopatolojik olarak fibroadenomlar ile karışırlar. Bu yazıda, filloides meme tümörü nedeni ile tedavi edilen hastalarımızın demografik özellikleri, klinikopatolojik bulguları, takip sonuçları ve uygulanan tedavi yöntemlerinin incelenmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2010-Temmuz 2019 tarihleri arasında tedavi edilen 24 filloides tümör hastasının verileri retrospektif olarak incelendi.Bulgular: Yaş ortalaması 44,1 (20-64) yıl idi. En sık başvuru semptomu hızlı büyüyen kitle idi. Hastalık 12 hastada sağ memede, 2 hastada bilateral idi. Biyopsi yöntemi olarak, 10 hastada tru-cut biyopsi, 13 hastada eksiyonel, 1 hastada insizyonel biyopsi kullanıldı. Eksizyonel biyopsi (n:6), segmental mastektomi(n:11) ve mastektomi (n:7) uygulanan cerrahi prosedürler idi. Ortalama tümör boyutu 64,6 mm(20-220) olarak saptandı. Histopatolojik olarak, 9 benign, 6 borderline ve 9 malign filloides tümör tanısı konuldu. Ortalama takip süresi 18 (6-82)ay idi. Takipte, malign filloides tümörlü 4 hastada lokal nüks, 1 hastada uzak metastaz tespit edildi. 3 hasta kemoterapi ve 2 hasta radyoterapi tedavisi aldı. Sonuç: Filloid tümörler nadir görülen, miks tip meme tümörleridir. Klinik, radyolojik ve histopatolojik olarak meme fibroadenomları ile karışabilmektedir. Uygun cerrahi tedavinin yapılabilmesi için tru-cut biyopsi ile ameliyat öncesi tanının konulması önemlidir. Aksi taktirde re-operasyon ve lokal nüks oranları artmaktadır., Purpose: Phyllodes tumoris a rare fibroepithelial breast tumor that constitutes 0.3-1% of primary breast neoplasms. They are confused with fibroadenomas, clinically, radiologically and histopathologically. In this article, it is aimed to examine the demographic characteristics, clinicopathological findings, follow-up results and treatment methods of our patients treated due tophyllodes tumor.Materials and Methods: The data of 24 phyllodes tumor patients treated between January 2010 and July 2019 were analyzed retrospectively.Results: The average age was 44.1 (20-64) years. The most common symptom was the fast growing mass. The disease was on the right breast in 12 patients and bilateral in 2 patients. As a biopsy method, true-cut biopsy was used in 10 patients, excisional biopsy in 13 patients, and incisional biopsy in 1 patient. Excisional biopsy (n: 6), segmental mastectomy (n: 11) and masectomy (n: 7) were surgical procedures applied. The mean tumor size was determined as 64.6 mm (20-220). Histopathologically, 9 benign, 6 borderline and 9 malignant phyllodes tumors were diagnosed. The mean follow-up was 18 (6-82) months. During follow-up, local recurrence was detected in 4 patients and distant metastasis in 1 patient. 3 patients received chemotherapy and 2 patients received radiotherapy.Conclusion: Phyllodes tumors are rare, mixed-type breast tumors. It can be mixed clinically, radiologically and histopathologically with breast fibroadenomas. It is important to make a preoperative diagnosis with tru-cut biopsy for proper surgical treatment. Otherwise, re-operation and local recurrence rates increase.

Purpose: Radiation recall dermatitis (RRD) is a rare complication that occurs after completion of radiation therapy (RT) and initiation of a precipitating agent, most commonly chemotherapeutic medications. Various theories attempt to explain the mechanism, including activation of the body’s inflammatory pathways through nonimmune activation. Likewise, radiation-induced organizing pneumonia (RIOP) is an infrequent but potentially life-threatening complication of RT that, while not fully understood, is suspected to be partly an autoimmune reaction. Patient: We present the case of a 71-year-old female with a history of type 2 diabetes mellitus, hypothyroidism, interstitial cystitis, and osteoarthritis who presented with clinical stage T1N0M0 ER+/PR–/HER2– invasive ductal carcinoma of the lower outer quadrant of the left breast, for which she underwent left segmental mastectomy and sentinel lymph node biopsy followed by completion axillary lymph node dissection. Her final pathologic stage was T1N1M0. Result: The patient developed RRD and later RIOP following receipt of radiation and chemotherapy, which resolved with steroid administration. Conclusions: The rarity of both RRD and RIOP occurring in a patient, as in our case, suggests a shared pathophysiology behind these two complications. As both reactions involve some degree of inflammation and respond to corticosteroids, it seems likely that the etiologies of RRD and RIOP lie within the inflammatory pathway. However, further investigation should evaluate the frequency, duration, and triggering of concomitant RRD and RIOP.

■ RESUMO Introdução: Como o câncer de mama é a doença maligna mais prevalente em todo o mundo, o tratamento conservador é de extrema importância. No entanto, em muitos casos, a mastectomia continua sendo o procedimento cirúrgico indicado e, como qualquer outra amputação, leva um fardo significativo para essas pacientes. No caso da mastectomia, a reconstrução imediata da mama é o tratamento padrão. A reconstrução aloplástica continua sendo o tipo mais amplamente realizado de reconstrução mamária imediata. Métodos: Neste artigo, os autores apresentam uma série de 105 casos de reconstrução aloplástica imediata em 5 anos de 2015 a 2019 no Centro Hospitalar e Universitário de Coimbra, Portugal. Inclui mastectomias curativas e redutoras de risco realizadas por ginecologistas oncológicos. As opções de reconstrução oferecidas pela equipe de reconstrução plástica incluíram tanto a reconstrução direta no implante quanto a reconstrução em dois estágios com o uso de expansores de tecido. Resultados: Dados sobre a doença oncológica, tipo de mastectomia, critérios de seleção das pacientes e resultados pós-operatórios imediato e tardio com diferentes técnicas de reconstrução imediata foram coletados, analisados e comparados com a literatura. Em nosso estudo, o índice de massa corporal foi o único preditor mais significativo de complicações e seu impacto foi estatisticamente significativo. Conclusão: Os resultados obtidos representam uma etapa essencial para a melhoria da qualidade da assistência à mulher em reconstrução mamária. ■ ABSTRACT Introduction: With breast cancer being the most prevalent malignancy worldwide, conservative treatment is of tremendous importance. Nevertheless, in many cases, mastectomy remains the indicated surgical procedure, and like any other amputation, it carries a significant burden on those patients. In the case of mastectomy, immediate breast reconstruction is the standard of care. Alloplastic reconstruction remains the most widely performed type of immediate breast reconstruction. Methods: In this article, the authors present a series of 105 cases of immediate alloplastic reconstruction in 5 years from 2015 to 2019 in Centro Hospitalar e Universitário de Coimbra, Portugal. It includes curative and risk-reducing mastectomies performed by oncologic gynecologists. The reconstruction options offered by the plastic reconstructive team included both direct-to-implant reconstruction and two-stage reconstruction with the use of tissue expanders. Results: Data regarding the oncologic disease, type of mastectomy, patient selection criteria and immediate and late postoperative outcomes with different techniques of immediate reconstruction were collected, analyzed, and compared to literature. In our study, body mass index was the single most significant predictor of complications and, its impact was statistically significant. Conclusion: The results obtained represent an essential step to improving care quality for women undergoing breast reconstruction.

Introduction: Breast cancer is the second most common malignant neoplasm in women. Surgical intervention is one of the recommended treatments, which can lead to significant physical and sensorial sequelae. Objective: To analyze the musculoskeletal, cardiorespiratory, anthropometric and sensorial functions of women who underwent breast cancer surgery. Methods: An observational, cross-sectional study with women who underwent surgical resection of breast tumors at Amaral Carvalho, a reference hospital in the countryside of the São Paulo State, Jaú/SP, Brazil. Three assessments were obtained: pre-surgery (Ass1), one day after the surgery (Ass2) and 15 days after surgery (Ass3). Sociodemographic and gynecological data were collected, and anthropometric, cardiovascular, dermal sensitivity, range of motion (ROM) of the upper limbs, peripheral oxygen saturation (SpO2), inspiratory muscle strength (PImax), peak expiratory flow (PEF) and thoraco-abdominal mobility assessments were performed. Data were evaluated by repeated measures ANOVA and Wilcoxon statistical test with a Bonferroni correction (p < 0.05). Results: Eighteen women, with a mean age of 57.44 ± 9.35 years, mainly with the left side affected (61.1%) and lymphadenectomy performed in 50% of the cases. Differences were found in systolic and diastolic blood pressure, PEF and SpO2, axillary ROM index (Ass1>Ass2), PImax (Ass3>Ass2), perimetry (Ass2>Ass3), ROM in all axes of shoulder motion and wrist flexion (Ass2Ass2 and Ass1). Conclusion: The surgery for breast cancer excision resulted in hemodynamic and respiratory changes, especially on the first day after the procedure, returning to baseline values approximately 15 days later. Resumo Introdução: O câncer de mama é a segunda neoplasia maligna mais encontrada entre as mulheres, sendo a intervenção cirúrgica um dos tratamentos preconizados, o que pode acarretar sequelas físicas e sensoriais importantes. Objetivo: Analisar as funções musculoes-queléticas, cardiorrespiratórias, antropométricas e sensoriais de mulheres submetidas ao procedimento cirúrgico para neoplasia mamária. Métodos: Estudo observacional e transversal com mulheres que realizaram procedimento cirúrgico para ressecção de neoplasia mamária assistidas no interior paulista, Jaú/SP. Foram realizadas três avaliações: pré-cirurgia (AV1), um dia (AV2) e 15 dias após a cirurgia (AV3). Foram coletadas informações sociodemográficas e ginecológicas e realizadas avaliações antropométrica, cardiovascular, sensibilidade dérmica, amplitude de movimento (ADM) dos membros superiores, saturação periférica de oxigênio (SpO2), força muscular inspiratória (PImax), pico de fluxo expiratório (PFE) e mobilidade toracoabdominal. Os dados foram avaliados pelo teste estatístico ANOVA de medidas repetidas e Wilcoxon com correção de Bonferroni (p < 0,05). Resultados: Dezoito mulheres, de 57,44 ± 9,35 anos, tiveram o lado esquerdo mais acometido (61,1%) e a linfonodectomia foi realizada em 50% dos casos. Houve diferenças nas variáveis pressão arterial sistólica e diastólica, PFE e SpO2, índice de amplitude axilar (AV1>AV2), PImax (AV3>AV2), perimetria (AV2>AV3), ADM em todos os eixos de movimento do ombro e em flexão de punho (AV2AV2 e AV1). Conclusão: A cirurgia para exerese de neoplasia mamária acarretou alterações principalmente hemodinâmicas e respiratórias, sobremaneira no primeiro dia após a cirurgia, retornando aos valores basais aproxi-madamente 15 dias após o procedimento.

Introduction Fibroepithelial lesions of the breast (FEL) are heterogeneous lesions ranging from fibroadenomas (FA) to phyllodes tumors (PT). FEL with cellular stroma are diagnostic challenges on core needle biopsy (CNB) as it is difficult to distinguish cellular FA from PT. The purpose of this study was to determine the features of FEL on CNB that may be predictive of PT, the upstage rate to PT after excision, and the outcomes of those who did not undergo excision. Methods Overall, 305 patients with FEL on CNB between 2009 and 2019 were identified from a prospectively maintained institutional database. Presentation, imaging, and pathology were evaluated. Results Mean age at diagnosis was 43.8 years. Pathology on CNB included 97 cases of FEL favoring FA, 19 cases of FEL favoring PT, 3 cases of FEL versus pseudoangiomatous stromal hyperplasia, and 186 cases of FEL not otherwise specified. Following CNB, 96 (31.5%) patients were observed, 158 (51.8%) patients had an excisional biopsy, 48 (15.7%) patients underwent segmental mastectomy, and 3 (1.0%) patients underwent a mastectomy. The upgrade rate from FEL on CNB to PT upon excision was 25.8%. PT on final pathology was more commonly seen when the CNB identified stromal overgrowth, necrosis, and diagnosis of FEL favoring PT. On multivariable analysis, a final diagnosis of PT was associated with age >50 years, larger tumor size >2 cm, stromal overgrowth, and ≥1 mitoses/10 high power fields (HPF) on CNB. Patients who were observed had smaller tumors compared with those who underwent excision. Conclusion In this 10-year single-institution experience of FEL, the upstage rate to PT was 25.8%. Excision of FEL is recommended. Furthermore, the observation of lesions appeared to be safe in select cases, specifically in patients with smaller tumor size.

Background In addition to conventional breast‐conserving surgery (BCS), oncoplastic breast surgery (OBS) is an operation technique that strives simultaneously to increase oncological safety and patient's satisfaction. It is the combination of the best‐proven techniques in plastic surgery with surgery for breast cancer. In a growing number of indications, OBS overcomes the limit of conventional BCS by allowing larger resection volumes while avoiding deformities. The aim of our retrospective study (2012–2014) was to compare oncological outcomes of OBS versus BCS. Methods We compared two groups of patients with primary non‐metastatic breast tumours: group A (n = 291), where BCS was performed, versus group B (n = 52), where OBS was performed. Surgical interventions were performed in German and Swiss teaching hospital settings. The surgeon for group B had subspecialist training in OBS. We assessed outcome in term of re‐excision rates, resection margin and complications. Results Groups were homogenous (no significant differences in terms of age, tumour size, tumour type or grade). The resection margin was larger in group B (7 mm) than in group A (3 mm). Re‐excision rate of group B (8%) was significantly lower than in group A (31%). Complication rates were comparably low in groups A and B. Conclusion Despite the limits of retrospective design, our study confirms that OBS is safe and reduces the re‐excision rates and the need for further surgery. OBS has the potential to improve oncological care and should be more widely adopted., Oncoplastic breast surgery is oncologically safe, allows large resection volumes, achieving more frequently clear margins. The re‐excision rates are three times lower than with conventional surgery group. The need for additional surgery is drastically reduced.

BACKGROUND Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. METHODS Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. RESULTS Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P

Resumen La enfermedad de Paget mamaria es una neoplasia infrecuente de la mama, muchas veces de difícil diagnóstico y mal pronóstico. El objetivo es revisar los aspectos fundamentales clínicos, diagnósticos, así como los avances más recientes en su tratamiento. Se realizó una búsqueda bibliográfica a través de PUBMED, GOOGLE SCHOLAR y UPTODATE, de los últimos 20 años. Fueron seleccionados e incluidos en la revisión 38 artículos. La enfermedad de Paget mamaria es una neoplasia maligna infrecuente del complejo areola pezón de características inflamatorias al examen físico, asociado en un 85% de los casos a un cáncer de mama subyacente, en el 50% de los casos no identificable al examen físico, de difícil diagnóstico, cuya sospecha clínica se confirma con imágenes, biopsia e inmunohistoquímica. El tratamiento es mastectomía versus cirugía conservadora y radioterapia. Un mal enfoque clínico, retrasa el diagnóstico y empeora la sobrevida. MÉD.UIS.2021;34(1): 45-53. Abstract Paget’s disease of the breast is an uncommon neoplasm of the breast, many times difficult to diagnose and of poor prognosis. The objective is to review the fundamental clinical and diagnostic aspects, as well as the most recent advances in its treatment. A bibliographic search of the last 20 years was carried out through PUBMED, GOOGLE SCHOLAR and UPTODATE. 38 articles were selected and included in the review. Mammary paget disease is a rare malignant neoplasm of the nipple areola complex with inflammatory features on physical examination, associated in 85% of cases with underlying breast cancer, in 50% of cases not recognizable on physical exam, difficult to diagnose, whose clinical suspicion is confirmed by imaging, biopsy and immunohistochemistry. Treatment is mastectomy versus conservative surgery and radiotherapy. A poor clinical approach delays the diagnosis and worsens survival rate. MÉD.UIS.2021;34(1): 45-53.

PAST and PRESENT TRENDS in the MANAGEMENT of the PATIENT WITH BREAST CANCER. Organizing for Collaborative Management: What are the Options? Management of Primary Breast Cancer: A Biologic and Therapeutic Review. Coping with Breast Cancer: What Health Professionals Can Do to Help. Payments for Breast Cancer During 1985: The Michigan Blue Cross/Blue Shield Experience. Legal Requirements of Informed Consent for Treatment of Breast Cancer: Telling It All. Epidemiology of Breast Cancer. DIAGNOSIS and DECISION MAKING. Evaluation of Breast Masses. Mammography: Changing Role and Concepts. Fine Needle Aspiration: The New Diagnostic Technique? Technique of Segmental Mastectomy: The National Surgical Adjuvant Breast Project (NSABP) Experience. The Changing Role of the Pathologist in the Diagnosis of Breast Lesions. MANAGEMENT of the PATIENT WITH BREAST CANCER. The Surgeon's Role in the Management of the Patient with Breast Cancer. The Treatment of Breast Cancer with Excision Followed by Radiation Therapy. Contemporary Chemotherapy. Breast Reconstruction. Management Dilemmas: The Contralateral Breast and the Role of Prophylactic Mastectomy. Dilemmas in Breast Cancer: Occult Carcinoma and Paget's Disease of the Breast. Breast Cancer Management in Pregnancy and Young Women. New Horizons in the Treatment of Breast Cancer. PSYCHOSOCIAL ISSUES and WELLNESS. Multidisciplinary Breast Care Center: Experience at The University of Michigan. Women's Experience of Choice: Confronting the Options for Treatment of Breast Cancer. Coping with Breast Cancer: Psychological Interventions and Skills. Rehabilitation. Diet and Exercise in the Management of the Patient with Breast Cancer. Nursing Management of the Patient with Breast Cancer. Social Work with the Breast Cancer Patient. Update on the Psychosocial Issues of Breast Cancer Treatments.

Paraneoplastic neurologic syndromes (PNS) are a group of disorders characterized by an autoimmune response against the nervous system due to cross-reactivity between malignant and normal neural tissue. The most commonly associated malignancies include small cell lung cancer, ovarian cancer, breast cancer, and lymphoma. Multiple PNS have been reported including paraneoplastic cerebellar degeneration, retinopathy, sensorimotor peripheral neuropathy, encephalopathy, opsoclonus-myoclonus syndrome, and stiff-person syndrome. We report a case of a 67-year-old woman with breast cancer who presented with a history of progressive oropharyngeal dysphagia as a paraneoplastic neurologic complication. She was diagnosed with invasive ductal carcinoma, nuclear grade 3 with moderate peritumoral lymphoid infiltrate. Hormone receptors were weakly positive for estrogen receptor (ER) (H score 15), weakly positive for progesterone receptor (PR) (H score 30), and negative for human epidermal growth factor receptor 2 (HER-2/NEU). The patient underwent a localized segmental mastectomy but declined any further adjuvant treatment. Three years after being diagnosed with invasive ductal carcinoma of the breast, she developed progressive oropharyngeal dysphagia that warranted percutaneous endoscopic gastrostomy (PEG) tube placement. Testing for onconeural antibodies was positive for voltage-gated calcium channel antibody. An extensive workup was negative for any alternative etiology that would explain her neurological symptoms. The patient declined further treatment and eventually succumbed to her illness.

PURPOSE: To evaluate the acceptability and impact of 3D printed breast models (3D-BM) on treatment-related decisional conflict (DC) of breast cancer patients. METHODS: Patients with breast cancer were accrued in a prospective IRB-approved trial. All patients underwent contrast-enhanced breast MRI (MRI). A personalized 3D-BM was derived from MRI. DC was evaluated pre and post 3D-BM review. 3D-BM acceptability was assessed post 3D-BM review. RESULTS: DC surveys before and after 3D-BM review and 3D-BM acceptability surveys were completed by 25 patients. 3D-BM were generated in 2 patients with bilateral breast cancer. The mean patient age was 48.8 years (28–72). Tumor stage was Tis (7), 1 (8), 2 (8) and 3 (4). Nodal staging was 0 (19), 1 (7), 3 (1). Tumors were unifocal (15), multifocal (8) or multicentric (4). Patients underwent mastectomy (13) and segmental mastectomy (14) with (20) or without (7) oncoplastic intervention. Neoadjuvant therapy was given to 7 patients. Patients rated the acceptability of the 3D-BM as good/excellent in understanding their condition (24/24), understanding disease size (25/25), 3D-BM detail (22/25), understanding their surgical options (24/25), encouraging to ask questions (23/25), 3D-BM size (24/25) and impartial to surgical options (17/24). There was significant reduction in overall DC post 3D-BM review, indicating patients became more assured of their treatment choice (p=0.002). Reduction post 3D-BM review was also observed in the uncertainty (p=0.012), feeling informed about options (p=.005), clarity about values (p=0.032) and effective (p=0.002) DCS subscales. CONCLUSIONS: 3D-BMs are an acceptable tool to decrease decisional conflict in breast cancer patients. CLINICAL RELEVANCE: Breast cancer patients may experience decisional conflict when considering their surgical options. 3D-BM are an acceptable, impartial tool that reduces decisional conflict in patients with breast cancer.

Purpose To perform a planned interim analysis of acute (within 12 months) and late (after 12 months) toxicities and cosmetic outcomes after proton accelerated partial breast irradiation (APBI). Methods and Materials A total of 100 patients with pTis or pT1-2 N0 (≤3cm) breast cancer status after segmental mastectomy were enrolled in a single-arm phase 2 study from 2010 to 2019. The clinically determined postlumpectomy target volume, including tumor bed surgical clips and operative-cavity soft-tissue changes seen on imaging plus a radial clinical expansion, was irradiated with passively scattered proton APBI (34 Gy in 10 fractions delivered twice daily with a minimum 6-hour interfraction interval). Patients were evaluated at protocol-specific time intervals for recurrence, physician reports of cosmetic outcomes and toxicities, and patient reports of cosmetic outcomes and satisfaction with the treatment or experience. Results Median follow-up was 24 months (interquartile range [IQR], 12-43 months). Local control and overall survival were 100% at 12 and 24 months. There were no acute or late toxicities of grade 3 or higher; no patients experienced fat necrosis, fibrosis, infection, or breast shrinkage. Excellent or good cosmesis at 12 months was reported by 91% of patients and 94% of physicians; at the most recent follow-up, these were 94% and 87%, respectively. The most commonly reported late cosmetic effect was telangiectasis (17%). The total patient satisfaction rate for treatment and results at 12 and 24 months was 96% and 100%, respectively. Patients’ mean time away from work was 5 days (IQR, 2-5 days), and the median out-of-pocket cost was $700 (IQR, $100-$1600). The mean left-sided heart dose was 2 cGy (range, 0.2-75 cGy), and the mean ipsilateral lung dose was 19 cGy (range, 0.2-164 cGy). Conclusions Proton APBI is a maturing treatment option with high local control, favorable intermediate-term cosmesis, high treatment satisfaction, low treatment burden, and exceptional heart and lung sparing.

Effective intraoperative tumor margin assessment is needed to reduce re-excision rates in breast-conserving surgery (BCS). Mapping the attenuation coefficient in optical coherence tomography (OCT) throughout a sample to create an image (attenuation imaging) is one promising approach. For the first time, three-dimensional OCT attenuation imaging of human breast tissue microarchitecture using a wide-field (up to ~45 × 45 × 3.5 mm) imaging system is demonstrated. Representative results from three mastectomy and one BCS specimen (from 31 specimens) are presented with co-registered postoperative histology. Attenuation imaging is shown to provide substantially improved contrast over OCT, delineating nuanced features within tumors (including necrosis and variations in tumor cell density and growth patterns) and benign features (such as sclerosing adenosis). Additionally, quantitative micro-elastography (QME) images presented alongside OCT and attenuation images show that these techniques provide complementary contrast, suggesting that multimodal imaging could increase tissue identification accuracy and potentially improve tumor margin assessment.

Introduction: Breast cancer is the most common malignant tumour and the second cause of death among women in Poland following lung cancer. Its therapy includes a number of procedures, including surgical treatment, the choice of which depends, among others, on the histological form of the cancer and disease severity. In recent years, radical surgical techniques have been replaced by conserving ones, and in the context of routine resection of the axillary lymph nodes (lymphadenectomy), biopsy was introduced, i.e. sentinel lymph node biopsy (SNB). Also, wide access to reconstructive treatments carried out with various techniques, using patients’ own tissues or artificial materials (breast implants) have been applied. Study aim: The aim of the work is to present the current state of knowledge on the principles of breast cancer treatment and its undesirable consequences, as well as the selection of physiotherapeutic methods depending on the type of upper limb dysfunction as a result of the performed surgery. Research materials: The research materials consist of patients treated using various surgical and oncological methods as well as physiotherapeutic procedures at the Holy Cross Oncology Centre in Kielce, from 2014 to 2016. The written consent of the Clinic Chief and patients for the publication of their image was obtained. The authors of the work do not indicate any conflict of interest. Research Methods: The research methodology was based on the presentation of selected patients treated using various oncological and surgical methods for breast cancer treatment, as well as characterization of the physiotherapeutic methods necessary in restoring expected functional upper limb status in these patients. Conclusions: Modern methods used in breast cancer treatment should be conditioned by good cooperation of an entire team of specialists from various clinical areas and physiotherapists. The purpose of this procedure is to cure the patient, minimize the occurrence of complications and adverse side effects, and restore functional capacity. An integral part of such breast cancer treatment patients is, among others, their effective rehabilitation.