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Gümüscü, R., Wärnberg, F., de Boniface, J., Sund, M., Åhsberg, K., Hansson, E., . . . Mani, M. (2024). Timing and type of breast reconstruction in SweBRO 3: long-term outcomes. British Journal of Surgery, 111(9), Article ID znae240.
Open this publication in new window or tab >>Timing and type of breast reconstruction in SweBRO 3: long-term outcomes
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2024 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 111, no 9, article id znae240Article in journal (Refereed) Published
Abstract [en]

Background

Breast reconstruction after mastectomy helps women with breast cancer feel better about their bodies and lives. There is debate about the best time and type of reconstruction (immediate versus delayed, and using own tissue versus implants). Long-term studies are rare.

Aim

This study looked at long-term results of different breast reconstruction methods and timings in Swedish women who had mastectomies in 2000, 2005 or 2010. It focused on how satisfied the women were with their surgeries and their quality of life.

Method

The study included 5853 women from the Swedish National Breast Cancer Registry who had mastectomies in 2000, 2005 or 2010. Of these, 2904 women answered the survey, and 895 had breast reconstruction. Satisfaction and quality of life were measured using two surveys: EORTC QLQ-BRECON23 and BREAST-Q.

Results

Of the women who answered the survey, 895 (31%) had breast reconstruction. Of these, 176 (20%) had immediate reconstruction, and 719 (80%) had delayed reconstruction; 58% had implant-based reconstructions, 31% had reconstructions using their own tissue, 2% had both types and 9% did not report the type of reconstruction. There were no major differences in satisfaction between immediate and delayed reconstruction. Women who used their own tissue were more satisfied with their results and breast appearance than those with implants.

Conclusion

Autologous reconstruction leads to better satisfaction and outcomes than implants. The timing of reconstruction (immediate versus delayed) was less of an influence on quality of life. Breast reconstruction following mastectomy plays a crucial role in restoring body image and quality of life for women with breast cancer. The optimal timing and reconstruction type remain subjects of debate, and population-based long-term studies on this topic are lacking. This national long-term follow-up survey highlights better well-being and quality of life among women with autologous reconstructions compared to implant-based reconstructions.

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-540110 (URN)10.1093/bjs/znae240 (DOI)001319335500001 ()39316573 (PubMedID)
Funder
The Breast Cancer Foundation
Available from: 2024-10-17 Created: 2024-10-17 Last updated: 2024-10-17Bibliographically approved
Karakatsanis, A., Eriksson, S., Pistiolis, L., Olofsson Bagge, R., Nagy, G., Man, V., . . . Wärnberg, F. (2023). Delayed Sentinel Lymph Node Dissection in Patients with a Preoperative Diagnosis of Ductal Cancer In Situ by Preoperative Injection with Superparamagnetic Iron Oxide (SPIO) Nanoparticles: The SentiNot Study. Annals of Surgical Oncology, 30(7), 4064-4072
Open this publication in new window or tab >>Delayed Sentinel Lymph Node Dissection in Patients with a Preoperative Diagnosis of Ductal Cancer In Situ by Preoperative Injection with Superparamagnetic Iron Oxide (SPIO) Nanoparticles: The SentiNot Study
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2023 (English)In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 30, no 7, p. 4064-4072Article in journal (Refereed) Published
Abstract [en]

Background

Difficulty in preoperatively assessing the risk for occult invasion or surgery that precludes future accurate axillary mapping in patients with ductal cancer in situ (DCIS) account for overutilization of SLND.

Methods

Prospective, multicenter, cohort study, including women with any DCIS planned for mastectomy or DCIS grade 2 and > 20 mm, any DCIS grade 3, any mass-forming DCIS and any planned surgery. Patients received an interstitial SPIO injection during breast surgery, but no upfront SLND was performed. If invasion was identified on final pathology, delayed SLND (d-SLND) was performed separately with the coadministration of isotope ± blue dye (BD). Study outcomes were proportion of upfront SLNDs that were avoided, detection rates during d-SLND, and impact on healthcare costs.

Results

In total, 78.7% of study participants (N = 254, mean age 60 years, mean DCIS size 37.8 mm) avoided upfront SLND. On d-SLND (median 28 days, range 9–46), SPIO outperformed Tc99 with (98.2% vs. 63.6%, p < 0.001) or without BD (92.7% vs. 50.9%, p < 0.001) and had higher nodal detection rate (86.9% vs. 32.3%, p < 0.001) and with BD (93.9% vs. 41.4%, p < 0.001). Only 27.9% of all SLNs retrieved were concordant for Tc99 and SPIO. Type of breast procedure (WLE vs. oncoplastic BCT vs. mastectomy) affected these outcomes and accounted for the low performance of Tc99 (p < 0.001). d-SLND resulted in a 28.1% total cost containment for women with pure DCIS on final pathology (4190 vs. 5828 USD, p < 0.001).

Conclusions

Marking the SLN with SPIO may avoid overtreatment and allow for accurate d-SLND in patients with DCIS.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-556744 (URN)10.1245/s10434-022-13064-0 (DOI)000924165400001 ()36719570 (PubMedID)2-s2.0-85147299527 (Scopus ID)
Funder
Uppsala UniversityRegion UppsalaBröstcancerförbundet
Note

De två första författarna delar förstaförfattarskapet

Abdi Fatah Hersi, Allan Jazrawi och Peter Stålberg ingår i gruppen SentiNot Trialists Group

Available from: 2025-05-19 Created: 2025-05-19 Last updated: 2025-05-19Bibliographically approved
Enlund, M., Berglund, A., Enlund, A., Lundberg, J., Wärnberg, F., Wang, D.-X., . . . Bergkvist, L. (2023). Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane. eClinicalMedicine, 60, Article ID 102037.
Open this publication in new window or tab >>Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane
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2023 (English)In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 60, article id 102037Article in journal (Refereed) Published
Abstract [en]

Background: Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery.

Methods: From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and perprotocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064.

Findings: Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P = 0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR = 1.01 (0.71-1.44); P = 0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P = 0.829, log rank test).

Interpretation: No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Breast cancer, Anaesthesia, Inhalation, Intravenous, Survival analysis
National Category
Anesthesiology and Intensive Care Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-510652 (URN)10.1016/j.eclinm.2023.102037 (DOI)001044157800001 ()37333664 (PubMedID)
Funder
Swedish Research Council
Available from: 2023-09-01 Created: 2023-09-01 Last updated: 2023-09-01Bibliographically approved
Pantiora, E., Jazrawi, A., Hersi, A.-F., Abdsaleh, S., Ahlstedt, H., Molnar, E., . . . Karakatsanis, A. (2023). Magnetic Seed vs Guidewire Breast Cancer Localization With Magnetic Lymph Node Detection. JAMA Surgery
Open this publication in new window or tab >>Magnetic Seed vs Guidewire Breast Cancer Localization With Magnetic Lymph Node Detection
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2023 (English)In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262Article in journal (Refereed) Epub ahead of print
Abstract [en]

Importance  Guidewires have been the standard for breast lesion localization but pose operative and logistic challenges. Paramagnetic seeds have shown promising results, but to the authors’ knowledge, no randomized comparison has been performed.

Objective  To determine whether the combination of a paramagnetic seed and superparamagnetic iron oxide (SPIO) is equivalent to guidewire and SPIO for breast cancer localization and sentinel lymph node detection (SLND).

Design, Setting, and Participants  This was a phase 3, pragmatic, equivalence, 2-arm, open-label, randomized clinical trial conducted at 3 university and/or community hospitals in Sweden from May 2018 to May 2022. Included in the study were patients with early breast cancer planned for breast conservation and SLND. Study data were analyzed July to November 2022.

Interventions  Participants were randomly assigned 1:1 to a paramagnetic seed or a guidewire. All patients underwent SLND with SPIO.

Main Outcomes and Measures  Re-excision rate and resection ratio (defined as actual resection volume / optimal resection volume).

Results  A total of 426 women (median [IQR] age, 65 [56-71] years; median [IQR] tumor size, 11 [8-15] mm) were included in the study. The re-excision rate was 2.90% (95% CI, 1.60%-4.80%), and the median (IQR) resection ratio was 1.96 (1.15-3.44). No differences were found between the guidewire and the seed in re-excisions (6 of 211 [2.84%] vs 6 of 209 [2.87%]; difference, −0.03%; 95% CI, −3.20% to 3.20%; P = .99) or resection ratio (median, 1.93; IQR, 1.18-3.43 vs median, 2.01; IQR, 1.11-3.47; P = .70). Overall SLN detection was 98.6% (95% CI, 97.1%-99.4%) with no differences between arms (203 of 207 [98.1%] vs 204 of 206 [99.0%]; difference, −0.9%; 95% CI, −3.6% to 1.8%; P = .72). More failed localizations occurred with the guidewire (21 of 208 [10.1%] vs 4 of 215 [1.9%]; difference, 8.2%; 95% CI, 3.3%-13.2%; P < .001). Median (IQR) time to specimen excision was shorter for the seed (15 [10-22] minutes vs 18 [12-30] minutes; P = .01), as was the total operative time (69 [56-86] minutes vs 75.5 [59-101] minutes; P = .03). The experience of surgeons, radiologists, and surgical coordinators was better with the seed.

Conclusions and Relevance  The combination of SPIO and a paramagnetic seed performed comparably with SPIO and guidewire for breast cancer conserving surgery and resulted in more successful localizations, shorter operative times, and better experience.

Trial Registration  ISRCTN.org Identifier: ISRCTN11914537

Place, publisher, year, edition, pages
American Medical Association (AMA), 2023
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-524259 (URN)10.1001/jamasurg.2023.6520 (DOI)001134191000002 ()38150215 (PubMedID)
Funder
Uppsala UniversityThe Breast Cancer Foundation
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2025-02-19Bibliographically approved
Jazrawi, A., Wärnberg, M., Hersi, A.-F., Obondo, C., Pistioli, L., Eriksson, S., . . . Wärnberg, F. (2022). A Comparison of Skin Staining after Sentinel Lymph Node Biopsy in Women Undergoing Breast Cancer Surgery Using Blue Dye and Superparamagnetic Iron Oxide Nanoparticle (SPIO) Tracers. Cancers, 14(23), Article ID 6017.
Open this publication in new window or tab >>A Comparison of Skin Staining after Sentinel Lymph Node Biopsy in Women Undergoing Breast Cancer Surgery Using Blue Dye and Superparamagnetic Iron Oxide Nanoparticle (SPIO) Tracers
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2022 (English)In: Cancers, ISSN 2072-6694, Vol. 14, no 23, article id 6017Article in journal (Refereed) Published
Abstract [en]

Simple Summary Both superparamagnetic iron oxide nanoparticles (SPIO) and blue dye (BD) have been reported to cause skin staining after breast-conserving surgery. SPIO is a novel tracer that has been shown to identify sentinel lymph nodes (SLNs) in patients with breast cancer. Our study was the first to compare the incidence and size of skin staining between the two tracers. We reported on these outcomes in a preplanned secondary analysis of a prospective clinical trial in which women received both SPIO and BD. This study investigated whether there was a difference in the incidence and size of skin staining between SPIO and BD after SLN-dissection. In all, 270 women were operated on with breast-conserving surgery and received SPIO, and 204 of these women also received BD. After 24 months of follow up, there was no statistically significant difference between the two tracers with regard to the size and incidence of skin staining. Superparamagnetic iron oxide nanoparticles (SPIO) are a tracer for sentinel lymph node (SLN) detection. In a preplanned secondary analysis of a prospective clinical trial (SentiDose) we reported on skin staining after SPIO and blue dye (BD) injections. For SPIO, either a 1.5 mL retroareolar injection on the day of surgery or a 1.0 mL peritumoral/retroareolar injection 1-7 days before surgery was given. A 1.0 mL sub-/intradermal periareolar injection of BD was also administered to all these women. Staining was then assessed at 6, 12 and 24 months after surgery. A total of 270 women received SPIO and were operated on with breast-conserving surgery. Of these, 204 women also received BD. A total of 58 (21.5%) women had an SPIO stain 6 months postoperatively with a median size of 6.8 cm(2) (p = 0.56), while 51 (25.0%) had a BD stain with a median size of 8.5 cm(2) (p = 0.93). The incidence and size of SPIO and BD staining decreased over time reciprocally. At 24 months, the incidence and median size of SPIO was 23 (8.6%) and 4 cm(2), respectively. For BD, the incidence was 14 (6.3%, p = 0.13), and the median size was 3.5 cm(2) (p = 0.18). There was, therefore, no statistically significant difference in the incidence or size of skin staining between SPIO and BD over time.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
sentinel lymph node biopsy, breast cancer, blue dye, superparamagnetic iron oxide, magnetic tracer, sentinel lymph node, skin staining
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-492358 (URN)10.3390/cancers14236017 (DOI)000897533100001 ()36497498 (PubMedID)
Funder
The Breast Cancer Foundation
Available from: 2023-01-04 Created: 2023-01-04 Last updated: 2024-04-03Bibliographically approved
Bekkhus, T., Avenel, C., Hanna, S., Franzén Boger, M., Klemm, A. H., Vasiliu-Bacovia, D., . . . Ulvmar, M. H. (2022). Automated detection of vascular remodeling in human tumor draining lymph nodes by the deep learning tool HEV-finder. Journal of Pathology, 258(1), 4-11
Open this publication in new window or tab >>Automated detection of vascular remodeling in human tumor draining lymph nodes by the deep learning tool HEV-finder
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2022 (English)In: Journal of Pathology, ISSN 0022-3417, E-ISSN 1096-9896, Vol. 258, no 1, p. 4-11Article in journal (Refereed) Published
Abstract [en]

Vascular remodeling is common in human cancer and has potential as future biomarkers for prediction of disease progression and tumor immunity status. It can also affect metastatic sites, including the tumor-draining lymph nodes (TDLNs). Dilation of the high endothelial venules (HEVs) within TDLNs has been observed in several types of cancer. We recently demonstrated that it is a premetastatic effect that can be linked to tumor invasiveness in breast cancer. Manual visual assessment of changes in vascular morphology is a tedious and difficult task, limiting high-throughput analysis. Here we present a fully automated approach for detection and classification of HEV dilation. By using 12,524 manually classified HEVs, we trained a deep-learning model and created a graphical user interface for visualization of the results. The tool, named the HEV-finder, selectively analyses HEV dilation in specific regions of the lymph nodes. We evaluated the HEV-finder's ability to detect and classify HEV dilation in different types of breast cancer compared to manual annotations. Our results constitute a successful example of large-scale, fully automated, and user-independent, image-based quantitative assessment of vascular remodeling in human pathology and lay the ground for future exploration of HEV dilation in TDLNs as a biomarker.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
HEV-finder, artificial intelligence (AI), breast cancer, deep learning, high endothelial venules (HEVs), tumor-draining lymph nodes (TDLNs), vascular remodeling
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-469951 (URN)10.1002/path.5981 (DOI)000823061100001 ()35696253 (PubMedID)
Funder
Swedish Research Council, 2016-02492Swedish Cancer Society, 2017/759Swedish Cancer Society, 20 0970 PjFKjell and Marta Beijer Foundation
Available from: 2022-03-16 Created: 2022-03-16 Last updated: 2023-11-27Bibliographically approved
Strandberg, E., Vassbakk-Svindland, K., Henriksson, A., Johansson, B., Vikmoen, O., Kudrén, D., . . . Raastad, T. (2021). Effects of heavy-load resistance training during (neo-)adjuvant chemotherapy on muscle cellular outcomes in women with breast cancer. Medicine, 100(10), Article ID e24960.
Open this publication in new window or tab >>Effects of heavy-load resistance training during (neo-)adjuvant chemotherapy on muscle cellular outcomes in women with breast cancer
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2021 (English)In: Medicine, ISSN 0025-7974, E-ISSN 1536-5964, Vol. 100, no 10, article id e24960Article in journal (Refereed) Published
Abstract [en]

Introduction: 

(Neo-)adjuvant chemotherapy for breast cancer has a deleterious impact on muscle tissue resulting in reduced cardiorespiratory fitness, skeletal muscle mass and function. Physical exercise during treatment may counteract some of these negative effects. However, the effects of resistance training (RT) alone have never been explored. The present study aims to investigate if heavy-load RT during (neo-)adjuvant chemotherapy counteracts deleterious effects on skeletal muscle in women diagnosed with breast cancer. We hypothesize that (neo-)adjuvant treatment with chemotherapy will reduce muscle fiber size, impair mitochondrial function, and increase indicators of cellular stress and that RT during treatment will counteract these negative effects. We also hypothesize that RT during (neo-)adjuvant chemotherapy will increase muscle and blood levels of potential antitumor myokines and reduce treatment-related side effects on muscle strength and cardiorespiratory fitness.

Methods: 

Fifty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to either randomized to either intervention group or to control group.

The intervention group will perform supervised heavy-load RT twice a week over the course of chemotherapy (approximately 16-weeks) whereas the control group will be encouraged to continue with their usual activities. Muscle biopsies from m. vastus lateralis will be collected before the first cycle of chemotherapy (T0), after chemotherapy (T1), and 6 months later (T2) for assessment of muscle cellular outcomes. The primary outcome for this study is muscle fiber size. Secondary outcomes are: regulators of muscle fiber size and function, indicators of cellular stress and mitochondrial function, myokines with potential antitumor effects, muscle strength, and cardiorespiratory fitness.

Ethics and dissemination: 

Ethical approval has been obtained from the Regional Ethical Review Board in Uppsala, Sweden (Dnr:2016/230/2). Results will be disseminated through presentations at scientific meetings, publications in peer-reviewed journals, social media, and patient organizations.

Trial registration number: 

NCT04586517.

Keywords
cancer, exercise, muscle fiber cross-sectional area, oncology, strength training
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-439879 (URN)10.1097/MD.0000000000024960 (DOI)000659034600053 ()33725859 (PubMedID)
Funder
Swedish Cancer Society, 18-0356
Available from: 2021-04-12 Created: 2021-04-12 Last updated: 2022-02-10Bibliographically approved
Strell, C., Folkvaljon, D., Holmberg, E., Schiza, A., Thurfjell, V., Karlsson, P., . . . Ostman, A. (2021). High PDGFRb Expression Predicts Resistance to Radiotherapy in DCIS within the SweDCIS Randomized Trial. Clinical Cancer Research, 27(12), 3469-3477
Open this publication in new window or tab >>High PDGFRb Expression Predicts Resistance to Radiotherapy in DCIS within the SweDCIS Randomized Trial
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2021 (English)In: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 27, no 12, p. 3469-3477Article in journal (Refereed) Published
Abstract [en]

Purpose: This study analyzes the potential of stromal plateletderived growth factor receptor-beta (PDGFRb) expression as biomarker for radiotherapy (RT) benefit on ipsilateral breast events (IBE) in ductal carcinoma in situ (DCIS). Improved identification of DCIS patients refractory to adjuvant wholebreast RT is needed. Predictive biomarker studies in DCIS have focused on tumor cell features rather than the tumor-associated stroma, despite growing evidence of its influence on therapy efficiency. Experimental Design: Samples from the Swedish randomized radiotherapy DCIS trial (SweDCIS) were subjected to IHC analysis for stromal PDGFRb expression. IBE incidence at 10 years after breast-conserving surgery was the primary endpoint. Interactions between marker and treatment were analyzed. Results: PDGFRb score was predictive for RT benefit with regard to IBE (P-interaction = 0.002 and P-i(nteract)ion = 0.008 adjusted multivariably). Patients of the PDGFRb(low) group had a strong benefit from RT regarding IBE risk [HR, 0.23; 95% confidence interval (CI), 0.12-0.45; P < 0.001] with an absolute risk reduction of 21% (cumulative risk 7% vs. 28%) at 10 years. No significant risk reduction by RT was observed for patients of the PDGFRb hi g h group (HR, 0.83; 0.51-1.34; P = 0.444; cumulative risk 22% vs. 25%). The RT response-predictive effect of stromal PDGFRb was equally strong in analyses for in situ and invasive IBE when analyzed separately (in situ IBE: P = 0.029; invasive IBE: P = 0.044). Conclusions: Results suggest high stromal PDGFRb expression as a novel biomarker identifying DCIS patients who are refractory to standard whole-breast adjuvant RT. The data imply previously unrecognized fibroblast-mediated modulation of radiosensitivity of DCIS, which should be further explored from mechanistic and targeting perspectives.

Place, publisher, year, edition, pages
American Association For Cancer Research (AACR)AMER ASSOC CANCER RESEARCH, 2021
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-449207 (URN)10.1158/1078-0432.CCR-20-4300 (DOI)000662291200023 ()33952629 (PubMedID)
Funder
Swedish Cancer Society, 150895Swedish Cancer Society, 2019/0081Swedish Research Council, 349-2006-160The Cancer Research Funds of RadiumhemmetRegion Stockholm
Available from: 2021-07-21 Created: 2021-07-21 Last updated: 2024-01-15Bibliographically approved
Jazrawi, A., Pantiora, E., Abdsaleh, S., Vasiliu-Bacovia, D., Eriksson, S., Leonhardt, H., . . . Karakatsanis, A. (2021). Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial. Cancers, 13(17), Article ID 4285.
Open this publication in new window or tab >>Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial
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2021 (English)In: Cancers, ISSN 2072-6694, Vol. 13, no 17, article id 4285Article in journal (Refereed) Published
Abstract [en]

Simple Summary Superparamagnetic iron oxide nanoparticles (SPIO) have been shown to identify sentinel lymph nodes (SLNs) in patients with breast cancer. This study investigated whether a minimally invasive approach with MRI-LG after SPIO injection in the breast followed by a magnetic guided axillary ultrasound and core biopsy of the SLN (MagUS) could accurately stage the axilla. The study included not only patients planned for primary surgery but also patients with recurrent cancer after previous surgery, but also patients scheduled for neoadjuvant treatment (NAT). The latter underwent minimally invasive SLNB prior to treatment and had their SLN clipped; surgery in the axilla was performed after NAT. In 79 included patients, MagUS detected all patients with macrometastasis and performed comparably with surgical sentinel lymph node dissection (SLND). It also allowed for marking of the SLN in patients planned for PST and enabled tailored decision making in breast cancer recurrence. Lymph Node Dissection (SLND) is standard of care for diagnosing sentinel lymph node (SLN) status in patients with early breast cancer. Study aim was to determine whether the combination of Superparamagnetic iron oxide nanoparticles (SPIO) MRI-lymphography (MRI-LG) and a Magnetic-guided Axillary UltraSound (MagUS) with biopsy can allow for minimally invasive, axillary evaluation to de-escalate surgery. Patients were injected with 2 mL of SPIO and underwent MRI-LG for SN mapping. Thereafter MagUS and core needle biopsy (CNB) were performed. Patients planned for neoadjuvant treatment, the SLN was clipped and SLND was performed after neoadjuvant with the addition of isotope. During surgery, SLNs were controlled for signs of previous biopsy or clip. The primary endpoint was MagUS SLN detection rate, defined as successful SLN detection of at least one SLN of those retrieved in SLND. In 79 patients, 48 underwent upfront surgery, 12 received neoadjuvant and 19 had recurrent cancer. MagUS traced the SLN in all upfront and neoadjuvant cases, detecting all patients with macrometastases (n = 10). MagUS missed only one micrometastasis, outperforming baseline axillary ultrasound AUS (AUC: 0.950 vs. 0.508, p < 0.001) and showing no discordance to SLND (p = 1.000). MagUS provides the niche for minimally invasive axillary mapping that can reduce diagnostic surgery.

Place, publisher, year, edition, pages
MDPIMDPI, 2021
Keywords
sentinel lymph node biopsy, breast cancer, superparamagnetic iron oxide, magnetic tracer, sentinel lymph node
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-456477 (URN)10.3390/cancers13174285 (DOI)000694127400001 ()34503095 (PubMedID)
Available from: 2021-10-21 Created: 2021-10-21 Last updated: 2024-04-03Bibliographically approved
Unukovych, D., Gümüscü, R., Wärnberg, F., de Boniface, J., Eriksen, C., Sund, M., . . . Mani, M. (2020). Breast reconstruction patterns from a Swedish nation-wide survey. European Journal of Surgical Oncology, 46(10), 1867-1873
Open this publication in new window or tab >>Breast reconstruction patterns from a Swedish nation-wide survey
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2020 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 46, no 10, p. 1867-1873Article in journal (Refereed) Published
Abstract [en]

Objectives

The overall aim of the Swedish Breast Reconstruction Outcome Study was to investigate national long-term outcomes after mastectomy with or without breast reconstruction. The current report evaluates breast reconstruction (BR) patterns in Sweden over time.

Materials and methods

This is a cross-sectional, registry-based study where all women operated with mastectomy 2000, 2005, 2010 were identified (N = 5853). Geographical differences in type of BR were investigated using heatmaps. Distribution of continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using the chi-square test.

Results

Mean age at survey was 69 years (SD=±11.4) and response rate was 50%, responders were on average six years younger than the non-responders and had a more favourable tumor stage (both p < 0.01). Of the 2904 responders, 31% (895/2904) had received a BR: implant-based in 58% (516/895)autologous in 31% (281/895). BR was immediate in 20% (176/895) and delayed in 80% (719/895) women.

Women with BR were on average one year older, more often had a normal BMI, reported to be married or had a partner, had a higher educational level and a higher annual income when compared to those without BR (all p < 0.001). The independent factors of not receiving BR were older age and given radiotherapy.

Conclusions

To our knowledge, this is the first national long-term follow-up study on women undergoing mastectomy with and without BR. Around 30% of the survey responders have had a BR with a significant geographical variation highlighting the importance of information, availability and standardisation of indications for BR.

Keywords
Breast cancer, Reconstruction, Quality of life, Outcomes, Sweden, National
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-424571 (URN)10.1016/j.ejso.2020.04.030 (DOI)000576438500015 ()32698944 (PubMedID)
Available from: 2020-11-13 Created: 2020-11-13 Last updated: 2020-12-14Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0130-7296

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