Sexual quality of life of adolescents and young adult breast cancer survivors.

BACKGROUND: With increasing survival rates of adolescents and young adults (AYAs) with breast cancer, health-related quality of life (HRQoL) becomes more important. An important aspect of HRQoL is sexual QoL. This study examined long-term sexual QoL of AYA breast cancer survivors, compared sexual QoL scores with that of other AYA cancer survivors, and identified factors associated with long-term sexual QoL of AYA breast cancer survivors. MATERIALS AND METHODS: Data of the SURVAYA study were utilized for secondary analyses. Sexual QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). Descriptive statistics were used to describe sexual QoL of AYA cancer survivors. Linear regression models were constructed to examine the effect of cancer type on sexual QoL and to identify factors associated with sexual QoL. RESULTS: Of the 4010 AYA cancer survivors, 944 had breast cancer. Mean sexual QoL scores of AYA breast cancer survivors ranged from 34.5 to 60.0 for functional domains and from 25.2 to 41.5 for symptom-orientated domains. AYA breast cancer survivors reported significantly lower sexual QoL compared to AYA survivors of other cancer types on all domains. Age, time since diagnosis, relationship status, educational level, chemotherapy, hormonal therapy, breast surgery, body image, and coping were associated with sexual QoL of AYA breast cancer survivors. CONCLUSIONS: AYA breast cancer survivors experience decreased sexual QoL in the long term (5-20 years) after diagnosis and worse score compared to AYA survivors of other cancer types, indicating a clear need to invest in supportive care interventions for those at risk, to enhance sexual well-being.

Simultaneous use of an (125)I-seed to guide tumour excision and (99m)Tc-nanocolloid for sentinel node biopsy in non-palpable breast-conserving surgery.

PURPOSE: In the present study we describe patients with non-palpable breast lesions, in which an Iodine-125 ((125)I)-marker (or "seed") for excision of the primary tumour and Technetium-99m nanocolloid ((99m)Tc-nanocolloid) for sentinel node biopsy (SNB) are used simultaneously. The purpose was to investigate any interference between (125)I-seeds and (99m)Tc-nanocolloid by an in vitro and in vivo analysis. METHODS: Contrast/interference-ratios between (125)I and (99m)Tc count-rates were determined in vitro using a realistic simulation model. Measurements were performed with 3 gamma-probes with different crystal materials. In 25 consecutive patients (99m)Tc-nanocolloid was intratumourally administered at the site of a previously implanted (125)I-seed. Respectively, the (125)I-setting and (99m)Tc-setting of the gamma-probe guided the wide local excision and SNB and maximum counts-per-second (cps) were measured. RESULTS: In vitro the different probes varied in (125)I- and (99m)Tc-sensitivity. The contrast-ratio between (125)I and (99m)Tc in the (125)I-channel was 4.6 for a 3-month-old (125)I-seed using the most appropriate gamma-probe. In vivo the gamma-probe in the (125)I-setting measured a median of 16,300 cps at the tumour site compared to 4820 cps using the (99m)Tc-setting. The (125)I-seed could be well distinguished from the (99m)Tc-nanocolloid in 92% of the patients and 96% required a single operation. The SNB was successful in all patients. CONCLUSIONS: Simultaneous use of (125)I-seeds and (99m)Tc-nanocolloid is possible under well-standardised conditions. Non-palpable breast lesions can be safely excised using the (125)I-seed in combination with a SN procedure. Use of (125)I-seeds is a next step within fine-tuning breast-conserving surgery that should lead to further investigation to confirm its value.

Lymphoscintigraphy and SPECT/CT in multicentric and multifocal breast cancer: does each tumour have a separate drainage pattern? Results of a Dutch multicentre study (MULTISENT).

PURPOSE: To investigate whether lymphoscintigraphy and SPECT/CT after intralesional injection of radiopharmaceutical into each tumour separately in patients with multiple malignancies in one breast yields additional sentinel nodes compared to intralesional injection of the largest tumour only. METHODS: Patients were included prospectively at four centres in The Netherlands. Lymphatic flow was studied using planar lymphoscintigraphy and SPECT/CT until 4 h after administration of (99m)Tc-nanocolloid in the largest tumour. Subsequently, the smaller tumour(s) was injected intratumorally followed by the same imaging sequence. Sentinel nodes were intraoperatively localized using a gamma ray detection probe and vital blue dye. RESULTS: Included in the study were 50 patients. Additional lymphatic drainage was depicted after the second and/or third injection in 32 patients (64%). Comparison of planar images and SPECT/CT images after consecutive injections enabled visualization of the number and location of additional sentinel nodes (32 axillary, 11 internal mammary chain, 2 intramammary, and 1 interpectoral. A sentinel node contained metastases in 17 patients (34%). In five patients with a tumour-positive node in the axilla that was visualized after the first injection, an additional involved axillary node was found after the second injection. In two patients, isolated tumour cells were found in sentinel nodes that were only visualized after the second injection, whilst the sentinel nodes identified after the first injection were tumour-negative. CONCLUSION: Lymphoscintigraphy and SPECT/CT after consecutive intratumoral injections of tracer enable lymphatic mapping of each tumour separately in patients with multiple malignancies within one breast. The high incidence of additional sentinel nodes draining from tumours other than the largest one suggests that separate tumour-related tracer injections may be a more accurate approach to mapping and sampling of sentinel nodes in patients with multicentric or multifocal breast cancer.

Radio guided occult lesion localization (ROLL) for non-palpable invasive breast cancer.

BACKGROUND: Wire guided localization (WGL) for non-palpable breast cancer is technically difficult and patient unfriendly. Radio guided occult lesion localization (ROLL) takes advantage of the possibility to detect the tumor through the nuclear tracer that is injected directly into the tumor for the sentinel node procedure. METHODS: Forty patients with 41 invasive breast carcinomas were treated using ROLL. Patients received a dose of 120 Mbq 99mTc Nanocolloid intra-tumorally on the day of surgery or a dose of 370 Mbq 99mTc Nanocolloïd intra-tumorally the prior day. The sentinel node (SN) was located using patent blue and a gamma ray detection probe that was also employed to guide the tumor excision. RESULTS: In 31 patients (78%) the invasive tumor was adequately excised. In two cases (5%) a re-excision was required due to inadequately excised carcinoma in situ and in three patients (7.5%) both the invasive and the in situ tumor were inadequately excised. In 35 patients (88%) the SN was found and removed. CONCLUSIONS: The ROLL procedure seems to be an alternative to WGL in patients with non-palpable breast carcinoma. To determine the place of ROLL versus WGL in the treatment of non-palpable breast cancer, a randomized clinical trial is needed.

Axillary recurrence after a tumour-negative sentinel node biopsy in breast cancer patients: A systematic review and meta-analysis of the literature.

BACKGROUND: Sentinel node biopsy became the standard of care before consensus on the technique was reached and without randomized studies having shown a similar or decreased axillary recurrence rate. The purpose of this study was to evaluate studies reporting on patients with a negative sentinel node biopsy. METHODS: We performed a systematic review and meta-analysis of the literature for studies concerning clinically node-negative breast cancer patients with a tumour-negative sentinel node biopsy and no subsequent axillary node dissection. The axillary recurrence rate was determined, as well as the sensitivity of the sentinel node procedure and the differences in lymphatic mapping techniques. RESULTS: Forty-eight studies concerning 14 959 sentinel node-negative breast cancer patients followed for a median of 34 months were selected. Sixty-seven patients developed an axillary recurrence, resulting in a recurrence rate of 0.3%. The sensitivity of the sentinel node biopsy was 100%. Uni- and multivariable variable analyses showed that the lowest recurrence rates were reported in studies performed in cancer centres, in studies that described the use of (99m)Tc-sulphur colloid, and also when investigators used the superficial injection technique or evaluated the harvested sentinel nodes with haematoxylin-eosin and immunohistochemistry staining (p<0.01). CONCLUSIONS: In this systematic literature review, the axillary recurrence rate in sentinel node-negative patients is 0.3%, which is well within the desired range. The median sensitivity of the procedure appears to be as high as 100%. The recurrence rate is influenced by the differences in the lymphatic mapping technique.

'Radioguided occult lesion localisation' (ROLL) for non-palpable breast lesions: a review of the relevant literature.

BACKGROUND: 'Radioguided occult lesion localisation' (ROLL) is a possible alternative to the commonly used 'wire-guided localisation' (WGL) of non-palpable breast lesions. Intratumoural injection of a radiotracer identifies both the primary tumour and the sentinel lymph nodes for intraoperative gamma probe guided dissection. METHOD: A broad literature search was conducted, using the Pubmed, Embase and The Cochrane Library databases. Five clinically controlled trials and one randomised controlled trial, all of modest size, were selected which describe both ROLL and WGL. Four articles were found that describe the combined use of the ROLL technique with the sentinel node procedure. RESULTS: In the ROLL group between 69% and 84% of the lesions were radically excised, compared with 44-60% of the lesions in the WGL group. The studies that combined ROLL and the sentinel node procedure mentioned even higher percentages of radically excised specimens ranging from 90% to 95% and an identification rate of sentinel nodes up to 100%. One randomised controlled trial mentioned that the ROLL procedure had a faster localisation time, was easier to perform, was less painful and gave a better cosmetic result than WGL. CONCLUSION: ROLL seems a promising technique, which appears to be more radical than WGL. Localisation tends to be more accurate and faster, the excision procedure is more elegant and simple to perform, and the cosmetic result seems to be better. Further research is necessary to establish the exact role of ROLL in the management of non-palpable breast lesions.

Radiofrequency ablation for breast cancer: a review of the literature.

INTRODUCTION: Radiofrequency ablation (RFA) provides an effective technique for minimally invasive tissue destruction. A novel application is the use for treatment of small breast carcinoma. METHODS: A broad search was conducted in Pubmed, Embase and the Cochrane library. Results of the relevant articles were analysed. RESULTS: The analysed studies were all feasibility or pilot studies using different patient and tumour characteristics and ablation settings. Despite many methodological differences, high percentages of complete tumour ablation varying between 80% and 100% were reported. CONCLUSION: Radiofrequency ablation is a promising new tool for minimally invasive ablation of small carcinomas of the breast. A large randomized control study is required to assess the long-term advantages of RFA compared to the current breast conserving therapies.