Publications by authors named "Dar Ren Chen"

Background: The aims of this cohort study were to identify (1) the incidence and risk factors for axillary web syndrome (AWS) with shoulder movement limitation within 4 weeks after axillary lymph node dissection (ALND) for Asian women with breast cancer (BC), and (2) whether early intervention with physical therapy (PT) could improve AWS, and how many PT sessions would be needed.

Methods: A cohort study of patients with BC receiving ALND was performed at Changhua Christian Hospital, Taiwan, between January 2019 and December 2020. Those patients who were diagnosed with AWS with shoulder movement limitation were referred to receive PT twice weekly at the Department of Physical Medicine and Rehabilitation.

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  • Endoscopic-assisted breast surgery (EABS) offers better cosmetic results for breast cancer patients, but traditional axillary lymph node dissection (ALND) requires larger incisions and more retraction.
  • The proposed single-port three-dimensional endoscopic-assisted ALND (S-P 3D E-ALND) uses a minimally invasive technique with high success rates and improved visualization, analyzed from a study of 11 patients.
  • Preliminary results show 100% success without open surgery conversion, short operative times, minimal blood loss, and no significant complications over a median follow-up of 7 months, suggesting that S-P 3D E-ALND is a viable alternative for ALND.
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Purpose: This prospective study aimed to investigate estrogen-induced carcinogenesis by assessing the background levels of abasic sites (apurinic/apyrimidinic sites, AP sites) in Taiwanese breast cancer patients following 5 years of postoperative treatment without recurrence (5-year survivors) (n = 70). The study also sought to compare the extent of these DNA lesions with those found in healthy controls and in breast cancer patients prior to treatment.

Methods: Abasic sites were measured using an aldehyde reactive probe and quantified as the total number of abasic sites per total nucleotides.

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  • The ALKBH dioxygenase superfamily is important for gene regulation and its role in cancer, particularly under hypoxic conditions, is being analyzed; specifically, the function of ALKBH4 is under investigation.
  • Experimental methods include real-time PCR, Western blot analysis, and various assays to assess tumor characteristics and behavior in vitro and in vivo.
  • Results show that ALKBH4 may act as a tumor suppressor, with higher levels linked to better patient outcomes in certain cancers, suggesting its potential as a therapeutic target for tumors affected by hypoxia.
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  • * Results revealed that HO induces primarily 5'- and 3'-nicked AP sites, whereas MMS creates mainly non-excisable, residual, and intact AP sites in the DNA samples analyzed.
  • * Comparisons showed that AP site patterns in breast cancer patients before treatment were linked to DNA damage from reactive oxygen species, and 5-year survivors displayed similar site characteristics to healthy controls, indicating potential DNA repair deficiencies in the cancer patients.
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  • Study Overview
  • : This research is a phase II randomized trial comparing the effectiveness and safety of pegylated liposomal doxorubicin (PLD) versus epirubicin as adjuvant chemotherapy for stage I-II HER2-negative breast cancer.
  • Methods and Results
  • : A total of 256 patients were divided into two groups, with results showing no significant difference in 5-year disease-free survival (DFS) and overall survival (OS) rates between PLD and epirubicin. However, the PLD group experienced less severe side effects and improved quality of life (QoL) during treatment.
  • Conclusion
  • : Both treatment regimens showed comparable efficacy and safety, but the
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Background: The assessment information of tumor margins is extremely important for the success of the breast cancer surgery and whether the patient undergoes a second operation. However, conducting surgical margin assessments is a time-consuming task that requires pathology-related skills and equipment, and often cannot be provided in a timely manner. To address this challenge, digital breast tomosynthesis technology was utilized to generate detailed cross-sectional images of the breast tissue and integrate deep learning algorithms for image segmentation, achieving an assessment of tumor margins during surgery.

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  • The study introduces a new "scarless" technique for implanting Totally Implantable Venous Access Ports (TIVAP) in breast cancer patients, aimed at preserving cosmetic results after surgery.
  • A total of 125 patients underwent the procedure with a 100% success rate, a mean operation time of 46 minutes, and low blood loss, while also showing a significant decrease in operation time after the initial learning phase.
  • Patient feedback indicated over 90% satisfaction with aesthetic outcomes and the overall surgical experience, suggesting that the scarless technique is a safe and effective alternative for those needing chemotherapy with minimal scarring.
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  • A study was conducted to evaluate the effectiveness and safety of minimal-access nipple-sparing mastectomy (MA-NSM) in patients with large breasts, as previously it was mostly applied to those with small to medium-sized breasts.
  • This retrospective analysis included data from 728 patients between 2011 and 2022, comparing outcomes of conventional nipple-sparing mastectomy (C-NSM) with MA-NSM, focusing on complications and blood loss based on breast size.
  • Results showed that MA-NSM was successful in large breasts, with less blood loss and lower rates of severe complications compared to C-NSM, indicating that MA-NSM is a viable option for this patient demographic.
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  • Sentinel lymph node biopsy (SLNB) is the standard procedure for assessing axillary metastasis in early-stage breast cancer patients with up to 2 positive nodes; this study evaluates the effectiveness of 18F-FDG PET/CT and breast MRI in detecting these metastases.
  • The study involved 275 patients, analyzing the sensitivity, specificity, and predictive values of PET/CT and MRI; results showed that combined imaging methods significantly improved the ability to predict axillary lymph node burden compared to each method alone.
  • Both PET/CT and MRI demonstrated valuable predictive capabilities for low-burden axillary metastasis, with the highest predictive correctness achieved when both imaging techniques were used together, indicating a strong reliability
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  • * Over four years, 145 patients underwent this procedure, primarily involving nipple-sparing mastectomies and some breast-conserving surgeries, with differing operative times and minimal blood loss reported.
  • * While the procedure showed some complications, the majority of patients reported satisfactory cosmetic results, indicating a promising approach for breast surgery.
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Background: Breast fibroadenoma is the most common benign breast tumour. This study aimed to investigate the advantages and disadvantages of endoscopic-assisted resection via a gas-less transaxillary single-port approach for breast fibroadenoma in adolescent patients, compared with a traditional approach.

Methods: The clinical data of 83 patients with breast fibroadenoma treated in our hospital from October 2019 to October 2021 were collected for retrospective analysis.

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  • The study investigates how effective MRI is in evaluating axillary lymph node (ALN) metastasis in breast cancer patients, particularly across different intrinsic tumor subtypes.
  • Analysis included data from 2,473 patients and found that MRI's ability to detect ALN metastasis significantly differed among subtypes, with tumor size and histologic type being key predictive factors.
  • The research suggests that using MRI along with clinicopathologic factors can enhance the prediction of ALN metastasis risk, identifying low-risk groups that might benefit from less aggressive treatment.
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  • The study evaluated nipple and skin sensation after nipple-sparing mastectomy (NSM) to identify factors influencing these sensations.
  • A total of 460 patients were analyzed, with a mean age of 48.3, highlighting various surgical methods used (conventional, endoscopic, robotic) and their impact on sensation outcomes.
  • Results indicated that longer postoperative follow-up significantly improved nipple and skin sensations, particularly with specific incision types showing better outcomes.
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  • The study addressed the potential risks of residual breast tissue (RBT) after robotic-assisted nipple-sparing mastectomy (R-NSM) in breast cancer patients.
  • MRI scans were used on 105 patients to evaluate RBT presence and location, with 43 patients' scans analyzed post-surgery.
  • RBT was found in 13% of mastectomies, mainly behind the nipple-areolar complex, but overall, R-NSM did not significantly increase RBT prevalence, and MRI proved effective for its evaluation.
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  • The study compares outcomes of minimal access nipple-sparing mastectomy (R-NSM, E-NSM) to conventional nipple-sparing mastectomy (C-NSM) in terms of clinical results, patient satisfaction, and costs.
  • Both R-NSM and E-NSM showed better wound healing and patient-reported satisfaction with scars, although R-NSM incurred higher medical costs compared to the other two methods.
  • All three procedures demonstrated comparable safety concerning complications and oncological outcomes, indicating minimal access approaches are safe alternatives to conventional surgery.
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  • Breast reconstruction after mastectomy can significantly enhance the quality of life for breast cancer patients and is often performed by a dual-trained oncoplastic reconstructive breast surgeon (ORBS) alongside breast surgeons.
  • The study reviewed 542 patients treated with reconstruction by an ORBS, revealing high satisfaction rates (95%) and low implant loss (1.2%), indicating successful outcomes and improved skills over time.
  • Factors influencing the likelihood of undergoing reconstruction included younger age, the use of MRI, nipple-sparing mastectomy, and experiences with high-volume surgeons.
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Introduction: Using mammographic density as a significant biomarker for predicting prognosis in adjuvant hormone therapy patients is controversial due to the conflicting results of recent studies. This study aimed to evaluate hormone therapy-induced mammographic density reduction and its association with prognosis in Taiwanese patients

Methods: In this retrospective study, 1941 patients with breast cancer were screened, and 399 patients with estrogen receptorpositive breast cancer who received adjuvant hormone therapy were enrolled. The mammographic density was measured using a fully automatic estimation procedure based on full-field digital mammography.

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Background: The purpose of this study is to identify clinicopathologic factors and/or preoperative MRI vascular patterns in the prediction of ischemia necrosis of the nipple-areola complex (NAC) or skin flap post nipple-sparing mastectomy (NSM).

Methods: We performed a retrospective analysis of 441 NSM procedures from January 2011 to September 2021 from the breast cancer database at our institution. The ischemia necrosis of NAC or skin flap was evaluated in correlation with clinicopathologic factors and types of skin incision.

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Triple-negative breast cancer (TNBC) accounts for 15-20% of all breast cancer. TNBC does not express the estrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2. Cytotoxic chemotherapy and surgery are the current therapeutic strategies for TNBC patients, but the chemoresistance of TNBC limits the efficiency of this strategy and shortens the lifespan of patients.

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In this study, an advanced semantic segmentation method and deep convolutional neural network was applied to identify the Breast Imaging Reporting and Data System (BI-RADS) lexicon for breast ultrasound images, thereby facilitating image interpretation and diagnosis by providing radiologists an objective second opinion. A total of 684 images (380 benign and 308 malignant tumours) from 343 patients (190 benign and 153 malignant breast tumour patients) were analysed in this study. Six malignancy-related standardised BI-RADS features were selected after analysis.

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Aims: The aim of this study was to simultaneously analyze estrogen quinone-derived adducts, including 17β-estradiol-2,3-quinone (E-2,3-Q) and 17β-estradiol-3,4-quinone (E-3,4-Q), in human albumin (Alb) and hemoglobin (Hb) derived from breast cancer patients with five-year postoperative treatment without recurrence in Taiwan and to evaluate the treatment-related effects on the production of these adducts.

Settings And Design: Cohort Blood samples derived from breast cancer 5-year survivors without recurrence were collected. Albumin and hemoglobin adducts of E-3,4-Q and E-2,3-Q were analyzed to evaluate the degree of disposition of estrogen to quinones and to compare these adduct levels with those in patients before treatment.

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Background: We hypothesized that different BMI might have different impact on pre-operative MRI axillary lymph node (ALN) prediction accuracy and thereby subsequent surgical lymph node management. The aim of this study is to evaluate the effect of BMI on presentation, surgical treatment, and MRI performance characteristics of breast cancer with the main focus on ALN metastasis evaluation.

Methods: The medical records of patients with primary invasive breast cancer who had pre-operative breast MRI and underwent surgical resection were retrospectively reviewed.

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Cilostazol is an antiplatelet agent with vasodilating, endothelial function restoration, and anti-inflammatory effects. This study aims to investigate the efficacy of oral cilostazol for preventing the development of diabetic peripheral neuropathy (DPN). Ninety adult male Sprague-Dawley rats were divided into five groups: 1) naïve (control); 2) diabetic (DM); 3) DM receiving 10 mg/kg cilostazol (cilo-10); 4) DM receiving 30 mg/kg cilostazol (cilo-30); and 5) DM receiving 100 mg/kg cilostazol (cilo-100).

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In this study, we applied semantic segmentation using a fully convolutional deep learning network to identify characteristics of the Breast Imaging Reporting and Data System (BI-RADS) lexicon from breast ultrasound images to facilitate clinical malignancy tumor classification. Among 378 images (204 benign and 174 malignant images) from 189 patients (102 benign breast tumor patients and 87 malignant patients), we identified seven malignant characteristics related to the BI-RADS lexicon in breast ultrasound. The mean accuracy and mean IU of the semantic segmentation were 32.

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