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Radu I, Scripcariu V, Panuța A, Rusu A, Afrăsânie VA, Cojocaru E, Aniței MG, Alexa-Stratulat T, Terinte C, Șerban CF, Gafton B. Breast Sarcomas-How Different Are They from Breast Carcinomas? Clinical, Pathological, Imaging and Treatment Insights. Diagnostics (Basel) 2023; 13:diagnostics13081370. [PMID: 37189471 DOI: 10.3390/diagnostics13081370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study.
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Affiliation(s)
- Iulian Radu
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Viorel Scripcariu
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andrian Panuța
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinic of Plastic and Reconstructive Microsurgery, Emergency Clinical Hospital "Sf. Spiridon", 700111 Iasi, Romania
| | - Alexandra Rusu
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Vlad-Adrian Afrăsânie
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria Gabriela Aniței
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Institute of Oncology, 700483 Iasi, Romania
| | | | - Bogdan Gafton
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Perioperative Risk Factors for Prolonged Blood Loss and Drainage Fluid Secretion after Breast Reconstruction. J Clin Med 2022; 11:jcm11030808. [PMID: 35160259 PMCID: PMC8837023 DOI: 10.3390/jcm11030808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Surgical breast reconstruction is an integral part of cancer treatment but must not compromise oncological safety. Patient-dependent risk factors (smoking, BMI, etc.) are said to influence perioperative outcomes and have often been investigated. Here, we analyzed independent perioperative risk factors for increased postoperative blood loss or drainage fluid volume loss and their possible impact. Methods: Patients undergoing breast reconstructions after breast cancer with either tissue expanders, definitive breast implants, or autologous breast reconstruction were analyzed. The collected data on patients’ characteristics, blood, and drainage fluid loss were correlated and statistically investigated. Results: Traditional patient-dependent risk factors did not influence blood loss or drainage volumes. On the contrary, patients with preoperative anemia had significantly higher drainage outputs compared to non-anemic patients (U = 2448.5; p = 0.0012). The administration of low molecular weight heparin showed a tendency of increased drainage output. Similar correlations could be seen in prolonged procedure time, all of which contributed to prolonged hospital stay (τb = 0.371; p < 0.00001). Conclusion: Preoperative anemia is one of the most critical factors influencing postoperative drainage fluid output. Previously assumed patient-dependent risk factors did not affect drainage output. Preoperative anemia must be monitored, and if possible, treated preoperatively to reduce postoperative morbidity.
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Method for Flushing Surgical Drains Using a Butterfly Needle. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3714. [PMID: 34367850 PMCID: PMC8341218 DOI: 10.1097/gox.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
Surgical drains placed during breast surgery can become blocked by clots or other debris, which may lead to infection of the prosthetic and seroma or hematoma formation from improper drainage. Current methods involve stripping the drain, which does not clear the pores inside the cavity, or flushing the drain at the opposite end using a syringe with the debris going into the cavity being drained. The authors propose an easily available flushing option using a butterfly needle inserted at an angle that provides a sterile and efficient method for flushing the drain near the body cavity and clearing blockages. This creates a self-sealing valve that can be reinforced with Tegaderm and allows for the use of antibiotics or hemostatic agents through it. The primary author has performed this technique in-office in multiple patients undergoing breast augmentation, mastopexy/mammaplasty, breast reconstruction after mastectomy, and breast revision surgeries requiring implants or expanders with satisfactory results and no complications. This method is limited in that it must be performed by a health care professional, but it is easy to perform.
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Nowak M, Lee S, Karbach U, Pfaff H, Groß SE. Short length of stay and the discharge process: Preparing breast cancer patients appropriately. PATIENT EDUCATION AND COUNSELING 2019; 102:2318-2324. [PMID: 31427170 DOI: 10.1016/j.pec.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/16/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients' satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation. METHODS Data of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses. RESULTS The majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge. CONCLUSION As hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient's rating of LOS. PRACTICE IMPLICATIONS The study results underscore the importance of ensuring the quality and thoroughness of the discharge process.
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Affiliation(s)
- Marina Nowak
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany.
| | - Susan Lee
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences of the Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Sophie E Groß
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany; LVR-Institute of Health Care Research, LVR Clinic Cologne, Cologne, Germany
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