Thursday, 25 October 2018

Inflammatory breast cancer. A challenging disease with poor prognosis

by Mariam Salim, Hafsa Arif, Osama Shakeel, Amina Iqbal, Huma Majeed, Zulqarnain Chaudhry  

The Breast: October 2018 Volume 41, Supplement 1, Page S22

Introduction: Inflammatory breast cancer (IBC) is an aggressive angioinvasive form of breast cancer associated with a high incidence of early nodal and systemic metastasis. It is a rare cancer in our population, while its incidence is increasing worldwide especially in the United States. It accounts for 1-6% of total breast cancer cases. By its ability to metastasize rapidly, most IBC tumors are characterized as stage IIIB at the time of detection. It is known for aggressive histopathologic features and poor survival.

Can breast cancer metastasize to an unusual organ? : case report and review

by Marija Karakolevska - Ilova  

The Breast: October 2018Volume 41, Supplement 1, Pages S21–S22

Introduction: Metastatic cancer in the thyroid is uncommon and large autopsy studies found out that the incidence of thyroid metastases in patients with a history of cancer ranges from 1.9% to 24%, so in any patient with a previous history of malignancy, a new thyroid mass should be considered as recurrence until proved otherwise. The most frequent primary cancers are renal cell (48.1%), colorectal (10.4%), lung (8.3%) and breast (7.8%) cancers.Most patients with thyroid metastases have widespread metastatic disease but occasionally the thyroid may be the only site of disease with the same impact on prognosis as nonthyroidal metastases.

Physicians attitudes and knowledge about fertility preservation

by M. Lambertini  

The Breast: October 2018Volume 41, Supplement 1, Page S4

In young breast cancer patients diagnosed during their reproductive years, the possible occurrence of treatment-induced premature ovarian insufficiency is of particular concern being associated with important menopause-related symptoms, psychosocial issues as well as infertility. Over the past years, solid evidence has been accumulated to support the management of young patients facing issues related to fertility preservation and specific guidelines have been developed to help physicians in dealing with this topic.

Follow-up clinics: nurses to lead them?

by Y. Wengström  

The Breast: October 2018 Volume 41, Supplement 1, Page S3

Despite substantial evidence that intensive follow up after cancer treatment may not lead to improvements in survival or quality of life, is inefficient at detecting recurrence, and is highly cost ineffective, most patients with cancer are routinely seen in outpatient clinics for many years. The high degree of psychological and functional morbidity among cancer patients suggests a need for close monitoring and support; however, research shows that routine follow up in busy clinics actually provides an environment conducive to supporting patients after a diagnosis of cancer.

Preoperative Multimodal Analgesia Decreases Postanesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery

 by Barker, Jenny C.; DiBartola, Kaitlin; Wee, Corinne; Andonian, Nicole; Abdel-Rasoul, Mahmoud; Lowery, Deborah; Janis, Jeffrey E.  

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 443e–450e

Background: The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths attributable to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies.
Methods: A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received (1) no preoperative analgesia (n = 333); (2) intraoperative intravenous acetaminophen (n = 78); (3) preoperative oral acetaminophen and gabapentin (n = 95); or (4) preoperative oral acetaminophen, gabapentin and celecoxib (n = 54). Outcomes included postanesthesia care unit narcotic use, pain scores, postanesthesia care unit length of stay, rescue antiemetic use, and 30-day complications. Results: Both oral multimodal analgesia regimens significantly reduced postanesthesia care unit narcotic use (oral acetaminophen and gabapentin, 14.3 ± 1.7; oral gabapentin, acetaminophen, and celecoxib, 11.9 ± 2.2; versus no drug, 19.2 ± 1.1 mg oral morphine equivalents; p = 0.0006), initial pain scores (oral acetaminophen and gabapentin, 3.9 ± 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.4 ± 0.7; versus no drug, 5.3 ± 0.3 on a 1 to 10 scale, p = 0.0002) and maximum pain scores (oral acetaminophen and gabapentin, 4.3 ± 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.6 ± 0.7; versus no drug, 5.9 ± 0.3 on a 1 to 10 scale; p < 0.0001). Both oral regimens were better than no medications or intravenous acetaminophen alone in multivariate models after controlling for age, body mass index, American Society of Anesthesiologists class, length of surgery, prior narcotic prescription availability, and intraoperative local anesthetic. Postanesthesia care unit length of stay, antiemetic use, and 30-day complications were not different.
Conclusions: Preoperative oral multimodal analgesia reduces narcotic use and pain scores in outpatient breast plastic surgery. These regimens are inexpensive, improve pain control, and contribute to narcotic-sparing clinical practice in the setting of a national opioid epidemic. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

[Review] Opportunities and priorities for breast surgical research

 by Ramsey I Cutress, Stuart A McIntosh, Shelley Potter, Amit Goyal, Cliona C Kirwan, James Harvey, Adele Francis, Amtul R Carmichael, Raghavan Vidya, Jayant S Vaidya, Patricia Fairbrother, John R Benson, Malcolm W R Reed, Association of Breast Surgery Surgical Gap Analysis Working Group  

The Lancet Oncology: Review | vol. 19, issue 10, PE521-E533, October 2018
The 2013 Breast Cancer Campaign gap analysis established breast cancer research priorities without a specific focus on surgical research or the role of surgeons on breast cancer research. This Review aims to identify opportunities and priorities for research in breast surgery to complement the 2013 gap analysis. To identify these goals, research-active breast surgeons met and identified areas for breast surgery research that mapped to the patient pathway. Areas included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy, and attention to special groups (eg, those receiving risk-reducing surgery).

The Functional Influence of Breast Implant Outer Shell Morphology on Bacterial Attachment and Growth

by Jones, Phoebe; Mempin, Maria; Hu, Honghua; Chowdhury, Durdana; Foley, Matthew; Cooter, Rodney; Adams, William P. Jr; Vickery, Karen; Deva, Anand K.  

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 837–849

Background: The introduction of texture to the outer shell of breast implants was aimed at increasing tissue incorporation and reducing capsular contracture. It has also been shown that textured surfaces promote a higher growth of bacteria and are linked to the development of breast implant–associated anaplastic large cell lymphoma.
Methods: The authors aimed to measure the surface area and surface roughness of 11 available implants. In addition, the authors aimed to subject these implant shells to an in vitro bacterial attachment assay with four bacterial pathogens (Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, and Ralstonia pickettii) and study the relationship among surface area, surface roughness, and bacterial growth. Results: Surface area measurement showed grouping of implants into high, intermediate, low, and minimal. Surface roughness showed a correlation with surface area. The in vitro assay showed a significant linear relationship between surface area and bacterial attachment/growth. The high surface area/roughness implant texture grew significantly more bacteria at 24 hours, whereas the minimal surface area/roughness implant textures grew significantly fewer bacteria of all types at 24 hours. For implants with intermediate and low surface areas, some species differences were observed, indicating possible affinity of specific bacterial species to surface morphology.
 Conclusions: Implant shells should be reclassified using surface area/roughness into four categories (high, intermediate, low, and minimal). This classification is superior to the use of descriptive terms such as macrotexture, microtexture, and nanotexture, which are not well correlated with objective measurement and/or functional outcomes.