Yanna Zhang

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial.

Objectives The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery. Methods Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests. Results Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions. Conclusions The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery. Trial Registration ClinicalTrial.gov NCT00418457

A hidden breast lump covered by nipple appendices in a patient with von recklinghausen disease: a case report and review of the literature.

Introduction It is well established that patients with von Recklinghausen disease, also called neurofibromatosis type 1 (NF1), have an increased Clinical Pra What is already known about this subject? ● Neurofibromatosis type 1 (NF1) increases the chance of breast cancer developing and belongs to a high-risk population for early screening. ● The diagnosis of breast cancer in patients with NF1 is usually delayed because the patient mistakenly identifies the breast lump as neurofibroma. ● Appendices on the nipple of patients with NF1 are neurofibromas in contrast to simple hyperplasia. ● The diagnosis of breast cancer in patients with NF1 is difficult, and most cases are diagnosed at an advanced stage. ● Chinese women are younger and have denser and smaller breasts when breast cancer develops than is true of their Western counterparts, and ultrasonography might be a better screening imaging test in China. What are the new findings? ● The nipples of patients with NF1 can be remarkably enlarged because of multiple neurofibroma appendi-

Prognosis of subtypes of the mucinous breast carcinoma in Chinese women: a population-based study of 32-year experience (1983-2014)

Purpose The heterogeneous nature of the mucinous breast cancer (MBC), with its pure (PMBC) and mixed subtypes (MMBC), calls for precise prognosis assessment. Methods We analyzed 197 consecutive MBC patients, including 117 PMBC and 80 MMBC, who were treated from 1983 to 2014. The clinicopathological features, treatment choice, disease-free survival (DFS) and overall survival (OS) were compared among PMBC, MMBC and MMBC subgroups. Prognostic factors of PMBC and MMBC were identified. Results Compared to PMBC, MMBC had more lymph node metastasis (p = 0.043), Her2 positivity (p = 0.036), high Ki-67 index (defined as>20%, p = 0.026) and anti-Her2 targeted therapy (p = 0.016). The 5-year DFS of PMBC and MMBC were 90.4% and 86.2%, whereas the 5-year OS were 99.0% and 98.7%. No significant difference was found in DFS or OS among all MBC subtypes. High Ki-67 (p = 0.020) appeared as DFS factor in PMBC, while anti-Her2 targeted therapy (p = 0.047) as the DFS predictors in MMBC. Conclusion MMBC manifested similar 5-year survival to PMBC in Chinese woman, suggesting that intra-tumoral heterogeneity might not interfere with MBC short-term prognosis.

Diabetic Mastopathy Mimicking Breast Cancer: Two Case Reports

Diabetic mastopathy (DMP) is a benign fibrous disease of the breast. DMP is closely associated with along-standing history of insulin-dependent diabetes mellitus and often demonstrates a palpable, hard, and nontender mass similar to breast cancer. In our study, excisional biopsy was performed for diagnosis in both patients. DMP is an uncommon benign fibrous disease of the breast that is difficult to differentiate from breast cancer by clinical examination. Breast ultrasonography and mammography are recommended. Core biopsy should be performed if the lesions become clinically or radiologically suspicious. Excisional biopsy should be performed if malignancy cannot be excluded. Regarding mastectomy, we think that the patients preference is very important; physicians can never make decisions for patients no matter how certain we are about nonmalignancy.

An investigative study of factors affecting breast cancer patients’ preference of extended endocrine therapy

Background: Even though the efficaciousness of 5 years of adjuvant endocrine therapy (AET) and another 5 years of extended endocrine therapy (EET) has been verified, it is a common phenomenon that many patients discontinue the treatment earlier and do not adhere to treatment as prescribed. The aim of this study was to investigate the patients’ preference of EET and relevant factors in a population of Chinese women with hormone receptor (HR) positive breast cancer in order to look for modifiable factors to increase compliance. Methods: An investigational study about the patients’ preference of EET was conducted in breast cancer patients with good AET adherence between May 2017 and July 2017. Socio-demographic and clinicopathological data of the participants were collected. Logistic regression models were used to assess the association between these factors and EET preference. Results: Of 179 enrolled women, 98 (54.7%) were willing to extend endocrine therapy to 10 years, 65 (36.3%) were unwilling and the remaining 16 patients (8.9%) would like to follow the doctor’s advice. After adjustment for socio-demographic and clinicopathological characteristics, type of breast surgery was found to be the only variable independently associated with EET preference with mastectomy patients more willing to receive EET (P=0.001, OR=4.010). The proportion of EET preference did not significantly differ in patients with or without medicine change, irregular medication and side effect. Conclusions: An important goal in the endocrine therapy is to assure the treatment compliance. The extension of treatment should be based on good AET compliance. Here, we investigated for the first time the patients’ preference of EET in patients with relatively better adherence. Mastectomy patients were found to be more willing to EET. More studies are needed to increase our understanding of patients’ preference and interventions to improve EET preference are also needed, especially for breast conserving patients.

Clinical characteristics, classification and surgical treatment of periductal mastitis

Background This study aimed to describe the clinical characteristics of periductal mastitis (PDM), propose the practical clinical classification system and evaluate the results of different surgical treatments in different type of PDM patients. Methods A retrospective study was carried out at department of breast surgery, Peking Union Medical College Hospital, Beijing, China. A total of 152 patients with the diagnosis of PDM were reviewed from March 2012 to December 2016. All of the patients underwent surgery. Data were collected regarding clinical manifestation, treatment, and outcomes. Results The median age was 36 years. A subareolar breast mass was the most frequent symptom. The most common clinical manifestations were mass (98.0%), rubefaction (41.1%), nipple retraction (36.8%), abscess (36.8%), skin ulceration (25.7%), and mammary duct fistula (19.1%). Fourteen (9.2%) patients were recurrent PDM at first hospitalization. Eight (5.3%) patients had prolactinoma. Five (3.3%) patients were taking antipsychotic medications. Only four (2.6%) patients were smokers. Eight patients were highly suspected to be breast cancer before surgery. A four-type classification system was first proposed according to clinical manifestations. The different surgeries in each category were evaluated. After 3 years median follow-up, 11 (7.2%) patients got recurrence including two initial recurrent PDM. Conclusions Periductal mastitis is a distinct benign breast condition of unknown etiology. Mass, abscess and fistula are most common manifestations of the disease. Wide surgical excision, fistulectomy and extended excision with transfer of a random breast dermo-glandular flap (BDGF) are effective surgical modalities for different type of PDM.

Abstract P6-05-12: Prognosis of subtypes of the mucinous breast carcinoma in Chinese women: A population-based study of 32-year experience (1983-2014)

Background: The heterogeneous nature of the mucinous breast cancer (MBC), with its subtypes of pure (PMBC) and mixed carcinoma (MMBC), calls for more precise individualized prognosis assessment. PMBC showed favorable prognosis in both Chinese and Caucasian women, with nodal status and TNM stage as the prognostic predictors [PMID: 18026874, 22451233]. However, few studies had investigated tumor biology and prognosis of MMBC in Chinese population, especially with respect to the different co-existing cancer components. Methods: From January 1983 to December 2014, 197 consecutive MBC patients, including 117 PMBC and 80 MMBC, received breast cancer surgery in Peking Union Medical College Hospital. The clinicopathological characteristics, treatment choice, disease-free survival (DFS) and overall survival (OS) were compared both between PMBC vs MMBC, and among subgroups of MMBC according to the mixed entities, including 24 women with ductal caricinoma in situ (DCIS) and 45 with IDC. Univariate and Cox multivariate analyses were performed to identify the prognostic factors. Results: The 197 MBC comprised 1.9% of contemporary 10,192 breast cancer (BC). Compared to PMBC, MMBC had significantly more lymph node metastasis (p=0.038), Her2 positivity (p=0.036), high Ki-67 index (defined as >20%, p=0.026) and anti-Her2 targeted therapy (p=0.006). All these differences remained significant when the comparison were performed among PMBC, MBC+DCIS and MBC+IDC, and additional significant difference were identified in tumor size (p=0.036), pTNM stage (p=0.003) and chemotherapy (p=0.003). However, no significant difference was found in DFS or OS between any two subtypes/subgroups of MBC, including PMBC, MMBC, MBC+DCIS and MBC+IDC. High Ki-67 index (p=0.046) appeared to be the significant DFS related prognostic factor for PMBC, whereas estrogen receptor (ER) status (univariate p=0.000, multivariate p=0.062) and immunophenotype (luminal, her2, or triple-negative, univariate p=0.000, multivariate p=0.079) might be the potential DFS predictors for MMBC. None of the above-mentioned clinicopathological factors could serve as OS predictors for MBC. Conclusion: This population-based study showed that there were significant difference in nodal status, Ki-67, Her2 positivity and targeted therapy between PMBC and MMBC, and furthermore in tumor size, stage and chemotherapy among PMBC and subgroups of MMBC such as MBC+DCIS and MBC+IDC. However, survival outcomes were similar between these clinical entities and subgroups, suggesting the intra-tumoral heterogeneity might not interfere with survival outcomes of MBC in Chinese woman. High Ki-67 index was identified as the significant DFS related prognostic factor for PMBC, whereas ER status and immunophenotype as the potential DFS predictors for MMBC. Citation Format: Yao R, Pan B, Sun Q, Zhou Y, Mao F, Lin Y, Guan J, Wang X, Zhang Y, Zhang X, Shen S, Zhong Y, Xu Y, Shi J, Zhu Q, Cai F, Liang Z. Prognosis of subtypes of the mucinous breast carcinoma in Chinese women: A population-based study of 32-year experience (1983-2014). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-05-12.