Investigational Paradigms in Downscoring and Upscoring DCIS: Surgical Management Review

Counseling patients with DCIS in a rational manner can be extremely difficult when the range of treatment criteria results in diverse and confusing clinical recommendations. Surgeons need tools that quantify measurable prognostic factors to be used in conjunction with clinical experience for the complex decision-making process. Combination of statistically significant tumor recurrence predictors and lesion parameters obtained after initial excision suggests that patients with DCIS can be stratified into specific subsets allowing a scientifically based discussion. The goal is to choose the treatment regimen that will significantly benefit each patient group without subjecting the patients to unnecessary risks. Exploring the effectiveness of complete excision may offer a starting place in a new way of reasoning and conceiving surgical modalities in terms of “downscoring” or “upscoring” patient risk, perhaps changing clinical approach. Reexcison may lower the specific subsets' score and improve local recurrence-free survival also by revealing a larger tumor size, a higher nuclear grade, or an involved margin and so suggesting the best management. It seems, that the key could be identifying significant relapse predictive factors, according to validated risk investigation models, whose value is modifiable by the surgical approach which avails of different diagnostic and therapeutic potentials to be optimal. Certainly DCIS clinical question cannot have a single curative mode due to heterogeneity of pathological lesions and histologic classification

Telehealth in oncofertility and breast cancer patients during COVID-19: preliminary results of insenoallasalute.it project

Abstract. – OBJECTIVE: Breast cancer (BC) is the leading diagnosis in premenopausal patients. Lockdown measures during COVID-19 pandemic reduced facilities for premenopausal patients, impairing oncological and reproductive health. To reduce its effect, a telehealth program called insenoallasalute.it was designed in Italy. PATIENTS AND METHODS: A national-based multicentric observational study was undertaken by insenoallasalute.it study group (Italian Ministry of Health, Modena Hospital and Tor Vergata University Hospital) to raise awareness among women on a) BC and its negative role on reproductive health; b) increase adherence to screening programs and self-examination; c) present oncofertility strategies. A webbased platform with two sections was designed: an informative section and a telehealth application activated with a mobile one-time password. After a self-evaluation test to select premenopausal women with maternal desire and family or personal history for BC or ovarian cancer, and premenopausal women with maternity desires with prior medically assisted procreation, a dedicated agenda for telehealth evaluation was displayed and planned. In case the patients fulfilled the criteria for further evaluation, they were invited to perform an outpatient evaluation in one of the pilot centers. RESULTS: From July 2021 to December 2021, 2,830 single accounts were activated, and 2,450 (86.57%) completed the tests. 53 patients were selected to undergo telehealth consultation and 40 (80.0%) scheduled the telehealth visit. 6 patients underwent surgery in the study centers. CONCLUSIONS: In our experience insenoallasalute.it embodied an innovative solution to spread BC awareness, BC screening program, and oncofertility opportunities in the oncological population

FEM analysis of RF breast ablation: Multiprobe versus cool-tip electrode

Background: Radio-frequency ablation (RFA) has recently received much attention as an effective minimally invasive strategy for the local treatment of tumors. The purpose of this study was to evaluate the efficacy of single-needle cool-tip RF breast ablation in terms of temperature distribution and duration of the procedure as compared to multiprobe RF breast ablation. Materials and Methods: Two different commercially available radiofrequency ablation needle electrodes were compared. Finite-element method (FEM) models were developed to simulate the thermoablation procedures. A series of ex vivo radiofrequency thermal lesions were induced to check the response of the FEM calculations. Results: Data obtained from FEM models and from ex vivo procedures showed that cool-tip RF breast ablation assures better performances than multiprobe RF breast ablation in terms of temperature distribution and duration of the procedure. Histopathological analysis of the cool-tip RF thermoablated specimens showed successful induction of coagulation necrosis in the thermoablated specimens. Conclusion: Data obtained from FEM models and from ex vivo procedures suggest that the proposed cool-tip RF breast ablation may kill more tumor cells in vivo with a single application than the multiprobe RF breast ablation

Serum sE-selectin levels and carcinoembryonic antigen mRNA-expressing cells in peripheral blood as prognostic factors in colorectal cancer patients

This study analyzed the possible prognostic value of presurgical serum soluble (s)E-selectin levels and/or carcinoembryonic antigen (CEA) mRNA positivity in predicting the disease-free survival of colorectal cancer (CRC) patients

Prognostic value of vascular endothelial growth factor tumor tissue content of colorectal cancer

A longitudinal study was designed to quantify tumor tissue content of vascular endothelial growth factor (VEGF) in patients with colorectal cancer (CRC) and to evaluate its prognostic value in respect to the relapse-free and overall survivals

Prognostic value of carcinoembryonic antigen and vascular endothelial growth factor tumor tissue content in colorectal cancer

This study was designed to assess the prognostic significance of the combined measurement of vascular endothelial growth factor (VEGF) and carcinoembryonic antigen (CEA) tissue content with respect to relapse-free and overall survival of patients with colorectal cancer (CRC)

Spontaneous immunogenicity of ribosomal P0 protein in patients with benign and malignant breast lesions and delay of mammary tumor growth in P0-vaccinated mice

A common carboxyl-terminal epitope (C-22 P0) of the ribosomal P proteins (P0, P1 and P2) was shown to elicit autoantibodies in systemic lupus erythematosus (SLE) and in head and neck cancer patients. In this report we provide evidence for the in vivo immunogenicity of the P0 protein in breast cancer patients. Using recombinant P proteins, we demonstrated that sera from breast carcinoma patients (8/75) displayed significant reactivity to P0 protein when compared with healthy donor sera (0/45). Four out of the eight sera showed simultaneous reactivity to all P proteins. Breast benign tumor (3/17) and mammary hyperplasia (3/17) patient sera also showed significant reactivity to P proteins, thus suggesting that the occurrence of P protein autoantibodies might reveal mammary cell cycle dysregulation. Patient sera reacting with all P proteins recognized C-22 P0. Anti-P0 autoantibodies did not correlate with prognostic parameters of breast carcinomas. High level expression of C-22 P0 was found in mammary carcinomas compared with normal adjacent epithelium and benign lesions. To determine the antitumor activity of P0 as an immunogen, BALB-neuT transgenic mice displaying age-related breast cancer progression were vaccinated using xenogeneic P0 at the stage of mammary atypical hyperplasia. P0 vaccination significantly delayed the onset of mouse mammary tumors that overexpressed C-22 P0. Sera from P0 vaccinated mice recognized C-22 P0. Evidence for immunity to the P0 protein, its overexpression in carcinomas and its peculiar surface localization on cancer cells, along with its antitumor activity as an immunogen might be relevant for the use of P0 protein in monitoring cancer progression and in planning immunotherapeutic strategies

Ultrasound-guided laser ablation after excisional vacuum-assisted breast biopsy for small malignant breast lesions: Preliminary results

Background: The purpose of this preliminary study is to evaluate the feasibility of the excisional ultrasound (US) guided vacuum-assisted breast biopsy (VAE), followed by US-guided Laser Interstitial Thermal Therapy (LITT) in the treatment of unifocal ductal breast carcinomas ≤ 1 cm and estimate the ablation rate analyzing the final histopathological results after subsequent surgical excision. Methods: In a single session 11 female patients with unifocal less than a centimeter breast cancer underwent 2 different minimally invasive percutaneous US-guided techniques: a VAE breast biopsy with an 8 G needle to remove the lesion and, immediately after, a LITT ablation in the biopsy site. Four weeks later, all patients underwent radiological follow-up. Afterward, a systematic surgery was performed, the ablation rate was calculated, and iconographic and histological features were correlated. Results: Average maximum diameter of the lesions was 7.6 mm (5-10 mm). No patient reported pain or discomfort during procedure. 1/11 patient (9.1%) reported an early minor complication (a small superficial skin burn). After surgical excision, the histopathological evaluation reported in 10/11 cases (90.9%) complete ablation of the target lesion. In only one case (9.1%) residual cancer was detected. The necrotic-hemorrhagic cavities showed a mean maximum diameter of 27.3 mm (20-35 mm). Conclusions: Laser ablation performed after excisional biopsy could be considered a valid alternative to surgical excision for the treatment of lesions ≤ 1 cm, if carried out by expert radiologists. The association of these minimally invasive percutaneous methods has proven to be reliable, fast, and safe with an ablation rate of 90.9% and excellent aesthetic results. RM and CESM are potentially able to quantifying treatment results and to follow-up the ablation effects

Evaluation of a new 12km regional perturbed parameter ensemble over Europe

We evaluate a 12-member perturbed parameter ensemble of regional climate simulations over Europe at 12km resolution, carried out as part of the UK Climate Projections (UKCP) project. This ensemble is formed by varying uncertain parameters within the model physics, allowing uncertainty in future projections due to climate modelling uncertainty to be explored in a systematic way. We focus on present day performance both compared to observations, and consistency with the driving global ensemble. Daily and seasonal temperature and precipitation are evaluated as two variables commonly used in impacts assessments. For precipitation we find that downscaling, even whilst within the convection-parameterised regime, generally improves daily precipitation, but not everywhere. In summer, the underestimation of dry day frequency is worse in the regional ensemble than in the driving simulations. For temperature we find that the regional ensemble inherits a large wintertime cold bias from the global model, however downscaling reduces this bias. The largest bias reduction is in daily winter cold temperature extremes. In summer the regional ensemble is cooler and wetter than the driving global models, and we examine cloud and radiation diagnostics to understand the causes of the differences. We also use a low-resolution regional simulation to determine whether the differences are a consequence of resolution, or due to other configuration differences, with the predominant configuration difference being the treatment of aerosols. We find that use of the EasyAerosol scheme in the regional model, which aims to approximate the aerosol effects in the driving model, causes reduced temperatures by around 0.5K over Eastern Europe in Summer, and warming of a similar magnitude over France and Germany in Winter, relative to the impact of interactive aerosol in the global runs. Precipitation is also increased in these regions. Overall, we find that the regional model is consistent with the global model, but with a typically better representation of daily extremes and consequently we have higher confidence in its projections of their future change

Breast cancer rehabilitation and reconditioning

Breast Cancer (BC), a prominent oncological disease, has become an increasing concern for countless women across the globe. The rising incidences underscore the urgent need for a comprehensive post-treatment rehabilitation strategy to address the challenges posed by intensive treatments. This rehabilitation is not merely about physical recovery but requires a holistic lens, considering disability as an overarching loss of functional integrity. Embracing this perspective enables healthcare professionals to devise strategies that focus on the entirety of a patient's well-being. Central to this approach is the Individual Rehabilitation Project (IRP), a tailored program designed to elevate the post-treatment quality of life. It stresses the importance of early interventions, particularly after surgery, to mitigate potential complications and functional deficits. Physical activities, curated and executed under professional guidance, form a cornerstone of the rehabilitation process. Depending on each patient's specific condition and stage of recovery, a range of exercises is recommended. Beyond the immediate post-surgical phase, patients are introduced to adaptive physical endeavors like fencing and dragon boating. Such activities are not merely for physical recovery but also play a significant role in enhancing self-esteem, self-perception, and overall mental resilience. Once acute and post-acute care has been completed, and a clinical functional stability is reached, BC patients, now better defined as person with BC disability (PwBC). As the narrative unfolds, it becomes clear that BC rehabilitation is an intricate dance between physical recovery and psychological well-being, necessitating an individualized, patient-centric approach. Furthermore, this opinion paper highlights the urgency for rigorous research, especially randomized trials, to refine and validate the efficacy of these rehabilitation procedures, ensuring that patients not only survive but thrive post-treatment