scholarly journals Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

2016 ◽  
Vol 103 (7) ◽  
pp. 830-838 ◽  
Author(s):  
J. M. Dixon ◽  
C. Newlands ◽  
C. Dodds ◽  
J. Thomas ◽  
L. J. Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Incomplete Excision

scholarly journals Preoperative Assessment of Small Tumours in Women with Breast Cancer

2005 ◽  
Vol 94 (1) ◽  
pp. 15-20 ◽  
Author(s):  
B. A. Kald ◽  
P. Boiesen ◽  
K. Ronnow ◽  
P. E. Jonsson ◽  
T. Bisgaard
Keyword(s):  
Breast Cancer ◽  
Standard Deviation ◽  
Tumour Size ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Breast Conserving Surgery ◽  
Surgical Strategy ◽  
Breast Cancers ◽  
Optimal Method ◽  
Small Breast

Background and Objectives: In patients with breast cancer, planning of the surgical strategy may rely on preoperative tumour size. The optimal method for assessment of small tumours has not been established. We compared findings from preoperative mammography and ultrasonography with histopathological tumour size in patients treated with breast-conserving surgery. Material and Methods: The study was retrospective and the setting a single institution clinic with free referral of patients. The patients were examined before the operation with mammography, ultrasonography, and findings were compared with postoperative histopathological tumour size. Results: The study included 131 patients (median age was 59) years with grade I, II, and III cancers in 47, 71 and in 13 patients, respectively. The medium histological tumour size was 14 mm, range 4–45 mm. A wide 95 % confidence interval between histopathological tumour size and preoperative mammography (standard deviation 4.8 mm) and ultrasonography (standard deviation 4.8 mm) was found. The combination of mammography and ultrasonography did not improve the results (standard deviation 4.3 mm). Preoperative mammography tended to over estimate the tumour size compared with histological tumour size whereas preoperative ultrasonography tended to underestimate the tumour size. Conclusion: In this retrospective study with preoperative evaluation of small breast cancers by mammography and ultrasonography, wide 95 % confidence intervals for the methods were found and they should therefore be used with caution in the planning of the surgical strategy.

scholarly journals TP8.1.10 Factors predicting residual disease on re-excision after breast conserving surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Duncan Simpson ◽  
Jennifer Allan ◽  
Brendan McFall
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Residual Disease ◽  
Tumour Size ◽  
Multivariable Analysis ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Linear Fashion ◽  
Initial Surgery ◽  
Disease Free

Abstract Introduction Breast conserving surgery is the standard of care for early breast cancer, however in a quarter of patients, satisfactory margins are not achieved, usually leading to re-excision. Residual disease is found in less than half of these re-excisions, leading to increased morbidity, poorer cosmesis and increased cost with no oncological benefit. Our study aimed to identify a group of patients with unsatisfactory margins but a low risk of residual disease, who may be able to avoid re-excision. Methods All patients from our unit undergoing re-excision for unsatisfactory margins after breast conserving surgery between January 2013 and October 2019 were identified. Pathological factors predicting residual disease were investigated using univariable and multivariable analysis. Results 220 patients were included. 90 (41%) had residual disease in the re-excision specimen. Residual disease was more likely in those having mastectomy than cavity shaves (61% vs 32%, p < 0.0001). Residual disease increased in a linear fashion with number of involved margins and with increasing tumour size. Tumour size <20mm (p = 0.045), a pathological to radiological tumour size ratio less than 1.5 (p < 0.0001) and disease-free cavity shaves taken at initial surgery (p = 0.041) were all significant predictors of a low chance of residual disease on multivariable analysis. Patients with all three factors had a 14% chance of residual disease. Conclusions More than half of patients undergo unnecessary re-excision, and patients with small, radiologically obvious tumours are less likely to have residual disease. The decision on re-excision should include these factors in addition to the margin status.

scholarly journals De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada?

2021 ◽  
Vol 29 (1) ◽  
pp. 144-154
Author(s):  
Hannah Kapur ◽  
Leo Chen ◽  
Rebecca Warburton ◽  
Jin-Si Pao ◽  
Carol Dingee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Invasive Cancer ◽  
Breast Cancer Surgery ◽  
Patient Demographics ◽  
Multiple Factors ◽  
Medical Need ◽  
Canadian Population

Quality Indicators (QIs), including the breast-conserving surgery (BCS) rate, were published by the European and American Breast Cancer Societies and this study assesses these in a Canadian population to look for opportunities to de-escalate surgery. A total of 2311 patients having surgery for unilateral, unifocal breast cancer between 2013 and 2017 were identified and BCS QIs calculated. Reasons for mastectomy had been prospectively collected with synoptic operative reporting. Our BCS rate for invasive cancer < 3 cm was 77.1%, invasive cancer < 2 cm was 84.1%, and DCIS < 2 cm was 84.9%. There was no statistically significant change in BCS rates over a five-year period, but there was a reduction in contralateral prophylactic mastectomies (CPM) from 28% in 2013 to 16% in 2017 (p < 0.001). Trend analysis looking at tumour size and medical need for mastectomy indicated that 80% of patients at our centre would be eligible for BCS with tumour cut off of 2.5 cm. Our institution met American but not European QI standards for BCS rates, potentially indicating a difference in patient demographics compared to Europe. Our results support the understanding that BCS rates are influenced by multiple factors and are challenging to compare across jurisdictions. CPM rates may offer a more actionable opportunity to de-escalate surgery for breast cancer.

scholarly journals Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
R V Dave ◽  
S Cheung ◽  
M Sibbering ◽  
O Kearins ◽  
J Jenkins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Invasive Breast Cancer ◽  
Tumour Size ◽  
Growth Factor Receptor ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Axillary Node ◽  
Axillary Node Clearance

Abstract Background Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC. Methods Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC. Results Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients. Conclusion This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.

Harmonic scalpel versus traditional ligation in axillary dissection for breast cancer: a retrospective multivariate analysis

2020 ◽  
Vol 99 (11) ◽  
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Harmonic Scalpel ◽  
Breast Conserving Surgery ◽  
Seroma Formation ◽  
Nodal Involvement ◽  
Single Centre ◽  
Absorbable Material ◽  
Drain Removal ◽  
The Mean

Introduction: The aim of this pilot retrospective study is to evaluate the complication rate in patients after axillary dissection comparing preparation with harmonic scalpel vs traditional ligation technique, and to analyse risk factors for complications occurrence. Methods: 144 patients with 148 axillary dissections operated in a single centre between January 2014 and 2019 were included into the study. Axillary dissection was performed using harmonic scalpel in 73 and absorbable ligations in 70 cases. Results: Seroma formation was observed in 41 patients (56.2%) in the harmonic scalpel group and in 21 patients (30.0%) in the ligations group (p=0.003). The mean period from the surgery to drain removal was 4.0 days in the harmonic scalpel group and 3.0 days in the ligations group (p<0.001). The mean amount of the drained fluid after mastectomy was 300.9 ml in the harmonic scalpel group and 168.7 ml in the ligations group (p=0.005); after breast conserving surgery, it was 241.9 ml and 107.4 ml, respectively (p =0.023). Conclusion: In comparison with traditional ligations with absorbable material, axillary dissection using harmonic scalpel significantly increases the risk of postoperative seroma formation, prolongs the time from the surgery to drain removal, and increases the amount of drained fluid.ut any suspicion of nodal involvement, hemithyroidectomy is considered to be a sufficient procedure or the method of choice, respectively.

Co-expression of ER-beta and HER2 associated with poorer prognosis in primary breast cancer

2009 ◽  
Vol 32 (3) ◽  
pp. 250 ◽  
Author(s):  
Wen-sheng Qui ◽  
Lu Yue ◽  
Ai-ping Ding ◽  
Jian Sun ◽  
Yang Yao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cell Differentiation ◽  
Primary Breast Cancer ◽  
Tumour Size ◽  
Univariate Analysis ◽  
Growth Factor Receptor ◽  
Disease Free Survival ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Er Alpha

Purpose: To assess the prognostic value of co-expression of estrogen receptor (ER)-beta and human epidermal growth factor receptor 2 (HER2) in primary breast cancer patients in China. Methods: Tumour specimens from 308 patients undergoing surgery for primary breast cancer were evaluated. Expression of ER-beta and HER-2 was investigated by the immunohistochemistry. Results: 123 patients (40%) were ER-beta positive and 58 (18.5 %) were HER2 positive. Among the 58 HER2 positive patients, 44 were ER-beta positive and 14 were ER-beta negative. ER-beta positive was associated with HER2 positive (75.9%, P=0.018) as well as ER-alpha positive (79.7%, P=0.023), poor cell differentiation (77.2% grade 2 or 3, P=0.010) and menopause age < 45 yr (55.3%, P=0.031). HER2 positive was associated with poor cell differentiation (93.1%, P=0.001), ?3cm tumour size (67.2%, P=0.011). Conclusion: Both ER-beta positive and HER2 positive status was associated with poorer overall survival (OS) by univariate analysis. In both HER2 positive and HER2 negative subgroups, ER-beta positive was associated with poorer distant disease free survival (DDFS) but not OS, which implied that ER-beta might relate to metastasis in breast cancer.

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