Introduction: Encapsulated papillary carcinoma (EPC)of the breast is a rare type of breast cancer with excellent prognosis. It is usually considered a variant of ductal carcinoma in situ (DCIS). However, no consensus on EPC treatment and management has been achieved. We provide some data from our clinical centers to help better manage this disease.Methods: We performed a retrospective analysis of patients diagnosed with EPC from March 2015 to December 2019 at The First Affiliated Hospital of Anhui Medical University. Demographic information, tumor details, immunohistochemical markers, clinical data, stage of the disease, treatment modalities, and oncological outcomes were collected.Results: Eleven cases were included in this retrospective study: three cases had pure EPC, six cases had EPC associated with DCIS, and two cases had EPC associated with invasive cancer. Among the patients, two had lymph node metastases. The mean age of female patients at diagnosis was 53.6 years. The one male patient was 48 years old. The mean tumor size was 2.4 cm. Myoepithelial cell layers were completely absent in all cases. Ten patients were estrogen receptor and progesterone receptor positive and human epidermal growth factor receptor-2 negative. Nine patients underwent mastectomy, and two underwent breast-conserving surgery.Conclusion: Adequate local therapy results in excellent prognosis. Radiation therapy should be offered to patients with EPC who undergo breast-conserving surgery. Immunohistochemistry is necessary in diagnosing EPC and excluding other papillary lesions. Excisional biopsy should be performed to achieve comprehensive diagnosis. Sentinel lymph node biopsy is recommended for patients with EPC.
BackgroundAI-based clinical decision support system (CDSS) has important prospects in overcoming the current informational challenges that cancer diseases faced, promoting the homogeneous development of standardized treatment among different geographical regions, and reforming the medical model. However, there are still a lack of relevant indicators to comprehensively assess its decision-making quality and clinical impact, which greatly limits the development of its clinical research and clinical application. This study aims to develop and application an assessment system that can comprehensively assess the decision-making quality and clinical impacts of physicians and CDSS.MethodsEnrolled adjuvant treatment decision stage early breast cancer cases were randomly assigned to different decision-making physician panels (each panel consisted of three different seniority physicians in different grades hospitals), each physician made an independent “Initial Decision” and then reviewed the CDSS report online and made a “Final Decision”. In addition, the CDSS and guideline expert groups independently review all cases and generate “CDSS Recommendations” and “Guideline Recommendations” respectively. Based on the design framework, a multi-level multi-indicator system including “Decision Concordance”, “Calibrated Concordance”, “ Decision Concordance with High-level Physician”, “Consensus Rate”, “Decision Stability”, “Guideline Conformity”, and “Calibrated Conformity” were constructed.Results531 cases containing 2124 decision points were enrolled; 27 different seniority physicians from 10 different grades hospitals have generated 6372 decision opinions before and after referring to the “CDSS Recommendations” report respectively. Overall, the calibrated decision concordance was significantly higher for CDSS and provincial-senior physicians (80.9%) than other physicians. At the same time, CDSS has a higher “ decision concordance with high-level physician” (76.3%-91.5%) than all physicians. The CDSS had significantly higher guideline conformity than all decision-making physicians and less internal variation, with an overall guideline conformity variance of 17.5% (97.5% vs. 80.0%), a standard deviation variance of 6.6% (1.3% vs. 7.9%), and a mean difference variance of 7.8% (1.5% vs. 9.3%). In addition, provincial-middle seniority physicians had the highest decision stability (54.5%). The overall consensus rate among physicians was 64.2%.ConclusionsThere are significant internal variation in the standardization treatment level of different seniority physicians in different geographical regions in the adjuvant treatment of early breast cancer. CDSS has a higher standardization treatment level than all physicians and has the potential to provide immediate decision support to physicians and have a positive impact on standardizing physicians’ treatment behaviors.
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