Fibrin Glue Reduces the Duration of Lymphatic Drainage after Lumpectomy and Level II or III Axillary Lymph Node Dissection for Breast Cancer: A Prospective Randomized Trial

This randomized prospective study investigated the effect of fibrin glue use on drainage duration and overall drain output after lumpectomy and axillary dissection in breast cancer patients. A total of 100 patients undergoing breast lumpectomy and axillary dissection were randomized to a fibrin glue group (N=50; glue sprayed onto the axillary dissection site) or a control group (N=50). Outcome measures were drainage duration, overall drain output, and incidence of seroma. Overall, the fibrin glue and control groups were similar in terms of drainage duration, overall drain output, and incidence of seroma. However, subgroup analysis showed that fibrin glue use resulted in a shorter drainage duration (3.5 vs. 4.7 days; p=0.0006) and overall drain output (196 vs. 278 mL; p=0.0255) in patients undergoing level II or III axillary dissection. Fibrin glue use reduced drainage duration and overall drain output in breast cancer patients undergoing a lumpectomy and level II or III axillary dissection

Association of lipid profile with obesity among breast cancer survivors: a cross-sectional study

Background The role of lipid metabolism in obesity and cancer manifestations cannot be underestimated, but whether alterations in lipid metabolism can manipulate the vasculature to promote obesity among breast cancer (BC) survivors is yet to be clearly understood. This study quantified plasma lipid and particle sizes using high-throughput proton (1H) nuclear magnetic resonance (NMR) and tested their associations with obesity among breast cancer (BC) survivors. Methods A total of 348 (225 premenopausal and 123 postmenopausal) BC survivors enrolled from five hospitals in Korea were included. We assessed thirty-four plasma lipid biomarkers using 1H NMR, and obesity status was defined as a body mass index (BMI) of 25 kg/m2 or greater. Generalized linear and logistic regression models were applied to estimate the least-square means of BMI (kg/m2) and odds ratio (OR)s of obesity, respectively, and the corresponding 95% confidence interval (CI)s across plasma lipid levels. Results Mean (SD) values of BMI was 23.3 (3.2) kg/m2 and 90 (25.9%) had BMI of ≥ 25 kg/m2. BMI levels increased with increasing total triglycerides (TG), TG in lipoproteins and very-low-density lipoprotein (VLDL) subfractions. However, BMI levels decreased with increasing tertiles of high-density lipoprotein (HDL)-cholesterol (C) and HDL particle size (HDL-p). Similar associations were observed in the logistic regression models. The increasing and decreasing BMI trends with TG and HDL profiles respectively were predominantly limited to premenopausal BC survivors. Conclusions Increasing levels of plasma total TG and TG in lipoproteins were associated with increasing levels of BMI among premenopausal BC survivors. High HDL-C levels and large HDL-p were inversely associated with obesity among premenopausal BC survivors. Due to the cross-sectional design of this study, longitudinal studies are necessary to examine the association between obesity and lipid profile among BC survivors.This research was supported by the Brain Pool Program supported through the National Research Foundation of Korea, funded by the Ministry of Science and ICT (2020H1D3A1A04081265). Also, the data collection and recruitment of this work were supported by the National Research Foundation of Korea Grant funded by the Korean government (MSIT) (No. 2014R1A2A2A01007794, 2019R1F1A1061017 and 2021R1F1A1062476). The funders had no role in the study design, data collection and analysis, or decision to prepare and publish the manuscript

Determinants of Plasma 25-Hydroxyvitamin D Concentrations among Breast Cancer Survivors in Korea

We identified demographic, lifestyle, and clinical factors associated with vitamin D status among breast cancer survivors. The vitamin D prediction model may be a useful surrogate of circulating 25-hydroxvitamin D (25(OH)D) concentrations when this measure was not available. We included a total of 216 Korean breast cancer survivors aged 21–79 years who had been diagnosed with stage I to III primary breast cancer and had breast cancer surgery at least 6 months before enrolment. We used linear and logistic regressions to identify determinants for the plasma 25(OH)D concentrations and vitamin D insufficiency (plasma 25(OH)D concentration < 50 nmol/L). We observed that 48.85% of breast cancer survivors had a plasma 25(OH)D concentration less than 50 nmol/L. We identified the following determinants for plasma 25(OH)D concentrations: time since diagnosis (β = −0.005 for 1 month increment), supplementary vitamin D intake (β = 0.06 for 10 μg/day increment), season of the blood draw (β = 0.35 for summer; β = 0.32 for fall; β = 0.26 for winter vs. spring), smoking status (β = 0.28 for former vs. never), use of any supplement (β = −0.35 for non-use vs. use), and the parity number (β = −0.30 for three or more vs. one) were associated with the plasma 25(OH)D concentrations. In addition to the aforementioned variables, body mass index (BMI) was associated with the prevalence of vitamin D insufficiency. We identified the determinants for the plasma 25(OH)D concentrations among Korean breast cancer survivors. Future studies are needed to investigate the role of vitamin D in the progression of breast cancer among Korean breast cancer survivors

TZAP Mutation Leads to Poor Prognosis of Patients with Breast Cancer †

Background and Objectives: ZBTB48 is a telomere-associated factor that has been renamed as telomeric zinc finger-associated protein (TZAP). It binds preferentially to long telomeres, competing with telomeric repeat factors 1 and 2. Materials and Methods: We analyzed the TZAP mutation in 128 breast carcinomas (BCs). In addition, its association with telomere length was investigated. Results: The TZAP mutation (c.1272 G > A, L424L) was found in 7.8% (10/128) of the BCs and was associated with the N0 stage. BCs with the TZAP mutation had longer telomeres than those without this mutation. Survival analysis showed that the TZAP mutation resulted in poorer overall survival. Conclusions: These results suggest that the TZAP mutation is a possible prognostic marker in BC

Sonographic Lesion Size of Ductal Carcinoma In Situ as a Preoperative Predictor for the Presence of an Invasive Focus

BACKGROUND AND OBJECTIVES: To investigate the preoperative factors associated with upstage to invasive cancer in patients with core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) by ultrasound guidance alone. METHODS: Between 2000 and 2007, 201 patients with DCIS diagnosed at 11- or 14-gauge CNB by ultrasound guidance alone were examined. Preoperative factors were all analyzed to correlate with the presence of invasive cancer after definitive resection. The Pearson chi-square test and stratified analysis with the Mantel-Haenszel chi-squire test were used to assess the association between the preoperative factors and upstage to invasive cancer. RESULTS: Compared with the overall underestimation rate (84 of 201, 41.8%), 47 (60.3%) of 78 patients with abnormal breast palpation, 46 (55.4%) of 83 patients with mammographic finding of a mass lesion, and 38 (67.9%) of 56 patients with a sonographic lesion size >20 mm had invasive cancer components on the final pathology review (Odds ratio [OR] = 2.45; P = 0.04, OR = 3.66; P = 0.002, and OR = 4.13; P = 0.002 respectively). CONCLUSION: A sonographic lesion size >20 mm can be used as another guideline for surgeons to consider sentinel lymph node biopsy in patients with DCIS diagnosed by a sonographically guided CNB.Grant sponsor: The Korea Health 21 R&D Project, Ministry of Health & Welfare, R.O.K; Grant number: 01-PJ3-PG6–01GN07–0004

A scoring system to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a comparison with other scoring systems

BACKGROUND: The majority of breast cancer patients with metastatic sentinel lymph node (SLN) do not harbor additional metastasis in non-SLN. It is unclear which patients with metastatic SLN require axillary lymph node dissection (ALND). The aim of this study was to identify predictive factors of non-SLN metastasis and to develop a scoring system. METHODS: The training dataset consisted of 184 breast cancer patients. The independent validation dataset consisted of 82 breast cancer patients. The receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems. RESULTS: Multivariate analysis revealed that non-SLN status was predicted by preoperative ultrasonographic findings of the axilla, lymphovascular invasion, increasing tumor size, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Based on multivariate logistic regression, we developed a scoring system for predicting non-SLN metastasis. The AUC for our scoring system was superior to other published scoring systems when identical validation data were applied. CONCLUSION: The likelihood of metastatic non-SLN correlated with preoperative ultrasonographic findings of the axilla, increasing pathologic size of the primary tumor, presence of lymphovascular invasion, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Our scoring system appears to be effective and accurate for selecting patients for whom ALND can be avoided