Mammary fat necrosis following radiotherapy in the conservative management of localized breast cancer: Does it matter?
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA. Radiotherapy and Oncology
(Impact Factor: 4.36).
03/2010; 97(1):92-4. DOI: 10.1016/j.radonc.2010.02.021
Fat necrosis is a well-described and relatively common complication arising from post-lumpectomy irradiation of the breast, most commonly breast brachytherapy. We wish to assess the clinical significance of fat necrosis resulting from post-lumpectomy breast irradiation.
We reviewed the literature to determine the overall incidence and significance of fat necrosis to determine whether or not fat necrosis poses a significant clinical problem.
Fat necrosis occurs in up to one-quarter of patients following post-lumpectomy breast irradiation. Only rarely is invasive intervention required however, it does significantly degrade the quality of all modalities of breast imaging.
Fat necrosis is a common complication of radiotherapy which rarely requires therapeutic intervention. However, post-therapeutic clinical imaging such as mammography, ultrasound and magnetic resonance imaging are affected which may result in additional diagnostic procedures up to and including biopsy.
Available from: Gerald Weisser
- "Indeed, according to previous mammographic and ultrasound studies, we can assume that large wound cavities with fat necrosis will develop in most patients after IORT   . After conventional treatment (BCS with postoperative radiation), the incidence of fat necrosis is about 20% ; based on present knowledge, rates of 40%–60% have been reported after IORT  . However, changes that arise in the tumor bed after IORT have not been investigated by magnetic resonance mammography (MRM) to date. "
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ABSTRACT: The aim was to investigate changes in the tumor bed on magnetic resonance mammography (MRM) after intraoperative radiotherapy (IORT) and whether they would limit the diagnostic value of posttherapeutic MRM. We retrospectively investigated 36 patients undergoing MRM after IORT (median interval 2.8 years, range 0.4-7.1). Wound cavities with fat necrosis were common after IORT (81%). They were associated with persisting contrast enhancement, i.e., enhancement was mostly seen irrespective of the posttherapeutic interval. It normally presented as rim enhancement and did not cause any diagnostic uncertainty if viewed together with other tissue characteristics. We do not expect a limited diagnostic value of MRM after IORT.
Available from: Jung Dug Yang
- "Small fat necrosis less than 2 cm can be resolved using conservative management and massage as time passes; in addition, non-steroidal anti-inflammatory drugs can be helpful if constant pain occurs. Surgical excision may be needed in only 2% to 7% of cases . Improvement in symptoms using ultrasound-assisted liposuction occurs in more than 80% of cases, and complete resolution or reduction of sizes in large fat necroses has been reported recently [39,40]. "
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ABSTRACT: Oncoplastic surgery has revolutionized the field of breast conserving surgery (BCS). The final aims of this technique are to obtain an adequate resection margin that will reduce the rate of local recurrence while simultaneously improving cosmetic outcomes. To obtain successful results after oncoplastic surgery, it is imperative that patients be risk-stratified based on risk factors associated with positive margins, that relevant imaging studies be reviewed, and that the confirmation of negative margins be confirmed during the initial operation. Patients who had small- to moderate-sized breasts are the most likely to be dissatisfied with the cosmetic outcome of surgery, even if the defect is small; therefore, oncoplastic surgery in this population is warranted. Reconstruction of the remaining breast tissue is divided into volume displacement and volume replacement techniques. The use of the various oncoplastic surgeries is based on tumor location and excised breast volume. If the excised volume is less than 100 g, the tumor location is used to determine which technique should be used, with the most commonly used technique being volume displacement. However, if the excised volume is greater than 100 g, the volume replacement method is generally used, and in cases where more than 150 g is excised, the latissimus dorsi myocutaneous flap may be used to obtain a pleasing cosmetic result. The local recurrence rate after oncoplastic surgery was lower than that of conventional BCS, as oncoplastic surgery reduced the rate of positive resection margins by resecting a wider section of glandular tissue. If the surgeon understands the advantages and disadvantages of oncoplastic surgery, and the multidisciplinary breast team is able to successfully collaborate, then the success rate of BCS with partial breast reconstruction can be increased while also yielding a cosmetically appealing outcome.
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ABSTRACT: The most complicated step in decoding BCH codes is the algebraic
operation of converting the syndrome vector derived from a received data
vector into an error location polynomial over the finite field GF
(2<sup>m</sup>). The classic method uses Berlekamp's iterative
algorithm to fill rows of a table with various quantities including
partial polynomials until a maximum row is reached. Where this occurs
depends on the distance of the code. This process is tedious,
time-consuming, and is difficult to realize in hardware. The complete
closed solution to the algorithm for each t ⩽5 is presented
as a set of decision trees. The only computation required is the numeric
evaluation of one formula over GF (2<sup>m</sup>) at each level of the
tree as well as the evaluation of a formula for each coefficient in the
resulting polynomial. The closed solution is more easily realized in
hardware or software than the iterative algorithm, and it is shown by
simulation that the closed solution is considerably faster even though
some of the formulas are rather long. Also, the closed formulas can be
proven correct, where it is almost impossible to totally verify an
implementation of the iterative method
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