scholarly journals Breast-conserving surgery with 3D-printed surgical guide: a single-center, prospective clinical study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhen-Yu Wu ◽  
Hee Jeong Kim ◽  
Jongwon Lee ◽  
Il Yong Chung ◽  
Jisun Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Ductal Carcinoma ◽  
Bilateral Breast Cancer ◽  
Tumor Resection ◽  
Breast Conserving Surgery ◽  
Patient Specific ◽  
Prospective Clinical Study ◽  
Surgical Guide ◽  
The Mean

AbstractTo facilitate precise tumor resection at the time of breast-conserving surgery (BCS), we developed and implemented a magnetic resonance imaging (MRI)-based three-dimensional-printed (3DP) breast surgical guide (BSG). This prospective cohort study was conducted at a single institution from July 2017 to February 2019 on women with breast cancer who underwent partial breast resection using patient-specific 3DP BSGs. Eighty-eight patients with invasive cancer were enrolled, of whom 1 patient had bilateral breast cancer. The mean size of the tumor long-axis on MRI before surgery was 2.8 ± 0.9 cm, and multiple tumors were observed in 34 patients. In 16 cases (18.0%), the resection margin was tumor-positive according to intraoperative frozen biopsy; all of these tumors were ductal carcinoma in situ and were re-excised intraoperatively. In 93.3% of the cases, the resection margin was tumor-free in the permanent pathology. The mean pathological tumor size was 1.7 ± 1.0 cm, and the mean distance from the tumor to the border was 1.5 ± 1.0 cm. This exploratory study showed that the tumor area on the MRI could be directly displayed on the breast when using a 3DP BSG for BCS, thereby allowing precise surgery and safe tumor removal.Trial Registration Clinical Research Information Service (CRIS) Identifier (No. KCT0002375, KCT0003043).

scholarly journals Magnetic resonance imaging based 3-dimensional printed breast surgical guide for breast-conserving surgery in ductal carcinoma in situ: a clinical trial

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhen-Yu Wu ◽  
Aisha Alzuhair ◽  
Heejeong Kim ◽  
Jong Won Lee ◽  
Il Yong Chung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Resonance Imaging ◽  
Surgical Guide

Abstract Breast-conserving surgery (BCS) is performed in patients with ductal carcinoma in situ (DCIS) because of the small size of the tumor. It is essential to know the quantitative extent of the tumor before performing this precise partial resection surgery. A three-dimensional printed (3DP) breast surgical guide (BSG) was developed using information obtained from supine magnetic resonance imaging (MRI) and 3D printing technology and it was used for treating patients with breast cancer. Here, we report our experience with the application of the BSG for patients with DCIS. Patients with breast cancer who underwent BCS from July 2017 to February 2019 were included in this study. The patients underwent partial resection with a supine-MRI based 3DP-BSG. A total of 102 BCS using 3DP-BSG were conducted, and 11 cases were DCIS. The patients’ median age was 56 years (range, 38–69 years). The mean tumor diameter was 1.3 ± 0.9 cm. The median surgical time was 70 min (range, 40–88 min). All patients had tumor-free resection margins. The median distance from the tumor to the margin was 11 mm (range, 2–35 mm). Direct demarcation of the tumor extent in the breast and a pain-free procedure are the advantages of using 3DP-BSG in patients with DCIS. Trial registration: Clinical Research Information Service (CRIS) Identifier Number: KCT0002375, KCT0003043.

scholarly journals Clinical efficacy of intraoperative ultrasound for margin assessment in breast conserving surgery

2020 ◽  
Author(s):  
Jeeyeon Lee ◽  
Ho Yong Park ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Yungeun Ji ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Frozen Section ◽  
Intraoperative Ultrasound ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Clinicopathologic Characteristics ◽  
Tumor Margin ◽  
The Mean

Abstract Background: Surgical margin negativity is highly related to local recurrence of breast cancer. The authors performed this study to evaluate if specimen mammography or ultrasonography can replace the frozen section procedure for surgical margins. Methods: One-hundred fifty five patients with breast cancer were included in this study. After the surgery, the frozen biopsies were assessed in more than three different directions, and all specimens were analyzed with mammography and ultrasonography. The clinicopathologic characteristics of the patients were assessed, and closest tumor margin–resection margin distance (TM–RM distance) to the tumor was compared among specimen mammography, ultrasonography, and pathology. Results: On comparing initial cases of positive and negative margins, the mean closest TM–RM distance in specimen ultrasonography and final pathologic reports was statistically different between both groups (DCIS: p < 0.001, p = 0.006; IDC: p = 0.042, p = 0.022). Conclusion: When the closest TM–RM distance is less than 1.8 mm in specimen ultrasonography, the frozen section cannot be waived because of high risk of margin positivity. However, if the closest TM–RM distance is >4 mm in specimen ultrasonography, the frozen section can be omitted carefully because of the very low risk of margin positivity.

Harmonic scalpel versus traditional ligation in axillary dissection for breast cancer: a retrospective multivariate analysis

2020 ◽  
Vol 99 (11) ◽  
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Harmonic Scalpel ◽  
Breast Conserving Surgery ◽  
Seroma Formation ◽  
Nodal Involvement ◽  
Single Centre ◽  
Absorbable Material ◽  
Drain Removal ◽  
The Mean

Introduction: The aim of this pilot retrospective study is to evaluate the complication rate in patients after axillary dissection comparing preparation with harmonic scalpel vs traditional ligation technique, and to analyse risk factors for complications occurrence. Methods: 144 patients with 148 axillary dissections operated in a single centre between January 2014 and 2019 were included into the study. Axillary dissection was performed using harmonic scalpel in 73 and absorbable ligations in 70 cases. Results: Seroma formation was observed in 41 patients (56.2%) in the harmonic scalpel group and in 21 patients (30.0%) in the ligations group (p=0.003). The mean period from the surgery to drain removal was 4.0 days in the harmonic scalpel group and 3.0 days in the ligations group (p<0.001). The mean amount of the drained fluid after mastectomy was 300.9 ml in the harmonic scalpel group and 168.7 ml in the ligations group (p=0.005); after breast conserving surgery, it was 241.9 ml and 107.4 ml, respectively (p =0.023). Conclusion: In comparison with traditional ligations with absorbable material, axillary dissection using harmonic scalpel significantly increases the risk of postoperative seroma formation, prolongs the time from the surgery to drain removal, and increases the amount of drained fluid.ut any suspicion of nodal involvement, hemithyroidectomy is considered to be a sufficient procedure or the method of choice, respectively.

scholarly journals The Utilization of Physics Parameter to Classify Histopathology Types of Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC) by using K-Nearest Neighbourhood (KNN) Method

2018 ◽  
Vol 8 (4) ◽  
pp. 2442
Author(s):  
Anak Agung Ngurah Gunawan ◽  
I Wayan Supardi ◽  
S. Poniman ◽  
Bagus G. Dharmawan
Keyword(s):  
Breast Cancer ◽  
Invasive Ductal Carcinoma ◽  
Invasive Lobular Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Diagnose Breast Cancer ◽  
Object Based ◽  
Computer Aided ◽  
The Mean ◽  
Learning Data

<p>Medical imaging process has evolved since 1996 until now. The forming of Computer Aided Diagnostic (CAD) is very helpful to the radiologists to diagnose breast cancer. KNN method is a method to do classification toward the object based on the learning data which the range is nearest to the object. We analysed two types of cancers IDC dan ILC. 10 parameters were observed in 1-10 pixels distance in 145 IDC dan 7 ILC. We found that the Mean of Hm(yd,d) at 1-5 pixeis the only significant parameters that distingguish IDC and ILC. This parameter at 1-5 pixels should be applied in KNN method. This finding need to be tested in diffrerent areas before it will be applied in cancer diagnostic.</p>

scholarly journals Treatment planning comparison of volumetric modulated arc therapy with Trilogy and Halcyon for bilateral breast cancer

2021 ◽  
Author(s):  
Tao Sun ◽  
Xiutong Lin ◽  
Guifang Zhang ◽  
Qingtao Qiu ◽  
Chengqiang Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Planning ◽  
Volumetric Modulated Arc Therapy ◽  
Bilateral Breast Cancer ◽  
Planning System ◽  
Skin Dose ◽  
Delivery Time ◽  
Dose Volume ◽  
Arc Therapy ◽  
The Mean

Abstract Background: The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods: On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann-Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results:Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p<0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion: For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

scholarly journals Breast Cancer in Men: Clinical and Pathological Analysis of 817 Cases

2020 ◽  
Vol 14 (4) ◽  
pp. 155798832090810
Author(s):  
Fernanda Servidoni Spreafico ◽  
Cassio Cardoso-Filho ◽  
Cesar Cabello ◽  
Luis Otávio Sarian ◽  
Luiz Carlos Zeferino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Prevalence Ratio ◽  
Breast Cancer Diagnosis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Histological Types ◽  
The Mean ◽  
Breast Cancer In Men

The objective of the current study was to describe breast cancer cases in men according to age, stage, and histology, calculating risks compared to women. It is a retrospective cross-sectional study of all breast cancer cases of the Hospital Cancer Registry of São Paulo state, Brazil, 2000–2015. Variables were age, sex, stage, and histology. Absolute numbers and proportions, Mann–Whitney test and prevalence ratio with 95% confidence interval were used. The study included 93,737 cases, of which 817 were males. The mean age at diagnosis was 60.3 years in men and 56.2 years in women ( p < .001). Stage II was the most common in both sexes (33.9% in men and 36.5% in women). Men had a higher frequency of stage III than women (PR 1.18, 95% CI 1.01–1.37). Stage 0 was significantly more common in women (PR 0.69, 95% CI 0.51–0.94). Ductal carcinoma and its variants were the most common histological types in both sexes (88.7% in men and 89.0% in women). Men had a higher frequency of rarer histological types such as papillary (PR 2.17, 95% CI 1.36–3.44) and sarcomas (PR 4.10, 95% CI 1.86–9.01). In conclusion, in men, breast cancer diagnosis occurred in more advanced ages and stages. Invasive ductal carcinoma was the primary histological type observed, although rarer types were more frequent.

Male Breast Cancer: 13-Year Single Institution Experience

2020 ◽  
Vol 86 (10) ◽  
pp. 1345-1350
Author(s):  
Marissa K. Srour ◽  
Farin Amersi ◽  
James Mirocha ◽  
Armando E. Giuliano ◽  
Alice Chung
Keyword(s):  
Breast Cancer ◽  
Male Breast Cancer ◽  
Ductal Carcinoma ◽  
Disease Free Survival ◽  
Recurrence Score ◽  
Breast Conserving Surgery ◽  
Male Breast ◽  
Brca Mutations ◽  
Estrogen Receptor Positive ◽  
Stage 1

Due to the low incidence of male breast cancer (BC), there are few studies evaluating outcomes. We evaluated the clinicopathologic features and outcomes of male BC. Male patients with BC from January 2006 to December 2018 were identified. Of 49 patients, mean age was 64 (range 33-94) years. Of the 27 (55.1%) patients who had genetic testing, 9 (33.3%) had a Breast Cancer gene (BRCA) 1 or 2 mutation. The majority of patients had a mastectomy (n = 43/49, 87.8%) and had invasive ductal carcinoma (n = 47/49, 95.9%). 20 patients (n = 20/43, 46.5%) had positive lymph nodes. 41 (n = 41/47, 87.2%) patients had estrogen receptor positive disease. The majority of patients were pathologic stage 2 (n = 21/46, 45.7%), followed by stage 1 (n = 15/46, 32.6%), stage 3 (n = 6/46, 13.0%), and stage 4 (n = 4/46, 8.7%). Eight patients had the 21-gene recurrence score performed. Of patients with stage 1-3 BC, 10 (n = 10/43, 23.3%) patients had recurrence. With median follow-up of 4.1 (range .6-10.6) years, 5-year overall survival was 82.9% and 5-year disease-free survival was 65.9%. In conclusion, our cohort of patients with male BC had a high incidence of BRCA mutations and most commonly had high-grade estrogen positive stage 2 tumors. Breast conserving surgery was utilized in 4% of patients and genomic testing utilized in 55% of patients.

Dosimetric comparison of volumetric-modulated arc therapy and helical tomotherapy for adjuvant treatment of bilateral breast cancer

2020 ◽  
pp. 1-9
Author(s):  
Reena Phurailatpam ◽  
Tabassum Wadasadawala ◽  
Kamalnayan Chauhan ◽  
Subhajit Panda ◽  
Rajiv Sarin
Keyword(s):  
Breast Cancer ◽  
Helical Tomotherapy ◽  
Treatment Time ◽  
Volumetric Modulated Arc Therapy ◽  
Bilateral Breast Cancer ◽  
Whole Body ◽  
Dosimetric Comparison ◽  
Significant Difference ◽  
Arc Therapy ◽  
The Mean

Abstract Purpose: Dosimetric comparison between volumetric-modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of bilateral breast cancer (BBC). Materials and methods: Ten patients treated on HT were selected retrospectively. Dose prescription was 50 Gy in 25 fractions to breast/chest wall and supraclavicular fossa (SCF) while tumour bed was simultaneously boosted to 61 Gy in 25 fractions. VMAT plans were made with four mono-isocentric partial arcs. The monitoring unit (MU) and treatment time were used to quantify the treatment efficiency. Target volumes were compared for homogeneity index (HI), conformity index (CI) while organs at risk (OARs) were compared for relevant dose volumes and integral doses (IDs). Result: For targets, no significant difference is observed between VMAT and HT in CI but VMAT could give better HI. The mean lung dose, V20 and V5 is 10·6 Gy versus 8·4 Gy (p-value 0·03), 12% versus 11·5% (p-value 0·5) and 78·1% versus 43·4% (p-value 0·005), respectively. The mean heart dose, V30 and V5 is 4·9 Gy versus 4·7 Gy (p-value 0·88), 0·5% versus 1·5% (p-value 0·18) and 26·2% versus 22·8% (p-value 0·4). Integral dose (ID) for the whole body and heart are comparable: 289 Gy kg versus 299 Gy kg (p-value 0·24) and 2·9 Gy kg versus 2·8 Gy kg (p-value 0·80). ID for lungs was significantly higher with VMAT: 7·9 Gy kg versus 6·3 Gy kg (p-value 0·03). There is a 53% reduction in treatment time and 78% in MU with VMAT against HT. Conclusion: VMAT can generate clinically acceptable plans comparable to HT for BBC. HT shows better control over low dose spillage in lungs compared to VMAT thereby increasing ID to lungs. VMAT shows better homogeneity and efficient treatment delivery than HT.

scholarly journals Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tao Sun ◽  
Xiutong Lin ◽  
Guifang Zhang ◽  
Qingtao Qiu ◽  
Chengqiang Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Planning ◽  
Volumetric Modulated Arc Therapy ◽  
Bilateral Breast Cancer ◽  
Planning System ◽  
Skin Dose ◽  
Delivery Time ◽  
Dose Volume ◽  
Arc Therapy ◽  
The Mean

Abstract Background The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann–Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p < 0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

Indication of sentinel lymph node biopsy with breast-conserving surgery for ductal carcinoma in situ considering lymphatic flow.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 192-192
Author(s):  
Ayane Yamaguchi ◽  
Shigeru Tsuyuki ◽  
Miru Okamura ◽  
Yukiko Kawata ◽  
Kosuke Kawaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Outer Quadrant ◽  
Lymphatic Flow ◽  
Node Biopsy

192 Background: Ductal carcinoma in situ (DCIS) has been regarded as curable with resection, but axillary lymph node metastases have been reported in 2% of DCIS patients. Even when DCIS has been diagnosed by preoperative core needle biopsy (CNB), 8% to 38% of the patients have been found to have invasive ductal carcinoma (IDC) on the basis of pathological diagnosis after surgical treatment. The indication of sentinel lymph node biopsy (SLNB) and breast-conserving surgery (BCS) for DCIS is still controversial. Methods: SLNB is a standard surgical technique for early breast cancer treatment, and indocyanine green (ICG) fluorescence method is remarkable in terms of the visualization of lymphatic flow. We analyzed the variation in lymphatic drainage routes from the nipple to the SLN (sentinel lymphatic routes) by using the ICG florescence method in early breast cancer patients and investigated the effects on the localization of the tumor to the sentinel lymphatic routes after BCS. Results: From November 2010 to April 2012, we recorded the sentinel lymphatic routes in 118 patients. All the routes passed through the upper outer quadrant (UOQ) area, and there were more than 2 routes in 53 cases. Of these routes, 73% passed through only the UOQ area and 27% passed through the UOQ via the upper inner, lower inner, and/or lower outer quadrant area. Conclusions: We should confirm the sentinel lymphatic routes by using the ICG florescence method before BCS for preoperatively diagnosed DCIS. If the lymphatic routes do not pass over the extent of resection of BCS, we can omit SLNB in the first surgical treatment and await the final pathological result. However, we should perform SLNB in addition to BCS in cases in which the lymphatic routes pass over the tumor in the region except the UOQ area.

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