Monday 17 December 2012

Ten years of tamoxifen ups cancer survival rates

Ten years of tamoxifen ups cancer survival rates. Dec. 2012, NHS Choices [online]

http://www.nhs.uk/news/2012/12December/Pages/Ten-years-of-tamoxifen-ups-cancer-survival-rates.aspx


Tamoxifen is commonly offered alongside other breast cancer treatments and it is usually recommended that treatment with the drug continues for five years after other treatments have ended. This is because research has found that a long-term course of tamoxifen can reduce the risk of breast cancer returning (recurrence) and can also help prevent breast cancer deaths. The researchers thought that extended treatment for 10 years may offer further benefits. They did in fact find that cancer recurrence was lower in women receiving 10 years of treatment compared with women getting the standard five years of treatment.

"SIEF" - Simultaneous implant exchange with fat

"SIEF" - Simultaneous implant exchange with fat: A new option in revision breast implant surgery. Plastic & reconstructive surgery, Dec. 2012, Vol. 130(6), p.1187-96.

Del Vecchio, D.A.

http://journals.lww.com/plasreconsurg/Fulltext/2012/12000/_SIEF__Simultaneous_Implant_Exchange_with_Fat___A.4.aspx

A technique of implant exchange is reported using recipient-site preexpansion followed by autologous fat transplantation to the breast in 12 consecutive patients with breast implants who desired implant removal. 


Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone

Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone.  Plastic & reconstructive surgery, Dec. 2012, Vol. 130(6), p.1169-78.

Card, A., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/12000/Reduced_Incidence_of_Breast_Cancer_Related.1.aspx

As breast cancer survivorship has increased, so has an awareness of the morbidities associated with its treatment. The incidence of breast cancer–related lymphedema has been reported to be 8 to 30 percent in all breast cancer survivors.

Monday 26 November 2012

Effects of three decades of screening mammography on breast-cancer incidence

Effects of three decades of screening mammography.  New england journal of medicine, Nov. 2012, 367:p.1998-2005.

Bleyer, A. & Welch, HG.

http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

To reduce mortality, screening must detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage.

Menarche, menopause and breast cancer risk: individual patient meta-analysis

Menarche, menopause and breast cancer risk: individual patient meta-analysis, including 118964 women with breast cancer from 117 epidemiological studies.  The lancet oncology, Nov. 2012, Vol. 13(11), p.1141-1151.

Collaborative group on hormonal factors in breast cancer.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70425-4/abstract?rss=yes

Menarche and menopause mark the onset and cessation, respectively, of ovarian activity associated with reproduction, and affect breast cancer risk. Our aim was to assess the strengths of their effects and determine whether they depend on characteristics of the tumours or the affected women.

Menarche, menopause and breast cancer risk

Menarche, menopause and breast cancer risk. The lancet oncology, Nov. 2012, Vol. 13(11), p.1071-72.

Britt, K.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70456-4/fulltext?rss=yes

The longer a woman is exposed to cycling reproductive hormones the higher her risk of breast cancer. If she has an early menarche or a late menopause, or both, her risk of breast cancer is increased. Additionally, women who bear children (parous) have a decreased risk of breast cancer compared those without children (nulliparous),purportedly because of the break in reproductive cycling. An understanding of how these reproductive behaviours mediate breast cancer risk will help to establish whether the cumulative length of cycling itself increases breast cancer risk, or whether exposure to the mitogenic effects of oestrogen is more important. 

Genetic link to male breast cancer

Genetic link to male breast cancer. The lancet oncology, Dec. 2012, Vol. 13(11), p.e465.

Burki, T.K.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70438-2/fulltext?_eventId=login&rss=yes

Changes in RAD51B can increase the risk of men developing breast cancer by 50%, according to the results of a new study. Changes elsewhere on the gene have previously been reported to increase the risk of female breast cancer, but this is the first time that this particular single nucleotide polymorphism, occurring in 15% of the population, has been highlighted.

A formula for implant volume choice in breast reconstruction after nipple sparing mastectomy

A formula for implant volume choice in breast reconstruction after nipple sparing mastectomy. The breast, Dec. 2012, Vol. 21(6), p.781-82.

Georgiou, C.A., et al.

http://www.thebreastonline.com/article/PIIS0960977612001932/abstract?rss=yes

Implant choice after Nipple Sparing Mastectomy (NSM) is a problematic perioperative issue. In this retrospective study, the authors searched for a correlation between mastectomy weight and implant volume choice after NSM. 

Mastectomy in the era of implant-based reconstruction

Mastectomy in the era of implant-based reconstruction: Should we be removing the pectoralis fascia? The breast, Dec. 2012, Vol. 21(6), p.779-80.

Vallejo, da Silva, A., et al.

http://www.thebreastonline.com/article/PIIS0960977612001622/abstract?rss=yes

Though removing of the pectorals fascia has always been routinely performed in modified radical mastectomy for invasive breast cancer, there is no evidence that this routine is justified.

Additional value of the 70-gene signature and levels of ER and PR for the prediction of outcome in tamoxifen-treated ER-positive breast cancer

Additional value of the 70-gene signature and levels of ER and PR for the prediction of outcome in tamoxifen-treated ER-positive breast cancer. The breast, Dec. 2012, Vol. 21(6), p.769-78.

Kok, M., et al.

http://www.thebreastonline.com/article/PIIS0960977612000823/abstract?rss=yes

Breast cancer patients with node positive disease can have an excellent outcome with tamoxifen only. It is unclear whether analysing both the 70-gene signature and hormone receptors provides superior prediction of outcome in tamoxifen-treated patients than either alone.

What factors may influence psychological well being at three months and one year post BRCA genetic result disclosure?

What factors may influence psychological well being at three months and one year post BRCA genetic result disclosure? The breast, Dec. 2012, Vol. 21(6), p.755-60.

Bosch, N., et al.

http://www.thebreastonline.com/article/PIIS0960977612000318/abstract?rss=yes

Genetic testing for breast cancer predisposition has been available in the clinical practice for more than a decade. How the result of genetic testing affects the psychological well-being of the individuals is an under-researched area in many populations. Follow-up analysis of psychological well-being via HADS scale was performed in 364 individuals at 3 months and 1 year after the disclosure of BRCA1/2 genetic result.

Putative relationship between hormonal status and serum pyrrolidone carboxypeptidase activity in pre- and post- menopausal women with breast cancer

Putative relationship between hormonal status and serum pyrrolidone carboxypeptidase activity in pre- and post- menopausal women with breast cancer. The breast, Dec. 2012, Vol. 21(6), p.751-54.

del Pillar Carrera-Gonzalez, M., et al.

http://www.thebreastonline.com/article/PIIS0960977612000288/abstract?rss=yes

In breast cancer, hormonal changes are rather constant in post-menopausal women since they tend to vary only over long time spans. However, in pre-menopausal women, the development of breast cancer is associated with hormonal physiological variations.

Health care utilization one year following the diagnosis benign breast disease or breast cancer

Health care utilization one year following the diagnosis benign breast disease or breast cancer. The breast, Dec. 2012, Vol. 21(6), p.746-50.

Keyzer-Dekker, C.M.G., et al.

http://www.thebreastonline.com/article/PIIS0960977612000240/abstract?rss=yes

We analyzed health care utilization (HCU) and its predictors in the first year after the diagnostic process for breast cancer (BC) or benign breast disease (BBD) using questionnaires. The impact of trait anxiety on HCU was examined.

Axillary lymphadenectomy for breast cancer

Axillary lymphadenectomy for breast cancer: A randomized controlled trial comparing a bipolar vessel  sealing system to the conventional technique. The breast, Dec. 2012, Vol. 21(6), 739-45.

Nespoli, L., et al.

http://www.thebreastonline.com/article/PIIS0960977612001713/abstract?rss=yes

To compare safety and efficacy of a bipolar vessel sealing system (BVSS) to the conventional technique in axillary node dissection.

CT staging for breast cancer patients with poor prognostic tumours

CT staging for breast cancer patients with poor prognostic tumours. The breast, Dec. 2012, Vol. 21(6), p.735-38.

James, J.J., et al.

http://www.thebreastonline.com/article/PIIS0960977612001695/abstract?rss=yes

The aim of this study was to assess the value of computed tomography (CT) staging of the chest, abdomen and pelvis in patients with poor prognostic tumours and no symptoms of metastatic disease in those who have undergone primary surgical management for the treatment of breast cancer.

Characteristics of HER2-positive breast cancer diagnosed following the introduction of universal HER2 testing

Characteristics of HER2-positive breast cancer diagnosed following the introduction of universal HER2 testing. The breast, Dec. 2012, Vol. 21(6), p.724-29.

Pathmanathan, N., et al.

http://www.thebreastonline.com/article/S0960-9776(12)00187-7/abstract

The aim of this study was to determine the impact of universal HER2 testing on the clinico-pathologic profile of HER2+ breast cancer. Data were extracted from breast cancer pathology reports spanning two periods: before (2003/4, n = 379), and after (2008/9, n = 560) the introduction of universal testing.


An exploratory study of sunitinib in combination with docetaxal and trastuzumab as first-line therapy for HER-2 positive metastatic breast cancer

An exploratory study of sunitinib in combination with docetaxal and trastuzumab as first-line therapy  for HER-2 positive metastatic breast cancer. The breast, Dec. 2012, Vol. 21(6), p.716-23.

Cardoso, F., et al.

http://www.thebreastonline.com/article/PIIS0960977612001889/abstract?rss=yes

This exploratory study assessed the safety, pharmacokinetics, and antitumor activity of sunitinib combined with docetaxel and trastuzumab.

Accelerated partial breast irradiation

Accelerated partial breast irradiation: The need for well-defined patient selection criteria, improved volume definitions, close follow-up and discussion of salvage treatment.  The breast, Dec. 2012, Vol. 21(6), p.707-715.

Moser, E.C. & Vrieling, C.

http://www.thebreastonline.com/article/PIIS0960977612002007/abstract?rss=yes

Breast-conserving therapy, including whole breast irradiation, has become a well-established alternative to mastectomy in early-stage breast cancer patients, with similar survival rates and better cosmetic outcome. However, many women are still treated with mastectomy, due to logistical issues related to the long course of radiotherapy (RT). To reduce mastectomy rates and/or omission of RT after breast-conserving surgery, shorter, hypofractionated RT treatments have been introduced. 

Disease burden and treatment outcomes in second-line therapy of patients with estrogen receptor-positive advanced breast cancer

Disease burden and treatment outcomes in second-line therapy of patients with estrogen receptor-positive advanced breast cancer: A review of the literature. The breast, Dec. 2012, Vol. 21(6), p.701-06.

Boswell, K.A., et al.

http://www.thebreastonline.com/article/PIIS0960977612001919/abstract?rss=yes

To determine the variable burden of disease of patients with advanced estrogen receptor-positive (ER+) breast cancer and assess the current treatment landscape after failure of first-line endocrine therapy.

Costs of different follow-up strategies in early breast cancer

Costs of different follow-up strategies in early breast cancer: A review of the literature. The breast, Dec. 2012, Vol. 21(6), p.693-700.

Van Hezewijk, M., et al.

http://www.thebreastonline.com/article/PIIS0960977612001956/abstract?rss=yes


We reviewed the literature between January 1985 and June 2011 on the costs of different follow-up strategies for patients treated for early breast cancer. A total of 186 abstracts were retrieved of which eleven publications were considered relevant; 6 randomised clinical trials, 4 retrospective cohort studies and 1 ‘minisymposium’.  The follow-up strategies, outcome measures and methods of analysis used in these studies vary widely, so no general conclusions can be drawn. However, from the results we infer that patient-led follow-up by a nurse practitioner, follow-up by a general practitioner, or telephone follow-up is feasible and cost-effective, without routine additional tests, except annual mammograms.




The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients

The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients. Plastic & reconstructive surgery, Nov. 2012, Vol. 130(5), p.991-1000.

Garvey, P.B., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2012/11000/The_Advantages_of_Free_Abdominal_Based_Flaps_over.4.aspx

The authors hypothesized that, for obese patients, delayed abdominal-based free flap (rather than implant-based and immediate) breast reconstruction would result in fewer overall complications and reconstruction losses.

Long-term outcomes following fat grafting in prosthetic breast reconstruction

Long-term outcomes following fat grafting in prosthetic breast reconstruction: A comparative analysis.  Plastic & reconstructive surgery, Nov 2012, Vol. 130(5), p.984-90.

Seth, A.K., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/11000/Long_Term_Outcomes_following_Fat_Grafting_in.3.aspx

Autologous fat grafting has become a common technique for optimizing aesthetic outcomes following breast reconstruction. Its long-term oncologic implications, however, remain unclear. The authors evaluated long-term outcomes following tissue expander breast reconstruction with and without fat grafting.

Monday 22 October 2012

The impact of mammographic screening on breast cancer mortality in Europe

The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. Journal of medical screening, Sept. 2012, Vol. 19 Supp.1, p.14-25.

Broeders, M., et al.

http://jms.rsmjournals.com/content/19/suppl_1/14.full.pdf+html


Valid observational designs are those where sufficient longitudinal individual data are
available, directly linking a woman’s screening history to her cause of death. From such studies, the
best ‘European’ estimate of breast cancer mortality reduction is 25–31% for women invited for
screening, and 38–48% for women actually screened. Much of the current controversy on breast
cancer screening is due to the use of inappropriate methodological approaches that are unable to capture the true effect of mammographic screening.

Breast cancer: incidence, mortality and survival

Breast cancer: incidence, mortality and survival. Office for national statistics, England, September 2012.

http://www.ons.gov.uk/ons/rel/cancer-unit/breast-cancer-in-england/2010/sum-1.html

Breast cancer is the most common cancer in women in England. In 2010, 41,259 new cases were diagnosed, an increase of 1.8 per cent (731 cases) compared to 2009. There were 126 new cases per 100,000 women in 2010, compared with 125 new cases per 100,000 women in 2009. These incidence rates have increased by 90 per cent between 1971 and 2010.

Trastuzumab emtansine for HER2-positive advanced breast cancer

Trastuzumab emtansine for HER2-positive advanced breast cancer. New england journal of medicine, October 2012.

Verma, S., et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1209124#t=articleTop

We randomly assigned patients with HER2-positive advanced breast cancer, who had previously been treated with trastuzumab and a taxane, to T-DM1 or lapatinib plus capecitabine. The primary end points were progression-free survival (as assessed by independent review), overall survival, and safety. Secondary end points included progression-free survival (investigator-assessed), the objective response rate, and the time to symptom progression. Two interim analyses of overall survival were conducted.

Bevacizumab in combination with capecitabine for the first-line treatment of metastatic breast cancer

Bevacizumab in combination with capecitabine for the first-line treatment of metastatic breast cancer (TA263). NICE guidance, August 2012.

http://guidance.nice.org.uk/TA263

NICE does not recommend bevacizumab in combination with capecitabine as first-line treatment for metastatic breast cancer when other chemotherapy (including drugs known as taxanes or anthracyclines) is not appropriate, or taxanes or anthracyclines have been given in the past 12 months.

lnfiltration of epinephrine in reduction mammoplasty

Infiltration of epinephrine in reduction mammoplasty: a systematic review of the literature. Plastic & reconstructive surgery, October 2012, Vol. 130(4), p.773-778.

Hardwicke, J.T., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/10000/Infiltration_of_Epinephrine_in_Reduction.7.aspx

Evidence of the benefit of dilute epinephrine infiltration before reduction mammaplasty is provided by several controlled trials. Despite variation in operative technique and data collection, a reduction in intraoperative blood loss has been shown. The aim of this review of the literature is to weigh the available evidence with respect to reducing blood loss during surgery and other outcome measures such as postoperative drainage.

Breast augmentation

Breast augmentation.  Journal of plastic & reconstructive surgery, October 2012, Vol. 130(4), p.5983-612e.

Adams, W.P. & Mallucci, P.

http://journals.lww.com/plasreconsurg/Abstract/2012/10000/Breast_Augmentation.40.aspx

The process of breast augmentation includes patient education, tissue-based preoperative planning, refined surgical technique, and defined postoperative management. This CME article reviews and discusses the current relevant topics and issues surrounding breast implants.

Current status of implant-based breast reconstruction

Current status of implant-based breast reconstruction in patients receiving post-mastectomy radiation therapy. Plastic & reconstructive surgery, October 2012, Vol. 130(4), p.513e-524e.

Kronowitz, S.J.

http://journals.lww.com/plasreconsurg/Fulltext/2012/10000/Current_Status_of_Implant_Based_Breast.9.aspx

Increasing numbers of patients with breast cancer are being treated with postmastectomy radiation therapy. The author reviewed the literature to determine the clinical impact of this increasing use of postmastectomy radiation therapy in patients with breast cancer who desire implant-based breast reconstruction.

Differentiating fat necrosis from recurrent malignancy in fat-grafted breasts

Differentiating fat necrosis from recurrent malignancy in fat-grafted breasts: an imaging classification system to guide management.  Plastic & reconstructive surgery, October 2012, Vol.130(4), p.761-72.

Parikh, R.P., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/10000/Differentiating_Fat_Necrosis_from_Recurrent.6.aspx

In breast reconstruction with autologous fat grafting, concerns persist about the ability to differentiate palpable masses representing fat necrosis from recurrent cancer. The authors' objective was to develop standardized imaging classifications to distinguish benign from malignant lesions after fat grafting. 

Bad medicine: clinical breast examination

Bad medicine: clinical breast examination, October 2012, BMJ 2012; 345: e6789.

Spence, D.


http://www.bmj.com/content/345/bmj.e6789?rss=1&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%25253A+bmj%25252Frecent+%252528Latest+from+BMJ%252529

To question clinical examination is to open a rich vein of debate. Clinical examinations are unquestioned, given disproportionate weight, and considered “must do.” Not doing a full examination implies you are a bad doctor. But much of examination is mere ritualistic dogma passed down through the ages. 

Thursday 13 September 2012

The template technique for breast mound planning

The template technique for breast mound planning when using abdominal flaps for breast reconstruction. The Breast, October 2012, Vol. 21(5), p.686-689.

Tregaskiss, A., et al.

http://www.thebreastonline.com/article/PIIS0960977612000379/abstract?rss=yes

Delayed breast reconstruction with abdominal flaps typically involves a process of ‘trial and error’ when moulding the flap into a satisfactory breast mound. This moulding process is crucial to the final aesthetic result. We present a template technique to preoperatively plan the skin envelope of each reconstruction.

High prevalence of neuroendocrine carcinoma in breast lesions

High prevalence of neuroendocrine carcinoma in breast lesions detected by the clinical symptom of bloody nipple discharge. The Breast, October 2012, Vol. 21(5), p.652-656.

Kawasaki, T., et al.

http://www.thebreastonline.com/article/PIIS0960977612000227/abstract?rss=yes

Bloody nipple discharge (BND) is an important clinical symptom in breast disorders, especially cancers. However, the association between this symptom and breast neuroendocrine carcinomas (NECs) has not been sufficiently investigated or well understood.

Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy

Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision.  The Breast, October 2012, Vol. 21(5), p.641-645.

Kim, J., et al.

http://www.thebreastonline.com/article/PIIS0960977612001300/abstract?rss=yes

The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision.

Predictors of invasive breast cancer and lymph node involvement in ductal carcinoma in situ

Predictors of invasive breast cancer and lymph node involvement in ductal carcinoma in situ initially diagnosed by vacuum-assisted breast biopsy: experience of 733 cases. The Breast, October 2012, Vol. 21(5), p.635-640.

Trentin, C., et al.

http://www.thebreastonline.com/article/PIIS0960977612001270/abstract?rss=yes

We retrospectively analyzed 733 patients with preoperatively diagnosed DCIS, investigating the association of clinical–radiological variables with invasive component and nodal involvement. 

Radiotherapy as sole adjuvant treatment for older patients with low-risk breast cancer

Radiotherapy as sole adjuvant treatment for older patients with low-risk breast cancer. The Breast, October 2012, Vol. 21(5), p.629-634.

Walker, G.A., et al.

http://www.thebreastonline.com/article/PIIS0960977612001269/abstract?rss=yes

Partly as a result of screening, increasing numbers of older patients are presenting with ‘low risk’ breast cancer: tumours from which the likelihood of breast cancer death is minute; even so, these patients have a measurable risk of local recurrence if conservative surgery is not followed by some form of adjuvant treatment. 

Intramammary lymph nodes

Intramammary lymph nodes: a question seeking for an answer, or an answer seeking for a question? The Breast, October 2012, Vol. 21(5), p.615-620.

Troupis, T., et al.

http://www.thebreastonline.com/article/S0960-9776(12)00118-X/abstract

Intramammary lymph nodes have not received for a long time enough attention from the medical literature and thus many of their characteristics are not sufficiently explored. Their incidence at various studies ranges between 0, 7 and 48%. They may be found in all breast quadrants but usually at the Upper Outer Quadrant (UOQ).

Increasing the time to expander-implant exchange after postmastectomy radiation therapy

Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plastic & reconstructive surgery, Sept 2012, Vol. 130(3), p.503-509.

Peled, A.W., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/09000/Increasing_the_Time_to_Expander_Implant_Exchange.2.aspx

Increased rates of complications can occur when postmastectomy radiation therapy is required after immediate expander-implant breast reconstruction. The sequence and timing of tissue expansion and implant exchange with regard to postmastectomy radiation therapy may impact complication rates.

Once is not enough

Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection.  Plastic & reconstructive surgery, Sept 2012, Vol. 130(3), p.495-502.

Clayton, J.L., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/09000/Once_Is_Not_Enough___Withholding_Postoperative.1.aspx

There has been a trend toward limiting perioperative prophylactic antibiotics, based on research not conducted in plastic surgery patients. The authors' university hospital instituted antibiotic prescribing guidelines based on the Surgical Care Improvement Project. An increased rate of surgical-site infections was noted in breast reconstruction patients.

Lives saved by breast cancer screening

Lives saved by breast cancer screening outnumber cases of overdiagnosis.  BMJ 2012; 345: e6155.

Hawkes, N.

http://www.bmj.com/highwire/filestream/602388/field_highwire_article_pdf/0/bmj.e6155.full.pdf


A Europe-wide review of breast cancer screening has concluded that the benefits in lives saved outweigh the risks of overdiagnosis. The analysis, carried out by a working group from nine European countries, showed that for every 1000 women between the ages of 50 and 69 who are screened, between seven and nine lives are saved and four women are “overdiagnosed.”

Monday 3 September 2012

Sonographic appearance of invasive ductal carcinoma of the breast

Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR, Sept 2012, Vol. 119(3), p.W402-W408.

Blaichman, J., et al.

http://www.ajronline.org/content/199/3/W402.abstract?rss=1

The purpose of this study was to compare the efficacy of the sonographic features in the BI-RADS lexicon for predicting malignancy grade of invasive ductal breast carcinoma in women assigned a BI-RADS category of 4 or 5.

Bilateral axillary ectopic breast tissue

Bilateral axillary ectopic breast tissue.  The Lancet, 2012; 380: 835.

Seifert, F., et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60316-X/fulltext?rss=yes

A 14-year-old girl presented with progressively growing bilateral painful axillary tumours (). Histopathology showed slightly hyperplastic glandular tissue without cytological atypia within the reticular dermis and fatty tissue (). The glandular epithelium stained positive for oestrogen and progesterone receptors (), which led to the diagnosis of ectopic breast tissue. 

Thursday 16 August 2012

One in five need reoperation after breast-conserving surgery

One in five need reoperation after breast-conserving surgery. The Lancet oncology, August 2012, Vol. 13(8), p.e334.

Bennett, N.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70339-X/fulltext?rss=yes#

20% of women with breast cancer who undergo breast-conserving surgery will need a second operation, according to the results of a retrospective study from England.

Late seromas after breast implants

Late seromas after breast implants: Theory and practice.  Plastic & reconstructive surgery, August 2012, Vol. 130(2), p.423-435.

Spear, S.L., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2012/08000/Late_Seromas_after_Breast_Implants___Theory_and.26.aspx

Late seromas surrounding breast implants are becoming an increasingly important issue in breast surgery. The authors report their experience with late seromas and describe their previous management options.

A prospective randomized study comparing two different expander approaches in implant-based breast reconstruction

A prospective randomized study comparing two different expander approaches in implant-based breast reconstruction: One stage versus two stages.  Plastic & reconstructive surgery, August 2012, Vol. 130(2), p. 254e-264e.

Eriksen, C., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/08000/A_Prospective_Randomized_Study_Comparing_Two.3.aspx

 Implant-based reconstruction is performed in the majority of women offered primary reconstruction for breast cancer. Two different expander implants were compared prospectively. The primary endpoint was the number of operations needed in each group to obtain patient satisfaction. 

A prospective study of short- and long-term cosmetic outcome after reduction mammoplasty

A prospective study of short- and long-term cosmetic outcome after reduction mammoplasty from three different perspectives: The patient, a department surgeon and an independent private practitioner in plastic surgery.  Plastic & reconstructive surgery, August 2012, Vol. 130(2), p.273-281.

Brieting, L.B., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2012/08000/A_Prospective_Study_of_Short__and_Long_Term.4.aspx

Numerous studies have examined the outcome of reduction mammaplasty. This study evaluates the cosmetic outcome after reduction mammaplasty from the perspective of the patient, a ward surgeon, and a private practitioner in plastic surgery, and analyzes which factors influence it.

Current status of autologous tissue-based breast reconstruction in patients receiving postmastectomy radiation therapy

Current status of autologous tissue-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plastic & reconstructive surgery, August 2012, Vol. 130(2), p.282-292.

Kronowitz, S.J.

http://journals.lww.com/plasreconsurg/Fulltext/2012/08000/Current_Status_of_Autologous_Tissue_Based_Breast.5.aspx

The threshold for patients with breast cancer to receive radiation therapy continues to be lowered. The author reviewed the literature to determine the clinical impact that the increasing use of radiation therapy has had on the management of patients with breast cancer who desire autologous tissue–based breast reconstruction. 

Patterns of use and patient satisfaction with breast reconstruction among obese patients

Patterns of use and patient satisfaction with breast reconstruction among obese patients: Results from a population-based study. Plastic & reconstructive surgery, August 2012, Vol. 130(2), p.263-270.

Kulkarni, A.R., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/08000/Patterns_of_Use_and_Patient_Satisfaction_with.1.aspx

The national obesity epidemic is contributing to an increased proportion of overweight and obese breast cancer patients. The authors' purpose was to determine whether patterns of use and outcomes of reconstruction differed among obese and nonobese patients.

Aesthetic improvement of the female breast in funnel chest deformity by surgical repair of the thoracic wall

Aesthetic improvement of the female breast in funnel chest deformity by surgical repair of the thoracic wall: Indication or lifestyle surgery?  Plastic & reconstructive surgery, August 2012, Vol. 30(2), p.245e-253e.

Schwabegger, A.H., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/08000/Aesthetic_Improvement_of_the_Female_Breast_in.2.aspx

Adults are increasingly seeking surgical correction of pectus excavatum deformity, and the alternative custom-made silicone implant is not always desired or suitable. The paramount concern of female patients is the apparent strabism of their breasts. In some cases, the standard minimally invasive reconstruction of pectus excavatum procedure or a modified approach with a semiopen technique can help remodel the anterior thoracic wall and simultaneously reposition the female breasts to a desired and aesthetically acceptable position.

Thursday 26 July 2012

BCCT.core - Can a computer program be used for the assessment of aesthetic outcome after breast reconstructive surgery?

BCCT.core - Can a computer program be used for the assessment of aesthetic outcome after breast reconstructive surgery? The breast, August 2012, Vol. 21(4), p.597-600.


Preuss, J., et al.


Aesthetic outcome is as an important endpoint of breast cancer treatment and is associated with better psychological recovery and improved quality of life. Researchers in Portugal have developed a computerised program, BCCT.core, to objectively assess aesthetic outcome of conservation breast treatment photographs. This study aimed to investigate the correlation between the Harris Scale and the BCCT.core program in patients who have undergone mastectomy and reconstruction for breast cancer.

Breast surgeons performing immediate breast reconstruction with implants

Breast surgeons performing immediate breast reconstruction with implants - Assessment of resource-use and patient-reported outcome measures. The breast, August 2012, Vol. 21(4), 590-596.


Robertson, S., et al.


http://www.thebreastonline.com/article/PIIS0960977612000045/abstract?rss=yes


Oncoplastic surgery, including immediate breast reconstruction (IBR), is expanding as a result of public demand. IBR in women with breast carcinoma is resource intense and the reconstruction is often completed concurrently with adjuvant oncological treatment. A series of 223 patients with implant-based IBRs, performed by breast surgeons 2005–2008, were analysed for use of resources and outcome.

Angiosarcoma of the breast

Angiosarcoma of the breast: A difficult surgical challenge.  The breast, August 2012, Vol. 21(4), p.584-589.


Hui, A., et al.


http://www.thebreastonline.com/article/PIIS0960977612000021/abstract?rss=yes


Breast angiosarcoma presents following radiotherapy after breast conserving surgery, in the setting of chronic lymphoedema after axillary dissection or as a primary tumour. The Peter MacCallum Cancer Centre has significant experience due to large breast and sarcoma units and as a primary radiotherapy centre. Our aims were to evaluate the management and locoregional and distant outcomes after breast angiosarcoma.

Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer

Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer: To do or not to do? The breast, August 2012, Vol. 21(4), p.578-583.


Leenders, M.W.H., et al.


http://www.thebreastonline.com/article/PIIS0960977612000902/abstract?rss=yes


The purpose of our study was to evaluate the accuracy of axillary ultrasound and ultrasound-guided fine needle aspiration cytology in the preoperative diagnosis of axillary metastases.

Pregnancy-associated breast cancers

Pregnancy-associated breast cancers: Do they differ from other breast cancers in young women?  The breast, August 2012, Vol. 21(4), p.550-555.


Genin, A.S., et al.


http://www.thebreastonline.com/article/PIIS0960977612000847/abstract?rss=yes


The impact of pregnancy in the physiopathology of pregnancy-associated breast cancer (PABC) is still unclear.
We compared the characteristics of PABCs and breast cancers not associated with pregnancy (non-PABCs) in terms of their loco-regional invasion and histological phenotype.

Factors predicting the non-sentinel lymph node involvement in breast cancer patients

Factors predicting the non-sentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases. The breast, August 2012, Vol. 21(4), p.518-523.


Boler, D.E., et al.


http://www.thebreastonline.com/article/PIIS0960977612000392/abstract?rss=yes


In a significant proportion of patients, the sentinel lymph node (SLN) is the only involved axillary node. The goal of the present study was to identify predictive factors associated with a positive SLN and with a positive non-SLN in patients in whom axillary lymph node dissection was performed.

The neoadjuvant net

The neoadjuvant net: A patient- and surgeon-friendly device to facilitate safe breast-conserving surgery in patients who underwent neoadjuvant treatment.  The breast, August 2012, Vol. 21(4), p.499-502.


Taffurelli, M., et al.


http://www.thebreastonline.com/article/PIIS096097761100436X/abstract?rss=yes


The primary goal of the study was to describe an innovative and helpful tool in defining the minimal surgical margins necessary during breast-conserving surgery after neoadjuvant treatment: the Neoadjuvant Net . The secondary endpoint was to assess its usefulness in achieving postoperative disease-free margins and reducing Ipsilateral Breast Tumor Recurrences. 

SPEC/CT scans allow precise anatomical location of sentinel lymph nodes in breast cancer

SPEC/CT scans allow precise anatomical location of sentinel lymph nodes in breast cancer and redefine lymphatic drainage from the breast to the axilla.  The breast, August 2012, Vol. 21(4), p.480-486.


Uren, R.F., et al.


http://www.thebreastonline.com/article/PIIS096097761100405X/abstract?rss=yes


Historical studies of lymphatic drainage of the breast have suggested that the lymphatic drainage of the breast was to lymph nodes lying in the antero-pectoral group of nodes in the axilla just lateral to the pectoral muscles. The purpose of this study was to confirm this is not correct.

Updated follow up of patients treated with the oncoplastic 'crescent' technique for breast cancer

Updated follow up of patients treated with the oncoplastic 'crescent' technique for breast cancer. The breast, August 2012, Vol. 21(4), p.475-479.


Aljarrah, A., et al.


http://www.thebreastonline.com/article/PIIS0960977611004024/abstract?rss=yes


Conservative treatment of lower pole breast cancer in small or medium sized breasts could be attended with poor cosmetic outcomes. The purpose of this study was to assess the results of the “Crescent” Oncoplastic technique in this indication.

The effect of introducing an in-theatre intra-operative specimen radiography system

The effect of introducing an in-theatre intra-operative specimen radiography system on the management of palpable breast cancer within a single unit. The breast, August 2012, Vol. 21(4), p.459-463.


Layfield, D.M., et al.


http://www.thebreastonline.com/article/PIIS0960977611003778/abstract?rss=yes


Intra-operative specimen radiography (IOSR) is used to screen specimens during breast-conserving surgery and attempt to identify incompletely excised lesions. Universal use of IOSR during surgery for impalpable breast cancer is advocated by current guidelines. This study evaluates the role of IOSR during breast-conserving surgery for palpable breast cancer.

Sentinel lymph node biopsy using indigo carmine blue dye

Sentinel lymph node biopsy using indigo carmine blue dye and the validity of '10% rule' and '4 nodes rule.'  The breast, August 2012, Vol. 21(4), p.455-458.


Nagao, T., et al.


http://www.thebreastonline.com/article/PIIS096097761100378X/abstract?rss=yes


This is the study which assessed sentinel lymph node biopsy (SNB) using indigo carmine blue dye and the validity of the ‘10% rule’ and ‘4 nodes rule’. Patients (302) were performed SNB using the combined radioisotope (RI)/indigo carmine dye method. Excised SLNs were confirmed whether they were stained and numbered in order of RI count and the percentage of radioactivity as compared to the hottest node was calculated. 

Accuracy of needle biopsy of breast lesions visible on ultrasound

Accuracy of needle biopsy of breast lesions visible on ultrasound: Audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes. The breast, August 2012, Vol. 21(4), p.449-454.


Brancato, B., et al.


http://www.thebreastonline.com/article/S0960-9776(11)00375-4/abstract


Core needle biopsy (CNB) has progressively replaced fine needle aspiration cytology (FNAC) in the diagnosis of breast lesions. Less information is available on how these tests perform for biopsy of ultrasound (US) visible breast lesions. This study examines the outcomes of CNB and FNAC in a large series ascertained with surgical histology or clinical-imaging follow-up.

Lymphatic mapping after previous breast surgery

Lymphatic mapping after previous breast surgery.  The breast, August 2012, Vol. 21(4), p.444-448.


Maaskant-Braat, A.J.G., et al.


http://www.thebreastonline.com/article/PIIS0960977611003742/abstract?rss=yes


To assess the feasibility of lymphatic mapping and determine the lymphatic drainage pathways in patients previously treated with breast conserving therapy.

Enhancing the clinical pathway for patients undergoing axillary lymph node dissection

Enhancing the clinical pathway for patients undergoing axillary lymph node dissection.  The breast, August 2012, Vol. 21(4), p.440-443.


Barry, M., et al.


http://www.thebreastonline.com/article/PIIS0960977611003699/abstract?rss=yes


Day-case axillary lymph node dissection (ALND) is not standard practice. Here we assess the feasibility of converting this traditional inpatient procedure to an outpatient procedure without compromising the quality or continuity of patient care, identify barriers to introducing an enhanced clinical pathway based on this conversion, and report strategies employed to overcome these barriers.

Breast cancer early detection methods for low and middle income countries

Breast cancer early detection methods for low and middle income countries, a review of the evidence. The breast, August 2012, Vol. 21(4), p.428-434.


Corbex, M., et al.


http://www.thebreastonline.com/article/PIIS0960977612000033/abstract?rss=yes


Organized national mammographic screening has been adopted as the gold standard for breast cancer early detection in western countries; however it may not be the most cost-effective approach to early detection in low and middle income countries (LMC) as it is very demanding in terms of human and financial resources. Moreover, its benefit to harm ratio has been questioned lately, particularly in women <50 years, the age group which produces the majority of breast cancer cases in LMC.

Alcohol and breast cancer

Alcohol and breast cancer. The breast, August 2012, Vol. 21(4), p.426-427.

Seitz, H.K.

Ethanol consumption is a major health problem worldwide and is responsible for more than 200 diseases. The World Health Organization has calculated that alcohol accounts for approximately 1.8 million deaths per year (3.2% of all deaths) including addiction, liver cirrhosis and cancer. Epidemiology has convincingly shown that chronic alcohol ingestion is a significant risk factor for the development of cancer of the upper alimentary tract (oropharynx, larynx and oesophagus), for the colorectum, the liver and the female breast. Recently, the International Agency for Research on Cancer has identified all alcoholic beverages as carcinogenic to humans and acetaldehyde as a carcinogen. Compared to other organs, the breast seems especially sensitive towards the carcinogenic action of ethanol as breast cancer risk starts already at very low daily ethanol consumption without any threshold. As ethanol use is widespread and breast cancer is the most frequent cancer in women in USA and in Europe, alcohol as a risk factor for breast cancer is of public concern. In contrast to the liver and the upper gastrointestinal tract, mechanisms by which ethanol stimulates mammary carcinogenesis are still unclear, complex and not well understood.

Inverted-T skin-reducing mastectomy with immediate implant reconstruction

Inverted-T skin-reducing mastectomy with immediate implant reconstruction using the submuscular-subfascial pocket. Plastic and reconstructive surgery, July 2012, Vol. 130(1), p.31-41.


Salgarello, M., et al.


http://journals.lww.com/plasreconsurg/Abstract/2012/07000/Inverted_T_Skin_Reducing_Mastectomy_with_Immediate.7.aspx


The inverted-T skin-reducing mastectomy with implant reconstruction represents a very effective reconstructive and cosmetic option in patients with macromastia. However, in this subset of patients, the risk of skin flap necrosis, especially at the T-junction, is significant. In this setting, complete implant coverage with viable tissue beneath the mastectomy skin flaps is essential to reduce morbidity. In this article, the authors retrospectively review their series of 16 skin-reducing mastectomy and immediate one-stage implant reconstructions using the submuscular-subfascial pocket, analyzing the reconstructive issues and cosmetic outcomes.

Post-mastectomy breast reconstruction in the irradiated breast

Post-mastectomy breast reconstruction in the irradiated breast: A comparative study of DIEP and latissimus dorsi flap outcome. Plastic and reconstructive surgery, July 2012, Vol. 130(1), p. 10-18.


Lindegren, A., et al.


http://journals.lww.com/plasreconsurg/Abstract/2012/07000/Postmastectomy_Breast_Reconstruction_in_the.2.aspx


Autologous tissue transfer is often indicated to achieve improved tissue quality during breast reconstruction after radiotherapy. The authors evaluated satisfaction with postmastectomy breast reconstruction among irradiated patients. The aim was to compare deep inferior epigastric perforator (DIEP) and latissimus dorsi flaps regarding satisfaction with aesthetic outcome between patients and plastic surgeons.

Inferiorly based parenchymal flap mammaplasty

Inferiorly based parenchymal flap mammaplasty: A safe, reliable, and versatile technique for breast reduction and mastopexy. Plastic and reconstructive surgery, July 2012, Vol. 130(1), p.116e-125e.


Bonomi, S., et al.


http://journals.lww.com/plasreconsurg/Abstract/2012/07000/Inferiorly_Based_Parenchymal_Flap_Mammaplasty___A.41.aspx


 Breast reduction and mastopexy are among the most frequent procedures in aesthetic breast surgery. Many approaches have been described, and various types of dermaglandular pedicles for the nipple-areola complex have been used. The authors present a technique suitable for either mastopexy or breast reduction whereby the superior or superomedial pedicle supplying the nipple-areola complex is combined with an inferior dermaglandular flap to restore the upper pole fullness, thereby improving breast shape and projection.

Pre-operative needle biopsy of sentinel lymph nodes

Pre-operative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast enhanced ultrasound in patients with breast cancer.  AJR, August 2012, Vol. 199(2), p.465-470.


Sever, A.R., et al.


http://www.ajronline.org/content/199/2/465.abstract?rss=1


The purpose of this study was to assess whether sentinel lymph nodes that undergo targeted needle biopsy after identification by contrast-enhanced ultrasound (CEUS) using intradermally injected microbubbles results in more node-positive breast cancer patients being diagnosed preoperatively. Furthermore, we sought to determine whether the addition of CEUS to gray-scale sonography of the axilla reduces the number of patients having axillary lymph node  dissection as a second procedure.

Triple receptor-negative breast cancer

Triple receptor-negative breast cancer: Imaging and clinical characteristics.  AJR, August 2012, Vol. 199(2), p.458-464.

Krizmanich-Conniff, K.Z., et al.

http://www.ajronline.org/content/199/2/458.abstract?rss=1

The objective of our study was to retrospectively evaluate the imaging findings of patients with breast cancer negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)—so-called “triple receptor–negative cancer”—and to compare the mammographic findings and clinical characteristics of triple receptor–negative cancer with non–triple receptor–negative cancers.


High-risk breast lesions at imaging guided needle biopsy

High-risk breast lesions at imaging guided needle biopsy: Usefulness of MRI for treatment decision. AJR, August 2012, Vol.119(2), p.W240-W250.

Londero, V., et al.

http://www.ajronline.org/content/199/2/W240.abstract?rss=1

The purpose of this study is to evaluate the role of MRI for characterization of high-risk breast lesions diagnosed at imaging-guided needle biopsy.

Benefit of exercise in lowering breast cancer risk

Benefit of exercise in lowering breast cancer risk is lost in postmenopausal women who had gained weight. [News item] BMJ 2012, 344 (published 26 June 2012).

Mayor, S.

Link to article (log in with your Athens username)

Physical activity reduces women’s risk of breast cancer except among postmenopausal women who gained substantial weight during adulthood, shows a US study.

Reoperation rates after breast conserving surgery for breast cancer among women in England

Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ 2012, 345 (published 12 July 2012).

Jeevan, R., et al.

Click to access full text

To examine whether rate of reoperation after breast conserving surgery is associated with patients’ characteristics and investigate whether reoperation rates vary among English NHS trusts.

Mammography screening has little or no effect on breast cancer deaths

Mammography screening has little of no effect on breast cancer deaths, Swedish data indicate. [News article] BMJ 2012, 345 (published 17 July 2012).

Mayor, S.

Link to article (log in with your Athens username)

Mammography screening has little or no effect on mortality from breast cancer in women aged 40-69, shows an analysis of Swedish figures published this week. But commentators argue that trends in breast cancer deaths cannot be used to evaluate screening in isolation from developments in diagnostic methods and treatment.

Tuesday 10 July 2012

Local breast cancer recurrence after mastectomy and immediate breast reconstruction

Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: A meta-analysis

Gieni, M., et al.

http://www.thebreastonline.com/article/PIIS0960977611004218/abstract?rss=yes

The main priorities in the surgical treatment of patients with breast cancer are to achieve cure, local control and prevent recurrence. It is increasingly important to address quality of life and self-image with women undergoing surgical intervention for breast cancer. There is a lack of consensus as to the oncologic safety of immediate breast reconstruction (IBR). The purpose of this paper is to systematically review the literature and compare the frequency of recurrence in patients with and without IBR following mastectomy for breast cancer.

Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction

Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. Plastic and reconstructive surgery, June 2012, Vol. 129(6), p.909e-918e.

Roostaeian, J., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/06000/Comparison_of_Immediate_Implant_Placement_versus.5.aspx

Tissue expansion is currently the most common method used in prosthetic breast reconstruction. Skin-sparing mastectomy techniques have facilitated immediate placement of a permanent implant. Proposed benefits to immediate implants include less time and fewer operations to complete reconstruction. Whether it leads to poorer outcomes remains unknown. The authors compared immediate implant-based and staged tissue expander breast reconstruction.

The three dermoglandular flap support in reduction mammaplasty

The three dermoglandular flap support in reduction mammaplasty. Plastic and reconstructive surgery, July 2012, Vol. 130(1), p.1e-10e.

Pascone, M., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/07000/The_Three_Dermoglandular_Flap_Support_in_Reduction.6.aspx

Bilateral breast reduction is an established procedure performed to relieve the physical pain and psychological discomfort associated with heavy, pendulous breasts. Numerous techniques have been developed over the years with several refinements to obtain safe nipple-areola complex transposition and harmonious breast shape. 

Thursday 3 May 2012

Detection of breast cancer with addition of annual screening ultrasound

Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA, 2012, Vol. 307(13), p.1394-1404.

Berg, W.A., et al.

http://jama.ama-assn.org/content/307/13/1394.short?rss=1

Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening.

Association between treatment with brachytherapy vs whole breast irradiation

Association between treatment with brachytherapy vs whole breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA, 2012, Vol. 307(17), p.1827-1837.

Smith, G.L., et al.

http://jama.ama-assn.org/content/307/17/1827.short?rss=1

Brachytherapy is a radiation treatment that uses an implanted radioactive source. In recent years, use of breast brachytherapy after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard whole-breast irradiation (WBI).

Are pfanennsteil scars a boon or a curse for DIEP flap breast reconstructions?

Are pfanennsteil scars a boon or a curse for DIEP flap breast reconstructions? Plastic and reconstructive surgery, April 2012, Vol. 129(4), p.797-805.

Mahajan, A.L., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/04000/Are_Pfannenstiel_Scars_a_Boon_or_a_Curse_for_DIEP.1.aspx

Abdominal incisions and their subsequent scarring alter the vascular architecture of the abdominal pannus. This is of significance when reconstructing the breast with the deep inferior epigastric perforator (DIEP) flap. This study aimed to objectively investigate the impact of the lower abdominal Pfannenstiel scar in utilizing the DIEP flap. 

Neglecting to screen women between the ages of 40-49 years with mammography

Neglecting to screen women between the ages of 40-49 years with mammography: What is the impact on breast cancer diagnosis?  AJR, May 2012, Vol. 198(5), p.1218-1222.

Kremer, M.E., et al.

http://www.ajronline.org/content/198/5/1218.abstract?rss=1

The purpose of this study was to compare breast cancer stage at diagnosis in two groups of women between 40 and 49 years old: women undergoing screening mammography and women with a symptom needing diagnostic workup. 

The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction

The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction.  Plastic & reconstructive surgery, May 2012, Vol. 129(5), p.1049-1058.

Weichman, K.E., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2012/05000/The_Use_of_Acellular_Dermal_Matrix_in_Immediate.5.aspx

Acellular dermal matrix is commonly used in implant-based breast reconstruction to allow for quicker tissue expansion with better coverage and definition of the lower pole of the breast. This study was performed to analyze complications associated with its use in immediate two-stage, implant-based breast reconstruction and to subsequently develop guidelines for its use.

Assessment of zonal perfusion using intraoperative angiography during abdominal flap breast reconstruction

Assessment of zonal perfusion using intraoperative angiography during abdominal flap breast reconstruction. Plastic & reconstructive surgery, April 2012, Vol. 129(4), p.618e-624.

Losken, A., et al.

http://journals.lww.com/plasreconsurg/Abstract/2012/04000/Assessment_of_Zonal_Perfusion_Using_Intraoperative.5.aspx

There is an ongoing debate about the reliability of various lower abdominal flaps for breast reconstruction. The authors evaluate in vivo perfusion of these flaps to objectively determine which techniques and which skin island zones had better perfusion.

Implant-based two-stage breast reconstruction in the setting of radiation injury

Implant-based two-stage breast reconstruction in the setting of radiation injury: An outcome study. Plastic & reconstructive surgery, April 2012, Vol. 129(4), p.817-823.

Lin, K.Y., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2012/04000/Implant_Based,_Two_Stage_Breast_Reconstruction_in.6.aspx

More women with breast cancer who either have already had radiation therapy or will be getting radiation therapy as part of their treatment protocol are now seeking implant-based breast reconstruction. The literature on the success of this type of reconstruction in the setting of radiation injury is mixed.

Medullary carcinoma of the breast: MRI findings

Medullary carcinoma of the breast: MRI findings.  AJR, May 2012, Vol. 198(5), W482-487.

Jeong, S.J., et al.

http://www.ajronline.org/content/198/5/W482.abstract?rss=1

The objective of our study was to describe the MRI findings of medullary carcinoma of the breast and to correlate those findings with the histopathologic findings.

Thursday 19 April 2012

Accuracy of magnetic resonance in suspicious breast lesions

Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis. Breast Cancer Research and Treatment 2011; Vol. 126(2), p. 273-285.

Medeiros L.R., et al.

http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=12011004113

This review concluded that breast magnetic resonance imaging (MRI) was a useful preoperative test for differentiating between breast cancer/high-risk lesions and benign lesions.

Cost-effectiveness of contralateral prophylactic mastectomy

Cost-effectiveness of contralateral prophylactic mastectomy versus routine surveillance in patients with unilateral breast cancer. Journal of Clinical Oncology 2011; Vol. 29(22), p. 2993-3000.

Zendejas, B., et al.

http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=22011001483


The objective was to evaluate the cost-effectiveness of contralateral prophylactic mastectomy versus routine surveillance in patients with unilateral breast cancer. The authors concluded that contralateral mastectomy was cost-effective, compared with surveillance, for patients younger than 70 years.

Tuesday 10 April 2012

Breast clinic triage tool

Breast clinic triage tool: Telephone assessment of new referrals. The breast, April, 2012, Vol. 21(2), p.215-217.

Cusack, L., et al.

Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease.

Combination of two local flaps for large defects after breast conserving surgery

Combination of two local flaps for large defects after breast conserving surgery. The breast, April 2012, Vol. 21(2), p.194-198.

Lee, J., et al.


Oncoplastic surgery is a technique for wide excision of breast cancer without compromising the natural shape of the breast. We have combined two local flaps, referred to as a ‘combined local flap’, for large defects of the breast after a partial mastectomy.

Improved sub-areolar breast tissue removal in nipple-sparing mastectomy using hydrodissection

Improved sub-areolar breast tissue removal in nipple-sparing mastectomy using hydrodissection. The breast, April 2012, Vol. 21(2), p.190-193.

Folli, S., et al.


We report on a new technique of dissection of the nipple-areola-complex (NAC) in nipple-sparing mastectomy (NSM). NACs removed due to the presence of tumor cells beneath them were histologically examined for the presence of normal breast glandular tissue.

A critical review of women's sleep-wake patterns in the context of neo-/adjuvant chemotherapy

A critical review of women's sleep-wake patterns in the context of neo-/adjuvant chemotherapy for early-stage breast cancer. The breast, April 2012, Vol. 21(2), p.128-141.

Kotronoulas, G., et al.


Complaints of poor nocturnal sleep and daytime dysfunction may be frequent among women receiving chemotherapy for breast cancer. A critical review of the literature was conducted, which aimed at summarising and critically analysing findings regarding sleep in women with early-stage breast cancer across neo-/adjuvant chemotherapy treatment.

Clinical review - breast adenoid cystic carcinoma

Clinical review - breast adenoid cystic carcinoma. The breast, April 2012, Vol. 21(2), p.124-127.

Boujelbene, N. et al.


ACC of the breast has a favourable prognosis. An accurate diagnosis and appropriate treatment are therefore important.

Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer

Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer. The breast, April 2012, Vol. 21(2), p.112-123.

Brennan, M.E., & Houssami, N.


While guidelines recommend against routine use of staging imaging to detect asymptomatic distant metastases (DM) in newly diagnosed breast cancer (BC), modern imaging technologies may have improved detection capability and may have a role in some cases.