Care of Seniors with Breast Cancer – Treatment Received and Refining Decision Making

AimsTreatment decisions for older patients with breast cancer are complex and evidence is largely extrapolated from younger populations. Frailty and comorbidity need to be considered. We studied the baseline characteristics and treatment decisions in older patients in Christchurch with breast cancer and assessed survival outcomes and prognostic/discriminatory performance of several tools.Materials and methodsWe searched the Canterbury Breast Cancer Registry and identified patients aged 70 years or older at diagnosis with invasive, non-metastatic breast cancer between 1 June 2009 and 30 June 2015. We retrieved demographics, treatment and outcome information. Overall survival and breast cancer-specific survival were estimated. Tools analysing performance status and comorbidity were assessed for their prognostic and discriminatory power.ResultsIn total, 440 patients were identified. Primary surgery was carried out for 362 patients (82.3%): breast-conserving surgery in 114 (of whom 88.6% received radiation therapy); mastectomy in 248 (of whom 24.6% received radiation). Hormone therapy was given for 265 (71.1%) patients with oestrogen receptor-positive cancers. Two hundred and seventy-four (62.3%) patients received full standard treatment, which was associated with significantly improved 5-year survival and 5-year breast cancer-specific survival. The median estimated overall survival was 8.2 years (95% confidence interval 7.3–9.1 years). Of those who died, 71.3% of deaths were due to causes other than breast cancer or unknown causes. The comorbidity-adjusted life expectancy (CALE) showed partial prognostic accuracy. CALE, Charlson and Eastern Cooperative Oncology Group tools all showed discriminatory value.ConclusionIn this population-based series of older patients with breast cancer, showing high levels of primary and adjuvant treatment, patients were more likely to die of causes other than breast cancer. Performance status and comorbidity tools showed prognostic and discriminatory potential in this population supporting their use in treatment decision making. CALE showed the most potential to improve treatment decisions but requires validation in this population to improve prognostic accuracy.     

Biopsia selectiva de ganglio centinela en cáncer de mama, ¿está justificada la espera al resultado intraoperatorio?

IntroductionIn our institution, the study of selective sentinel node biopsy (SLNB) is performed intraoperatively. The main objective of our study is to know the proportion of patients who benefits from the waiting of the results of SLNB.MethodsA retrospective analysis of patients operated on our center between January 1 st, 2018 and June 30, 2019 was carried out. We included women diagnosed with T1–T2 tumors, treated by lumpectomy and SLNB studied using OSNA method.ResultsOur study included 149 women. There were not statistically significant differences in terms of demographic data between the group treated with axillary lymph node dissection (ALND) and exclusively SLNB group. After analysis of SLN intraoperatively, there were performed 18 axillary lymphadenectomies. Only in six of these 18 cases, three or more sentinel nodes were founded. The location of the tumor, the presence of lymphovascular permeation and the total tumor load (TTL) showed statistically significant differences between groups. Only the TTL was established as the independent factor of the need for ALND.ConclusionsObtaining a deferred result of the SLNB allowed reducing the time of anesthesia and occupation of the operating room, since in a high percentage of cases an additional procedure is not performed.     

Diagnostic pitfalls in needle core biopsy of the breast

Breast core biopsies are a standard component of the triple approach that includes clinical examination, imaging and tissue sampling. Conventional cores, diagnostic vacuum assisted biopsy and vacuum assisted excisions are established methods for sampling and managing breast lesions. It is important to be aware of the potential pitfalls in the technical handling and interpretation of the limited core biopsy samples. Here, we present a clinically oriented, well illustrated overview of the common diagnostic pitfalls based on the author's diagnostic and second opinion practice, emphasize the value of clinicopathological correlation and provide histological tips and clues with useful immunohistochemistry to aid the reporting pathologists in their daily interpretation of breast core biopsies.     

基于超声影像组学的乳腺癌预测模型的诊断性能研究

目的评估并比较基于不同机器学习算法建立的乳腺癌超声影像组学预测模型的诊断性能。 方法回顾性收集2017年1月至2019年4月就诊皖南医学院第一附属医院、有明确病理结果的乳腺肿块病例828例，以2018年8月31日为节点将其分为训练集（526例）和验证集（302例），提取肿块的超声影像组学特征并进行特征筛选，运用k最近邻（kNN）、逻辑回归（LR）、朴素贝叶斯（NB）、随机森林（RF）和支持向量机（SVM）5种机器学习算法分别建立预测模型，使用重复交叉验证方法做内部验证，计算比较各模型的敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV），并实施外部验证，绘制ROC曲线并比较ROC曲线下面积（AUC）以评价模型的鉴别诊断性能，绘制校准曲线评价模型校准度。 结果从提取的109个影像组学特征中筛选出19个特征建立了5种机器学习算法模型。在内部验证中，5种模型的敏感度、特异度、PPV、NPV比较，总体差异均有统计学意义（P均＜0.001）。LR模型的特异度、PPV、NPV中位数分别为0.769、0.816、0.778，3项指标均高于其他4种模型；敏感度中位数为0.824，高于kNN、RF和SVM模型。此外，SVM模型的特异度、PPV、NPV中位数分别为0.706、0.774、0.759，虽均低于LR模型，但均高于其他3种模型。在外部验证中，LR、SVM、RF、kNN和NB的AUC依次为0.890、0.832、0.821、0.746和0.703，其中LR与SVM的AUC差异有统计学意义（P=0.012）；此外，各模型在校准性能上表现并不一致，LR和SVM模型的校准曲线显示乳腺癌实际概率与预测概率之间的一致性较好。 结论以超声影像组学特征为基础，运用不同机器学习算法建立的乳腺癌超声预测模型，均表现出较高的诊断性能，其中LR模型表现最为突出；选择合适的机器学习算法有助于进一步提高预测模型的诊断性能，提供更加准确的量化预测结果。     

情绪释放技术对乳腺癌术后化疗患者预期性悲伤的影响

目的 探讨情绪释放技术对改善乳腺癌术后化疗患者预期性悲伤的效果。方法 采用便利抽样法选取乳腺癌术后化疗患者60例为研究对象,采用随机数字表法将其分为对照组和干预组,各30例。对照组给予常规护理,干预组在对照组的基础上实施情绪释放干预疗法。比较干预前后2组心理痛苦程度和预期性悲伤得分水平。结果 干预后,干预组心理痛苦程度低于对照组(t=-17.930,P＜0.001);预期性悲伤总分及各维度得分均低于对照组(P＜0.001)。结论 对乳腺癌术后化疗患者应用情绪释放技术进行护理干预,可以减轻患者心理痛苦程度,降低患者预期性悲伤,值得临床推广应用。     

4万余例沈阳地区妇女HPV感染情况分析北大核心

目的:分析我院2020年1月1日至2020年9月中旬近4万余例女性HPV感染情况,为HPV疫苗接种、宫颈病变预防、治疗、随访提供流行病学数据。方法:选取我院2020年1月1日至2020年9月中旬之间,于我院妇科门诊及病房、皮肤科门诊及体检中心的37 325接受HPV分型检测的患者的临床资料,分析检测结果。结果:HPV感染率为13.91%(5 193/37 325),单一感染率11.46%(4 276/37 325),阳性构成比82.34%(4 276/5 193),高危亚型感染以HPV16最多见,其次52、58,低危型以6最多见,其次为11、44,与5年前HPV感染情况分析中最常见的低危亚型为cp8304不同。不同年龄段感染率不同。结论:近年沈阳地区妇女HPV感染率为13.91%,较5年前感染率18.60%有所下降,以单一、高危亚型感染为主,多重感染并存为特征。