AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2690-1897/082
1 Consultant, Department of Surgical Oncology, Fortis Hospital, Mulund, Mumbai, India.
2 Registrar, Department of Surgical Oncology, Fortis Hospital, Mulund, Mumbai, India.
*Corresponding Author: Anil Heroor, Head of Department, Surgical Oncology, Fortis Hospital, Mulund, Mumbai, India
Citation: Yadhukrishnan T.P., Aysha Khan, Ziaul Rahman, Arul Vanan, Hitesh Singhavi, Anil Heroor (2021) Clinical Value of Size, quadrant, and Hormonal Status in Predicting Axillary Node Metastasis in Early Clinico-Radiologically Negative Indian Breast Cancer- A Hospital Based Prospective Observational Study. J, Surgical Case Reports and Images 4(8); DOI: 10.31579/2690-1897/082
Copyright: © 2021, Anil Heroor, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 27 May 2021 | Accepted: 10 August 2021 | Published: 23 October 2021
Keywords: sentinel node biopsy, breast cancer, axillary node metastasis, sentinel node metastasis
Background: Sentinel lymph node biopsy (SLNB) is standard of care in clinico- radiologically negative axilla in early breast cancer case. It’s an oncologically safe alternative to Axillary lymph node dissection (ALND), however factors predicting sentinel node metastasis in Indian population is lacking.
Methods: A prospective observational study which recruited 80 patients with breast cancer who underwent SLNB with or without ALND, with evaluation of predictive factors including size, type and quadrant , hormonal status of breast this characteristics were prospectively analyzed to predict the axillary metastasis and need of SLNB .
Result: Mean age of the patients included in our study was 52.4 years. On univariate analysis, size (p<0.013), upper outer quadrant (UOQ) (p<0.038), central quadrant (CQ) (0.07) were significantly associated with axillary node metastasis in T2 tumors. While on multivariate analysis, UOQ (P<0.009), CQ (p<0.02) metastasis were associated with axillary node metastasis in T2 tumors. Overall sensitivity, specificity, positive predictive valve (PPV) and negative predictive valve (NPV) of SLNB in predicting axillary node status was 77.59%, 100%, 100% and 62.86% respectively. The overall accuracy was 83.7%.
Conclusion: Upper outer quadrant, central quadrant and size of the tumors are important prognostic factors to predict axillary node metastasis without the need of sentinel node biopsy in early breast cancers.
Sentinel lymph node (SLNB) mapping and dissection is a sensitive and accurate technique for nodal evaluation and has been applied to staging of axillary lymph nodes in patients with breast cancer [1]. It has prognostic value, least invasive and less surgical morbidity than with axillary lymph node dissection (ALND), it’s also important prognostic indicator of overall survival in patients with breast cancer. However, SNB has its own limitation. Its false negative rate is 5 percent according to Amersi et al, there is increase the risk of recurrence and its controversial in pregnancy, vital blue dye is contraindicated in pregnant patients, or use of radioactive colloid alone to map this subgroup of patients [2].Similarly other relative disadvantages of SNB includes its implication of finding micro metastases in the sentinel nodes, and its effectiveness after neo adjuvant therapy, and in staging of axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery. The British journal on cancer, published a study which show the model estimated that SLNB results in 1.1 more axillary recurrences per 1000 patients at 5 years, and 1.9 more axillary recurrences per 1000 patients at 20 years than ALND [3, 4].
We need to find out usefulness of SLNB in a patient with high risk of axillary metastasis. Patients at high risk for nodal involvement based on clinical characteristics may remain at unacceptably higher incidence of axillary disease. There are many studies around the globe regarding the controversies of axillary lymph node dissection and sentinel lymph node biopsy However data of Indian population with respect to site (quadrant) of breast cancer influencing axillary metastasis and axillary dissection without sentinel lymph node biopsy in early breast cancer is scarce.
In those specific high risk cases of early stage, usefulness of SNB may be questionable. Therefore, we decided to study those specific cases in which axillary node dissection can be performed in resource constrain settings. We also aimed to find out site and size-specific incidence of ALNM depending on the quadrant of the breast involved.
This is a prospective observational study done in our tertiary care center from January 2019 – January 2020. Early stage, clinic-radiological negative patients with Fine needle aspiration cytology or true cut biopsy positive patients were included in the study. Patient receiving any definitive prior treatment were excluded. All patients underwent surgery as a definitive treatment. They underwent breast conservative therapy or modified radical mastectomy with sentinel node biopsy followed by Axillary node dissection. A pretested proform was used to collect relevant information (patient data, detailed history, clinical examination, FNAC/Trucut biopsy, USG breast and axilla, mammography and chest x-ray, lab investigations, etc.) from all selected patient was assessed. All patient underwent required preoperative investigations, informed consent from all participating patients and after ensuring fitness for surgery, these patients were taken for SLNB along with wide local excision with axillary clearance or modified radical mastectomy. Methylene blue dye was injected in sub areolar region 2 minutes prior to surgery. Intra operatively, sentinel lymph node was searched after raising superior flap. Axillary node dissection was done to detect stained node. All blue nodes and any node receiving a blue lymphatic channel was considered as sentinel nodes. After excising the stained lymph nodes, nodes were sent for frozen section examination and complete axillary clearance was done. In node positive, removal of breast tissue was done. Further histopathological examination and pathological data including histopathological type, size of the tumor, ER/PR status, HeR2Neu status, and lymph node status in sentinel and non-sentinel lymph nodes was collected. SLNs were routinely examined by serial sectioning with two sections of 200 microns each were stained, one with routine hematoxylin and eosin (H&E) and one by IHC using cytokeratin. Lymph nodes were examined by H&E staining. Negative lymph node was additionally stained with IHC.
Demographic, histopathological data was categorically. To analyze the effect of presence of breast cancer (site), size, ER, PR and HER’s-2 status on the presence of ALNM and SNLM. Univariate analysis was done using chi-square test. Multivariate analysis was performed using logistic regression analysis for those factors which were significant on Univariate analysis. Odds ratios and p-values were calculated with 95% confidence intervals (CI). All p-values less than 0.05 were used for statistical significance. Statistical analyses for evaluating sensitivity, specificity, accuracy, and positive and negative predictive values of SLNB were performed in comparison to ALND. False-negative sentinel lymph nodes localization was defined as negative sentinel lymph nodes with other nodes in the basin positive for metastatic breast cancer. Sensitivity was calculated by the number of patients in whom the histological characteristics of the sentinel lymph nodes reflected the histological characteristics of the rest of the nodes in the basin. All analyses were performed using SPSS software version 20.0 (IBM Corp., Armonk, NY, USA).
The study included 80 cases of early breast cancer, of which 44 (55 %) showed axillary metastasis. Mean age of the patient at the time of surgery was 52.84 years which ranged from 30-70 years. 32 patients were below 50 years of age. The tumor size was T2 (2–5 cm) in 65 patients and T1 (<2>
39 patients (48.75%) had grade II tumors which were the most common. ER was positive in 54 patients while PR was positive in 42 patients. On ER and PR immunohistochemistry, it was not significantly associated with low risk of ALNM (p < 0.002 Table 2). Quadrant- wise location of breast cancer is presented in Table 1. To identify the clinical traits affecting SNLM, Univariate analysis was performed on all candidate predictors. The results showed that T2 has higher significance on SLNM (p<0>Table 2). Features statistically significant in the Univariate logistic regression model were included in the multivariable logistic regression model. The results showed that size, UO and central quadrant were independent risk factors of SLNM. (P<0>
UOQ= Upper outer quadrant
UIQ= Upper outer quadrant
LO=Lower outer
LI=Lower inner
CQ=Central quadrant
T1 = tumor less than or equal to 2 cm
T2=size 2cm-5cm
ER=Estrogen receptor
PR=Progesterone receptor
Her 2 neu=Human epidermal receptor
To identify the clinical traits affecting ALNM, Univariate logistic regression was performed on all clinical factors influencing ALNM. The results showed that T2 (P < 0 value =0.015), value =0.08),>Table 2). Features statistically significant in the univariate analysis model were included in the multivariable logistic regression model. The results showed that size, UOQ, and CQ were independent risk factors of ALNM. (p<0>
The presence of axillary disease is the most important prognostic factor in breast cancer. Axillary metastasis indicates biological aggressiveness and extent of tumor involvement, often with systemic spread [18]. SNB has replaced axillary lymph node dissection (ALND) in clinically node negative axilla. Multiple randomized trials have demonstrated that when the SLN is tumor-free, observation alone confers similar regional control and survival compared to SNB followed by ALND [5-8] .Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ, and planned for mastectomy, with previous breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB, however SNB is thought to be safer before chemotherapy due to its systemic therapy induced lymphatic changes. Also,SNB for patients with ductal carcinoma in situ (DCIS) is controversial. While women with large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or are pregnant should not undergo SNLB [9]. In NSABP-B32, pathologically negative SLNs, 99.9% on follow-up at 95.6 months, there was no statistically significant difference between the SNB plus ALND group and the SNB-only group with respect to regional recurrence (RR) , 8-year overall survival (OS) and 8-year disease-free survival (DFS) [10] Gary H et al suggested that SNB is associated with less morbidity than ALND, but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown [11]. Meanwhile, high-frequency ultrasonography, the first-line imaging modality in breast cancer diagnosis, can show the rich morphological features of breast tumor, associated with ALNM. [13-20]. Previous studies have shown that clinico-pathological features such as size, age at diagnosis, palpable mass or not, body mass index (BMI) and hormone receptors are related to ALNM [21-22]. However, in our study, we aimed to compare the incidence of SLNM and ALNM based on the quadrant of breast and size of tumor in breast cancer. We found that different quadrant of breast involvement had differential incidence of SLNM and ALNM.In our study Upper outer quadrant had significantly higher incidence of breast cancer. We also found that incidence of SLNM and ALNM was significantly higher for this specific quadrant. It was interesting to note that there was no significant difference between the SLNM and ALNM. Thus, axillary node can be addressed in the patient having disease in the outer upper quadrant without the need of sentinel node biopsy especially in low resource settings. Another study led by Franco et al has shown that USG guided FNAC can be an effective alternative to SLNB with frozen section of nodes [23]. It concluded that USG guided FNAC had better specificity, cost reduction and reduction in false positive results. Lee et al in 2002 published a study stated that tumor size and Lymphovascular invasion LVI were the only variables independently predictive of positive SLNB results [22].
In our study, we found that T2 breast lesion had significantly higher number of SNM and ALNM.Similar results were concluded in the study led by Jong Hong Lee et al. [12]. Thus according to our study, quadrant of breast and size of tumor can be consider as a clinically valuable marker for axillary metastasis and reducing the use of SLNB. This can not only help us in cost reduction avoiding the use of radioactive tracer but also in reducing intraoperative timing and need for second surgery. This algorithm will help us in reducing the false negative cases improving overall survival without compromising oncological safety. Indian study led by Nandu [23] showed the Sensitivity of SLNB is 90.48%, specificity is 85.71%, PPV of is 90.48%, NPV is 85.71%, and accuracy is 88.57% comparable to our sensitivity, specificity, PPV, NPV and accuracy of 77.59%, 100%,100%, 62.86% ,83.7% respectively.
Limitation: Lymphovascular invasion, perineural invasion were not taken into consideration for SLNM and ALNM as our study limited to clinical factors influencing the metastasis. Our study is first of its kind Indian study to state the importance of site of early breast cancer in influencing SLNM and ALNM.
Upper outer quadrant, central quadrant and size of the tumors are important prognostic factors to predict axillary node metastasis without the need of sentinel node biopsy in early breast cancers.
None.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
