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  • 文章类型: Systematic Review
    OBJECTIVE: To synthesize the current evidence of the usefulness of radiomics in PET/CT image analysis in local and locally advanced breast cancer. Also, to evaluate the methodological quality of the radiomic studies published.
    METHODS: Systematic review of articles in different databases until 2021 using the terms \"PET\", \"radiomics\", \"texture\", \"breast\". Only articles with human data and that included a PET image were included. Studies with simulated data and with less than 20 patients were excluded. Were extracted sample size, radiotracer used, imaging technique, and radiomics characteristics from each article. The methodological quality of the studies was determined using the QUADAS-2 tool.
    RESULTS: 18 articles were selected. The retrospective design was the most used. The most studied radiomic characteristic was SUVmax. Several radiomic parameters were correlated with tumor characterization, and tumor heterogeneity proved useful for predicting disease course and response to treatment. Most articles showed a high risk of bias, mainly from the patient selection.
    CONCLUSIONS: A high probability of bias was observed in most of the published articles. Radiomics is a developing field and more studies are needed to demonstrate its usefulness in routine clinical practice. The QUADAS-2 tool allows critical assessment of the methodological quality of the available evidence. Despite its limitations, radiomics is shown to be an instrument that can help to achieve personalized oncologic management of breast cancer.
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  • 文章类型: Systematic Review
    背景:世界范围内癌症幸存者的数量正在增长,但是放疗的副作用仍然很常见,影响努力能力,呼吸功能和生活质量。目的是了解体育锻炼如何影响呼吸功能和对努力的耐受性,在放疗后的乳腺癌患者中。
    方法:搜索在Pubmed的数据库中进行,PEDro,网络科学,科克伦,EMBASE,UptoDate和Tripdatabase。纳入了接受放射治疗并纳入锻炼计划的乳腺癌患者的研究。主要结果是:最大耗氧量,6分钟步行测试,强制肺活量,肺活量,1秒用力呼气量,休息室总容量,吸气量,以及肺部对一氧化碳的扩散能力。
    结果:结果表明,最大耗氧量提高了15%,在6分钟步行测试中提高了6.675%,虽然它们对呼吸功能有限。
    结论:体育锻炼可有效提高放疗治疗乳腺癌患者的努力能力,不改变呼吸功能。然而,有必要进行新的研究,以深入研究体育锻炼对这些和平时期的影响,以及程序的理想设计。
    BACKGROUND: The number of survivors with cancer is growing worldwide, but the adverse effects of the radiotherapy are still frequent, affecting effort capacity, respiratory function and quality of life. The objective is to know how the physical exercise influences the respiratory function and tolerance to effort, in pacients with breast cancer after the radiotherapy treatment.
    METHODS: The searches were carried out in the databases of Pubmed, PEDro, Web Of Science, Cochrane, EMBASE, UptoDate and Tripdatabase. Were included studies with patients with breast cancer treated with radiotherapy and included in an exercise program. The main results were: maximum oxygen consumption, 6 minutes walking test, forced vital capacity, vital capacity, forced expiratory volume in 1 second, total lounge capacity, inspiratory capacity, and the diffusion capacity of the lungs for carbon monoxide.
    RESULTS: The results show an increase of the effort capacity with 15% improvements in the maximum oxygen consumption and 6.675% in the 6 minutes walking test, while they are limited for the respiratory function.
    CONCLUSIONS: The physical exercise is effective for improve the effort capacity in pacients with breast cancer treated with radiotherapy, without changes in the respiratory function. Nevertheless, new studies are necessary to investigate deeply how the physical exercise influences in those pacients, and the ideal design of the programs.
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  • 文章类型: Journal Article
    OBJECTIVE: Breast cancer is the most common cause of cutaneous metastases. In our review of the literature, we found no studies that have investigated the prevalence of cutaneous metastases from breast cancer in Latin America or compared survival in relation to the site of cutaneous involvement or the presence of visceral metastases. The aims of this study were to characterize the prevalence and clinical features of cutaneous metastases from breast cancer and analyze survival in relation to site of involvement and the concomitant presence of visceral metastases.
    METHODS: Retrospective cohort study. We evaluated patients with breast cancer and histologically confirmed cutaneous metastases.
    RESULTS: Data from 914 patients with breast cancer seen between 2007 and 2014 were analyzed. Thirty-one of the patients, all women, had cutaneous metastases (prevalence, 3.4%; 95% CI, 2.3%-4.7%). The most common form of metástasis was nodular, metachronous, and asymptomatic. There were discrepancies between the immunohistochemical findings for the primary tumor and the metastases in 5 of 21 women. The metastases were locorregional in 23 patients and distant in 8. No differences were observed between patients with locorregional and distant metastases for survival after diagnosis of the primary tumor (median of 4.7 vs. 4.8 years; P=.085) or the cutaneous metastases (median of 2.9 vs. 1.1 years, P=.06). Women with a simultaneous diagnosis of cutaneous and visceral metastases had the shortest survival.
    CONCLUSIONS: This is the first study in Latin America to estimate the prevalence of cutaneous metastases from breast cancer and we found it to be lower than rates reported for other parts of the world.
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  • 文章类型: Journal Article
    The role of the selective sentinel node biopsy (SNB) is increasing in relevance in breast cancer women with indication of neoadjuvant chemotherapy (NAC). The Radiosurgery Working Group of the SEMNIM is aware of the necessity of establishing the need for SNB before or after NAC, and also how to manage patients with axillary node-negative or node-positive. There is sufficient data to assess that the SNB with radioisotope techniques are feasible and safe in all these scenarios. An adequate axilla evaluation prior to surgery and the possibility of marking prior to NAC the nodes infiltrated must be the two main pillars to guarantee the success of the SNB. It has been shown that to incorporate the SNB in breast cancer women with indication of NAC increases the rate of a conservative treatment of the axilla that will be a clear benefit for these patients.
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  • 文章类型: Journal Article
    背景:放射治疗后,大多数患者会出现一定程度的急性皮肤毒性。这项系统评价的目的是评估有关局部治疗对放疗后发生放射性皮炎的乳腺癌患者的有效性的现有证据。
    方法:该综述包括旨在评估局部疗法预防或治疗乳腺癌女性急性放射性皮炎的临床试验,于2009年至2014年间出版。书目搜索在以下数据库中进行:PubMed,Cinahl,CochranePlus,IBECS和LILACS。这些研究是由同行评审员使用西班牙语版本的关键评估技能计划独立选择的。
    结果:确定了86篇参考文献。对20篇临床试验的全文文章进行了评估,其中2篇因为未完成而被排除在外;12篇临床试验评估了使用乳膏和软膏的局部治疗,三个用皮质类固醇乳膏,其他三个用敷料。人表皮生长因子乳膏的有效性,亚油酸乳液,局部磺胺嘧啶银,这些临床试验中已显示皮质类固醇乳膏和聚氨酯敷料。
    结论:鉴于放射性皮炎是一个动态过程,这些外用药物在皮肤毒性的不同阶段都有效。其中一些延迟了发病,其他人降低了急性皮肤毒性程度的发展和严重程度,其他人改善了主观症状(瘙痒,疼痛,燃烧)。只有聚氨酯敷料表明在皮肤毒性的所有阶段都有效,在预防方面,管理不同程度的皮肤毒性和改善健康。
    BACKGROUND: After radiation therapy most patients experience acute skin toxicity to some degree. The purpose of this systematic review is to assess the available evidence concerning the effectivity of topical therapies on patients with breast cancer that experience radiodermatitis after radiotherapy.
    METHODS: The review included clinical trials aimed to evaluate topical therapies for prevention or treatment of acute radiodermatitis in women with breast cancer, which were published between 2009 and 2014. The bibliographic search was carried out in the following databases: PubMed, Cinahl, Cochrane Plus, IBECS and LILACS. The studies were selected independently by peer reviewers using the Critical Appraisal Skills Programme in its Spanish version.
    RESULTS: 86 bibliographical references were identified. Twenty full-text articles of clinical trials were assessed and two were excluded because they were not completed; 12 of clinical trials evaluated topical treatment with creams and ointments, three with corticosteroid creams and other three with dressings. The effectivity of human epidermal growth factor cream, linoleic acid emulsion, topical silver sulfadiazine, corticosteroids creams and polyurethane dressings has been shown in these clinical trials.
    CONCLUSIONS: Given that radiodermatitis is a dynamic process, these topical agents were effective in different stages of skin toxicity. Some of them delayed the onset, others decreased the development and severity of acute skin toxicity degree and others improved the subjective symptoms (itching, pain, burning). Only polyurethane dressings suggest effectiveness in all stages of skin toxicity, in prevention, management of the different skin toxicity degrees and improvement of wellbeing.
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  • 文章类型: Journal Article
    OBJECTIVE: To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer.
    METHODS: We systematically searched MedLine, EMBASE, and Web of Science for the terms breast cancer, screening, tomosynthesis, mammography, sensitivity, and specificity in publications in the period comprising June 2010 through February 2013. We included studies on diagnostic tests and systematic reviews. Two reviewers selected and evaluated the articles. We used QUADAS 2 to evaluate the risk of bias and the NICE criteria to determine the level of evidence. We compiled a narrative synthesis.
    RESULTS: Of the 151 original studies identified, we selected 11 that included a total of 2475 women. The overall quality was low, with a risk of bias and follow-up and limitations regarding the applicability of the results. The level of evidence was not greater than level II. The sensitivity of tomosynthesis ranged from 69% to 100% and the specificity ranged from 54% to 100%. The negative likelihood ratio was good, and this makes tomosynthesis useful as a test to confirm a diagnosis. One-view tomosynthesis was no better than two-view digital mammography, and the evidence for the superiority of two-view tomosynthesis was inconclusive.
    CONCLUSIONS: The results for the diagnostic validity of tomosynthesis in the diagnosis of breast cancer were inconclusive and there were no results for its use in screening.
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