Invasive Cancer Found In 40% of AEH Patients

Abstract Background Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS). This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. Methods We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 2014 and 2018. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. Results The rate of upstaging to invasive cancer was 19.2% (59/307). DCIS diagnosed by core-needle biopsy (odds ratio [OR]: 6.861, 95% confidence interval [CI]: 2.429–19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224–6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197–8.323) were found to be associated with upstaging. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. Conclusions In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy.

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Invasive Cancer in the Vulvar Region

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.3109/00016348209156540 ◽

1982 ◽

Vol 61 (2) ◽

pp. 113-119 ◽

Cited By ~ 21

Author(s):

Benny Andreasson ◽

Johannes E. Bock ◽

Edgar Weberg

Keyword(s):

Invasive Cancer

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A121 UNDERWATER EMR FOR NON-LIFTING SESSILE COLORECTAL LESIONS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.119 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 102-103

Author(s):

C Galts ◽

R Barclay ◽

D Percy

Keyword(s):

Surgical Resection ◽

De Novo ◽

Lesion Size ◽

Colorectal Polyps ◽

Invasive Cancer ◽

Previous Attempt ◽

Tubular Adenoma ◽

En Bloc ◽

Clinical Role ◽

Submucosal Injection

Abstract Background Sessile colorectal lesions which do not elevate with submucosal injection — “non-lifting” lesions — are considered poor candidates for EMR due to concerns of possible invasive cancer and increased procedural risk. However, a non-lifting sign is an unreliable predictor of malignancy, relegating many benign lesions to surgical resection. Underwater EMR (UEMR), which obviates submucosal injection, is effective for sessile colorectal polyps but has not been evaluated specifically for non-lifting lesions. Aims The aim of this study was to assess the efficacy of UEMR for “non-lifting” large sessile colorectal lesions with the hypothesis that UEMR may have a clinical role in managing complex lesions. Methods We reviewed our database from 2016 to 2019 for patients referred for large (≥ 20 mm) non-lifting colorectal lesions without overt signs of invasive cancer, who subsequently underwent UEMR. Results Thirty-two cases were successfully treated with single session UEMR. 18 (56%) were de novo lesions whereas the remainder had undergone previous attempt(s) at conventional EMR. The mean lesion size was 37 ± 17 mm. 4 cases (13%) were resected en bloc; the remainder piecemeal. Final pathology was T1 adenocarcinoma, N=3 (9%); tubulovillous adenoma, N=15 (47%); tubular adenoma, N=8 (25%); sessile serrated, N=6 (19%); high-grade dysplasia, N=2 (6%). One patient with cancer underwent surgical resection (T1N0); the remainder had endoscopic follow-up over 8 ± 3 months with benign recurrent/residual lesions in 8%, all amenable to UEMR. There were no procedural complications. Conclusions In this series of large sessile non-lifting colorectal lesions, UEMR was effective for both de novo and previously treated lesions, obviating surgery in the majority of cases. Funding Agencies None

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Risk-based cervical screening guidelines should utilize large diverse national database and specifically measure invasive cancer risk of screened patients

Gynecology and Obstetrics Clinical Medicine ◽

10.1016/j.gocm.2020.10.004 ◽

2021 ◽

Vol 1 (1) ◽

pp. 2-4

Author(s):

R. Marshall Austin ◽

Chengquan Zhao

Keyword(s):

Cancer Risk ◽

Cervical Screening ◽

Invasive Cancer ◽

National Database ◽

Screening Guidelines

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High consistency between characteristics of primary intraductal breast cancer and subtype of subsequent ipsilateral invasive cancer

Tumori Journal ◽

10.1177/0300891619867845 ◽

2019 ◽

Vol 106 (1) ◽

pp. 64-69

Author(s):

Massimiliano Gennaro ◽

Elisabetta Meneghini ◽

Paolo Baili ◽

Sara Bravaccini ◽

Annalisa Curcio ◽

...

Keyword(s):

Breast Cancer ◽

Active Surveillance ◽

Hormone Receptors ◽

Ductal Carcinoma ◽

Tumor Grade ◽

Receptor Expression ◽

Invasive Cancer ◽

Her2 Positive ◽

Hormone Receptor Expression ◽

High Consistency

Background: Ductal carcinoma in situ (DCIS) is considered a morphologic precursor of invasive cancer and is often treated with adjuvant whole-breast irradiation and endocrine therapy, as if it were an invasive cancer. Our aim was to provide further support for treatment de-escalation or enrollment of such patients in active surveillance trials. Methods: We retrospectively analyzed data on patients with conservatively treated primary DCIS subsequently diagnosed with ipsilateral invasive breast cancer (IBC) at 2 comprehensive breast cancer centers. From their merged databases, we identified 50 cases with full details on tumor grade, hormone receptor expression, and HER2 amplification, for both the primary DCIS and the corresponding IBC, and we assessed the similarities and differences between the two. Results: Distributions of hormone receptors were similar in primary DCIS and IBC, while high-grade and HER2-positive status was less common in IBC than in primary DCIS. The positivity for estrogen receptors (ER) and well-differentiated or moderately differentiated morphology in the primary DCIS persisted in 90% of the matching IBC. Changes in progesterone receptor expression were slightly more common than those in ER expression. Overall consistency for the luminal-like receptors subtype was found in 90% of cases. Conclusion: The high consistency between the features of primary DCIS and those of subsequent IBC (in the rare but not negligible cases of local failure) should be borne in mind when considering the therapeutic options. Treatment de-escalation and accrual of patients for active surveillance trials could be appropriate for luminal-like precursors.

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