The Breast : official journal of the European Society of Mastology
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Review Meta Analysis
Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: meta-analysis of randomised controlled trials.
Management of the ICBN during axillary dissection is controversial and the division of ICBN is often trivialised. The effect of dividing the ICBN, and its association with sensory disturbance, is unclear. A systematic review and meta-analysis was performed to evaluate the effect of preserving the ICBN during axillary dissection. ⋯ This meta-analysis demonstrates that division of the ICBN is associated with higher risk of sensory disturbance, and that the nature of this sensory disturbance is more likely to be hyposensitivity, attributable to reduced nerve function.
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The estrogen steroid hormone receptor (ER) and human epithelial growth factor receptor 2 membrane tyrosine kinase growth factor receptor (HER2) are the mediators of two key pathways involved in breast carcinogenesis, invasive behavior and cell growth. Co-expression of these receptors results in specific biological features that are not fully understood, but include relative resistance to hormonal therapy and chemotherapy as well as better long-term outcome imparted by ER and worse outcome by HER2 expression. The ER and HER2 signaling pathways interact with each other as do many biological networks, and this creates opportunities for therapeutic co-targeting with agents that modulate these respective pathways. ⋯ Newer generation signal transduction inhibitors can augment the efficacy of hormonal therapy, with one such example of mTOR blockade using everolimus now in the clinic. The logical extension of ER and HER2 co-targeting is the discovery and clinical testing of "synthetic lethal" combinations attacking diverse pathways that produce quantum improvements over either therapy alone. Molecular annotation of human cancers can further inform personalized combinatorial regimens based on the unique circuitry of an individual patient's tumor, with the potential to yield much more than incremental gains in survival.
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Sentinel node and occult lesion localization (SNOLL) is an alternative to wire-guided localization (WGL) for guiding surgical excision of non-palpable breast cancer and the performance of concurrent sentinel lymph node biopsy (SLNB). This review provides an overview of the available evidence on the accuracy of SNOLL in patients undergoing breast-conserving surgery. ⋯ Available scientific evidence suggests that SNOLL is a safe and accurate technique for the localization of non-palpable breast cancers.
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Sentinel node and occult lesion localization (SNOLL) is an alternative to wire-guided localization (WGL) for guiding surgical excision of non-palpable breast cancer and the performance of concurrent sentinel lymph node biopsy (SLNB). This review provides an overview of the available evidence on the accuracy of SNOLL in patients undergoing breast-conserving surgery. ⋯ Available scientific evidence suggests that SNOLL is a safe and accurate technique for the localization of non-palpable breast cancers.
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Ductal carcinoma in situ (DCIS) is a heterogeneous, pre-malignant disease accounting for 10-20% of all new breast tumours. Evidence shows a statistically significant local control benefit for adjuvant radiotherapy (RT) following breast conserving surgery (BCS) for all patients. ⋯ Ongoing studies are attempting to define subgroups of patients who are at sufficiently low risk of recurrence that RT may be safely omitted; investigating RT techniques and dose fractionation schedules; and defining the role of endocrine therapy. Future directions in the management of patients with DCIS will include investigation of prognostic and predictive biomarkers to inform individualised therapy tailored to the risk of recurrence.