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Sentinel-lymph-node (SLN) surgery was designed to minimise the side-effects of lymph-node surgery but still offer outcomes equivalent to axillary-lymph-node dissection (ALND). The aims of National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-32 were to establish whether SLN resection in patients with breast cancer achieves the same survival and regional control as ALND, but with fewer side-effects. NSABP B-32 was a randomised controlled phase 3 trial done at 80 centres in Canada and the USA between May 1, 1999, and Feb 29, 2004. Women with invasive breast cancer were randomly assigned to either SLN resection plus ALND (group 1) or to SLN resection alone with ALND only if the SLNs were positive (group 2). Random assignment was done at the NSABP Biostatistical Center (Pittsburgh, PA, USA) with a biased coin minimisation approach in an allocation ratio of 1:1. Stratification variables were age at entry (≤49 years, ≥50 years), clinical tumour size (≤2·0 cm, 2·1–4·0 cm, ≥4·1 cm), and surgical plan (lumpectomy, mastectomy). SLN resection was done with a blue dye and radioactive tracer. Outcome analyses were done in patients who were assessed as having pathologically negative sentinel nodes and for whom follow-up data were available. The primary endpoint was overall survival. Analyses were done on an intention-to-treat basis. All deaths, irrespective of cause, were included. The mean time on study for the SLN-negative patients with follow-up information was 95·6 months (range 70·1–126·7). This study is registered with ClinicalTrials.gov, number NCT00003830. 5611 women were randomly assigned to the treatment groups, 3989 had pathologically negative SLN. 309 deaths were reported in the 3986 SLN-negative patients with follow-up information: 140 of 1975 patients in group 1 and 169 of 2011 in group 2. Log-rank comparison of overall survival in groups 1 and 2 yielded an unadjusted hazard ratio (HR) of 1·20 (95% CI 0·96–1·50; p=0·12). 8-year Kaplan-Meier estimates for overall survival were 91·8% (95% CI 90·4–93·3) in group 1 and 90·3% (88·8–91·8) in group 2. Treatment comparisons for disease-free survival yielded an unadjusted HR of 1·05 (95% CI 0·90–1·22; p=0·54). 8-year Kaplan-Meier estimates for disease-free survival were 82·4% (80·5–84·4) in group 1 and 81·5% (79·6–83·4) in group 2. There were eight regional-node recurrences as first events in group 1 and 14 in group 2 (p=0·22). Patients are continuing follow-up for longer-term assessment of survival and regional control. The most common adverse events were allergic reactions, mostly related to the administration of the blue dye. Overall survival, disease-free survival, and regional control were statistically equivalent between groups. When the SLN is negative, SLN surgery alone with no further ALND is an appropriate, safe, and effective therapy for breast cancer patients with clinically negative lymph nodes. US Public Health Service, National Cancer Institute, and Department of Health and Human Services.

Background Nipple-sparing mastectomy (NSM) is an increasingly common procedure; however, concerns exist regarding its oncological safety due to the potential for residual breast tissue to harbor occult malignancy or future cancer. Methods A systematic literature review was performed. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in a meta-analysis of overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Studies lacking comparison arms were only included in the systematic review to evaluate mean OS, DFS, LR, and nipple–areolar recurrence (NAR). Results The search yielded 851 articles. Twenty studies with 5594 patients met selection criteria. The meta-analysis included eight studies with comparison arms. Seven studies that compared OS found a 3.4 % risk difference between NSM and MRM/SSM, five studies that compared DFS found a 9.6 % risk difference between NSM and MRM/SSM, and eight studies that compared LR found a 0.4 % risk difference between NSM and MRM/SSM. Risk differences for all outcomes were not statistically significant. The systematic review included all 20 studies and evaluated OS, DFS, LR, and NAR. Studies with follow-up intervals of <3 years, 3–5 years, and >5 years had mean OS of 97.2, 97.9, and 86.8 %; DFS of 93.1, 92.3, and 76.1 %; LR of 5.4, 1.4, and 11.4 %; and NAR of 2.1, 1.0, and 3.4 %, respectively. Conclusions This study did not detect adverse oncologic outcomes of NSM in carefully selected women with early-stage breast cancer. Use of prospective data registries, notably the Nipple-Sparing Mastectomy Registry, will add clarity to this important clinical question.

To evaluate the implementation and effectiveness of progressive rehabilitation nursing in patients undergoing modified radical mastectomy for breast cancer. A total of 70 patients undergoing modified radical mastectomy for breast cancer in our hospital were selected as the research subjects, and they were randomly divided into a control group and an observation group, with 35 patients in each group. The control group received routine rehabilitation nursing intervention after surgery, while the observation group received progressive rehabilitation nursing intervention based on the control group's nursing. The quality of life, self-care ability, mental state, and incidence of complications were compared between the two groups. Before the intervention, the two groups had no significant difference in the quality of life (P > .05). After the intervention, the quality of life in the observation group was significantly better than that in the control group (P < .05). Before the intervention, the two groups had no significant difference in the self-care ability (P > .05). After the intervention, the self-care ability in the observation group was significantly better than that in the control group (P < .05). Before the intervention, the two groups had no significant difference in the SAS and SDS scores (P > .05). After the intervention, the SAS and SDS scores in the observation group were significantly lower than those in the control group (P < .05). The incidence of complications in the control group was 22.86%, while that in the observation group was 5.71%. The incidence of complications in the observation group was significantly lower than in the control group (P < .05). Compared with routine nursing intervention, the implementation of progressive rehabilitation nursing intervention can further improve the quality of life, self-care ability, and mental state of patients undergoing modified radical mastectomy for breast cancer and reduce the risk of related complications, which helps promote the recovery process of patients and is worthy of clinical promotion and application.

ObjectiveThis study aimed to assess the oncological safety of nipple- and areola-sparing mastectomy (NSM) compared to mastectomy without preservation of the nipple-areola complex (NAC) in patients with breast cancer presenting with nipple discharge.MethodsClinical data were retrospectively reviewed for 93 patients who underwent NSM and 133 patients who underwent mastectomy without NAC preservation for non-metastatic breast cancer between March 2015 and August 2023 at two hospitals. All patients presented with bloody or serous nipple discharge. Clinicopathological characteristics of both groups were assessed to evaluate the oncological safety of NSM and identify prognostic factors.ResultsLocal recurrence rates and disease-free survival rates at 3 and 5 years did not differ significantly between the groups (p > 0.05). Univariate analysis identified tumor T stage, lymph node metastasis count, and histological grade as independent risk factors influencing disease-free survival and overall survival (p < 0.05). Tumors larger than 2 cm, lymph node positivity, and grade III histology were associated with an elevated risk of recurrence. Multivariate analysis further confirmed tumor T stage and lymph node metastasis count as significant risk factors for both disease-free survival and overall survival, with larger tumors and positive lymph node status linked to an increased risk of mortality.ConclusionNSM demonstrated oncological safety in this patient population. Prognostic factors significantly affecting survival outcomes included tumor T stage, lymph node metastasis count, and histological grade.

We aimed to identify factors predicting surgery for de novo stage IV inflammatory breast cancer (IBC) and determine the association of surgery with overall survival (OS). Female patients with unilateral AJCC clinical stage IV IBC treated 2010–2018 in the NCDB were identified. Logistic regression and multivariable proportional Cox hazards regressions determined factors associated with treatment and OS. Of 1049 patients, 29.1% underwent breast surgery (BS) and 70.9% had no surgery (NS). Increasing age and more recent treatment year were significantly associated with NS. 2-Year OS was superior in BS patients (71% vs 38% NS). Single-site and bone-only metastasis had no association with treatment type or OS. Contrary to guidelines, 1/3 of de novo stage IV IBC patients underwent BS, and had an independent OS benefit irrespective of extent or site of metastasis. Further research is needed to determine which patients with stage IV IBC should undergo BS. •Breast surgery for de novo stage IV breast cancer is contraindicated by guidelines.•Up to one-third of patients with de novo stage IV inflammatory breast cancer in a national cohort undergo this intervention.•Breast surgery was associated with an independent overall survival benefit irrespective of extent or site of metastasis.

Breast conservation therapy (BCT) consisting of lumpectomy and postoperative radiation has become an accepted alternative to mastectomy (MRM) for the treatment of early stage breast cancer. We currently report the 25 year outcomes of a single institution, prospective, randomized clinical trial at the National Cancer Institute. 237 women with pathologically confirmed invasive breast tumors 5 cm or less were accrued between 1979 and 1987 and randomized to receive either BCT or MRM. Overall survival was the primary endpoint. Patients with node positive disease were included and treated with doxorubicin and cyclophosphamide. Both arms received axillary dissection. BCT patients had radiation to the whole breast followed by a boost. At a median follow-up of 25.7 years, overall survival was 43.8% for the MRM group and 37.9% for BCT ( P  = 0.38). Although the cumulative incidence of a disease-free survival event was higher in BCT patients (29.0% MRM vs. 56.4% BCT, P  = 0.0017), the additional treatment failures were primarily isolated ipsilateral breast tumor recurrences (IBTR’s) requiring salvage mastectomy. 22.3% of BCT patients experienced an IBTR. Distant disease and second cancers were similar in both arms. After 25 years, long term survival between BCT and MRM continues to be similar in patients treated for early stage breast cancer. Patients receiving BCT may be at risk for additional treatment-related morbidity, which may occur as a late event. Further studies are required to delineate patients at higher risk for these events, and prolonged follow up should be encouraged after treatment for all women.

Background We aimed to evaluate the influence of mammographic breast density at diagnosis on the risk of cancer recurrence and survival outcomes in patients with invasive breast cancer after modified radical mastectomy. Methods This case-control study included 121 case-control pairs of women diagnosed with invasive breast cancer between 2004 and 2009, and who had undergone modified radical mastectomy and had mammographic breast density measured before or at diagnosis. Women with known locoregional recurrence or distant metastasis were matched by pathological disease stage, age, and year of diagnosis to women without recurrence. Locoregional recurrence was defined as recurrence in the ipsilateral chest wall, or axillary, internal mammary, or supraclavicular nodes. The median follow-up duration was 84.0 months for case patients and 92.9 months for control patients. Results Patients with heterogeneously dense (50–75% density) and extremely dense (>75% density) breasts had an increased risk of locoregional recurrence (hazard ratios 3.1 and 5.7, 95% confidence intervals 1.1–9.8 and 1.2–34.9, p  = 0.043 and 0.048, respectively) than did women with less dense breasts. Positive margins after surgery also increased the risk of locoregional recurrence (hazard ratio 3.3, 95% confidence interval 1.3–8.3, p  = 0.010). Multivariate analysis that included dense breasts (>50% density), positive margin, no adjuvant radiotherapy, and no adjuvant chemotherapy revealed that dense breasts were significant factors for predicting locoregional recurrence risk (hazard ratio 3.6, 95% confidence interval 1.2–11.1, p  = 0.025). Conclusions Our results demonstrate that dense breast tissue (>50% density) increased the risk of locoregional recurrence after modified radical mastectomy in patients with invasive breast cancer. Additional prospective studies are necessary to validate these findings. Trial registration The study is retrospectively registered with ClinicalTrials.gov, number NCT02771665 , on May 11, 2016.

Objective: The aim of this retrospective study was to evaluate the clinical efficacy and prognosis of breast-conserving surgery versus modified radical mastectomy in the treatment of early stage breast cancer. Patients and Methods: Two hundred and nineteen cases of early stage breast cancer were reviewed and retrospectively included in this study form two hospitals (Quzhou hospitalof Zhejiang university and Quzhou Traditional Chinese Hospital). The characteristics of operation procedure such as operation time, intraoperative blood loss and length of hospital stay were compared between the two groups. And the prognosis was recurrence rate was also compared to the two groups. Results: For the included 219 early breast cancer cases, 107 subjects received the breast-conserving operation, and other 112 cases received the modified radical mastectomy. The operation time, intraoperative blood loss and length of hospital stay were (56.7 ± 14.6) min, (39.2 ± 10.1) ml, (12.1 ± 2.1) day in the breast-conserving group and (95.6 ± 1 3.5) min, (79.5 ± 13.6) ml, (14.8 ± 3.2) day in the modified radical mastectomy group respectively. The operation time, intraoperative blood loss and length of hospital stay were smaller in the breast-conserving group as compared with modified radical mastectomy group with statistical difference (P < 0.05). The overall survival was compared with Kaplan-Meier curve by using log-rank test for the hazard ratio (HR). And the HR was 0.75 with its 95% confidence interval of 0.38-1.48, which indicated that no statistical difference of overall survival was existed between the two groups (P > 0.05). Conclusion: The breast-conserving operation was superior to modified radical mastectomy in the aspects of operation time, intraoperative blood loss and length of hospital stay.

Background Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. Methods This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. Results A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30–49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5–8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2–14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1–5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3–3.9)). No in-hospital mortality occurred during the course of the study. Conclusion Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.

Objective To describe the clinical outcome and physical condition of patients with locally advanced breast cancer (LABC) who received neoadjuvant chemotherapy followed by mastectomy and latissimus dorsi myocutaneous flap repair. Methods A retrospective review of 142 patients with locally advanced breast cancer was selected from 1156 breast cancer patients in the South and North areas of The Affiliated Calmette Hospital of Kunming Medical University between May 2008 and December 2018. Results All participants ( n = 142) were women aged 40–55 years (average age 47.35 ± 0.43 years) who received neoadjuvant chemotherapy followed by mastectomy and latissimus dorsi flap repair. The median follow-up period was 16 months (range 12–24 months). For stage of disease, there were 19 cases (13%) in stage IIB, 31 cases (22%) in stage IIIA, 39 cases (28%) in stage IIIB, and 53 cases (37%) in stage IIIC, which were statistically significant with the physical condition of patients (≤ 0.001). Neoadjuvant chemotherapy was administered to shrink the tumors, and an average tumor size decrease from 10.05 ± 1.59 cm × (8.07 ± 1.54) cm to 6.11 ± 1.72 cm × (3.91 ± 1.52) cm ( P < 0.001) was considered statistically significant. A t test was used for the ECOG score statistics, and the results showed that the scores were statistically significant (≤ 0.001) before and after neoadjuvant chemotherapy and after surgery. Conclusions Neoadjuvant chemotherapy is an accepted treatment option for patients with locally advanced breast cancer, and the use of a latissimus dorsi musculocutaneous flap for post-mastectomy reconstruction may improve the patients’ physical condition. Our results indicated that this strategy was safe and feasible.