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Atzori G, Gipponi M, Cornacchia C, Diaz R, Sparavigna M, Gallo M, Ruelle T, Murelli F, Franchelli S, Depaoli F, Friedman D, Fregatti P. " No Ink on Tumor" in Breast-Conserving Surgery after Neoadjuvant Chemotherapy. J Pers Med 2022; 12:jpm12071031. [PMID: 35887526 PMCID: PMC9320436 DOI: 10.3390/jpm12071031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background/Aim: Patients with Stage I-II breast cancer undergoing breast-conserving surgery after neoadjuvant chemotherapy (BCS-NAC) were retrospectively assessed in order to evaluate the extent of a safe excision margin. Materials and Methods: Between 2003 and 2020, 151 patients underwent risk-adapted BCS-NAC; margin involvement was always assessed at definitive histology. Patients with complete pathological response (pCR) were classified as the RX group, whereas those with residual disease and negative margins were stratified as R0 < 1 mm (margin < 1 mm) and R0 > 1 mm (margin > 1 mm). Results: Totals of 29 (19.2%), 64 (42.4%), and 58 patients (38.4%) were included in the R0 < 1 mm, R0 > 1 mm, and RX groups, respectively, and 2 patients with margin involvement had a mastectomy. Ten instances of local recurrence (6.6%) occurred, with no statistically significant difference in local recurrence-free survival (LRFS) between the three groups. A statistically significant advantage of disease-free survival (p = 0.002) and overall survival (p = 0.010) was observed in patients with pCR. Conclusions: BCS-NAC was increased, especially in HER-2-positive and triple-negative tumors; risk-adapted BCS should be preferably pursued to highlight the cosmetic benefit of NAC. The similar rate of LRFS in the three groups of patients suggests a shift toward the “no ink on tumor” paradigm for patients undergoing BCS-NAC.
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Affiliation(s)
- Giulia Atzori
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Marco Gipponi
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Correspondence: ; Tel.: +30-010-5558805
| | - Chiara Cornacchia
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Raquel Diaz
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Marco Sparavigna
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Maurizio Gallo
- Department of Internal Medicine (Di.M.I.), University of Genoa, 16132 Genoa, Italy;
| | - Tommaso Ruelle
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Federica Murelli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Simonetta Franchelli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Francesca Depaoli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Daniele Friedman
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Piero Fregatti
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
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Bundred J, Michael S, Bowers S, Barnes N, Jauhari Y, Plant D, Maishman T, Cutress R, Holleczek B, Dodwell D, Bundred N. Do surgical margins matter after mastectomy? A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:2185-2194. [PMID: 32907774 DOI: 10.1016/j.ejso.2020.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND No consensus exists regarding adequacy of margins after mastectomy. To determine if pathological margin proximity is associated with local (LR) or distant recurrence after mastectomy for early invasive breast cancer or ductal carcinoma in situ. METHODS A systematic review of literature published from 1980 to 2019 and meta-analysis was conducted. Unpublished data were sought from authors (PROSPERO (CRD42019127541)). Thirty-four studies comprising 34,833 breast cancer patients were included in the quantitative synthesis. Eligible studies reported on patients undergoing curative mastectomy for cancer allowing estimation of outcomes in relation to margin status/width. The association between pathological margin status and local (LR) and distant recurrence was considered using random effects modelling. PRISMA guidelines were followed. RESULTS Positive margins were associated with increased LR on multivariable analyses (HR, 2·64, (95%CI 2·01-3·46)) and LR was higher regardless of the distance of tumour from the margin defined as positive. After skin-sparing mastectomy, positive margins were associated with increased LR (HR 3·40, (95%CI 1·9-6·2)). In the 4 studies reporting distant recurrence, patients with involved margins had a higher risk (HR 1·53, (95%CI 1·03-2·25)). CONCLUSIONS Failure to achieve clear margins after mastectomy may increase the risks of local and distant recurrence. Adequate margin clearance should be recommended to minimize recurrence after mastectomy in National and International Guidelines.
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Affiliation(s)
- James Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Michael
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK; University of Manchester, Manchester, M13 9PT, UK
| | - Sarah Bowers
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK; University of Manchester, Manchester, M13 9PT, UK
| | | | - Yasmin Jauhari
- Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Dafydd Plant
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Thomas Maishman
- University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ramsey Cutress
- University of Southampton, Tremona Road, Southampton, SO16 6YD, UK; University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, 69120, Heidelberg, Germany; Saarland Cancer Registry, Präsident Baltz-Straße 5, 66119, Saarbrücken, Germany
| | - David Dodwell
- Nuffield Dept. of Population Health,University of Oxford, OX3 7LF, UK
| | - Nigel Bundred
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK; University of Manchester, Manchester, M13 9PT, UK.
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Wimmer K, Bolliger M, Bago-Horvath Z, Steger G, Kauer-Dorner D, Helfgott R, Gruber C, Moinfar F, Mittlböck M, Fitzal F. Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival. Ann Surg Oncol 2019; 27:1700-1707. [PMID: 31873929 PMCID: PMC7138765 DOI: 10.1245/s10434-019-08089-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Indexed: 12/27/2022]
Abstract
Background While “no tumour on ink” is an accepted margin width for R0 resection in primary surgery, it’s unclear if it’s oncologically safe after neoadjuvant chemotherapy (NAC). Only limited data demonstrate that surgery within new margins in cases of a pathological complete response (pCR) is safe. We therefore investigated the influence of different margins and pCR on local recurrence and survival rates after NAC. Methods We retrospectively analysed data of 406 women with invasive breast cancer, treated with NAC and breast-conserving therapy between 1994 and 2014 in two certified Austrian breast health centres. We compared R ≤ 1 mm, R > 1 mm and RX (pCR) for local recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS). Results After a median follow-up of 84.3 months, the 5-year LRFS (R ≤ 1 mm: 94.2%, R > 1 mm: 90.6%, RX: 95.0%; p = 0.940), the 5-year DFS (R ≤ 1 mm: 71.9%, R > 1 mm: 74.1%, RX: 87.2%; p = 0.245) and the 5-year OS (R ≤ 1 mm: 85.1%, R > 1 mm: 88.0%, RX: 96.4%; p = 0.236) did not differ significantly between narrow, wide, nor RX resections. Regarding DFS and OS, a negative nodal status reduced the hazard ratio significantly. Conclusion There is no significant difference in LRFS, DFS and OS comparing close, wide or unknown margins after pCR. We suggest that resection in new margins after NAC is safe according to “no tumour on ink”. Resection of the clipped area in cases of pCR is emphasized.
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Affiliation(s)
- K Wimmer
- Department of Surgery, Medical University of Vienna, Vienna, Austria.,Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - M Bolliger
- Department of Surgery, Medical University of Vienna, Vienna, Austria.,Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - G Steger
- Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Oncology Medical, University of Vienna, Vienna, Austria
| | - D Kauer-Dorner
- Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Radio-oncology, Medical University of Vienna, Vienna, Austria
| | - R Helfgott
- Department of Surgery, Ordensklinikum Linz/Hospital of the Sisters of Charity, Linz, Austria
| | - C Gruber
- Department of Pathology, Ordensklinikum Linz/Hospital of the Sisters of Charity, Linz, Austria
| | - F Moinfar
- Department of Pathology, Ordensklinikum Linz/Hospital of the Sisters of Charity, Linz, Austria
| | - M Mittlböck
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria. .,Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.
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Schnitt SJ. Evaluation of margins in invasive carcinoma and ductal carcinoma in situ: The pathologist's perspective. Breast 2017; 34 Suppl 1:S58-S60. [PMID: 28663004 DOI: 10.1016/j.breast.2017.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Pathology, Harvard Medical School, Boston, MA, USA.
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Chauhan A, Sharma MM, Kumar K. Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery. Indian J Surg Oncol 2016; 7:413-419. [PMID: 27872528 DOI: 10.1007/s13193-016-0549-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
Abstract
The purpose of this study was to compare early oncologic outcomes of oncoplastic breast surgery and conventional breast conservation surgery in patients of locally advanced breast cancer. A single-center, prospective, non-randomized study enrolled select cases of locally advanced breast cancer (TNM T3/T4, N0/1/2) who after neoadjuvant chemotherapy, were considered for breast conservation surgery with oncoplasty techniques. The specimen volume resected, the mean margins and mean closest margin obtained were noted. The re-surgery rates, complication rates, and incidence of locoregional recurrence were also noted. Variables were compared with a retrospective cohort of similar patients who had undergone conventional breast conservation surgery. Fifty-seven patients underwent OBS (group 1) and were compared with 43 cases that had undergone conventional BCS (group 2). Majority of the patients in group 1 (73 %) had cT3 with N0 or N+ and a minority (17 %) were with limited skin involvement (cT4 and N0/N+). Relatively larger sized, post-NACT tumors could undergo OBS(4.4 vs 2.3 cm). Relatively greater proportion of tumors in central and lower quadrants were addressed by oncoplasty than traditional BCS (17/57, 29 % vs 4/43, 9 %, p = 0.04). The mean specimen volume excised in group 1 was more than that in group 2. (187.54 vs 125.19; p = 0.01). The mean of the margins were obtained more in group 1 (1.04 vs 0.69 cm); p < 0.01) as also the mean closest margin (0.86 vs 0.49 cm; p < 0.01). The incidence of close or involved margins was lesser in the OBS group (8 vs 24 %). Overall incidence of complications was similar in both groups (8/57, 14 % vs 4/43, 9 %; p = 0.34 NS). The median follow-up period of group 1 is 18 months (range 06-30 months) while group 2 is 34 months (14-44 months. There was no recurrence in group 1, but there were 5 cases (11 %) in group 2. Oncoplasty breast surgery offers more opportunity for breast conservation and oncologic safety than conventional breast conserving surgery.
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Affiliation(s)
| | | | - Kishore Kumar
- Department of Medicine, Command Hospital(CC), Lucknow, India
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Neoadjuvant chemotherapy in breast-conserving surgery – Consequences on margin status and excision volumes. Eur J Surg Oncol 2016; 42:986-93. [DOI: 10.1016/j.ejso.2016.02.252] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 11/20/2022] Open
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Bouzón A, Acea B, García A, Iglesias Á, Mosquera J, Santiago P, Seoane T. Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy. Cir Esp 2016; 94:379-84. [PMID: 27158077 DOI: 10.1016/j.ciresp.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. METHODS A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. RESULTS Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596). CONCLUSIONS A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy.
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Affiliation(s)
- Alberto Bouzón
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Benigno Acea
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
| | - Alejandra García
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Ángela Iglesias
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Joaquín Mosquera
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Paz Santiago
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Teresa Seoane
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
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Incidence, predictive factors, and prognosis for winged scapula in breast cancer patients after axillary dissection. Support Care Cancer 2014; 22:1611-7. [PMID: 24492929 DOI: 10.1007/s00520-014-2125-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Axillary lymph node dissection is part of breast cancer surgery, and winged scapula is a possible sequela. Data regarding its incidence, predictive factors, and patient prognosis remains inconsistent. Ignorance of its diagnosis may lead to undertreatment with physical morbidity. METHODS Breast cancer patients with axillary lymph node dissection were prospectively recruited. Postoperative examinations by the physiotherapy staff were performed. RESULTS One hundred eighty-seven patients were recruited during July-October 2012; 51 patients had a positive diagnosis (27.2 %), with 38 patients (86 %) who recovered completely from the winged scapula, while 6 patients (13 %) still had winged scapula at 6 months after surgery. One hundred thirty patients underwent mastectomy and 100 cases had immediate reconstruction. Age, BMI, previous shoulder joint morbidity, and breast surgery were not associated with winged scapula. Neoadjuvant treatment, mastectomy or conservative surgery, immediate reconstruction, tumor size, and nodal involvement also did not show any correlation. Breast reconstruction with prosthesis, even with serratus muscle dissection, does not increase the incidence of winged scapula. CONCLUSION Winged scapula is not an uncommon incidence after breast cancer surgery. Physiotherapy is related to the complete recovery. The severity or grading of the winged scapula and the recovery time after physiotherapy should be investigated in the future studies.
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CHEN JEONHOR, BAHRI SHADFAR, MEHTA RITAS, CARPENTER PHILIPM, MCLAREN CHRISTINEE, CHEN WENPIN, FWU PETERT, HSIANG DAVIDJB, LANE KARENT, BUTLER JOHNA, SU MINYING. Impact of factors affecting the residual tumor size diagnosed by MRI following neoadjuvant chemotherapy in comparison to pathology. J Surg Oncol 2014; 109:158-67. [PMID: 24166728 PMCID: PMC4005994 DOI: 10.1002/jso.23470] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/26/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES To investigate accuracy of magnetic resonance imaging (MRI) for measuring residual tumor size in breast cancer patients receiving neoadjuvant chemotherapy (NAC). METHODS Ninety-eight patients were studied. Several MRI were performed during NAC for response monitoring, and the residual tumor size was measured on last MRI after completing NAC. Covariates, including age, tumor characteristics, biomarkers, NAC regimens, MRI scanners, and time from last MRI to operation, were analyzed. Univariate and Multivariate linear regression models were used to determine the predictive value of these covariates for MRI-pathology size discrepancy as the outcome measure. RESULTS The mean (±SD) of the absolute difference between MRI and pathological residual tumor size was 1.0 ± 2.0 cm (range, 0-14 cm). Univariate regression analysis showed tumor type, morphology, HR status, HER2 status, and MRI scanner (1.5 T or 3.0 T) were significantly associated with MRI-pathology size discrepancy (all P < 0.05). Multivariate regression analyses demonstrated that only tumor type, tumor morphology, and biomarker status considering both HR and HER-2 were independent predictors (P = 0.0014, 0.0032, and 0.0286, respectively). CONCLUSION The accuracy of MRI in evaluating residual tumor size depends on tumor type, morphology, and biomarker status. The information may be considered in surgical planning for NAC patients.
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Affiliation(s)
- JEON-HOR CHEN
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - SHADFAR BAHRI
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
| | - RITA S. MEHTA
- Department of Medicine, University of California, Irvine, California
| | | | | | - WEN-PIN CHEN
- Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | - PETER T. FWU
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
| | | | - KAREN T. LANE
- Department of Surgery, University of California, Irvine, California
| | - JOHN A. BUTLER
- Department of Surgery, University of California, Irvine, California
| | - MIN-YING SU
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
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Zucca Matthes AG, Uemura G, Kerr L, Matthes ÂCS, Michelli RAD, Folgueira MAAK, da Costa Viera RA. Feasibility of oncoplastic techniques in the surgical management of locally advanced breast cancer. Int J Surg 2012; 10:500-5. [PMID: 22858800 DOI: 10.1016/j.ijsu.2012.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/17/2012] [Accepted: 07/22/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Locally advanced breast cancer (LABC) is still common in developing countries. The association between neoadjuvant chemotherapy (NC) and oncoplastic surgery (OS) might provide an oncological treatment with satisfactory aesthetic results. PURPOSE The goal was to demonstrate if oncoplastic surgical techniques can be utilized to treat LABC which was submitted to neoadjuvant chemotherapy. METHODS This prospective clinical trial included breast cancer patients, clinical stage III, who underwent established NC regimen. All patients underwent preoperative planning to control the tumor size and to define the surgical technique. A detailed analysis of the pathological specimen was performed. RESULTS 50 patients were assessed and surgically treated. Tumor size ranged from 3.0 to 14.0 cm (median 6.5 cm). Pathologic response was rated as stable, progressive, partial response, and complete response in 10%, 8%, 80% and 2% of the cases, respectively. Seventeen (34%) patients were submitted to OS. No patient had positive margins. Skin involvement was presented in 36% of pathologic specimen. CONCLUSIONS Oncoplastic surgical techniques for selected patients decrease the rates of radical surgery despite large tumors. (www.clinicaltrials.gov, NCT00820690).
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Affiliation(s)
- Angelo Gustavo Zucca Matthes
- Department of Gynaecology, Obstetrics and Mastology, School of Medicine of Botucatu, UNESP-Distrito de Rubião Júnior, Botucatu-SP, Brazil.
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Ishitobi M, Ohsumi S, Inaji H, Ohno S, Shigematsu H, Akiyama F, Iwase T, Akashi-Tanaka S, Sato N, Takahashi K, Oura S. Ipsilateral breast tumor recurrence (IBTR) in patients with operable breast cancer who undergo breast-conserving treatment after receiving neoadjuvant chemotherapy: risk factors of IBTR and validation of the MD Anderson Prognostic Index. Cancer 2012; 118:4385-93. [PMID: 22252882 DOI: 10.1002/cncr.27377] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/01/2011] [Accepted: 11/08/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited information about the risk factors for ipsilateral breast tumor recurrence (IBTR) after patients undergo breast-conserving surgery plus radiotherapy (breast-conserving treatment [BCT]) subsequent to neoadjuvant chemotherapy (NAC). The objective of the current study was to analyze these risk factors. METHODS The authors collected data from 375 patients who underwent BCT and received NAC and analyzed the risk of IBTR associated with undergoing BCT after NAC. The usefulness of the MD Anderson Prognostic Index (MDAPI) for IBTR also was validated using the current data set. RESULTS The median follow-up was 47.8 months, and the 4-year IBTR-free survival rate was 95.6%. Multivariate analysis demonstrated that estrogen receptor (ER) status and multifocality of the residual tumor were associated significantly with IBTR-free survival. In addition, patients who had ER-positive and human epidermal growth factor 2 (HER2)-negative tumors did not develop IBTR during the observation period. Although prognostic stratification according to MDAPI was relatively good for the prediction of IBTR in the study patients, the IBTR rate in the high-risk group was not very high and was lower than that in the intermediate-risk group. Multivariate analyses demonstrated that IBTR was an independent predictive factor for overall survival. CONCLUSIONS ER status and multifocality of the residual tumor after NAC were independent predictors of IBTR after BCT. The MDAPI was barely adaptable to the study patients in terms of predicting IBTR. Patients with ER-positive and HER2-negative tumors had a favorable prognosis, whereas patients who developed IBTR after NAC had significantly worse overall survival. The authors propose a new IBTR prognostic index using the 2 factors that were identified as predictive of IBTR: ER status and multifocality of the residual tumor.
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Affiliation(s)
- Makoto Ishitobi
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
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Chen K, Jia W, Li S, He J, Zeng Y, Yang H, Jin L, Wu X, Su F. Cavity Margin Status Is an Independent Risk Factor for Local-Regional Recurrence in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy Before Breast-Conserving Surgery. Am Surg 2011. [DOI: 10.1177/000313481107701247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objection of this study is to investigate whether the cavity margin (CM) status has different predictive efficacy for local-regional recurrence (LRR) in patients who have received or have not received neoadjuvant chemotherapy (NAC) before breast-conserving surgery. We identified 61 patients who received NAC before breast-conserving surgery. A nonrandomized unmatched cohort of 295 patients without history of receiving NAC were also included in this study. Clinicopathological features and follow-up data were abstracted and analyzed. Patients in the NAC-treated group had more advanced diseases when compared with patients in the non NAC-treated group. With a median follow-up of 42 months, the LRR-free survival rate of patients with positive CMs was significantly lower than that of patients with negative CMs in the NAC-treated group. This distinction was not observed in the nonNAC-treated group. Univariate and multivariate analysis revealed that positive CM was the only independent predictive factor for LRR in the NAC-treated group but not in nonNAC-treated patients. CM status had different predictive efficacy for LRR in different settings. Association between CM status and LRR was observed in NAC-treated patients rather than nonNAC-treated patients. More extensive surgical treatment might be needed in NAC-treated patients when their CMs are positive.
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Affiliation(s)
- Kai Chen
- Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Weijuan Jia
- Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shunrong Li
- Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianrong He
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunjie Zeng
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hua Yang
- Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
- Mammary Therapeutic Center, Henan Province Oncology Hospital, Zhengzhou, People's Republic of China
| | - Liang Jin
- Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiayi Wu
- Department of Prosthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, People's Republic of China
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Breast conservation and sentinel lymph node biopsy after neoadjuvant systemic therapy. Breast 2010; 18 Suppl 3:S90-2. [PMID: 19914551 DOI: 10.1016/s0960-9776(09)70281-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Sirohi B, Leary A, Johnston SRD. Ipsilateral breast tumor recurrence: is there any evidence for benefit of further systemic therapy? Breast J 2009; 15:268-78. [PMID: 19645782 DOI: 10.1111/j.1524-4741.2009.00716.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, there are no standard guidelines for treating patients with ipsilateral breast tumor recurrence (IBTR). Current practice is to resect the recurrence with a radical intent followed possibly by radiotherapy if the patient has not received this before, but the role of further adjuvant medical (hormone or chemotherapy) therapy remains undefined. Currently Phase III trials are underway to answer this question. In this review, we will focus on published data relating to IBTR and discuss recent trials. The results from the Phase III trials will not be available for sometime. At the time of IBTR, it is reasonable to change the endocrine therapy with indirect evidence from sequencing of impact on outcome. There is currently no conclusive evidence to suggest that further adjuvant chemotherapy post loco-regional recurrence impacts on survival, though the use of noncross-resistant chemotherapy drugs may make sense in those at highest risk. Biopsy at IBTR is helpful to distinguish whether it is a true recurrence or a new primary tumor and receptor phenotyping may be helpful for HER2. Future trials in IBTR need to address the following issues: to be able to distinguish between true recurrence and new primary (consensus required on definitions); pathologic processing relating to margins needs to be standardized (1 or 5 mm wide specimens); documentation of the pattern of IBTR in relation to each histopathologic subtype and methods used for pathologic examination by centers. Regional nodal recurrence including supraclavicular node recurrence is not dealt with in this review.
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Affiliation(s)
- Bhawna Sirohi
- Breast Unit, Royal Marsden NHS Foundation Trust, Surrey, UK
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Allweis TM, Kaufman Z, Lelcuk S, Pappo I, Karni T, Schneebaum S, Spector R, Schindel A, Hershko D, Zilberman M, Sayfan J, Berlin Y, Hadary A, Olsha O, Paran H, Gutman M, Carmon M. A prospective, randomized, controlled, multicenter study of a real-time, intraoperative probe for positive margin detection in breast-conserving surgery. Am J Surg 2008; 196:483-9. [PMID: 18809049 DOI: 10.1016/j.amjsurg.2008.06.024] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 05/29/2008] [Accepted: 06/12/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND This randomized, double-arm trial was designed to study the benefit of a novel device (MarginProbe, Dune Medical Devices, Caesarea, Israel) in intraoperative margin assessment for breast-conserving surgery (BCS) and the associated reduction in reoperations. METHODS In the device group, the probe was applied to the lumpectomy specimen and additional tissue was excised according to device readings. Study arms were compared by reoperation rates and by correct surgical reaction confirmed by histology. RESULTS Three hundred patients were enrolled. Device use was associated with improved correct surgical reaction, defined as additional re-excision in all histologically detected positive margins, with tumor within 1 mm of inked margin. The repeat lumpectomy rate was significantly reduced by 56% in the device arm: 5.6% versus 12.7% in the control arm. There were no differences in excised tissue volume or cosmetic outcome. CONCLUSIONS Intraoperative use of the MarginProbe for positive margin detection is safe and effective in BCS and decreases the rate of repeat operations.
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Affiliation(s)
- Tanir M Allweis
- Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Fitzal F, Riedl O, Jakesz R. Recent developments in breast-conserving surgery for breast cancer patients. Langenbecks Arch Surg 2008; 394:591-609. [DOI: 10.1007/s00423-008-0412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
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Surgical Margins in Breast-Conservation Operations for Invasive Carcinoma: Does Neoadjuvant Chemotherapy Have an Impact? J Am Coll Surg 2008; 206:1116-21. [DOI: 10.1016/j.jamcollsurg.2007.12.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 12/21/2007] [Accepted: 12/26/2007] [Indexed: 11/20/2022]
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Breast conserving surgery after neoadjuvant therapy for large primary breast cancer. Eur J Surg Oncol 2008; 34:863-867. [PMID: 18304777 DOI: 10.1016/j.ejso.2008.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 01/16/2008] [Indexed: 02/02/2023] Open
Abstract
AIM The aim of this study was to evaluate the safety of breast conserving surgery in patients with breast tumours satisfactorily downstaged after neoadjuvant therapy. METHODS A retrospective cohort study was undertaken to analyze the loco-regional recurrence (LRR) after breast conserving surgery. We enrolled 88 patients with breast cancer subjected to neoadjuvant therapy (NAT group) who achieved an objective response due to neoadjuvant treatment and compared them with 191 patients with early breast cancer (EBC group) who were submitted to primary conserving surgery. Lumpectomy or quadrantectomy with axillary lymph node dissection was performed in all patients who received adjuvant radiotherapy. Systemic adjuvant therapy was offered to all patients. The mean periods of observation were 61.3 months in the NAT group and 67.5 months in the EBC group. RESULTS The mean age was 53 years in the NAT group and 56 years in the EBC group (p=0.04). There was no histological type and histological grade difference between groups. In the NAT group, the mean diameter of residual tumour was lower and the mean volume of breast tissue resection was higher than in the EBC group (p=0.01 and p=0.002, respectively). The ipsilateral recurrence rate was 7.9% in the NAT group and 7.8% in the EBC group (p=0.9). The most important predictive factor of recurrence in the NAT group was the age of patient. CONCLUSION Breast conserving therapy is a safe procedure in satisfactorily downstaged breast cancer after neoadjuvant therapy.
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Liakakos T, Baltogiannis G. Reducing local recurrence after breast-conserving surgery for breast cancer. Ann Surg Oncol 2007; 15:949-50. [PMID: 17922227 DOI: 10.1245/s10434-007-9636-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 08/31/2007] [Indexed: 11/18/2022]
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