Maria João Cardoso

ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†

Advanced Breast Cancer (ABC) is a treatable but still generally incurable disease. The goals of care are to optimize both length and quality of life. Due to continuous research, several advances have been made, particularly for the HER-2-positive and for Luminal-like subtypes. Notwithstanding these advances, median overall survival of patients with ABC is still only 2–3 years, although the range is wide [1–5], and survival may be longer for patients treated in specialized institutions [6]. Implementation of current knowledge is highly variable among countries and within each country.

INbreast: toward a full-field digital mammographic database.

RATIONALE AND OBJECTIVES Computer-aided detection and diagnosis (CAD) systems have been developed in the past two decades to assist radiologists in the detection and diagnosis of lesions seen on breast imaging exams, thus providing a second opinion. Mammographic databases play an important role in the development of algorithms aiming at the detection and diagnosis of mammary lesions. However, available databases often do not take into consideration all the requirements needed for research and study purposes. This article aims to present and detail a new mammographic database. MATERIALS AND METHODS Images were acquired at a breast center located in a university hospital (Centro Hospitalar de S. João [CHSJ], Breast Centre, Porto) with the permission of the Portuguese National Committee of Data Protection and Hospitals Ethics Committee. MammoNovation Siemens full-field digital mammography, with a solid-state detector of amorphous selenium was used. RESULTS The new database-INbreast-has a total of 115 cases (410 images) from which 90 cases are from women with both breasts affected (four images per case) and 25 cases are from mastectomy patients (two images per case). Several types of lesions (masses, calcifications, asymmetries, and distortions) were included. Accurate contours made by specialists are also provided in XML format. CONCLUSION The strengths of the actually presented database-INbreast-relies on the fact that it was built with full-field digital mammograms (in opposition to digitized mammograms), it presents a wide variability of cases, and is made publicly available together with precise annotations. We believe that this database can be a reference for future works centered or related to breast cancer imaging.

Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment

OBJECTIVE This work presents a novel approach for the automated prediction of the aesthetic result of breast cancer conservative treatment (BCCT). Cosmetic assessment plays a major role in the study of BCCT. Objective assessment methods are being preferred to overcome the drawbacks of subjective evaluation. METHODOLOGY The problem is addressed as a pattern recognition task. A dataset of images of patients was classified in four classes (excellent, good, fair, poor) by a panel of international experts, providing a gold standard classification. As possible types of objective features we considered those already identified by domain experts as relevant to the aesthetic evaluation of the surgical procedure, namely those assessing breast asymmetry, skin colour difference and scar visibility. A classifier based on support vector machines was developed from objective features extracted from the reference dataset. RESULTS A correct classification rate of about 70% was obtained when categorizing a set of unseen images into the aforementioned four classes. This accuracy is comparable with the result of the best evaluator from the panel of experts. CONCLUSION The results obtained are rather encouraging and the developed tool could be very helpful in assuring objective assessment of the aesthetic outcome of BCCT.

Factors Determining Esthetic Outcome after Breast Cancer Conservative Treatment

Abstract:  The aim of this study was to evaluate the factors that determine esthetic outcome after breast cancer conservative treatment, based on a consensual classification obtained with an international consensus panel. Photographs were taken from 120 women submitted to conservative unilateral breast cancer surgery (with or without axillary surgery) and radiotherapy. The images were sent to a panel of observers from 13 different countries and consensus on the classification of esthetic result (recorded as excellent, good, fair or poor) was obtained in 113 cases by means of a Delphi method. For each patient, data were collected retrospectively regarding patient characteristics, tumor, and treatment factors. Univariate and multivariate analysis were used to evaluate the correlation between these factors and overall cosmetic results. On univariate analysis, younger and thinner patients as well as patients with lower body mass index (BMI) and premenopausal status obtained better cosmetic results. In the group of tumor‐ and treatment‐related factors, larger removed specimens, clearly visible scars, the use of chemotherapy and longer follow‐up period were associated with less satisfactory results. On multivariate analysis, only BMI and scar visibility maintained a significant association with cosmesis. BMI and scar visibility are the only factors significantly associated with cosmetic results of breast cancer conservative treatment, as evaluated by an international consensus panel.

3rd ESO-ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3).

• This ESO-ESMO ABC 5 Clinical Practice Guideline provides key recommendations for managing advanced breast cancer patients. • It provides updates on managing patients with all breast cancer subtypes, LABC, follow-up, palliative and supportive care. • Updated diagnostic and treatment algorithms are also provided. • All recommendations were compiled by a multidisciplinary group of international experts. • Recommendations are based on available clinical evidence and the collective expert opinion of the authors.

Recommendations for the aesthetic evaluation of breast cancer conservative treatment

During the Turning Subjective Into Objective seminar held in Lisbon in May 2011, experts in the topic gathered to discuss the unsolved problems of aesthetic evaluation of breast-conserving treatment (BCT). The purpose of this study is to review the main methodological issues related to the aesthetic evaluation of BCT, to discuss currently used methods of evaluation and the lack of a gold standard, and to write a set of recommendations that can be used as guidance for the aesthetic evaluation of BCT.

Management of locally advanced breast cancer—perspectives and future directions

Locally advanced breast cancer (LABC) constitutes a heterogeneous entity that includes advanced-stage primary tumours, cancers with extensive nodal involvement and inflammatory breast carcinomas. Although the definition of LABC can be broadened to include some large operable breast tumours, we use this term to strictly refer to inoperable cancers that are included in the above-mentioned categories. The prognosis of such tumours is often unfavourable; despite aggressive treatment, many patients eventually develop distant metastases and die from the disease. Advances in systemic therapy, including radiation treatment, surgical techniques and the development of new targeted agents have significantly improved clinical outcomes for patients with this disease. Notwithstanding these advances, LABC remains an important clinical problem, particularly in developing countries and those without widely adapted breast cancer awareness programmes. The optimal management of LABC requires a multidisciplinary approach, a well-coordinated treatment schedule and close cooperation between medical, surgical and radiation oncologists. In this Review, we discuss the current state of the art and possible future treatment strategies for patients with LABC.

2005 Special issue: Modelling ordinal relations with SVMs: An application to objective aesthetic evaluation of breast cancer conservative treatment

The cosmetic result is an important endpoint for breast cancer conservative treatment (BCCT), but the verification of this outcome remains without a standard. Objective assessment methods are preferred to overcome the drawbacks of subjective evaluation. In this paper a novel algorithm is proposed, based on support vector machines, for the classification of ordinal categorical data. This classifier is then applied as a new methodology for the objective assessment of the aesthetic result of BCCT. Based on the new classifier, a semi-objective score for quantification of the aesthetic results of BCCT was developed, allowing the discrimination of patients into four classes.

Assessing cosmetic results after breast conserving surgery

“Taking less treating better” has been one of the major improvements of breast cancer surgery in the last four decades. The application of this principle translates into equivalent survival of breast cancer conserving treatment (BCT) when compared to mastectomy, with a better cosmetic outcome. While it is relatively easy to evaluate the oncological results of BCT, the cosmetic outcome is more difficult to measure due to the lack of an effective and consensual procedure. The assessment of cosmetic outcome has been mainly subjective, undertaken by a panel of expert observers or/and by patient self‐assessment. Unfortunately, the reproducibility of these methods is low. Objective methods have higher values of reproducibility but still lack the inclusion of several features considered by specialists in BCT to be fundamental for cosmetic outcome. The recent addition of volume information obtained with 3D images seems promising. Until now, unfortunately, no method is considered to be the standard of care. This paper revises the history of cosmetic evaluation and guides us into the future aiming at a method that can easily be used and accepted by all, caregivers and caretakers, allowing not only the comparison of results but the improvement of performance. J. Surg. Oncol. 2014 110:37–44.

ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3)

The 3rd International Consensus Conference for Breast Cancer in Young Women (BCY3) took place in November 2016, in Lugano, Switzerland organized by the European School of Oncology (ESO) and the European Society of Medical Oncologists (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY2 with incorporation of new evidence to inform the guidelines, and areas of research priorities were identified. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).