The impact of COVID-19 pandemic on breast surgery in Italy: a multi-centric retrospective observational study

COVID-19 pandemic had an impact on surgical activities. The aim of this multi-centric, retrospective study was to evaluate the impact of the COVID-19 pandemic on breast surgery. The patients who operated during the pre-pandemic year 2019 were compared to those operated in 2020. Fourteen Breast Care Units provided data on breast surgical procedures performed in 2020 and 2019: total number of breast-conserving surgery (BCS), number of 1st level oncoplastic breast surgery (OBS), number of 2nd level OBS; total number of mastectomies, mastectomies without reconstruction, mastectomies with a tissue expander, mastectomies with direct to implant (DTI) reconstruction, mastectomies with immediate flap reconstruction; total number of delayed reconstructions, number of expanders to implant reconstructions, number of delayed flap reconstructions. Overall 20.684 patients were included: 10.850 (52.5%) operated during 2019, and 9.834 (47.5%) during 2020. The overall number of breast oncologic surgical procedures in all centers in 2020 was 8.509, compared to 9.383 in 2019 (- 9%). BCS decreased by 744 cases (- 13%), the overall number of mastectomies decreased by 130 cases (- 3.5%); mastectomy-BCS ratio was 39-61% in 2019, and 42-58% in 2020. Regarding immediate reconstructive procedures mastectomies with DTI reconstruction increased by 166 cases (+ 15%) and mastectomies with immediate expander reconstruction decreased by 297 cases (- 20%). Breast-delayed reconstructive procedures in all centers in 2020 were 142 less than in 2019 (- 10%). The outburst of the COVID-19 pandemic in 2020 determined an implemented number of mastectomies compared to BCS, an implemented number of immediate breast reconstructions, mainly DTI, and a reduction of expander reconstruction

Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer: A multicentre study on 1,950 patients

Background: Type of axillary surgery in breast cancer (BC) patients who convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized. Patients and methods: 1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR). Results: Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89, p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2 (OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75\u20130.80). After external validation the accuracy of the nomogram was confirmed. Conclusion: The accuracy makes this freely-available, nomogram-based online tool useful to predict nodal pCR after NAC, translating the concept of tailored axillary surgery also in this setting of patients

Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis

Background: Systemic inflammatory markers draw great interest as potential blood-based prognostic factors in several oncological settings. Objectives: The aim of this study is to evaluate whether neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV) predict nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in node-positive (cN+) breast cancer (BC) patients. Design: Clinically, cN+ BC patients undergoing NAC followed by breast and axillary surgery were enrolled in a multicentric study from 11 Breast Units. Methods: Pretreatment blood counts were collected for the analysis and used to calculate NLR and PIV. Logistic regression analyses were performed to evaluate independent predictors of nodal pCR. Results: A total of 1274 cN+ BC patients were included. Nodal pCR was achieved in 586 (46%) patients. At multivariate analysis, low NLR [odds ratio (OR) = 0.71; 95% CI, 0.51–0.98; p = 0.04] and low PIV (OR = 0.63; 95% CI, 0.44–0.90; p = 0.01) were independently predictive of increased likelihood of nodal pCR. A sub-analysis on cN1 patients (n = 1075) confirmed the statistical significance of these variables. PIV was significantly associated with axillary pCR in estrogen receptor (ER)−/human epidermal growth factor receptor 2 (HER2)+ (OR = 0.31; 95% CI, 0.12–0.83; p = 0.02) and ER−/HER2− (OR = 0.41; 95% CI, 0.17–0.97; p = 0.04) BC patients. Conclusion: This study found that low NLR and PIV levels predict axillary pCR in patients with BC undergoing NAC. Registration: Eudract number NCT05798806

Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice

Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1\u20132 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015\u20132016) were 0% and 83% in two centers located in different countries (p < 0.001). Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns

The last reconnection of the Marmara Sea (Turkey) to the World Ocean : A paleoceanographic and paleoclimatic perspective

Author Posting. © Elsevier B.V., 2008. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Marine Geology 255 (2008): 64-82, doi:10.1016/j.margeo.2008.07.005.During the late glacial, marine isotope Stage 2, the Marmara Sea transformed into a brackish lake as global sea level fell below the sill in the Dardanelles Strait. A record of the basin’s reconnection to the global ocean is preserved in its sediments permitting the extraction of the paleoceanographic and paleoclimatic history of the region. The goal of this study is to develop a high-resolution record of the lacustrine to marine transition of Marmara Sea in order to reconstruct regional and global climatic events at 24 a millennial scale. For this purpose, we mapped the paleoshorelines of Marmara Sea along the northern, eastern, and southern shelves at Çekmece, Prince Islands, and Imrali, using data from multibeam bathymetry, high-resolution subbottom profiling (chirp) and ten sediment cores. Detailed sedimentologic, biostratigraphic (foraminifers, mollusk, diatoms), X-ray fluorescence geochemical scanning, and oxygen and carbon stable isotope analyses correlated to a calibrated radiocarbon chronology provided evidence for cold and dry conditions prior to 15 ka BP, warm conditions of the Bolling-Allerod from ~15 to 13 ka BP, a rapid marine incursion at 12 ka BP, still stand of Marmara Sea and sediment reworking of the paleoshorelines during the Younger Dryas at ~11.5 to 10.5 ka BP, and development of strong stratification and influx of nutrients as Black Sea waters spilled into Marmara Sea at 9.2 ka BP. Stable environmental conditions developed in Marmara Sea after 6.0 ka BP as sea-level reached its present shoreline and the basin floors filled with sediments achieving their present configuration.Support for the analyses was from NSF-OCE-0222139; OCE-9807266 and PSC-CUNY 69138-00 38

The genetic diversity, phylogeography and morphology of Elphidiidae (Foraminifera) in the Northeast Atlantic

Genetic characterisation (SSU rRNA genotyping) and Scanning ElectronMicroscope (SEM) imaging of individualtests were used in tandem to determine the modern species richness of the foraminiferal family Elphidiidae(Elphidium, Haynesina and related genera) across the Northeast Atlantic shelf biomes. Specimens were collectedat 25 locations fromthe High Arctic to Iberia, and a total of 1013 individual specimenswere successfully SEMimagedand genotyped. Phylogenetic analyses were carried out in combination with 28 other elphidiid sequencesfrom GenBank and seventeen distinct elphidiid genetic types were identified within the sample set, sevenbeing sequenced for the first time. Genetic types cluster into sevenmain cladeswhich largely represent their generalmorphologicalcharacter. Differences between genetic types at the genetic, morphological and biogeographiclevels are indicative of species level distinction. Their biogeographic distributions, in combination with elphidiidSSU sequences from GenBank and high resolution images from the literature show that each of them exhibitsspecies-specific rather than clade-specific biogeographies. Due to taxonomic uncertainty and divergent taxonomicconcepts between schools, we believe that morphospecies names should not be placed onto molecularphylogenies unless both the morphology and genetic type have been linked to the formally named holotype,or equivalent. Based on strictmorphological criteria,we advocate using only a three-stage approach to taxonomyfor practical application in micropalaeontological studies. It comprises genotyping, the production of a formalmorphological description of the SEM images associated with the genetic type and then the allocation of themost appropriate taxonomic name by comparison with the formal type description. Using this approach, wewere able to apply taxonomic names to fifteen genetic types. One of the remaining two may be potentially cryptic,and one is undescribed in the literature. In general, the phylogeographic distribution is in agreement with ourknowledge of the ecology and biogeographical distribution of the corresponding morphospecies, highlighting thegenerally robust taxonomic framework of the Elphidiidae in time and space