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The deregulation of monounsaturated, polyunsaturated, and saturated fatty acids (MUFAs, PUFAs, SFAs) from de novo synthesis and hypoxia are central metabolic features of breast tumour. Early response markers for neoadjuvant chemotherapy (NACT) are critical for stratified treatment for patients with breast cancer, and restoration of lipid metabolism and normoxia might precede observable structural change. In this study, we hypothesised that peri-tumoural lipid composition and hypoxia might be predictive and early response markers in patients with breast cancer undergoing NACT. Female patients with breast cancer were scanned on a 3T clinical MRI scanner at baseline and Cycle1, with acquisition of lipid composition maps of MUFAs, PUFAs, and SFAs, and hypoxia maps of effective transverse relaxation rate R2*. The percentage change in lipid composition and hypoxia at Cycle1 was calculated with reference to baseline. Tumour-associated macrophages were analysed based on immunostaining of CD163 from biopsy and resection, with the percentage change in the resected tumour calculated across the entire NACT. We found no significant difference in lipid composition and R2* between good and poor responders at baseline and Cycle1; however, the correlation between the percentage change in MUFAs and PUFAs against CD163 suggested the modulation in lipids with altered immune response might support the development of targeted therapies. [ABSTRACT FROM AUTHOR]

Deregulation of lipid composition in adipose tissue adjacent to breast tumour is observed in ex vivo and animal models. Novel non-invasive magnetic resonance imaging (MRI) allows rapid lipid mapping of the human whole breast. We set out to elucidate the spatial heterogeneity of peri-tumoural lipid composition in postmenopausal patients with oestrogen receptor positive (ER +) breast cancer. Thirteen participants (mean age, 62 ± [SD] 6 years) with ER + breast cancer and 13 age-matched postmenopausal healthy controls were scanned on MRI. The number of double bonds in triglycerides was computed from MRI images to derive lipid composition maps of monounsaturated, polyunsaturated, and saturated fatty acids (MUFA, PUFA, SFA). The spatial heterogeneity measures (mean, median, skewness, entropy and kurtosis) of lipid composition in the peri-tumoural region and the whole breast of participants and in the whole breast of controls were computed. The Ki-67 proliferative activity marker and CD163 antibody on tumour-associated macrophages were assessed histologically. Mann Whitney U or Wilcoxon tests and Spearman's coefficients were used to assess group differences and correlations, respectively. For comparison against the whole breast in participants, peri-tumoural MUFA had a lower mean (median (IQR), 0.40 (0.02), p <.001), lower median (0.42 (0.02), p <.001), a negative skewness with lower magnitude (− 1.65 (0.77), p =.001), higher entropy (4.35 (0.64), p =.007) and lower kurtosis (5.13 (3.99), p =.001). Peri-tumoural PUFA had a lower mean (p <.001), lower median (p <.001), a positive skewness with higher magnitude (p =.005) and lower entropy (p =.002). Peri-tumoural SFA had a higher mean (p <.001), higher median (p <.001), a positive skewness with lower magnitude (p <.001) and lower entropy (p =.012). For comparison against the whole breast in controls, peri-tumoural MUFA had a negative skewness with lower magnitude (p =.01) and lower kurtosis (p =.009), however there was no difference in PUFA or SFA. CD163 moderately correlated with peri-tumoural MUFA skewness (rs = −.64), PUFA entropy (rs =.63) and SFA skewness (rs =.59). There was a lower MUFA and PUFA while a higher SFA, and a higher heterogeneity of MUFA while a lower heterogeneity of PUFA and SFA, in the peri-tumoural region in comparison with the whole breast tissue. The degree of lipid deregulation was associated with inflammation as indicated by CD163 antibody on macrophages, serving as potential marker for early diagnosis and response to therapy. [ABSTRACT FROM AUTHOR]

A national cohort ideal stage 2a/2b study comparing the safety and effectiveness of Wire- and RFID -guided localisation for impalpable breast lesions. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer worldwide, with remarkable advances in early diagnosis, systemic treatments, and surgical techniques. Robotic nipple-sparing mastectomy has been trialled; however, the complication rates, surgical outcomes, and oncological safety of this approach remain obscure. Methods: A systematic search of the literature was conducted from conception until September 2022. Studies examining complications and operative variables where robotic nipple-sparing mastectomy was compared with conventional nipple-sparing mastectomy were included. Primary study outcomes were complications (Clavien–Dindo grade III complications, skin or nipple necrosis, seroma, haematoma, infection, implant loss, and wound dehiscence) and oncological safety (recurrence and positive margins). The secondary outcomes included operative variables, length of stay, cost-effectiveness, learning curve, and aesthetic outcome. Results: A total of seven studies of overall fair quality, involving 1674 patients, were included in the systematic review and meta-analysis. Grade 3 complications were reduced in robotic nipple-sparing mastectomy without statistical significance (OR 0.60 (95 per cent c.i. 0.35 to 1.05)). Nipple necrosis was significantly reduced in robotic nipple-sparing mastectomy (OR 0.54 (95 per cent c.i. 0.30 to 0.96); P = 0.03; I2 = 15 per cent). Operating time (mean difference +58.81 min (95 per cent c.i. +28.19 to +89.44 min); P = 0.0002) and length of stay (mean difference +1.23 days (95 per cent c.i. +0.64 to +1.81 days); P < 0.0001) were significantly increased in robotic nipple-sparing mastectomy, whereas the opposite was true for blood loss (mean difference −53.18 ml (95 per cent c.i. −71.78 to −34.58 ml); P < 0.0001). Conclusion: Whilst still in its infancy, robotic breast surgery may become a viable option in breast surgery. Nonetheless, the oncological safety of this approach requires robust assessment. A total of seven studies of overall fair quality, involving 1674 patients, examining postoperative complications and operative variables that compared robotic nipple-sparing mastectomy versus conventional nipple-sparing mastectomy for breast cancer were included in this systematic review and meta-analysis. Overall, complication events were notably reduced in robotic nipple-sparing mastectomy, albeit not reaching statistical significance, namely grade 3 complications, re-operation, skin necrosis, seroma, and haematoma; however, postoperative infection, implant loss, and positive margins were increased in robotic nipple-sparing mastectomy. Although associated with a higher cost, a steep learning curve and patient-reported outcome measures favour robotic nipple-sparing mastectomy. Lay Summary: Robotic nipple-sparing mastectomy has been tried, but it is still not clear how often complications happen or how much better it is for cancer patients than conventional nipple-sparing mastectomy. The aim of this study was to compare robotic nipple-sparing mastectomy with conventional nipple-sparing mastectomy. A thorough search of all articles was performed from the start to September 2022. The studies that compared robotic nipple-sparing mastectomy with conventional nipple-sparing mastectomy in terms of problems and surgical factors were included. Complications and cancer outcomes (recurrence and positive margins) were the most important things that the study looked at. Surgical time, blood loss, length of hospital stay, cost-effectiveness, learning curve, and patient-reported outcome measures were some of the other things that were studied. This systematic review and meta-analysis looked at seven studies with fair quality and included 1674 patients. Even though there were fewer major problems with robotic nipple-sparing mastectomy, the difference was not significant. In robotic nipple-sparing mastectomy, there was less nipple necrosis, but the overall time it took to operate was much longer and the cost was higher. The average amount of bleeding was less in robotic nipple-sparing mastectomy. The robotic nipple-sparing mastectomy method had a better patient-reported outcome and a steep learning curve. Robotic nipple-sparing mastectomy is a safe method, with fewer problems than other methods. Future studies should look into if it is safe for cancer patients in the long run. [ABSTRACT FROM AUTHOR]

Background: This prospective feasibility study explores Field-Cycling Imaging (FCI), a new MRI technology that measures the longitudinal relaxation time across a range of low magnetic field strengths, providing additional information about the molecular properties of tissues. This study aims to assess the performance of FCI and investigate new quantitative biomarkers at low fields within the context of breast cancer., Methods: We conducted a study involving 9 people living with breast cancer (10 tumours in total, mean age, 54 ± 10 years). FCI images were obtained at four magnetic field strengths (2.3 mT to 200 mT). FCI images were processed to generate T1 maps and 1/T1 dispersion profiles from regions of tumour, normal adipose tissue, and glandular tissue. The dispersion profiles were subsequently fitted using a power law model. Statistical analysis focused on comparing potential FCI biomarkers using a Mann-Whitney U or Wilcoxon signed rank test., Results: We show that low magnetic fields clearly differentiate tumours from adipose and glandular tissues without contrast agents, particularly at 22 mT (1/T 1 , median [IQR]: 6.8 [3.9-7.8] s -1 vs 9.1 [8.9-10.2] s -1 vs 8.1 [6.2-9.2] s -1 , P < 0.01), where the tumour-to-background contrast ratio was highest (62%). Additionally, 1/T 1 dispersion indicated a potential to discriminate invasive from non-invasive cancers (median [IQR]: 0.05 [0.03-0.09] vs 0.19 [0.09-0.26], P = 0.038)., Conclusions: To the best of our knowledge, we described the first application of in vivo FCI in breast cancer, demonstrating relevant biomarkers that could complement diagnosis of current imaging modalities, non-invasively and without contrast agents., (© 2024. The Author(s).)

Residual microcalcifications on mammograms after neoadjuvant chemotherapy (NACT) pose a challenge in surgical decision-making. This single-centre retrospective review of all patients who had NACT for breast cancer over five years, evaluated the relationship between pathological complete response and residual microcalcifications, controlling for tumour size, nodal stage, grade, and receptor status, as well as the impact of residual microcalcifications on recurrence and survival. There was no significant association between pathological complete response (pCR) and residual microcalcifications (p = 0.763). We computed hazard ratios (HR) for Time to recurrence (TTR) and overall survival (OS) which were both not significant, with HR = 2.599, [0.290, 23.264], p = 0.393 and HR = 1.362 [0.123, 15.062], p = 0.801 respectively. The predictive and prognostic significance of residual microcalcifications remains to be proven. The surgical excision of these lesions should be considered based on individual patient risk., Competing Interests: Declaration of competing interest No relevant competing interests., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)