The Breast : official journal of the European Society of Mastology
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Adjuvant treatments for operable breast cancers are determined according to subtypes defined based on estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status. The ER+/HER2- subtype can be divided into luminal A and luminal B usually by Ki67 expression levels. Although tumor size, lymph node metastasis and tumor grade have been widely accepted in daily clinical practice, the identification of further prognostic indicators especially in the ER+/HER2- subtype is warranted. ⋯ By multivariable analysis, SUVmax (hazard ratio: 3.83, 95% confidence interval: 1.28-11.51, p = 0.017), tumor size (4.22, 1.39-12.82, p = 0.011) and lymph node metastasis (4.44, 1.81-10.87, p = 0.0012) were significant and independent prognostic factors for RFS. The ER+/HER2- subtype demonstrated consistently worse RFS in the SUVmax-high patients both in the luminal A (p = 0.037) and luminal B (p = 0.047) subtypes. Combination of Ki67 and SUVmax appears to be useful for selecting patients who have inferior prognosis and need further adjuvant treatment of the ER+/HER2- subtype.
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Immediate tissue expander/implant-based breast reconstruction (BR) is often avoided when post-mastectomy radiotherapy (PMRT) is planned due to concerns about high complication rates and poor aesthetic outcomes. This study evaluated surgical, aesthetic and quality of life (QoL) outcomes in women undergoing immediate implant-based BR (IIBR) followed by PMRT. ⋯ This study demonstrated acceptable cosmetic results, high patient satisfaction and low complication rates. It provides evidence that women are willing to accept the potential risks of IIBR in exchange for its benefits including enhanced body image during chemotherapy and PMRT and the possible avoidance of more complicated and costly delayed autologous BR. The results support the importance of access to BR, even in women with high-risk disease.
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Management of micrometastasis in the sentinel node is a controversial topic. Most of the guidelines don't recommend further axillary treatment if micrometastasis are the only finding in the sentinel node. However, some evidence suggests that micrometastasis have significant effect on long term outcomes and therefore indicate systemic treatment. ⋯ Although not an indication for axillary clearance recent guidelines, micrometastasis and ITC found in the SNB are a sign of a biologically different disease. This important information should be taken in consideration when planning the adjuvant treatment in those patients among other factors considered.