Role of MRI in screening,diagnosis and management of breast cancer

Screening and early diagnosis has an important role in reducing the morbidity and mortality associated with breast cancer. Mammography has an established role and has been approved for routine screening. MRI is an emerging tool and has the highest sensitivity of current breast imaging techniques. Although low specificity and high cost of MRI restricted its use in routine screening, it has been increasingly used in the screening of high-risk individuals, diagnosing occult cases, staging and assessing the response to chemotherapy. MRI-guided techniques, including needle-localization biopsy and vacuum-assisted breast biopsy, have a special role in diagnosis and management. This article focuses on the role of MRI in diagnosis, screening and management of breast cancer, and reviews the current indications for breast MRI.     

Assessing the reproducibility of dynamic contrast enhanced magnetic resonance imaging in a murine model of breast cancer

Quantitative dynamic contrast enhanced magnetic resonance imaging estimates parameters related to tissue vascularity and volume fractions; additionally, semiquantitative parameters such as the initial area under the curve can be utilized to describe tissue behavior. The aim of this study was to establish the reproducibility of quantitative and semiquantitative analysis of dynamic contrast enhanced magnetic resonance imaging in a murine model of breast cancer. For each animal, a T₁‐weighted, gradient‐echo sequence was used to acquire two sets of dynamic contrast enhanced magnetic resonance imaging data separated by 5 h. Data were acquired at both a 0.05 mm³ (128², n = 12) and a 0.2 mm³ (64², n = 12) resolution, and analysis was performed using both the Tofts–Kety (to estimate K^trans and v_e) and extended Tofts–Kety (K^trans, v_e, and v_p) models. Reproducibility analysis was performed for both the center slice and the total tumor volume for all parameters. For the total volume analysis, the repeatability index for K^trans is 0.073 min^?1 in the standard model analysis and 0.075 min^?1 in the extended model analysis at the 128² acquisition. For the 64² acquisition, the values are 0.089 and 0.063 min^?1 for the standard and extended models, respectively. The repeatability index for initial area under the curve was 0.0039 and 0.0042 mM min for the 128² and 64² acquisitions, respectively. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

Aims and objectives. This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. Background. Surgical removal of the breast may lead to activity limitation, self‐image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. Methods. One hundred and forty‐five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty‐six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2‐way anova s were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p‐values are two sided. All statistical analyses were performed using sas 9.2 for Windows. Results. The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. Conclusions. Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.     

Docetaxel-Ifosfamide Combination in Patients with Advanced Breast Cancer Failing Prior Anthracycline- Based Regimens: Results of a Phase I-II Study

Abstract

The established clinical activity of docetaxel and ifosfamide as single agents in anthracycline pre-treated breast cancer, led us to conduct a phase I-II study to define the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), and clinical activity of the docetaxel+ifosfamide combination in this setting. Patients with histologically confirmed metastatic breast cancer, after failure on prior anthracycline-based chemotherapy, were treated at successive dose levels (DLs) in cohorts of 3-6 with escalated doses of docetaxel 70-100 mg/m² over 1 h on day 1 followed by ifosfamide 5-6 g/m² divided over days 1+2 (2.5-3.0 g/m²/day over 1 h), every 21 days. G-CSF was added once dose-limiting neutropenia was encountered at a certain DL and planned to be incorporated prophylactically in subsequent higher DLs. Between March 1997 and December 2002, 65 patients with a median age of 57 years (range, 32-72) and performance status (WHO) of 1 (range, 0-2) were treated at 5 DLs as follows; 21 in phase I DLs (DL1: 3, DL2: 6, DL3: 3, DL4: 6, and DL5: 3) and the remaining 44 were treated at DL4 (total of 50 patients at DL4), which was defined as the level for phase II testing. All patients were assessable for toxicity and 62 for response. DLT (with the addition of G-CSF after DL2) was reached at DL5 with 2/3 initial patients developing febrile neutropenia. Clinical response rates (RRs), on an intention-to-treat basis, in phase II were: 56%; (95% CI, 42.2- 69.7%); 4 CRs, 24 PRs, 10 SD and 12 PD. The median response duration was 7 mo (3-24 mo), median TTP 6.5 mo (0.1-26 mo), and median OS 13 mo (0.1-33 mo). Grade 3/4 toxicities included: neutropenia in 72% of patients, with 60% developing grade 4 neutropenia (≤7 days) and in 10% of these febrile neutropenia, while no grade 3/4 thrombocytopenia was observed. Other toxicities included peripheral neuropathy grade 2 only in 10%, grade 1/2 reversible CNS toxicity in 16%, no renal toxicity, grade 2 myalgias in 8%, grade 3 diarrhea in 8%, skin/nail toxicity in 14%, and grade 2 fluid retention in 2% of patients. One patient in the study treated at phase II died as a result of acute liver failure after the first cycle.

The present phase I-II study has determined the feasibility, defined the MTD and demonstrated the encouraging activity of the docetaxel-ifosfamide combination in the phase II part of the study. Therefore, future randomized phase III studies versus single-agent docetaxel or combinations of the latter with other active agents are warranted.     

A Modified Weekly Docetaxel Schedule as First-Line Chemotherapy in Elderly Metastatic Breast Cancer: A Safety Study

Abstract

Standard dose docetaxel is burdened by severe toxicity. Weekly schedules have been shown to be active as standard scheme with reduced side effects. In 20-30% of elderly patients (pts) the classic 6-week schedule induces grade 3/4 fatigue and other cumulative toxicities. We carried out this safety study in order to evaluate whether a modified weekly docetaxel schedule would improve the toxicity profile. Twenty-one untreated elderly (≥70 years) pts suffering from metastatic breast cancer were enrolled in the study. Pts were treated with a weekly dose of 35 mg/m² docetaxel for 6 weeks, followed by a 2-week rest. Further cycles were performed with this modified schedule: docetaxel days 1, 8 and 15 every 29 days. All pts received at least the first cycle (6 weeks). A total of 261 doses were delivered. No toxic deaths occurred. The toxicity was mild: we recorded 1 episode of grade 3neutropenia and severe asthenia in only 2 pts (10%). We recorded an overall response rate of 33% (1 CR, 6 PR). Our data showed a reduced incidence of severe asthenia (2/21), obtained with a light modification of a weekly docetaxel schedule.     

丹芩消郁合剂治疗乳腺增生病疗效观察

目的:观察丹芩消郁合剂治疗乳腺增生病的临床疗效。方法:将80例乳腺增生病患者随机分为治疗组和对照组各40例,治疗组给予丹芩消郁合剂治疗,对照组给予消癥丸治疗,2个月为1个疗程,疗程结束后评价疗效。结果:两组患者治疗的总有效率均为92.5%,比较其差异无统计学意义(P0.05);两组愈显率分别为:治疗组52.5%,对照组30.0%,两组比较,差异有统计学意义(P0.05)。结论:丹芩消郁合剂治疗乳腺增生病疗效优于消癥丸。