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Tong Y, Sun F, Zhang C, Yang S, Yu Z, Zhao Y. Multifocal/multicentric breast cancer: Does each focus matter? Cancer Med 2023; 12:8815-8824. [PMID: 36734288 PMCID: PMC10134382 DOI: 10.1002/cam4.5626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Multifocal (MF) and multicentric (MC) breast cancer cases have been increasingly diagnosed owing to the extensive use of improved preoperative breast imaging. The current tumor-node-metastasis staging system uses the dimension of the largest tumor and recommends reporting the pathological features of the largest tumor in MF/MC breast cancers. AIM This study aimed to explore whether the largest or aggregate dimensions of MF and MC breast cancers can better predict tumor behavior. We also attempted to study the histological and biological heterogeneities of separate foci in MF and MC breast cancers to determine whether it was necessary to examine each lesion. METHODS We retrospectively analyzed 121 patients with MF/MC (103 with MF and 18 with MC) breast cancers and 484 patients with unifocal breast cancer who were treated at the First Affiliated Hospital of Nanjing Medical University. Two methods were used to record the T stage (using the dimensions of the largest lesion and aggregate dimensions of all lesions). The histological grade, immunohistochemical parameters, and molecular subtypes of the largest lesion and other lesions in MF/MC breast cancers were studied to assess intertumoral heterogeneity. RESULTS The use of aggregate dimensions upstaged 63 patients with MF/MC breast cancers to a more advanced stage and removed the independent effect of cancer multiplicity on lymph node positivity compared with the use of the largest dimension. Mismatches were found in the pathological type (9.9%), histological grade (4.1%), and molecular subtype (8.3%) among different foci. CONCLUSION The tendency of MF/MC breast tumors to metastasize may be related to tumor load, which can be better predicted by the aggregate dimensions of all foci. The use of the current staging systems may require further evaluation and modification. Intertumoral heterogeneity indicates the necessity for pathological and immunohistochemical assessments of each lesion in patients with MF/MC breast cancers.
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Affiliation(s)
- Ying Tong
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Feixiang Sun
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Chuanpeng Zhang
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Susu Yang
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Ziyi Yu
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Yi Zhao
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
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Zhang Y, Liu F, Gao Q, Chai Y, Ren Y, Tian H, Ma B, Song A. Comparing the outcome between multicentric/multifocal breast cancer and unifocal breast cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:1042789. [PMID: 36591500 PMCID: PMC9801517 DOI: 10.3389/fonc.2022.1042789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This systematic review and meta-analysis compares the outcome between MMBC and unifocal breast cancer (UFBC), in order to provide a theoretical basis for the design of an appropriate clinical therapeutic strategy of MMBC patients. Methods PubMed, Embase, The Cochrane Library, Web of science, CNKI, WanFang Data, CBM and VIP database were searched from inception to July 2021, and observational studies reporting the outcome of patients with MMBC and UFBC were included. We extracted or calculated the mortality rates of MMBC and UFBC patients; and obtained the hazard ratios; odds ratios; relative risks; and the corresponding 95% confidence intervals from the eligible studies. All the meta-analyses were conducted by using the Stata 15.0 software. Results 31 eligible studies comprising a total of 15,703 individuals were included. The meta-analysis revealed that MMBC did not have a significant association with poor overall survival (HR=1.04, 95% CI=0.96-1.12), disease-free survival (HR= 1.07, 95% CI= 0.84-1.36), breast cancer-specific survival (HR=1.42, 95% CI= 0.89-2.27), recurrence-free survival (HR= 0.878, 95% CI= 0.652-1.182), local recurrence-free survival (HR= 0.90, 95% CI= 0.57-1.42), and contralateral breast cancer risk (RR= 0.908, 95% CI= 0.667-1.234). However, MMBC appeared to have a correlation with a slightly higher risk of death (OR=1.31, 95% CI=1.18-1.45). Conclusion Patients with MMBC appeared to have a higher risk of death, however, it may not be independently associated with poorer outcomes. Considering the inter-study heterogeneity and other limitations, our results need to be validated by further multicenter prospective studies with a large sample size in the future.
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Affiliation(s)
- Yalan Zhang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China,Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Fan Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China,Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Qianqian Gao
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yahui Chai
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China,Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yan Ren
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China,Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Hongyou Tian
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China,Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Ailin Song
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China,Second Clinical Medical College, Lanzhou University, Lanzhou, China,*Correspondence: Ailin Song,
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Dal F, Ökmen H, Ulusan K, Çolak Ş, Havare SB, Trabulus FDC, Ferlengez E, Sari S. Does focal heterogeneity affect survival in postoperative ipsilateral multifocal and multicentric breast cancers? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:405-412. [PMID: 35442372 DOI: 10.1590/1806-9282.20211168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In multicentric/multifocal breast tumors, there may be immunological and histological differences between foci that may affect survival and treatment choice. We aimed to evaluate the effect of focal heterogeneity seen in multicentric/multifocal breast tumors on survival. METHODS We retrospectively collected and analyzed the clinicopathological data of 89 female patients with multifocal/multicentric breast cancer, whose surgical and medical treatment was completed and who were followed up for 5 years. RESULTS Of all patients, 29.2% (26/89) were heterogeneous. Heterogeneity of these foci was as follows: histologic heterogeneity of index foci (mix type): 15.7% (14/89), histologic heterogeneity of inter-foci: 7.9% (7/89), and immunohistochemical heterogeneity of inter-foci: 10.1% (9/89). When additional foci were evaluated, oncological therapy was changed for 3 (3.3%) of 89 patients. Heterogeneity does not have a significant (p>0.05) effect on recurrence and survival in multicentric/multifocal breast cancers. Pathological N stage is an independent risk factor for disease-free survival (hazard ratio=2.29, 95% confidence interval=1.39-3.76, p=0.001). CONCLUSIONS In multifocal/multicentric breast cancers, less than 4% of patients may experience heterogeneity requiring change in the therapeutic decision. However, heterogeneity does not have a significant effect on recurrence and survival in multifocal/multicentric breast cancers. The pathological N stage is an independent risk factor for disease-free survival.
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Affiliation(s)
- Fatih Dal
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
| | - Hasan Ökmen
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
| | - Kivilcim Ulusan
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
| | - Şükrü Çolak
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
| | - Semiha Battal Havare
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of Medical Pathology - İstanbul, Turkey
| | - Fadime Didem Can Trabulus
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
| | - Ekrem Ferlengez
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
| | - Serkan Sari
- Health Sciences University Turkish Ministry of Health İstanbul Research and Training Hospital, Department of General Surgery - İstanbul, Turkey
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Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57070725. [PMID: 34357006 PMCID: PMC8305998 DOI: 10.3390/medicina57070725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis.
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