Stefano Magno

Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview.

Abstract:  Conservative surgery has become a well‐established alternative to mastectomy in the treatment of breast cancer. However, in case of larger lesions or small‐size breasts, the removal of adequate volumes of breast tissue to achieve tumor‐free margins and reduce the risk of local relapse may compromise the cosmetic outcome, causing unpleasant results. In order to address this issue, new surgical techniques, so‐called oncoplastic techniques, have been introduced in recent years to optimize the efficacy of conservative surgery both in terms of local control and cosmetic results. This article discusses the indications, advantages, and limitations of these techniques and their results in terms of local recurrence and overall survival. 

Magnetic Resonance Imaging Features in Triple-Negative Breast Cancer: Comparison With Luminal and HER2-Overexpressing Tumors

BACKGROUND It has been ascertained that triple-negative (TN) breast cancer is characterized by an aggressive clinical course and a poor prognosis. The purpose of our study was to compare the magnetic resonance imaging (MRI) features of the 3 major different breast cancer subtypes (TN, luminal, and human epidermal growth factor receptor 2 [HER2]-overexpressing) and to suggest the criteria that might predict TN phenotype. MATERIALS AND METHODS From October 2007 to April 2011, we studied 77 patients with histologically confirmed TN breast cancer who underwent breast MRI. We randomly included 148 patients with non-TN breast cancer (110 luminal and 38 HER-overexpressing) as a control group. We evaluated the clinicopathologic data, the MRI morphologic and kinetic features, the signal intensity on T2-weighted images, and the apparent diffusion coefficient (ADC). RESULTS Our results confirmed that TN tumors are more aggressive, are usually diagnosed at a younger age compared with the other study groups, and show benign morphologic features with MRI. Backward stepwise logistic regression identified some parameters as independent predictors of TN-type lesions: age, size, shape, presence of edema, and infiltrative characteristics. The receiver operating characteristic (ROC) curve, built with 4 of 5 these factors as criteria to predict TN status, showed a 0.664 area under the curve (AUC) value (sensitivity 58.4%, specificity 73.2%). The inclusion of the fifth criterion showed a 0.699 AUC value (sensitivity, 49.4%; specificity, 89.4%). CONCLUSION We identified the clinicoradiologic parameters that are independent predictors of TN breast lesions, which might be helpful for earlier prediction of the TN status of a breast lesion.

DWI in breast MRI: role of ADC value to determine diagnosis between recurrent tumor and surgical scar in operated patients.

INTRODUCTION Purpose of our study is to evaluate the role of the apparent diffusion coefficient (ADC) in the diagnosis of recurrent tumor on the scar in patients operated for breast cancer. Assess, therefore, the weight of diagnostic diffusion echo-planar sequence, in association with the morphological and dynamic sequences in the diagnosis of tumor recurrence versus surgical scar. MATERIALS AND METHODS From September 2007 to March 2009, 72 patients operated for breast cancer with suspected recurrence on the scar were consecutively subjected to magnetic resonance imaging (MRI), including use of a diffusion sequence. All patients with pathological enhancement in the scar were then subjected to histological typing. MRI was considered negative in the absence of areas of suspicious enhancement. In all cases it was measured the ADC value in the scar area or in the area with pathological enhancement. The ADC values were compared with MRI findings and histological results obtained. RESULTS 26 cases were positive/doubtful at MRI and then subjected to histological typing: of these recurrences were 20 and benign were 6. 46 cases were judged negative at MRI and therefore not sent to cyto-histology. The average ADC value of recurrences was statistically lower of scarring (p<0.001). CONCLUSIONS ADC value can be a specific parameter in differential diagnosis between recurrence and scar. The diffusion sequence, in association with the morphological and dynamic sequences, can be considered a promising tool for the surgical indication in suspected recurrence of breast cancer.

Cystic Breast Lesions Sonographic Findings and Clinical Management

Objective. This article reviews basic sonographic findings for distinguishing cystic lesions of the breast. Methods. We describe sonographic features of simple and complicated cysts in comparison with complex masses and intracystic carcinomas. Results. We correlate cystic lesion appearances with histologic patterns and illustrate the diagnostic and therapeutic management of cystic breast lesions. Conclusions. Sonography is a useful tool in distinguishing simple cysts from complicated cysts and complex masses of the breast.

Early onset lactating adenoma and the role of breast MRI: a case report

IntroductionLactating adenoma is a benign condition, representing the most prevalent breast lesion in pregnant women and during puerperium; in this paper, a case of a woman with lactating adenoma occurring during the first trimester of pregnancy is reported. There have been no reports in the literature, according to our search, focusing on magnetic resonance imaging findings in cases of lactating adenomas. Also the early onset of the lesion during the first trimester of pregnancy is quite unusual and possibly unique.Case presentationWe report the case of a primiparous 30-year-old Caucasian woman, who noted an asymptomatic lump within her left breast during the 9th week of gestation, slightly increasing in size over the next few weeks. Ultrasound demonstrated a hypoecoic solid mass, hypervascularized and measuring 4 cm. On magnetic resonance imaging, performed in the first month after delivery, the lesion appeared as an ovoidal homogeneous mass, with regular margins and a significant contrast enhancement indicative of a giant adenoma.ConclusionMagnetic resonance imaging could play an important role in the differential diagnosis of pregnancy-related breast lumps, particularly during puerperium, thus avoiding unnecessary surgical biopsies.

Breast MRI in a Case of “Early Onset” Lactating Adenoma

lesion. Biopsy of that lesion showed sheets of plasma cells including immature and binucleated forms, consistent with the diagnosis of plasmacytoma with no evidence of carcinoma. Serum protein electrophoresis revealed a sharp band in the near gamma region (M protein) consistent with IgA kappa paraproteinaemia (Fig. 3), while no Bence Johns proteins were detected in her urine. Skeletal survey revealed a single rounded lytic lesion at the left parietal convexity (Fig. 4). Her bone marrow sample detected the presence of plasmacytoma (Fig. 5) with increased number of plasma cells of 18% (normal < 1.2%). Collectively, all supported the diagnosis of multiple myeloma. Ultrasound guided liver biopsy confirmed the diagnosis of metastatic carcinoma from the breast. The patient’s treatment plan consisted of seven cycles of FEC. Her clinical and radiological evaluation suggested almost complete regression of the breast and axillary mass and regression of liver and lung lesions at 2 years follow-up. The diagnosis of dual malignancy in a patient at the time of first presentation is rare. Recognizing both malignancies at the time of presentation and before initiation of treatment is crucial since the management of these co-existing malignancies is different.

Evidence-based usefulness of integrative therapies in breast cancer

In a modern concept of Precision Medicine, clinical approach should be tailored to a single patient with cancer rather than only to cancer itself, by combining a deep understanding of genetic and molecular features of her disease, the most updated and evidence-based treatments available and patient’s values and needs. Integrative oncology is a global strategy that includes lifestyle interventions and complementary therapies into mainstream care, to reduce the huge impact of oncological treatments for breast cancer (BC) both on patients’ physical and psycho-social aspects of life at any ages. This paper summarizes the major clinical and scientific evidences about the impact of lifestyle changes and usefulness of complementary treatments currently used in breast cancer management.

Physical rehabilitation after breast cancer

Improvement of overall survival in breast cancer patients has lead recently to an increased focus on prevention and management of breast cancer-related lymphedema (BCRL), a condition that deeply impacts function and quality of life (QoL) of cancer survivors. Current data still demonstrate BCRL rates ranging from 10% to 30% at 2 years, with a high heterogeneity of measurement methods and different incidence of the disease (from 5% after breast-conserving surgery to over 50% after mastectomy, radiation and chemotherapy). The present paper will describe the available data regarding the value of prevention and rehabilitation treatments of BCRL.