Deep Learning-Aided Automatic Contouring of Clinical Target Volumes for Radiotherapy in Breast Cancer After Modified Radical Mastectomy

Purpose: The aim of this study is to develop a practicable automatic clinical target volume (CTV) delineation method for radiotherapy of breast cancer after modified radical mastectomy.Methods: Unlike breast conserving surgery, the radiotherapy CTV for modified radical mastectomy involves several regions, including CTV in the chest wall (CTVcw), supra- and infra-clavicular region (CTVsc), and internal mammary lymphatic region (CTVim). For accurate and efficient segmentation of the CTVs in radiotherapy of breast cancer after modified radical mastectomy, a multi-scale convolutional neural network with an orientation attention mechanism is proposed to capture the corresponding features in different perception fields. A channel-specific local Dice loss, alongside several data augmentation methods, is also designed specifically to stabilize the model training and improve the generalization performance of the model. The segmentation performance is quantitatively evaluated by statistical metrics and qualitatively evaluated by clinicians in terms of consistency and time efficiency.Results: The proposed method is trained and evaluated on the self-collected dataset, which contains 110 computed tomography scans from patients with breast cancer who underwent modified mastectomy. The experimental results show that the proposed segmentation method achieved superior performance in terms of Dice similarity coefficient (DSC), Hausdorff distance (HD) and Average symmetric surface distance (ASSD) compared with baseline approaches.Conclusion: Both quantitative and qualitative evaluation results demonstrated that the specifically designed method is practical and effective in automatic contouring of CTVs for radiotherapy of breast cancer after modified radical mastectomy. Clinicians can significantly save time on manual delineation while obtaining contouring results with high consistency by employing this method.

PORT-A-CATH catheter rupture: case report

Introduction: The modern management of cancer treatment requires access to the venous system repeatedly for the passage of drugs, fluids and blood components. Peripheral veins are rapidly damaged by repeated punctures and by fluids that pass through them. To solve this problem, long-term vascular accesses avoid repeated punctures. One type of long-term venous access is the Port-A-Cath, which is an implantable device usually in the chest with a central venous catheter. Case report: Next, the case of a 34-year-old female with a diagnosis of breast cancer in the right breast is presented. It is treated with a radical mastectomy, and after the procedure a port-a-cath is placed in the left subclavian route for future treatments. The first cycle of chemotherapy is performed, later the patient reports pain at the catheter placement site with increased volume and progressive increase in pain. The patient goes to her health center for an evaluation, they decide to take a chest X-ray showing the migration of the catheter. The management used was through the seldinger technique at the femoral puncture site with a 6 Fr Amplatz GooseNeck Snare Guide, with which it was possible to extract the foreign body at the level of the left brachiocephalic vein. Conclusion: The implantation of a Port-A-Cath catheter is associated with some risks in the process. Catheter and patient care should be maintained to decrease the incidence of complications.

Study of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block to prevent pain syndrome by evaluating ccl2 gene expression after radical mastectomy

This study aimed to investigate the clinical effect of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block in preventing postoperative pain syndrome of breast cancer. For this purpose, 100 women treated for breast cancer from April 2018 to July 2019 were enrolled as research objects. Surgical procedures included local sentinel lymph node biopsy, mastectomy, sentinel lymph node biopsy for mastectomy, modified radical mastectomy, and implantation. The selected patients were randomly divided into two groups: control group (routine operation anesthesia; n = 50) and observation group (ultrasound-guided thoracic paravertebral block before induction of ropivacaine+butorphanol anesthesia; n = 50). The Real-time PCR technique was performed to evaluate CCL2 gene expression. VAS scores were recorded during the postoperative period. Compared with the control group, the observation group had lower VAS scores at six h, 24h, and 48h (P<0.05). The pain effect of the observation group was less than that of the control group. The observation group had better analgesic effects after anesthesia. The observation group had a lower incidence of pain syndrome at the 6th, 8th, and 12th months (P<0.05), and the incidence of pain syndrome in the two groups decreased with the extension of time. The observation group had lower levels of related factors (P<0.05), and the observation group had lower traumatic stress responses. The protein expression of IL-6, IL-17, and CRP in the observation group was lower than that in the control group (P<0.05). The results of CCL2 gene expression also showed that gene expression in the control group increased significantly (P=0.0047). Since the expression of this gene is one of the factors that stimulate pain signals in the body, the method used in the present study was able to reduce the amount of pain significantly. Therefore, the combination of ropivacaine combined with butorphanol ultrasound-assisted paravertebral block can reduce the intensity of postoperative pain in patients with breast cancer surgery, decrease the incidence of pain syndrome, and increase pain tolerance.

Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana, India

Objective: The study was conducted to assess the Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana. Study objectives were to (i) Assess the upper limb function among the clients with Modified Radical Mastectomy before the intervention. (ii) Demonstrate post-operative upper limb function exercises to the clients with breast cancer posted for Modified Radical Mastectomy. (iii) Assess the effectiveness of post-operative exercises on upper limb function among clients with Modified Radical Mastectomy. (iv) Find out the association between the upper limb function among clients with Modified Radical Mastectomy and selected variables. Methodology: Quantitative evaluative research approach was used for this study. The study was conducted at selected cancer hospitals, Hyderabad, Telangana. Pre-test post-test group only design adopted. The sample comprised of 30, 15 sample taken as experimental group,15 sample taken as experimental group. Sample was selected by purposive sampling technique. The data was collected by observational checklist. Results: The results revealed that pretest mean score was 64.03 and after intervention the post-test mean score was 57.16 there was a significant difference between the pre-test and post test scores from day 1 to day 5 of the clients at the level of p= 0.05, computed ‘t’ value is more than table value hence null hypothesis was rejected. The obtained’ value was 8.15, found greater than ‘t’ table value. Conclusion: The study concluded that most of the sample was improved upper limb function from day 1to day 5. There is a significant difference between pretest and post- test scores, The findings point out that demonstration of teaching programme would improve the upper limb function of clients with Modified Radical Mastectomy.

Comparative analysis of visual analog scales for assessing acute pain in women after radical mastectomy

BACKGROUND: Effective quantitative assessment of acute pain as an urgent problem in clinical medicine. One of the solutions to this problem is a color discrete scale (CDS). AIM: To determine the efficacy of the clinical usage of color discrete scale compared with linear visual analog scale to assess acute pain in women after radical mastectomy. MATERIALS AND METHODS: This study includes a prospective, observational, and non-randomized clinical trial. A total of 110 females who underwent radical mastectomy (RM) were interviewed. We used a 100-point linear visual analog scale (lVAS) and CDS with monotonic (mCDS) and random (rCDS) color arrangement. Pain was assessed 2, 6, 12, 24, 48, and 72 h after surgery. RESULTS: Pain scores obtained 2 h after RM were 6 (0; 30), 12 (0; 24), 8 (0; 20) points according to IVAS, mCDS, and rCDS, respectively (p 0.05). Furthermore, the pain scores were gradually reduced on all three scales and had no statistically significant difference (p 0.05). In women who underwent paravertebral blockade (PVB), pain scores were significantly less at 2, 6, 12, and 48 h after surgery (p 0.05). Spearmans correlation coefficient for lVAS and mCDS is 0.90, 0.86 for lVAS and rCDS, and 0.90 for mCDS and rCDS (all p 0.05). CONCLUSIONS: The CDS is an alternative, independent, and sufficient tool for quantifying pain. A strong correlation was found between the pain assessments according to CDS and lVAS. PVB significantly improves the quality of pain relief after RM.