Intraoperative Assessment of Endogenous Microbiota in the Breast / Avaliação intraoperatória da microbiota endógena da mama

Abstract Objective: Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast. Methods: Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter. Results: Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively. Conclusion: The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.

Resumo Objetivo: A cirurgia de mama é considerada uma cirurgia limpa; entretanto, as taxas de infecção variam entre 3 e 15%. O objetivo deste estudo foi investigar no intraoperatório a presença de microbiota autóctone na mama. Métodos: Pedaços de tecido mamário coletados de 49 pacientes submetidas à cirurgia eletiva da mama (reconstrutiva, diagnóstica ou oncológica) foram cultivados. Os pedaços de tecido mamário tinham aproximadamente 1 cm de diâmetro e foram removidos da área retroareolar e dos quadrantes medial e lateral. Cada pedaço de tecido foi incubado em caldo BHI (brain heart infusion) por 7 dias a 37 ° C, e nos casos em que o meio ficou turvo devido ao crescimento de microrganismos, as amostras foram colocadas em placas de Petri para cultivo e isolamento de cepas e para identificação de espécies usando um contador automatizado. Resultados: O crescimento do microrganismo foi observado nas amostras de 10 das 49 pacientes (20,4%) e em 11 dos 218 pedaços de tecido (5%). As espécies detectadas foram Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis e Aeromonas salmonicida. Nenhum paciente com amostras positivas apresentou infecção clínica no pós-operatório. Conclusão: A presença dessas bactérias no tecido mamário em aproximadamente 20% das pacientes desta série sugere que a cirurgia mamária deve ser considerada uma fonte potencial de contaminação que pode ter implicações nas reações adversas aos implantes mamários e deve ser estudada em um futuro próximo por suas implicações oncológicas na etiologia do linfoma de células grandes associado ao implante de mama.

Transformation of fibroadenoma to phyllodes tumor and the use of oncoplastic technique for breast conservative treatment / A transformação do fibroadenoma em tumor filóides e o uso de técnicas oncoplásticas no tratamento cirúrgico conservador de mama

Phyllodes tumors (PT) are rare neoplasms accounting for <1% of breast lesions. A transformation of a fibroadenoma (FA) to a PT is even more rare and unpredictable. Many challenges face PT management, since diagnostic through surgical treatment. We describe a case of a 63-year old woman with PT that was previously diagnosed as a FA who underwent an oncoplastic conservative surgery. A review of the literature on the diagnostic and surgical management of PT was performed. The diagnostic of PT can be hard mostly in needle biopsy, and the close follow up of negative lesions is recommended. Oncoplastic techniques might be an important tool on the conservative treatment of these patients.

O tumor filoide (TF) é uma rara neoplasia que corresponde a menos de 1% das lesões mamárias. A tranformação do fibroadenoma (FA) em TF é um evento raro e imprevisível. Existem muitos desafios no manejo dos TF, desde o seu diagnóstico ao tratamento. Nós descrevemos o caso de uma paciente de 63 anos com TF com diagnóstico prévio de FA que foi submetida ao tratamento cirúrgico conservador da mama por técnicas oncoplásticas. Uma revisão da literatura sobre o diagnóstico e tratamento do TF foi realizada. O diagnóstico dessa condição pode ser especialmente difícil quando feito a partir de amostra de biópsias por agulha, e em caso de resultados negativos recomenda-se acompanhamento rigoroso. As técnicas oncoplásticas podem ser uma importante ferramenta no tratamento cirúrgico conservador desses pacientes.

Cirugía oncoplástica de la mama. Experiencia inicial en el Centro Clínico de Estereotaxia CECLINES, Caracas / Breast oncoplastic surgery. initial experience at Centro Clínico de Estereotaxia, CECLINES. Caracas

La cirugía preservadora (CP) puede algunas veces generar deformi-dades en la mama conservada. La cirugía oncoplástica (COP) pre-tende entonces mejorar nuestros resultados estéticos aun en loscasos con grandes resecciones de tejido mamario. Objetivo:Elpropósito de este estudio es dar una evaluación objetiva de nues-tra experiencia inicial con COP, principalmente basado en nivelesde satisfacción por parte de los pacientes y cirujanos Métodos:Este estudio prospectivo fue realizado en CECLINES en Caracas,durante el periodo enero 2011 y octubre 2012, el cual involucró107 pacientes consecutivos en 2 grupos: 52 pacientes ­ nivel IIde COP vs 55 pacientes ­cirugía preservadora "tradicional" (CPT).Evaluamos el nivel de satisfacción y el resultado estético a los 6 y12 meses post operatorio utilizando una puntuación distribuidadesde 1 (malo) hasta 5 (excelente). La puntuación estética fuerecopilada durante el seguimiento clínico por parte de los ciruja-nos, por llamadas telefónicas y fotografías fueron evaluadas por unpanel de 4 observadores. Resultados:La participación en el nivelde satisfacción y resultado estético fue del 100% a los 6 meses y96.2 % a los 12 meses. El tamaño tumoral promedio fue 23 mm(DE 13.5) para el grupo de COP vs 17.6 mm (DE 8.3) para el grupode CPT (p=0.017). El peso promedio de la pieza quirúrgica fue 01 gr (rango 30 gr­512 gr) grupo COP vs 60.4 gr (rango 20gr­135gr) grupo CPT (p=0.004). Las técnicas de COP más utilizadasfueron mamoplastia circular 40.3% (21/52), mamoplastia en Tinvertida 26.8% (14/52) y mamoplastia vertical 15.3%(8/52). A51.9% (27/52) de las pacientes se les realizó un procedimiento desimetrización distribuido de acuerdo al período de estudio de lasiguiente manera: 77.2% (17/22) en 2011, 56.6% (17/30) en2012 y 18.1%(6/33) en 2013. Las complicaciones fueron 5.7%(3/52) en el grupo de COP y 0% para el grupo de CPT (p<0.005).La puntuación estética promedio a los 6 meses por las pacientespara el grupo de COP fue 4.4, siendo la puntuación 4 (bien) y5(excelente) 88.4 %. En el grupo de CPT la puntuación promedioa los 6 meses para las pacientes fue 4.2, siendo 4-5 el 83.4 %(p = 0,644). a puntuación estética para los cirujanos en el grupode COP a los 6 meses fue 4.5, representando la puntuación 4-5 el 94.2 %. En el grupo de CPT la puntuación promedio para loscirujanos a los 6 meses fue 4.1 con 84.5 %, siendo 4 ó 5 (p <0,005). La puntuación estética final por las pacientes en el grupode COP a los 12 meses fue 4.5, siendo el nivel de satisfacción(4-5) el 90.4 %. En el grupo de CPT la puntuación estética final alos 12 meses por las pacientes fue 4.2, siendo 77.5% puntos 4o 5 (p < 0,005). La puntuación estética final por los cirujanos enel grupo de COP a los 12 meses fue 4.5, siendo el nivel de satis-facción (4-5) el 92.3 %. En el grupo de CPT la puntuación finalpor parte de los cirujanos a los 12 meses fue de 4.1, 84.5 % delos puntos fueron 4 ó 5 (p < 0,005) Conclusión:La COP generabuenas tasas de satisfacción. Cuando una COP no está indicada,una CPT retribuye buenos niveles de satisfacción y resultados esté-ticos. Usualmente los resultados se mantienen estables después delos 6 meses. La utilización de COP permite la extirpación de lesio-nes y piezas quirúrgicas más voluminosas. Los procedimientos desimetrización no siempre son necesarios. Con la adecuada selec-ción de las pacientes la tasa de complicaciones es baja tanto enel grupo de COP como de CPT(AU)

Breast conservative surgery (BCS) may sometimes lead to deformi-ties in the remaining breast. Oncoplastic surgery (OPS) pretends toimprove our aesthetic results even in the case of major volumeresections. Objective:The purpose of this study is to give anobjective evaluation of our initial experience with OPS, mainlybased on levels of satisfaction by both patients and surgeons.Methods:This prospective study was performed at CECLINES inCaracas-Venezuela during the period January 2011-October 2012,which involved 107 consecutive patients in two groups: 52patients - level II OPS vs 55 patients -'Standard' BCS (SBCS). Weevaluated the level of satisfaction and cosmetic outcome at 6 and12 months post op using a score from 1(bad) to 5(excellent). Thecosmetic score was recorded during the follow-up by the surgeon,by phone calls and photographs were reviewed by a panel of fourobservers. Results: The participation rate in the cosmetic outco-me/level of satisfaction evaluation was 100% at 6 months and96.2% at 12 months. The average tumor size was 23mm (SD 13.5)OPS group vs 17.6 mm (SD 8.3) SBCS group (p=0.017). The ave-rage weigth for the surgical specimen was 101gr (range 30gr­512gr) OPS group vs 60.4gr (range 20gr­135gr) SBCS group(p=0.004). The OPS techniques most performed were round block40.3% (21/52), inverted T mammoplasty 26.8% (14/52) and ver-tical scar mammoplasty 15.3%(8/52). 51.9% (27/52) of patients had simetrization procedures performed distributed according tothe period of the study: 77.2% (17/22) in 2011, 56.6% (17/30) in2012 and 18.1 % (6/33) in 2013. Complications were 5.7%(3/52) in the OPS group and 0% for SBCS group (p<0.005). Theaverage cosmetic score at 6 months by patients in the OPS groupwas 4.4, patient ́s satisfaction scores of 4(good) and 5 (excellent)were 88.4 %. In the SBCS group at 6 months the mean score bypatients were 4.2 being scores 4-5 83.4 % (p = 0,644). The cos-metic score by surgeons in the OPS group at 6 months was 4.5,surgeon ́s satisfaction scores of 4-5 were 94.2 %. In the SBCS sur-geon ́s mean score at 6 months were 4.1 with 84.5 % of scoresbeing 4 or 5 (p < 0,005). The final cosmetic score by patients inthe OPS group at 12 months was 4.5, patient ́s satisfaction scoresof 4-5 were 90.4 %. In the SBCS group the final mean score at 12months by patients were 4.2, 77.5% of scores being 4 or 5 (p <0,005). The final cosmetic score by surgeons in the OPS group at12 months was 4.5, surgeon ́s satisfaction scores of 4-5 were92.3%. In the SBCS surgeon ́s final mean score at 12 months were4.1, 84.5% of scores being 4 or 5 (p < 0,005). Conclusion: OPSprovides good satisfaction rates. A SBCS when an OPS is not indi-cated, mostly retributes good satisfaction levels and cosmetic sco-res. Usually the results remain stable after 6 months. The use ofOPS allows the excision of bigger lesions and surgical specimens.Simmetrization procedures are not always required. With the appro-priate patient selection the rate of complications is low for bothOPS and SBCS(AU)

Breast-conserving surgery for early-stage breast cancer guided by intra-operative ultrasound / 国际外科学杂志

Objective To evaluate the feasibility of intra-operative ultrasound guide in breast conservative-surgery and its effect on positive margin rate and breast tissue volume.Methods Fifty-five cases of invasive breast cancer staged T1-2N0-1 were randomly assigned to palpation-guided group(control group) 26 cases and ultrasound-guided group(experiment group) 29 cases.Before and during operation,high-frequency ultrasound was used to guide the resection of breast cancer with 1 cm margin in experiment group.The resection margin positive rate deteced by tissue section frozen biopsy and resected breast tissue volume were compared between experiment and control group.Results The clinicopathologic features were accordant between two groups.The margin positive rate and near-margin positive rate in experiment group were 0 and 3.45％ respectively,slightly lower than that of control group 3.85％ and 15.38％,but with no statistical significance (P ＞ 0.05).The same situation occurred at the re-exision rate.The resected breast tissue volume in experiment group (32.40 ± 10.93) cm3 was lower than that of control group (55.11 ± 12.88) cm3,and with statistical significance (P ＜ 0.01).Conclusions Intra-operative ultrasound guide could reduce the margin positive rate and unnecessary resected brcast tissue volume in breast conservative-surgery,and improve cosmetic effect.

Oncoplasty in breast conservative surgery / 中华普通外科杂志

ObjectiveTo evaluate oncoplastic techniques on breast conservative surgery.MethodsClinical data of 50 breast cancer patients who received oncoplastic breast conservative surgery from October 2009 to August 2011 were retrospectively analyzed.The indication,methods,outcome and morbility of oncoplastic surgery were assessed. ResultsAll patients had solitary tumors.Twelve patients received neoadjuvant therapy and thirty-eight received upfront surgical therapy.Different oncoplastic surgery techniques were applied based on the location of tumor.There were 20 tumors located in upper outer quadrant receiving lateral radial or horizontal excision; Four lower inner and seven lower outer tumors received V and J shape excision respectively; Three low pole and seven upper pole tumors received inverted T and batwing excision respectively; Six tumors located periareolar area and three tumors located retroareolar area were removed using round block and J shape excision.Two patients experienced postoperative hematoma and three patients had incisional dehiscence followed by secondary infection. Another developed skin ischemia and necrosis. Thirty-five patients have finished the postoperative adjuvant radiotherapy. The appearances of the breasts were satisfactory in all patients except one having deviation of nipple and two patients suffering from dimpling in incisional region.Patients gave high scores about their breast appearance.After 4- 27 months follow-up,two patients had local recurrence and received mastectomy.Other patients were free of recurrence.ConclusionsBreast oncoplastic surgery technique benefits those whose tumors located in special area of the breast resulting in a satisfactory cosmetical appearance of the breast.

Intra-operative radiotherapy in breast-conserving surgery of early breast cancer patients / 中华普通外科杂志

Objective To evaluate intra-operative radiotherapy after breast conservative surgery in early breast cancer patients in terms of postoperative complications,cosmetic outcome and recurrence events.Methods From June 2007 to Dec 2010,115 early breast cancer patients received breast conserving surgery.Fifty-nine patients (study group) received intra-operative radiotherapy,compared with 56 patients (control group) receiving routine postoperative radiotherapy.Postoperative complications were evaluated 1 month after surgery; cosmetic outcome was evaluated 1 year postoperatively; recurrence and death events were followed up.Results The average wound healing time was 13 -22 days in study group and 9 - 14days in control group.In the study group,2 patients developed fat deliquescence,16 patients showed wound edema while no such side effects were found in control group.No infection or hematoma were found in either group.Overall cosmetic outcome was rated 1 year post operation.In the study group (41 cases),36 patients were graded as excellent or good,5 patients were as fair or poor.Meanwhile in the control group (37 cases),wounds in 25 patients were graded as excellent or good,that in 12 patients were as fair or poor (P =0.031).After a follow-up from 3 to 42 months(median:24 months),two patients (3.39％) in study group developed local cancer relapses,one of them( 1.7％ ) died.In control group,one patient ( 1.8％ )developed local relapse,and no one died.Conclusions Intra-operative radiotherapy is safe and reliable with good cosmetic outcome.

Expressions of PCNA, c-erbB-2, p53, ER and PR in tissues adjacent to breast cancer / 西安交通大学学报(医学版)

Objective To detect the expressions of proliferating cell nuclear antigen (PCNA), C-erbB-2, p53, estrogen receptor (ER) and progesterone receptor (PR) in order to explore the proper margin for breast conservative surgery on Chinese women. Methods We collected 40 resection specimens from breast cancer patients who had received radical surgery. Then we divided each specimen into primary tumor group and hyperplasia and gene expression characteristics of PCNA, c-erbB-2, p53, ER and PR were measured by pathological and immunohistochemical assay in the five groups. Results With the further distance from the primary tumor, the proportions of high-risk disease and positive gene expressions of PCNA, c-erbB-2 and p53 in paracarcinoma tissues gradually decreased (P<0.05). Higher risk and more positive expressions were related to paracarcinoma was no correlation of PCNA, ER and PR expressions adjacent to breast cancer with tissue differentiation and lymph node metastasis (P>0.05). a safe and appropriater region for breast conservative surgery.

Comparison of forward and inverse intensity modulation radiotherapy planning for breast cancer after breast-conservative surgery / 中华放射医学与防护杂志

Objective To compare the dosimetric difference in forward intensity modulation radiotherapy (fIMRT)and inverse IMRT(iIMRT)planning for breast cancer.Methods Six patients received radiotherapy alone after left breast-conserving surgery were selected.For each patient,two treatment phns(flMRT and iIMRT)were designed with Pinnacle3 7.4f.In each plan,the volume of PIT received prescription dose was not less than 95 %.The dosimetrie parameters were assessed with dose volume histograms in planning target volume (PIT)and organ of around risk(OAR).Results Of flMRT and ilMRT plans,the PTV average canformal indexwere(0.67±0.06)and(0.66±0.06)(t = 2.423,P ＞ 0.05),average homogeneity index were (28.2±6.0)% and(26.1±6.8)%(t = 2.164,P ＞ 0.05);the volume of left lung received 20 Gy(V20)were(18.7±3.3)% and(17.0±2.8)%(t =5.087,P<0.05),and V30 of left lung were(15.5±3.0)%and(14.0±2.6)%(t =7.272,P<0.05);V30 of heart were(4.1±3.1)% and(3.5±2.5)%(t=1.916,P ＞ 0.05);the total monitor units were(262±5)MU and(308±14)MU(t = 7.515,P < 0.05).Conclusions There were no significant differences of CI,HI,and V30 of heart between flMRT and iIMRT.Because of fewer MUs,fIMRT plan could reduce the machine abrasion and treatment time,but V30 and V30 of left lung are higher significantly than iIMRT plan.

Analysis of dosimetry and clinical outcome using intensity modulated radiation therapy for early breast cancer patients after breast conservative surgery / 中华放射医学与防护杂志

Objective To analyze the dosimetfic benefits, clinical effect and side-respond of whole breast using intensity modulated radiotherapy for early breast cancer after conservative surgery. Methods From Oct.2004 to Aug. 2005,103 patients received the whole breast intensity modulated radiation therapy (IMRT). A dosimetric comparison of IMRT with conventional radiotherapy (CR) was performed on each patient. The cosmetic results, clinical effect and side-respond were observed. Results The average volume proportion of 95% and 107% prescribed dose was 95.8% ± 4.90% and 84.0% ± 20.7% (t = 9.60, P < 0.01) with IMRT and CR in clinical target volume, respectively. The V20 (lung volume of aceepted> 20 Gy/all lung volume × 100%) of the ipsilateral lung were 15.70% ± 4.64% and 23. 11% ± 7.88% (t = - 13.3, P < 0.01). The V30of the heart were 4.44% ±3.93% and 15.55% ± 10.89%(t = - 11.3, P< 0.01) with IMRT and CR respectively for sixty-three left side breast cancer patients. The 1- and 2-year excellent rate of good cosmetic outcome was both 100%. The 1-, 2- and 3-year local control rate was 99% ,99% and 98% ,respectively. The 1-, 2- and 3-year disease-free survival rate was 99% ,99% and 96% ,respectively. The Grade 1 and 2 acute radiation skin reaction rate was 95.1% and 4.9%, respectively. Conclusion Compared with conventional radiotherapy, IMRT improves dose distribution of CTV and reduce the dose of normal tissue around CTV;but with better clinical effects and lower side-respond for early breast cancer patients after breast conservative surgery.

Breast Conservative Surgery for Large Breast Carcinoma after Neoadjuvant Chemotherapy:Report of 24 Cases / 中国微创外科杂志

Objective To investigate the feasibility of breast conservative surgery for large breast carcinoma(over 3 cm in diameter)after neoadjuvant chemotherapy.Methods A total of 24 patients with breast carcinoma larger than 3 cm in diameter underwent core needle biopsy and neoadjuvant chemotherapy with paclitaxel and/or epirubicin in our hospital from June 2003 to September 2006.The chemotherapy was carried out for 2 to 4 cycles,and then breast conservative surgery was performed in 7 to 10 days.Results After the neoadjuvant chemotherapy,3(12.5%)patients achieved CR,and 21(87.5%)had PR.Pathological CR was detected in 2(8.3%)of the patients.The breast conservative surgery was completed in 14 cases(58.3%),10 patients were converted to modified radical resection.The patients was followed up for 5 to 44 months with a median of 24,during which none of them had recurrence or distant metastasis.Conclusions For patients with large breast carcinoma,breast conservative surgery is feasible after neoadjuvant chemotherapy.

Clinical Features and Pathological Characteristics of Ductal Carcinoma in Situ of the Breast in Mastectomy and Breast Conservative Surgery

PURPOSE: Breast conservative surgery (BCS) with adjuvant radiation has recently shown similarly good treatment results in patients with early invasive breast cancer, as a mastectomy. However, a mastectomy is performed in some patients with ductal carcinoma in situ (DCIS) for many reasons. In order to compare a mastectomy with breast conservative surgery, the relationship between the clinical and pathological features, the prognoses, and factors affecting the choice of surgical method were evaluated. METHODS: A total 217 patients who underwent an operation for DCIS at Samsung Medical Center, between November 1994 and February 2002, were enrolled for this study. The patients' medical records were retrospectively reviewed for the clinical, radiological and pathological findings. RESULTS: The mean age of the mastectomy and conservative surgery groups were 47.5 and 45.0 years, respectively. A mastectomy was performed in 124 patients (57.1%), and breast conservative surgery was received by 93. The major causes for a mastectomy were a subareolar mass or calcification and multiple masses or calcifications. The median tumor size in the mastectomy group was 2.41cm, which was larger than the 1.05 cm in the BCS group (P<0.05). Recurrence was found in four patients during the follow up period (at a median of 34.0 months), but no additional recurrence was found after local excision or mastectomy for the recurred tumors. CONCLUSION: The patients in the mastectomy group were older, and their tumor size larger than the conservative surgery group. 57.1% of the patients, with nipple-areolar complex invasion, had a subareolar mass or calcification as the cause for their mastectomy, therefore, it is suggested that the patients with a subareolar mass or calcification should undergo a mastectomy for the complete excision of the tumor.

Conservative surgery and modified radical mastec tomy for early stage breast cancer / 临床外科杂志

0.05). The satisfied rate of cosmetic results of the former breast were 81.4%, compared with the latter (P

Study of breast conservation surgery for early stage breast cancer / 中国普通外科杂志

Objective To evaluate the results of breast conservation surgery combined with radiotherapy for early stage breast cancer.Methods The cinical data of 76 breast cancer patients who underwent breast(conservation) operation plus radiotherapy at Changzheng Hospital in the recent 6 years were retrospectively(analyzed).Results The 3-,and 5-year survival rate was 96.05% and 94.8%,respectively,the 3-,and 5-year local recurrence rate was 5.3% and 6.6% respectively,and the 3-,and 5-year breast conservation rate was 96.05% and 93.3%,respectively.Only one case had chest wall recurrence and there was no mortality.The case with recurrence was a 25-year old unmarried woman,who had an intense desire for breast conservation.After tumor recurrence,mastectomy was performed again and chemotherapy was(administered).The patient is presently alive and in good health.Postoperative cosmetic physical results were(satisfactory) in 80.5% of cases.Conclusions Breast conservation surgery plus radiotherapy can get(satisfactory) results.The important aspects for success of breast conservation treatment are standardization of(resection) and postoperative radiotherapy and integrated systemic therapy.