Psychometric Properties of Assessment Tools for Depression, Anxiety, Distress, and Psychological Problems in Breast Cancer Patients: A Systematic Review

Objective@#Various and accurate psychiatric assessments in patients with breast cancer who frequently suffer from psychological problems due to long-term survivors are warranted. This systematic review aimed to investigate the current evidence on psychometric properties of psychiatric assessment for evaluating psychological problems in breast cancer patients. @*Methods@#This systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Four electronic databases such as Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched. This study protocol was registered on Open Science Framework. @*Results@#Of the 2,040 articles, 21 papers were finally included. Among them, only five studies showed the performance of psychiatric assessment tools. Among 13 assessment tools used in the selected articles, the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), or Mini-Mental Adjustment to Cancer Scale was frequently used for the evaluation of psychological problems. The DT and Psychosocial Distress Questionnaire-Breast Cancer showed acceptable performances for the prediction of depression and anxiety assessed by the HADS. @*Conclusion@#This systematic review found psychiatric assessment tools with acceptable reliability and validity for breast cancer patients. However, comparative studies on reliability and validity of various scales are required to provide useful information for the selection of appropriate assessment tools based on the clinical settings and treatment stages of breast cancer. Joint research among the fields of psychiatry and breast surgery is needed for research to establish the convergent, concurrent, and predictive validity of psychiatric assessment tools in breast cancer patients.

Recurrent late seroma after immediate breast reconstruction with latissimus dorsi musculocutaneous flap

The latissimus dorsi musculocutaneous flap (LDMCF) is widely used for breast reconstruction. However, it has the disadvantage of frequent seroma formation at the donor site, and late seroma has also been reported. The authors report histological findings after the surgical treatment of a late, repeatedly recurrent seroma at 10 years after breast reconstruction with LDMCF. In 2008, a 66-year-old female patient underwent immediate breast reconstruction with LDMCF. In 2015, a late seroma was found at the donor site. After aspiration and drainage, the seroma recurred again in 2018. Total surgical excision of the seroma was performed and bloody-appearing fluid was identified in the capsule. The excised tissue was biopsied. Histological examination revealed no evidence of blood in the fluid, and multinucleated giant cells with amorphous eosinophilic proteinaceous material were identified. The cyst was suggestive of chronic granulomatous inflammation. There was no recurrence at 8 months postoperatively. The patient described herein underwent surgical treatment of late seroma that recurred after immediate breast reconstruction with LDMCF, and histological findings were identified. These results may be helpful for other future studies regarding late seroma after breast reconstruction with LDMCF.

A novel technique for placing titanium mesh with porous polyethylene via the endoscopic transnasal approach into the orbit for medial orbital wall fractures

BACKGROUND: The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. METHODS: Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. RESULTS: Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. CONCLUSIONS: We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

Early Stage Lymphedema in Breast Cancer Patient Detected by Indocyanine Green Lymphography but not by Lymphoscintigraphy: A Case Report

Secondary upper extremity lymphedema after lymph node dissection in breast cancer patients is a major complication affecting their quality of life. As lymphatic function is compromised before symptoms develop in most cases, early diagnosis and intervention before symptomatic manifestation is known to prevent severe progression of lymphedema. In this case report, we present a patient with secondary lymphedema, whose disease could be diagnosed at an early stage using indocyanine green (ICG) lymphography. The patient had mild edema of the left upper extremity that regressed with elevation, had normal lymph vessel distribution without dermal backflow pattern in lymphoscintigraphy. Her symptom improved after early prescription of complex decongestive physiotherapy. We conclude that ICG lymphography could be an effective diagnostic tool in addition to other imaging methods, for early diagnosis and intervention of lymphedema.

Iatrogenic Arteriovenous Fistula after Ultrasonography-Guided Core Needle Biopsy for Breast Lesion

Ultrasonography-guided core needle biopsy has been standard of care for diagnosing suspicious breast lesion. The procedure is safe and has a low rate of complications. Most common complication might be bleeding or hematoma, which could be avoided by careful process or changing it to excisional biopsy or managed by proper management. Rarely, Post-procedural arteriovenous fistula is reported in almost all body fields, which is life quality threatening, not life-threatening. Most of them occur with obvious vessel injury, and their primary end-point of management is the obliteration of fistula by thrombosis. However, we experienced a case of iatrogenic arteriovenous fistula after core needle biopsy for breast lesion with small vessel injury which was not but small ones, and its thrill did not disappear even after thrombosis. We would like to share our clinical learnings from surgical management process of this rare complication.

The Clinical Impact of 21-Gene Recurrence Score on Treatment Decisions for Patients with Hormone Receptor-Positive Early Breast Cancer in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The 21-gene (Oncotype DX) recurrence score (RS) assay is useful in predicting the benefits of adjuvant chemotherapy for early breast cancer patients and is widely used in Western countries. However, to date, it has not gained much popularity in East Asia. We analyzed the results from five institutions' experience from using the 21-gene assay and examined the impact of assay results on decision making of chemotherapy in Korean breast cancer patients and the associations between RS and clinicopathologic characteristics. MATERIALS AND METHODS: The 21-gene assay was performed on 212 patients with estrogen receptor-positive early breast cancer in five institutions. Each center made systemic treatment decisions both before and after the knowledge of assay results. RESULTS: Among the 212 patients, 132 (62.3%) had a low RS of or = 31. Histologic grade, presence of micrometastases, Ki-67, and presence of lymphatic invasion were statistically associated with the RS results. Treatment decisions were changed in 115 of 212 patients (54.2%) in 109 of 212 (51.4%) from chemotherapy plus hormone therapy to hormone therapy, and in six of 212 (2.8%) from hormone therapy to chemotherapy plus hormone therapy. CONCLUSION: The 21-gene breast cancer assay proved to have a significant impact on treatment decision- making. The test reduces chemotherapy use in more than 50% of Korean estrogen receptor-positive, early breast cancer patients.