AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Aliya Ishaq, Specialist general surgery Dubai hospital UAE.
Citation: A Ishaq, R soomro, N Lodhi, Muhammad S Khan, A Parveen, et al. (2021) Phyllodes Tumor of Breast:A 17 Years Audit of 260 Patients with Biopsy Proven Phyloldes Tumor Treated in our Institute. Journal of Clinical and Laboratory Research. 3(1); DOI:10.31579/2768-0487/028
Copyright: ©2021 Aliya Ishaq. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 27 May 2021 | Accepted: 08 June 2021 | Published: 11 June 2021
Keywords: phyllodes; breast neoplasms; benign; malignant
Phyllodes are rare breast neoplasms with higher rate of local and systemic recurrence. This study presents the results of an audit of all cases of biopsy proven phyllodes tumor presenting to breast services in Liquat National University Hospital Karachi, Pakistan, from 1993 to 2010. Total 260 female patients were retrospectively audited, 151 had benign, 35 borderline and 74 had malignant histology. Mean follow up duration for all types was 2 years. The mean age for benign lesions was 28, for borderline 36.8 and for malignant lesions 41 years. For all histopathological types the mean tumor size was 6.2 cm. It was 5.4 cm for benign, 7.8 cm for borderline and 11.2 cm for malignant lesions. 200/260 (76.9%) patients had breast conservation while 60/260 (23.0%) had mastectomy.
Histopathology type and grade has statistically significant relationship with recurrence ( p value .0001 % ) Overall recurrence rate was 20/260 (7.69%) with one patient with malignant phyllodes having recurrence 6 times despite clear margins and two patients with borderline phyllodes having recurrence twice . Tumor recurred in 2/151(1.3% ) of benign , 5.7% borderline ( 2/35 ) and 21.6% malignant ( 16/74 ) cases .Malignant group had 8 (10.8% ) systemic and 12 (16.2%)local recurrences. All patients with local recurrence and involved margins had reexcision except for 2 who had mastectomy with muscles involved posteriorly during the first surgery where re-excision was not possible. mortality rate for malignant phyllodes was 5.4 % ( 4/74 deaths as a result of systemic recurrence )
Conclusion: Phyllodes tumor is an aggressive disease, in our series, grade and type of tumor on histopathology is the significant risk factor for local and systemic recurrence with rate reaching up 21.6% for local and 10.8% for systemic recurrence in malignant lesions.
Phyllodes are uncommon neoplasms constituting less than 1 (0.3 to 0.9) percent of breast tumors [1, 2, 3, 4]. Histopathologically they are classified as benign, border line and malignant [5, 6].They are clinically, radiologically and pathologically very similar to fibroadenomas, causing diagnostic difficulties with a low pre-operative diagnostic rate [7, 1].Phyllodes have both epithelial and stromal component and it is the stromal component that has the metastatic potential. They have very high rate of local recurrence and approximately 15% tumors recur locally [8]. Factors contributing to local recurrence are positive resection margins within 1 cm, increased mitotic index, tumor necrosis, larger tumor size, stromal overgrowth, cellularity and atypia[9].Positive resection margin is one of the most important factor for recurrence.Treatment strateges are diverse,controversial and no consensus guidelines are available [10, 11].Review of literature shows small reterspective series without long term follow up[12, 13].
Genetic mutations in the chromosomal regions of +1q, +5p, +7, +8, −9p, −10p, −6, and −13 correlated with borderline and malignant phyllodes tumors of the breast [14]. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely [15].
There is paucity of large series in literature for phyllodes tumor because of rarity of this entity and absence of long term follow ups specially for third world countries. This retrospective study have tried to answer the same questions regarding management strategies,factors associated with recurrence,role of radiotherapy and the safest minimal margin of resection but will be among one of the largest single institutional studies on phyllodes over a period of 17 years with long term follow ups of up to 15 years.
To review different management strateges of all types of phyllodes tumors,factors associated with recurrence of these tumors and to find out the safest minimm margin of resection and role of radiotherapy in preventing recurrence.
Study Design: reterospective study.
Study Place: Breast Clinic Liaquat National Hospital and medical college Karachi, Pakistan.
Duration of study: 1993 – 2010 (17 years).
Data Collection: All data was retrived and reviewed from breast clinic files patients who did not have follow up were contected via phone and OPD.
Data Analysis: All enteries were done on designated spread sheats and SPSS version 19 was used or statistical analysise .Variables including age,histopathological typ,size of tumor,type of surgery,margin of clearance including minimum and maximum margin,use of radiotherapy,follow up duration,local and systemic recurrence,time to recurrence,treatment of recurrence and mortality were analysed .Sub group analysis was done and Chi-square test was used to show statistical significance with a p-value of < 0.001 where applicable.
Inclusion Criteria:
Exclusion Criteria:
There were 260 female patients diagnosed with phyllodes tumor during the 17-year study period (1993-2010). There were 151 histologically benign lesions, 35 borderline lesions and 74 malignant lesions.
Mean follow up duration for all types was 41.3 months ± 36.37 (range 5-180 months) The mean follow-up period for benign lesions was 31.9 months (range 5-132months), for border line 36.9 months (range 5-146 months) and for malignant lesions it was 62.5 months (range 8-180 months).Over all for all three types the mean age at the time of diagnosis was 32 years (range 12-85 years). The mean ages of patients with histologically benign lesions was 28.02 years±0.98, for borderline 36.8 years ±1.9 and for malignant lesions 41 years ±1.7 .All patients presented with a palpable breast lump. There is no statistically significant co-relation between age and histopathological type (p value 0.32).
Tumor Size:
Over all for all histopathological types the mean tumor size was 6.278 cm ± 4.14 ( range 1-21 cm ).The mean tumor size for benign lesion was 5.48 cm (range 1-20 cm), for border line 7.83 cm (rang 1-21 cm ) and for malignant phyllodes it was 11.2 cm (rang 2-30 cm ). The mean size of malignant lesions was larger (11.2 cm) than benign and borderline lesions (5.8cm and 7.83 cm, respectively) and there is statistically significant co-relation between size and type of tumor (p value 0.000), the more malignant the tumor type the larger is tumor size. No statistically significant relationship between size of tumor and recurrence is noted in our study (p value .265).
Type of Surgery:
Breast conservation (BCS) was done in 200/260 (76.9%) patients while 60/260 (23.0%) were treated with mastectomy. BCS was done in 144 (95.36%) cases of benign, 32 (91.4%) cases of bordline and 24 (32.4%) cases of malignant lesions. Mastectomy was done in 7 cases (4.63%) of benign, 3 (8.82%) cases of border line and 50 (67.56%) cases of malignant phyllodes as shown in graph below,
Recurrence:
Recurrences were noted in the present study in20/260 (7.69%) cases in 14 patients with one patient with malignant phyllodes having recurrence 6 times and two patients with intermediate phyllodes having recurrence twice once from IM to malignant and second time from malignant to malignant. Tumor recurred in 2/151(1.3% ) of benign , 5.7% borderline ( 2/35 ) and 21.6% malignant ( 16/74 ) cases in 11 patients.
Histopathology type has statistically significant relationship with recurrence (p value .0001 %), the more aggressive the histopathology type the more are the chances of recurrence. There were two patients in benign group who had local recurrence and the histopathology of recurrence for one patient was benign and for second it was intermediate. Two patients with intermediate phyllodes had recurrence and the histopathology of recurrence for both of them was malignant later on both these patients had local recurrence again as malignant phyllodes and then systemic recurrence and subsequently expired.
There was no systemic recurrence in benign and border line phyllodes tumors. Patients with malignant phyllodes had both systemic and local recurrences. For malignant phyllodes the over all rate of recurrence including both local and systemic recurrence was 16/74 (21.6%) in 11 patients. While the number of only systemic recurrences was 8 (10.8%) and number of local recurrences was 12 (16.2 %%).There were 4 patients who had both systemic as well as local recurrence.
The time to recurrence ranged from 15 days -72 months with mean time of 9.8 months ±17.46, the mean time of recurrence for individual histopathology type is 7.5 months for benign, 9 months for border line and 4.9 months for malignant lesions. All patients with recurrence were advised for WLE 0r mastectomy except for 2 patients who were advised only for radiotherapy as they already had mastectomy with excision of involved chest wall muscles and had positive margins and re-excision was not possible both of these patients expired.Out of remaining 12 patients 5 had wide local excision along with radiotherapy (41.6%) all of these 5 patients are alive without subsequent recurrence, 4 patients (33.3%) had mastectomy with radiotherapy and all these 4 patients died of systemic recurrence,one (8.3%) patient had only mastectomy without radiotherapy as tumor size was small and margins were clear ,this patient is alive with out further evidence of recurrence.One patient did not take any treatment and died of synstemic recurrence. Relationship between histipathology type and patient out come is shown below.
Out comes of surgical management.
Over all for all three types the mean margin of resection was 6.84 mm ± 4.3, while the minimum margin of resection was less than 1mm and maximum resection margin was 15 mm. 47 out of 260 18.0% patients had minimal margin of clearance of less than 1 mm. Of these 18% patients 27 (10.3%) had benign pathology, 8 (3.0%) had intermediate pathology and 12 (4.6%) had malignant lesions. When data was further analyzed for sub types it was found that number of patients in benign group who had minimum margin of clearance of less than 1 mm was 27/151 ( 17.8%),for intermediate type the figure was 08/35 ( 22.8%) and for malignant tumors it was 12/74 ( 16.2%).All these patients with minimum margin of clearance of less than 1 mm were advised re-excision except for 5 patients who were advised only radiotherapy ( out of these 5 patients 2 had mastectomy as initial surgery and posterior margin which included muscles of chest wall was positive so re –excision was not possible and only radiotherapy was advised rest of three patients had BCS ,they had maximum margin more than 1 cm at 3 or more sites and size of tumor was small so only radiotherapy was advised ).In benign subtype 27 patients with minimum margin less than 1 mm were advised re-excision but only 1 patient underwent re-excision (3.7%) rest did not under go re-excision and none of them had recurrence. In intermediate group 8 patients had minimum margin of clearance of less than 1 mm,all of these patients were advised re-excision and none of them was advised radiotherapy .None of them initially had re-excision, only one of these patients (12.5%) had recurrence after a period of 10 months as a malignant lesion and after that recurrence patient underwent mastectomy and had radiotherapy as well. In patients with malignant histopathology 12 patients had minimum margin of clearance of less than 1 mm (16.2%) Of these 12 patients in malignant group 5 patients were advised radiotherapy only for reasons mentioned above and seven were advised re-excision. Only two underwent re-excision one had BCS and second had mastectomy. Of 5 who had radiotherapy one expired with systemic recurrence rest survived and did not have local or systemic recurrence. Those who had re-excision one of these who had BCS survived with no recurrence and the one who had mastectomy with radiotherapy died of systemic recurrence. Out of remaining 4 who were advised re-excision but they did not under go re-excision 4 subsequently had no recurrence and survived and one patient lost follow up. Recurrence rate was 12.7% for patients with involved margins (minimum margin of clearance less than 1 mm ) verses 7.4% in patients with clear margins.
Radiotherapy:
Radiotherapy was given to 0 .19% patients (51/260). None of the patients with histological benign and intermediate tumor were given radiotherapy, all patients who received radiotherapy were histological malignant .So, and 68.9% (51/74) of malignant phyllodes patients were given radiotherapy. When recurrence was compared in patients who took radiotherapy verses who did not take radiotherapy in malignant phyllodes group it was found that 17.64% (9/15) of patients who took radiotherapy had recurrence and 20% (3/15) of patients with malignant phyllodes who did not take radiotherapy had recurrence however, this was not statistically significant ( p value 0.979%).This is shown in graph below.
Where,
Phyllodes tumors of the breast have a diverse range of biologic behaviour. The mainstay of treatment of non metastatic tumors is complete surgical resection with wide resection margins (atleast 1 cm) [9]. Wide local excision of tumor with 1 to 2 cm margin is the treatment of choice for border line and malignant tumors however for benign tumors 1mm margin of excision is sufficient and in benign tumors some literature supports wait and watch policy for tumors having positive margins [1]. In the study conducted by Chen et al. [2], surgical margin ( < 1 cm ) was significantly correlated with recurrence (P <0.001 ); In our study margins were considered as positive when the minimal resection margin was less than 1mm as apposed to other studies which took 1 cm as clear margin9,16,17,18.Further more the mean resection margin in our study was 6.48± 4.3 mm.In our study only 1.3% of benign and 5.7% of intermediate tumors recurred locally with minimum margin of clearance of 1 mm . 17.8% of our patients with benign phyllodes had minimum margin of clearance of < 1mm and none of them had local recurrence over a mean follow up period of 41.3% months.22.8% of our patients with borderline phyllodes had positive margins and only one of these patients had recurrence rest did not have recurrence. Our patients with malignant phyllodes have 21.6% recurrence and only 12.5% of these patients ( 2 patients ) had positive margins ( < 1mm ) in rest margins were clear ( > 1mm ).In our study margin of clearance of > 1mm has almost similar results as achieved in other studies that have minimum margin of clearance of up to 1 cm [9,17,18]. In our study clear margin (> 1mm) was found to be significant risk factors for recurrence (p value 0.0001%) as 12.7% of our patients with involved margins have recurrence as compare to 7.4 % with clear margins.
The analysis of data from the Surveillance, Epidemiology, and End Results (SEER) Program for the years 1983e2002 demonstrated that local failure rates for benign tumors range between 5.15% and 20.30% for malignant tumors [3, 4]; and in approximately 22% of cases, malignant phyllodes may give rise to haematogenous Over all rate of systemic. Metastasis for all types of phyllodes is 10% and for malignant phyllodes alone the rate of systemic metases is 20 %, local recurrence does not predict distant metastasis [5].The most frequent sites of distant metastases are the lungs followed by soft tissue, bone, and pleura [6]. In our study, 1.3% of benign, 5.7% if border line and 16.2% of malignant phyllodes had local recurrence.In our study, 10.8% of malignant phyllodes had systemic recurrence while the overall rate of systemic recurrence for all three types in our study is 3.76%.The common sites of systemic recurrence in our study were lungs,soft tissues and bone.
In the M.D. Anderson series of 101 patients, large tumor size was implicated as having an increased risk of recurrence [7].In our study tumor size was not found to be a significant risk factor for recurrence (p value 0.26%).
In our study, histopathological type was found to be a significant risk factors for recurrence (p value 0.0001%) with recurrence rate of 21.6% in malignant as compare to 5.7% in intermediate and 1.3% in benign group.
There is no proven benefit of radiotherapy or chemotherapy although radiotherapy may prove beneficial [8, 9] and some supports that radiotherapy should be given in malignant phyllodes for lumps of 2 cm or more in size if lumpectomy is done and for tumors of 5 cm or more if mastectomy is done [10, 11]. In two recent studies adjuvant radiotherapy was associated with better local control. Belkacémi et al [12]. Conducted a retrospective study in which 9% of patients received adjuvant radiotherapy. In the malignant and borderline group (n ¼ 159), radiotherapy significantly decreased local recurrence (p ¼ 0.02). In a prospective study, 46 patients with borderline or malignant phyllodes underwent breast-conserving surgery (with negative margins) were treated with adjuvant radiotherapy. In this study, after a median follow-up of 56 months, none of the 46 patients developed local recurrence [29].In our study after median follow up of 41.3 months 17.64% of patients with malignant phyllodes who took radiotherapy had recurrence compared to 20% who did not take radiotherapy but this value is not statistically significant (p value 0.979) and the other factor is that we did not give radiotherapy to any of the patient with intermediate phyllodes.
The role of endocrine therapy, such as tamoxifen has not fully understood in phyllodes tumours. Oestrogen and progesterone receptor expression has been shown in 40% and almost 100%, respectively. The use of endocrine therapy in either adjuvant or palliative setting has not been proven.Stromal c-kit positivity and epithelial endothelin-1 negativity are more often associated with malignant phyllodes tumour. The overall positive rate of c-kit immunoreactivity was 13% in benign and 67% in malignant phyllodes tumour.17 Endothelin-1 epithelial cytoplasmic staining was seen in 100% of benign and 17% of malignant phyllodes tumour [28].
Factors associated with recurrence of phyllodes tumors are histopathology type,size of tumor,margin of excision and use of radiotherapy in case of malignant phyllodes.
The mainstay of treatment of non metastatic phyllodes is complete surgical resection with resection margins of more than 1 mm. Phyllodes tumors have higher incidence of local recurrence with malignant lesions having more propensity to recur than benign. Histopathology type of recurrent tumor is always more aggressive than the original tumor. Systemic recurrence is one of the bad prognostic marker as all of patients in our series and all of our patients with systemic recurrence died. Radiotherapy should be given to patients with malignant phyllodes after discussion with oncologist and criteria need to be established for recommending radiotherapy in malignant phyllodes tumors.
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
My Testimonial Covering as fellowing: Lin-Show Chin. 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.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
