Introduction: Innovations in 3D spatial technology and augmented reality imaging driven by digita... more Introduction: Innovations in 3D spatial technology and augmented reality imaging driven by digital hightech industrial science have accelerated experimental advances in breast cancer imaging and the development of medical procedures aimed to reduce invasiveness. Presentation of case: A 57-year-old post-menopausal woman presented with screen-detected left-sided breast cancer. After undergoing all staging and pre-operative studies the patient was proposed for conservative breast surgery with tumor localization. During surgery, an experimental digital and non-invasive intra-operative localization method with augmented reality was compared with the standard pre-operative localization with carbon tattooing (institutional protocol). The breast surgeon wearing an augmented reality headset (Hololens) was able to visualize the tumor location projection inside the patient's left breast in the usual supine position. Discussion: This work describes, to our knowledge, the first experimental test with a digital non-invasive method for intra-operative breast cancer localization using augmented reality to guide breast conservative surgery. In this case, a successful overlap of the previous standard pre-operative marks with carbon tattooing and tumor visualization inside the patient's breast with augmented reality was obtained. Conclusion: Breast cancer conservative guided surgery with augmented reality can pave the way for a digital non-invasive method for intra-operative tumor localization.
Breast cancer incidence has been steadily increasing manly in high income countries as is life ex... more Breast cancer incidence has been steadily increasing manly in high income countries as is life expectancy. The majority of newly diagnosed breast cancer cases will occur in post-menopausal women with an increasing in the older age group. As in younger women oncoplastic surgery and post mastectomy breast reconstruction should also be viable options, when needed, in older women. However, this is not the case in most centres and chronological age alone seems to be a barrier to these surgical alternatives. We evaluated the most relevant and recently published literature on the topic to analyse the available evidence in favour and against the use of oncoplastic breast surgery and post mastectomy breast reconstruction in this age group. Older women are not significantly represented in randomized clinical trials. There is minimal published evidence on oncoplastic breast surgery. Regarding post mastectomy breast reconstruction, although there are more publications, most studies are retrospective, present an evident selection bias and are very heterogeneous. Regarding oncoplastic surgery and post mastectomy breast reconstruction, there is no evidence that, compared to younger age groups, higher rates of complications should lead to the denial of these choices to older women, especially in the absence of associated comorbidities. Patient reported outcomes are not sufficiently explored in older women but, based on the limited available evidence, older women report higher rates of satisfaction when compared to younger women regarding oncoplastic surgery and post mastectomy breast reconstruction. Decisions in older women proposed for breast surgery and in need of oncoplastic breast surgery or post mastectomy breast reconstruction should always integrate, patients preference, a geriatric assessment and a life expectancy estimation. In case of unfavourable geriatric assessment and low estimation of life expectancy, a higher complication rate should be anticipated. It is not likely that randomized controlled trials will happen in this age group not only due to ethical concerns (as oncoplastic surgery and post mastectomy reconstruction are already standard of care in other age groups) but also to the difficulties in obtaining meaningful numbers. However, well designed prospective cohorts can be a valuable alternative to the scarce available retrospective evidence.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introduction: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is locat... more Introduction: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma. Case presentation: We describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented. Conclusion: Awareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group.
Introduction: Augmented reality (AR) has demonstrated a potentially wide range of benefits and ed... more Introduction: Augmented reality (AR) has demonstrated a potentially wide range of benefits and educational applications in the virtual health ecosystem. The concept of real-time data acquisition, machine learning-aided processing, and visualization is a foreseen ambition to leverage AR applications in the healthcare sector. This breakthrough with immersive technologies like AR, mixed reality, virtual reality, or extended reality will hopefully initiate a new surgical era: that of the use of the so-called surgical metaverse. Methods: This paper focuses on the future use of AR in breast surgery education describing two potential applications (surgical remote telementoring and impalpable breast cancer localization using AR), along with the technical needs to make it possible. Conclusion: Surgical telementoring and impalpable tumors noninvasive localization are two examples that can have success in the future provided the improvements in both data transformation and infrastructures are capable to overcome the current challenges and limitations.
The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy ... more The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy reconstruction. Preoperative imaging techniques are routinely used to detect location, diameter and course of perforators, with direct intervention from the imaging team, who subsequently draw a chart that will help surgeons choosing the best vascular support for the reconstruction. In this work, the feasibility of using a computer software to support the preoperative planning of 40 patients proposed for breast reconstruction with a DIEP flap is evaluated for the first time. Blood vessel centreline extraction and local characterization algorithms are applied to identify perforators and compared with the manual mapping, aiming to reduce the time spent by the imaging team, as well as the inherent subjectivity to the task. Comparing with the measures taken during surgery, the software calibre estimates were worse for vessels smaller than 1.5 mm (P ¼ 6e-4) but better for the remaining ones (P ¼ 2e-3). Regarding vessel location, the vertical component of the software output was significantly different from the manual measure (P ¼ 0.02), nonetheless that was irrelevant during surgery as errors in the order of 2e3 mm do not have impact in the dissection step. Our trials support that a reduction of the time spent is achievable using the automatic tool (about 2 h/ case). The introduction of artificial intelligence in clinical practice intends to simplify the work of health professionals and to provide better outcomes to patients. This pilot study paves the way for a success story.
O síndrome do túnel cárpico é uma patologia frequente, ocorrendo em cerca de 3% da população ocid... more O síndrome do túnel cárpico é uma patologia frequente, ocorrendo em cerca de 3% da população ocidental. O seu tratamento é quase sempre cirúrgico, podendo ser feito por diversas técnicas que têm em comum a abertura do retináculo flexor do punho. Há a percepção que se trata de um procedimento simples, não sendo habitualmente pedidos exames de imagem pré-operatórios para avaliar a morfologia das estruturas anatómicas adjacentes ao nervo mediano. Contudo, as estruturas anatómicas desta região podem apresentar numerosas variações que aumentam o risco de iatrogenia durante a cirurgia, especialmente se estas variantes não forem tidas em consideração pelo cirurgião. Métodos: Em 3 doentes operados por síndrome do túnel cárpico, foram detectadas intraoperatoriamente variantes anatómicas. Em dois dos casos, existia uma artéria mediana persistente. Noutro caso, observava-se um nervo cutâneo palmar do nervo mediano com um trajecto transretinacular. A propósito destas variações, efectuou-se uma ...
The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy ... more The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy reconstruction. Preoperative imaging techniques are routinely used to detect location, diameter and course of perforators, with direct intervention from the imaging team, who subsequently draw a chart that will help surgeons choosing the best vascular support for the reconstruction. In this work, the feasibility of using a computer software to support the preoperative planning of 40 patients proposed for breast reconstruction with a DIEP flap is evaluated for the first time. Blood vessel centreline extraction and local characterization algorithms are applied to identify perforators and compared with the manual mapping, aiming to reduce the time spent by the imaging team, as well as the inherent subjectivity to the task. Comparing with the measures taken during surgery, the software calibre estimates were worse for vessels smaller than 1.5 mm (P ¼ 6e-4) but better for the remaining ones (P ¼ 2e-3). Regarding vessel location, the vertical component of the software output was significantly different from the manual measure (P ¼ 0.02), nonetheless that was irrelevant during surgery as errors in the order of 2e3 mm do not have impact in the dissection step. Our trials support that a reduction of the time spent is achievable using the automatic tool (about 2 h/ case). The introduction of artificial intelligence in clinical practice intends to simplify the work of health professionals and to provide better outcomes to patients. This pilot study paves the way for a success story.
Breast cancer conservative treatment (BCCT) is a form of treatment commonly used for patients wit... more Breast cancer conservative treatment (BCCT) is a form of treatment commonly used for patients with early breast cancer. This procedure consists of removing the cancer and a small margin of surrounding tissue, while leaving the healthy tissue intact. In recent years, this procedure has become increasingly common due to identical survival rates and better cosmetic outcomes than other alternatives. Although significant research has been conducted on BCCT, there is no gold-standard for evaluating the aesthetic results of the treatment. Recent works have proposed the automatic classification of cosmetic results based on breast features extracted from digital photographs. The computation of most of these features requires the representation of the breast contour, which becomes key to the aesthetic evaluation of BCCT. State-of-the-art methods use conventional image processing tools that automatically detect breast contours based on the shortest path applied to the Sobel filter result in a ...
Introduction: Augmented Reality (AR) has demonstrated a potentially wide range of benefits and ed... more Introduction: Augmented Reality (AR) has demonstrated a potentially wide range of benefits and educational applications in the virtual health ecosystem. The concept of real-time data acquisition, machine learning aided processing, and visualization, is a foreseen ambition to leverage AR applications in the healthcare sector. This breakthrough with immersive technologies like AR, mixed reality (MR), virtual reality (VR), or extended reality (XR) will hopefully initiate a new surgical era: that of the use of the so-called surgical metaverse. Main text: This paper focuses on the future use of AR in breast surgery education describing two potential applications (surgical remote telementoring and impalpable breast cancer localization using AR), along with the technical needs to make it possible. Conclusion: Surgical telementoring and impalpable tumors non-invasive localization are two examples that can have success in the future provided the improvements in both data transformation and i...
naïve patients' samples. Acquired resistance towards Docetaxel, Paclitaxel and Vinorelbine was ob... more naïve patients' samples. Acquired resistance towards Docetaxel, Paclitaxel and Vinorelbine was observed in 78%, 72% and 66% of pretreated patients' samples. Conclusion: Our study demonstrates the feasibility of CRR profiling of C-TACs in therapy naïve and pretreated patients. Adoption of C-TAC-CRR profiling can non-invasively provide real time oversight towards treatment selection, monitoring of drug resistance and timely therapeutic course correction.
Background: As a result of neoadjuvant systemic therapy (NST) 1 out of 3 patients with pre-treatm... more Background: As a result of neoadjuvant systemic therapy (NST) 1 out of 3 patients with pre-treatment node positive (cN+) breast cancer achieves an axillary pathologic complete response (ax-pCR). This urges the need for a less invasive axillary staging procedure to replace the traditional axillary lymph node dissection (ALND). We report on our experience with combining removal of the pre-treatment marked positive lymph node (MN) and sentinel lymph node (SN)(s) for staging of the axilla after NST in cN+ patients; is it feasible? Materials and Methods: in 3 hospitals with specialized breast cancer care, pathologically proven cN+ patients who underwent removal of the MN and SN(s) after NST were retrospectively identified. The positive lymph node was primarily marked either by an iodine seed or a radiopaque clip (in the latter followed by wire placement after completion of NST). Patients that underwent a completion ALND (cALND) as well as patients that did not undergo cALND were included. Since in the latter patients axillary residual disease may potentially be missed, adjuvant radiotherapy was recommended, also in case of ax-pCR. Results: 90 cN+ patients were identified (46,7% Iodine seed, 53,3% clip). Breast cancer was HER2-positive in 37,5% and triple negative in 17,8%. In 89 patients, 1 to 7 MN + SN(s) (mean 2,6) were identified during surgery. A total of 41,1% achieved an ax-pCR (residual disease consisted of isolated tumor cells (5,7%), micrometastasis (18,9%), macrometastasis (75,4%)). Axillary residual disease was detected in 38,9% by SN(s) alone, in 47% by MN alone and in 58,4% when outcomes of MN and SN(s) were combined. 24 patients underwent a cALND (21% because of macrometastasis, 79% because of local practice/surgeons decision): 1 patient was upstaged from ax-pCR to micrometastasis and 1 patient from micrometastasis to macrometastasis. In 95% of all patients adjuvant radiotherapy was planned. Conclusion: removal of MN and SN(s) for axillary staging after NST in cN+ patients is feasible in the hands of specialized breast cancer care teams. The combined procedure shows improved detection of axillary residual disease compared to relying solely on the outcome of either MN or SN(s). Research is ongoing to determine accuracy and safety of the combined procedure in order to optimize axillary staging and subsequent therapeutic management after NST in pretreatment cN+ patients.
Breast cancer incidence has been steadily increasing manly in high income countries as is life ex... more Breast cancer incidence has been steadily increasing manly in high income countries as is life expectancy. The majority of newly diagnosed breast cancer cases will occur in post-menopausal women with an increasing in the older age group. As in younger women oncoplastic surgery and post mastectomy breast reconstruction should also be viable options, when needed, in older women. However, this is not the case in most centres and chronological age alone seems to be a barrier to these surgical alternatives. We evaluated the most relevant and recently published literature on the topic to analyse the available evidence in favour and against the use of oncoplastic breast surgery and post mastectomy breast reconstruction in this age group. Older women are not significantly represented in randomized clinical trials. There is minimal published evidence on oncoplastic breast surgery. Regarding post mastectomy breast reconstruction, although there are more publications, most studies are retrospective, present an evident selection bias and are very heterogeneous. Regarding oncoplastic surgery and post mastectomy breast reconstruction, there is no evidence that, compared to younger age groups, higher rates of complications should lead to the denial of these choices to older women, especially in the absence of associated comorbidities. Patient reported outcomes are not sufficiently explored in older women but, based on the limited available evidence, older women report higher rates of satisfaction when compared to younger women regarding oncoplastic surgery and post mastectomy breast reconstruction. Decisions in older women proposed for breast surgery and in need of oncoplastic breast surgery or post mastectomy breast reconstruction should always integrate, patients preference, a geriatric assessment and a life expectancy estimation. In case of unfavourable geriatric assessment and low estimation of life expectancy, a higher complication rate should be anticipated. It is not likely that randomized controlled trials will happen in this age group not only due to ethical concerns (as oncoplastic surgery and post mastectomy reconstruction are already standard of care in other age groups) but also to the difficulties in obtaining meaningful numbers. However, well designed prospective cohorts can be a valuable alternative to the scarce available retrospective evidence.
Stevens-Johnson Syndrome (SJS), Overlap Syndrome (OS) and Toxic Epidermal Necrosis (TEN) are rare... more Stevens-Johnson Syndrome (SJS), Overlap Syndrome (OS) and Toxic Epidermal Necrosis (TEN) are rare medical emergencies associated with a high morbidity and mortality. The literature on the characteristics of these diseases in Portugal is scarce. A retrospective study was conducted based on the clinical notes of the 20 patients admitted to São José Burn Unit in the previous 15 years with the diagnosis of SJS, OS or TEN. Most patients had TEN (65%), followed by OS (25%) and SJS (10%). Average age was 57,1 ± 19,0 years. The mean duration of stay in the Burn Unit was 12,6 ± 7,8 days. Mortality was 50%, being significantly higher than the 16,4% overall mortality in the general Burn Unit population in the same period (p < 0,01). The mean surface area involved was 43,9 ± 28,6 %. Allopurinol was the causal agent most frequently implicated (35%) followed by UV light exposure (15%). Fourteen patients (70%) were treated with steroids in the first days, whereas six patients were treated conse...
Introduction: Innovations in 3D spatial technology and augmented reality imaging driven by digita... more Introduction: Innovations in 3D spatial technology and augmented reality imaging driven by digital hightech industrial science have accelerated experimental advances in breast cancer imaging and the development of medical procedures aimed to reduce invasiveness. Presentation of case: A 57-year-old post-menopausal woman presented with screen-detected left-sided breast cancer. After undergoing all staging and pre-operative studies the patient was proposed for conservative breast surgery with tumor localization. During surgery, an experimental digital and non-invasive intra-operative localization method with augmented reality was compared with the standard pre-operative localization with carbon tattooing (institutional protocol). The breast surgeon wearing an augmented reality headset (Hololens) was able to visualize the tumor location projection inside the patient's left breast in the usual supine position. Discussion: This work describes, to our knowledge, the first experimental test with a digital non-invasive method for intra-operative breast cancer localization using augmented reality to guide breast conservative surgery. In this case, a successful overlap of the previous standard pre-operative marks with carbon tattooing and tumor visualization inside the patient's breast with augmented reality was obtained. Conclusion: Breast cancer conservative guided surgery with augmented reality can pave the way for a digital non-invasive method for intra-operative tumor localization.
Breast cancer incidence has been steadily increasing manly in high income countries as is life ex... more Breast cancer incidence has been steadily increasing manly in high income countries as is life expectancy. The majority of newly diagnosed breast cancer cases will occur in post-menopausal women with an increasing in the older age group. As in younger women oncoplastic surgery and post mastectomy breast reconstruction should also be viable options, when needed, in older women. However, this is not the case in most centres and chronological age alone seems to be a barrier to these surgical alternatives. We evaluated the most relevant and recently published literature on the topic to analyse the available evidence in favour and against the use of oncoplastic breast surgery and post mastectomy breast reconstruction in this age group. Older women are not significantly represented in randomized clinical trials. There is minimal published evidence on oncoplastic breast surgery. Regarding post mastectomy breast reconstruction, although there are more publications, most studies are retrospective, present an evident selection bias and are very heterogeneous. Regarding oncoplastic surgery and post mastectomy breast reconstruction, there is no evidence that, compared to younger age groups, higher rates of complications should lead to the denial of these choices to older women, especially in the absence of associated comorbidities. Patient reported outcomes are not sufficiently explored in older women but, based on the limited available evidence, older women report higher rates of satisfaction when compared to younger women regarding oncoplastic surgery and post mastectomy breast reconstruction. Decisions in older women proposed for breast surgery and in need of oncoplastic breast surgery or post mastectomy breast reconstruction should always integrate, patients preference, a geriatric assessment and a life expectancy estimation. In case of unfavourable geriatric assessment and low estimation of life expectancy, a higher complication rate should be anticipated. It is not likely that randomized controlled trials will happen in this age group not only due to ethical concerns (as oncoplastic surgery and post mastectomy reconstruction are already standard of care in other age groups) but also to the difficulties in obtaining meaningful numbers. However, well designed prospective cohorts can be a valuable alternative to the scarce available retrospective evidence.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introduction: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is locat... more Introduction: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma. Case presentation: We describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented. Conclusion: Awareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group.
Introduction: Augmented reality (AR) has demonstrated a potentially wide range of benefits and ed... more Introduction: Augmented reality (AR) has demonstrated a potentially wide range of benefits and educational applications in the virtual health ecosystem. The concept of real-time data acquisition, machine learning-aided processing, and visualization is a foreseen ambition to leverage AR applications in the healthcare sector. This breakthrough with immersive technologies like AR, mixed reality, virtual reality, or extended reality will hopefully initiate a new surgical era: that of the use of the so-called surgical metaverse. Methods: This paper focuses on the future use of AR in breast surgery education describing two potential applications (surgical remote telementoring and impalpable breast cancer localization using AR), along with the technical needs to make it possible. Conclusion: Surgical telementoring and impalpable tumors noninvasive localization are two examples that can have success in the future provided the improvements in both data transformation and infrastructures are capable to overcome the current challenges and limitations.
The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy ... more The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy reconstruction. Preoperative imaging techniques are routinely used to detect location, diameter and course of perforators, with direct intervention from the imaging team, who subsequently draw a chart that will help surgeons choosing the best vascular support for the reconstruction. In this work, the feasibility of using a computer software to support the preoperative planning of 40 patients proposed for breast reconstruction with a DIEP flap is evaluated for the first time. Blood vessel centreline extraction and local characterization algorithms are applied to identify perforators and compared with the manual mapping, aiming to reduce the time spent by the imaging team, as well as the inherent subjectivity to the task. Comparing with the measures taken during surgery, the software calibre estimates were worse for vessels smaller than 1.5 mm (P ¼ 6e-4) but better for the remaining ones (P ¼ 2e-3). Regarding vessel location, the vertical component of the software output was significantly different from the manual measure (P ¼ 0.02), nonetheless that was irrelevant during surgery as errors in the order of 2e3 mm do not have impact in the dissection step. Our trials support that a reduction of the time spent is achievable using the automatic tool (about 2 h/ case). The introduction of artificial intelligence in clinical practice intends to simplify the work of health professionals and to provide better outcomes to patients. This pilot study paves the way for a success story.
O síndrome do túnel cárpico é uma patologia frequente, ocorrendo em cerca de 3% da população ocid... more O síndrome do túnel cárpico é uma patologia frequente, ocorrendo em cerca de 3% da população ocidental. O seu tratamento é quase sempre cirúrgico, podendo ser feito por diversas técnicas que têm em comum a abertura do retináculo flexor do punho. Há a percepção que se trata de um procedimento simples, não sendo habitualmente pedidos exames de imagem pré-operatórios para avaliar a morfologia das estruturas anatómicas adjacentes ao nervo mediano. Contudo, as estruturas anatómicas desta região podem apresentar numerosas variações que aumentam o risco de iatrogenia durante a cirurgia, especialmente se estas variantes não forem tidas em consideração pelo cirurgião. Métodos: Em 3 doentes operados por síndrome do túnel cárpico, foram detectadas intraoperatoriamente variantes anatómicas. Em dois dos casos, existia uma artéria mediana persistente. Noutro caso, observava-se um nervo cutâneo palmar do nervo mediano com um trajecto transretinacular. A propósito destas variações, efectuou-se uma ...
The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy ... more The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy reconstruction. Preoperative imaging techniques are routinely used to detect location, diameter and course of perforators, with direct intervention from the imaging team, who subsequently draw a chart that will help surgeons choosing the best vascular support for the reconstruction. In this work, the feasibility of using a computer software to support the preoperative planning of 40 patients proposed for breast reconstruction with a DIEP flap is evaluated for the first time. Blood vessel centreline extraction and local characterization algorithms are applied to identify perforators and compared with the manual mapping, aiming to reduce the time spent by the imaging team, as well as the inherent subjectivity to the task. Comparing with the measures taken during surgery, the software calibre estimates were worse for vessels smaller than 1.5 mm (P ¼ 6e-4) but better for the remaining ones (P ¼ 2e-3). Regarding vessel location, the vertical component of the software output was significantly different from the manual measure (P ¼ 0.02), nonetheless that was irrelevant during surgery as errors in the order of 2e3 mm do not have impact in the dissection step. Our trials support that a reduction of the time spent is achievable using the automatic tool (about 2 h/ case). The introduction of artificial intelligence in clinical practice intends to simplify the work of health professionals and to provide better outcomes to patients. This pilot study paves the way for a success story.
Breast cancer conservative treatment (BCCT) is a form of treatment commonly used for patients wit... more Breast cancer conservative treatment (BCCT) is a form of treatment commonly used for patients with early breast cancer. This procedure consists of removing the cancer and a small margin of surrounding tissue, while leaving the healthy tissue intact. In recent years, this procedure has become increasingly common due to identical survival rates and better cosmetic outcomes than other alternatives. Although significant research has been conducted on BCCT, there is no gold-standard for evaluating the aesthetic results of the treatment. Recent works have proposed the automatic classification of cosmetic results based on breast features extracted from digital photographs. The computation of most of these features requires the representation of the breast contour, which becomes key to the aesthetic evaluation of BCCT. State-of-the-art methods use conventional image processing tools that automatically detect breast contours based on the shortest path applied to the Sobel filter result in a ...
Introduction: Augmented Reality (AR) has demonstrated a potentially wide range of benefits and ed... more Introduction: Augmented Reality (AR) has demonstrated a potentially wide range of benefits and educational applications in the virtual health ecosystem. The concept of real-time data acquisition, machine learning aided processing, and visualization, is a foreseen ambition to leverage AR applications in the healthcare sector. This breakthrough with immersive technologies like AR, mixed reality (MR), virtual reality (VR), or extended reality (XR) will hopefully initiate a new surgical era: that of the use of the so-called surgical metaverse. Main text: This paper focuses on the future use of AR in breast surgery education describing two potential applications (surgical remote telementoring and impalpable breast cancer localization using AR), along with the technical needs to make it possible. Conclusion: Surgical telementoring and impalpable tumors non-invasive localization are two examples that can have success in the future provided the improvements in both data transformation and i...
naïve patients' samples. Acquired resistance towards Docetaxel, Paclitaxel and Vinorelbine was ob... more naïve patients' samples. Acquired resistance towards Docetaxel, Paclitaxel and Vinorelbine was observed in 78%, 72% and 66% of pretreated patients' samples. Conclusion: Our study demonstrates the feasibility of CRR profiling of C-TACs in therapy naïve and pretreated patients. Adoption of C-TAC-CRR profiling can non-invasively provide real time oversight towards treatment selection, monitoring of drug resistance and timely therapeutic course correction.
Background: As a result of neoadjuvant systemic therapy (NST) 1 out of 3 patients with pre-treatm... more Background: As a result of neoadjuvant systemic therapy (NST) 1 out of 3 patients with pre-treatment node positive (cN+) breast cancer achieves an axillary pathologic complete response (ax-pCR). This urges the need for a less invasive axillary staging procedure to replace the traditional axillary lymph node dissection (ALND). We report on our experience with combining removal of the pre-treatment marked positive lymph node (MN) and sentinel lymph node (SN)(s) for staging of the axilla after NST in cN+ patients; is it feasible? Materials and Methods: in 3 hospitals with specialized breast cancer care, pathologically proven cN+ patients who underwent removal of the MN and SN(s) after NST were retrospectively identified. The positive lymph node was primarily marked either by an iodine seed or a radiopaque clip (in the latter followed by wire placement after completion of NST). Patients that underwent a completion ALND (cALND) as well as patients that did not undergo cALND were included. Since in the latter patients axillary residual disease may potentially be missed, adjuvant radiotherapy was recommended, also in case of ax-pCR. Results: 90 cN+ patients were identified (46,7% Iodine seed, 53,3% clip). Breast cancer was HER2-positive in 37,5% and triple negative in 17,8%. In 89 patients, 1 to 7 MN + SN(s) (mean 2,6) were identified during surgery. A total of 41,1% achieved an ax-pCR (residual disease consisted of isolated tumor cells (5,7%), micrometastasis (18,9%), macrometastasis (75,4%)). Axillary residual disease was detected in 38,9% by SN(s) alone, in 47% by MN alone and in 58,4% when outcomes of MN and SN(s) were combined. 24 patients underwent a cALND (21% because of macrometastasis, 79% because of local practice/surgeons decision): 1 patient was upstaged from ax-pCR to micrometastasis and 1 patient from micrometastasis to macrometastasis. In 95% of all patients adjuvant radiotherapy was planned. Conclusion: removal of MN and SN(s) for axillary staging after NST in cN+ patients is feasible in the hands of specialized breast cancer care teams. The combined procedure shows improved detection of axillary residual disease compared to relying solely on the outcome of either MN or SN(s). Research is ongoing to determine accuracy and safety of the combined procedure in order to optimize axillary staging and subsequent therapeutic management after NST in pretreatment cN+ patients.
Breast cancer incidence has been steadily increasing manly in high income countries as is life ex... more Breast cancer incidence has been steadily increasing manly in high income countries as is life expectancy. The majority of newly diagnosed breast cancer cases will occur in post-menopausal women with an increasing in the older age group. As in younger women oncoplastic surgery and post mastectomy breast reconstruction should also be viable options, when needed, in older women. However, this is not the case in most centres and chronological age alone seems to be a barrier to these surgical alternatives. We evaluated the most relevant and recently published literature on the topic to analyse the available evidence in favour and against the use of oncoplastic breast surgery and post mastectomy breast reconstruction in this age group. Older women are not significantly represented in randomized clinical trials. There is minimal published evidence on oncoplastic breast surgery. Regarding post mastectomy breast reconstruction, although there are more publications, most studies are retrospective, present an evident selection bias and are very heterogeneous. Regarding oncoplastic surgery and post mastectomy breast reconstruction, there is no evidence that, compared to younger age groups, higher rates of complications should lead to the denial of these choices to older women, especially in the absence of associated comorbidities. Patient reported outcomes are not sufficiently explored in older women but, based on the limited available evidence, older women report higher rates of satisfaction when compared to younger women regarding oncoplastic surgery and post mastectomy breast reconstruction. Decisions in older women proposed for breast surgery and in need of oncoplastic breast surgery or post mastectomy breast reconstruction should always integrate, patients preference, a geriatric assessment and a life expectancy estimation. In case of unfavourable geriatric assessment and low estimation of life expectancy, a higher complication rate should be anticipated. It is not likely that randomized controlled trials will happen in this age group not only due to ethical concerns (as oncoplastic surgery and post mastectomy reconstruction are already standard of care in other age groups) but also to the difficulties in obtaining meaningful numbers. However, well designed prospective cohorts can be a valuable alternative to the scarce available retrospective evidence.
Stevens-Johnson Syndrome (SJS), Overlap Syndrome (OS) and Toxic Epidermal Necrosis (TEN) are rare... more Stevens-Johnson Syndrome (SJS), Overlap Syndrome (OS) and Toxic Epidermal Necrosis (TEN) are rare medical emergencies associated with a high morbidity and mortality. The literature on the characteristics of these diseases in Portugal is scarce. A retrospective study was conducted based on the clinical notes of the 20 patients admitted to São José Burn Unit in the previous 15 years with the diagnosis of SJS, OS or TEN. Most patients had TEN (65%), followed by OS (25%) and SJS (10%). Average age was 57,1 ± 19,0 years. The mean duration of stay in the Burn Unit was 12,6 ± 7,8 days. Mortality was 50%, being significantly higher than the 16,4% overall mortality in the general Burn Unit population in the same period (p < 0,01). The mean surface area involved was 43,9 ± 28,6 %. Allopurinol was the causal agent most frequently implicated (35%) followed by UV light exposure (15%). Fourteen patients (70%) were treated with steroids in the first days, whereas six patients were treated conse...
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Papers by Carlos Mavioso