scholarly journals Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Dhanya Vasudevan ◽  
P. S. Jayalakshmy ◽  
Suresh Kumar ◽  
Siji Mathew
Keyword(s):  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Tumor Response ◽  
Ductal Carcinoma ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Tumor Characteristics ◽  
Modified Radical Mastectomy ◽  
Tumor Bed

Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT) in the setting of locally advanced breast cancer (LABC) can render inoperable tumor (T4, N2/N3) resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response.Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n=48) were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier’s system which graded the responses into pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR).Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2–5 cms) and Bloom Richardson’s grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed.Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.

scholarly journals Evaluation of Clinicopathological Findings and Postoperative Outcomes of Modified Radical Mastectomy in a Tertiary Care Center in Lahore, Pakistan

2021 ◽  
Vol 10 (2) ◽  
pp. 89-94
Author(s):  
Usman Ali Rahman ◽  
Khalil Ahmad ◽  
Umair Nazir ◽  
Shabbar Hussain Changazi ◽  
Ayesha Choudary ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Hospital Stay ◽  
Ductal Carcinoma ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Clinicopathological Findings ◽  
Duration Of Surgery ◽  
The Mean ◽  
One Year

Background: Modified radical mastectomy (MRM) remains the mainstay of breast cancer surgery in under-developed countries like Pakistan as it reduces the morbidity and mortality associated with radical surgery. This study aims to delineate the clinicopathological findings and postoperative outcomes of patients undergoing modified radical mastectomy for breast carcinoma in a local setting.Material and Methods: This cross-sectional study was conducted in Gulab Devi hospital Lahore, Punjab Pakistan, from January 2016 to December 2019. Patients (n=70) with carcinoma breast planned for modified radical mastectomy were included in the study. Two suction drains were placed (in the axilla and under the flap) and removed when drainage was less than 30 cc in 24 hours. The patients were followed-up weekly for one month and then at monthly intervals for up to one year. Independent t-test and chi-square test were used to study associations between different variables. A P-value less than .05 was considered statistically significant.Results: The mean age of the patients was 48.43 ± 12.3 years. Most of the patients (42.86%) had stage-II, grade-I carcinoma (50%) with invasive ductal carcinoma as the most frequent histological variety (80%). Majority of the patients (n=60; 85.57%) were ER/PR positive. Mean duration of surgery was 124.8 ± 20.33 minutes, the mean duration of drains was 3.5±4.5 days, and the mean length of hospital stay was 4.67 ± 1.07 days. Most common complications of mastectomy were wound infection (23.57%) and seroma formation (20%). Six (8.57%) developed recurrence of disease in one year follow-up. Neoadjuvant chemotherapy increased the mean duration of surgery and drains placement (P<.05) but had no effect on mean hospital stay and complications associated with surgery (P>.05).Conclusions: Grade-I invasive ductal carcinoma with ER/PR positive receptor status was the most frequent variety of breast carcinoma. Neoadjuvant chemotherapy was associated with increased operative time and increased duration of drain placement.

scholarly journals Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome

2020 ◽  
Vol 7 (2) ◽  
pp. 526
Author(s):  
Dakshayani S. Nirhale ◽  
Rizhin Sooraj ◽  
Anshu Rawat
Keyword(s):  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Ductal Carcinoma ◽  
Locally Advanced Breast Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Conservative Surgery ◽  
Advanced Breast ◽  
Number Of Patients

Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase  the chance of recurrence in the follow up period. 

scholarly journals Assessment of pathological response to neoadjuvant chemotherapy in patients with breast carcinoma using Sataloff system

2019 ◽  
Vol 25 (2) ◽  
pp. 13-18
Author(s):  
Savita Agarwal ◽  
Pinki Pandey ◽  
Megha Ralli ◽  
Vineet Chaturvedi ◽  
Kailash Mittal ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Partial Response ◽  
Tumor Response ◽  
Ductal Carcinoma ◽  
Residual Disease ◽  
Locally Advanced ◽  
Pathological Response ◽  
Pathological Examination ◽  
Response To Neoadjuvant Chemotherapy

Background: Neoadjuvant chemotherapy is frequently administered to patients with breast carcinoma. Response to chemotherapeutic regime can be assessed clinically as well as by pathological examination of the breast tissue. It is essential to accurately categorize the patients with residual disease according to the standard guidelines for pathological evaluation of breast specimens after neoadjuvant chemotherapy. The present study was undertaken to assess the histomorphological changes in mastectomy specimens and axillary lymphatic nodes of patients receiving neoadjuvant chemotherapy, grade the pathological response using Sataloff system and to compare the clinical and pathological response after neoadjuvant chemotherapy. Methods: Present prospective study included a total of 31 patients with locally advanced breast carcinoma, diagnosed with infiltrating ductal carcinoma, not otherwise specified on biopsy specimen and subsequently treated with 2 to 6 cycles of neoadjuvant chemotherapy. Pathological response to neoadjuvant chemotherapy was assessed in breast and axillary lymphatic nodes according to Sataloff criteria. Results: Clinical response observed was complete (cCR) in four cases (12.9%), partial response (cPR) in 24 cases (77.4%), and no response (cNR) in three cases (9.7%). Based on tumor response, breast and lymph nodes were graded as pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR) in five (16.1%), 18 (58.1%) and eight (25.8%) cases respectively using Sataloff criteria. Ductal carcinoma in situ and lymphovascular invasion were seen in 11 (35.4%) and 16 cases (51.6%), respectively. Conclusion: The pathological assessment of tumor response remains the gold standard, as neither the clinical nor the radiological responses are sensitive predictors of tumor response after treatment. However pathological examination is quite challenging and demands sufficient experience along with detailed clinical and radiological data of pre- and postoperative neoadjuvant chemotherapy for precise response evaluation.

scholarly journals Role of flap fixation during modified radical mastectomy in locally advanced breast carcinoma patients: a randomised control study

2019 ◽  
Vol 6 (12) ◽  
pp. 4465
Author(s):  
Raghavendra R. T. ◽  
Sushanto Neogi
Keyword(s):  
Breast Carcinoma ◽  
Locally Advanced ◽  
Test Group ◽  
Radical Mastectomy ◽  
Control Group ◽  
Skin Flaps ◽  
Modified Radical Mastectomy ◽  
Fixation Technique ◽  
Flap Fixation ◽  
Clinically Significant

Background: Treatment of locally advanced breast carcinoma (LABC) patients involves multimodal approach. Modified radical mastectomy (MRM) is preferred in them. Seroma and prolonged drainage are most common post-op complications. This study was conducted to evaluate the effect Flap fixation technique in reducing drain output and seroma in patients with LABC.Methods: 30 stage III breast cancer patients undergoing MRM were included. Prior to skin closure patients were randomised into: test (15) and control group (15). In Test group, skin flaps were sutured to chest wall with vicryl 3-0 at 3 cm intervals and skin was closed with nylon. In conventional group, only skin was closed with nylon sutures. In both the groups conventional closed suction drains were placed. Total drain output, clinically significant seroma, post-operative complications were compared between the two groups.Results: Total drain output in test group (4445 ml) was lesser compared to control group (4801 ml) but not statistically significant (p=0.548), however the percentage reduction of drain output on day 2 was significantly higher in test group (42%) as compared to control group (31.8%) (p=0.04). The clinically significant Seroma formation rates were similar in both groups but the volume of seroma aspirated was significantly lower in test group (p<0.05).Conclusions: The flap fixation technique group had better approximation of skin flaps and chest wall, as evident with reduction of drain output, significant reduction in drain output on post op day 2 and reduction of seroma volume.

A PROSPECTIVE STUDY ON RELATION OF HISTOLOGICAL GRADE AS WELLAS HORMONE RECEPTOR PROFILE IN LOCALLY ADVANCED BREAST CARCINOMA PATIENTS IN RESPONSE TO NEOADJUVANT CHEMOTHERAPY

2021 ◽  
pp. 59-61
Author(s):  
Samir Ranjan ◽  
Arun Gupta
Keyword(s):  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Prospective Study ◽  
Ductal Carcinoma ◽  
Histological Grade ◽  
Lobular Carcinoma ◽  
Locally Advanced ◽  
Receptor Status ◽  
Her 2 ◽  
A Prospective Study

Introduction: Inltrating ductal carcinoma being the most common type of carcinoma (70%), lobular carcinoma is the 2nd most common followed by smaller groups such as medullary, mucinous,comedo, paget's disease, papillary, tubular and inammatory carcinoma. Aims and objectives:To establish incidence and correlation between ER, PR, HER 2 neu receptor status, histology with different patient proles. Assessment of therapeutic effectivity and its relation with receptor status and histology after neoadjuvant chemotherapy. Material and methods: This will be an institution-based observational and prospective study. Lab studies- hemoglobin, total count, fasting and postprandial blood sugar, urea, creatinine, albumin and total protein Pretested and predesigned perform Conclusion: This study shows that age group is an important factor for developing breast carcinoma, which was more prevalent in premenstrual population.

scholarly journals Assessment and Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer: A Comparison of Imaging Modalities and Future Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3521
Author(s):  
Valeria Romeo ◽  
Giuseppe Accardo ◽  
Teresa Perillo ◽  
Luca Basso ◽  
Nunzia Garbino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Response ◽  
Imaging Techniques ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Mri Imaging ◽  
Future Perspectives ◽  
Advanced Imaging

Neoadjuvant chemotherapy (NAC) is becoming the standard of care for locally advanced breast cancer, aiming to reduce tumor size before surgery. Unfortunately, less than 30% of patients generally achieve a pathological complete response and approximately 5% of patients show disease progression while receiving NAC. Accurate assessment of the response to NAC is crucial for subsequent surgical planning. Furthermore, early prediction of tumor response could avoid patients being overtreated with useless chemotherapy sections, which are not free from side effects and psychological implications. In this review, we first analyze and compare the accuracy of conventional and advanced imaging techniques as well as discuss the application of artificial intelligence tools in the assessment of tumor response after NAC. Thereafter, the role of advanced imaging techniques, such as MRI, nuclear medicine, and new hybrid PET/MRI imaging in the prediction of the response to NAC is described in the second part of the review. Finally, future perspectives in NAC response prediction, represented by AI applications, are discussed.

Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

2021 ◽  
Vol 17 (1) ◽  
pp. 52-55
Author(s):  
Shiraz Shaikh ◽  
Ambreen Munir ◽  
Shahnawaz Abro ◽  
Shahida Khatoon ◽  
Zameer Hussain Laghari ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
General Surgery ◽  
Stable Condition ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
University Hospital ◽  
P Value ◽  
Modified Radical Mastectomy ◽  
Group A ◽  
Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

scholarly journals Immunohistochemistry profile and its relation with prognosis in locally advanced breast cancer

2019 ◽  
Vol 6 (12) ◽  
pp. 4507
Author(s):  
Naseef Kannanavil ◽  
Nabeel Thommil Padinjarenalakath ◽  
Ahsan Vilayapoyilil ◽  
Abidali Karatparambil
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Response To Therapy ◽  
Advanced Breast ◽  
Age Group ◽  
Modified Radical Mastectomy ◽  
Number Of Patients ◽  
Related Mortality

Background: Breast cancer is one of the most common malignancy and leading cause of cancer related deaths in women worldwide. Immunohistochemistry (IHC) is done to characterize intracellular proteins or cell-surface antigens and is used to assess tumour subtypes, confirm diagnosis, predict prognosis and response to therapy. The aim of the present study was to evaluate the relationship of IHC profile- ER, PR and HER2 neu and prognosis of patients who underwent modified radical mastectomy for locally advanced breast cancer.Methods: A retrospective cohort study was conducted at MES Medical College Hospital from October 2015 to November 2017 in patients who underwent modified radical mastectomy for locally advanced breast carcinoma. A total of 65 women were enrolled in the study. 5 years survival was taken as the prognostic indicator.Results: Majority of the patients belong to the age group of 40-49 years with 40% patients followed by 33.84% patients in the age group of 50-59 years. Maximum number of patients was found in 2B stage of tumour. Maximum patients belonged to the ER/PR+, HER2- subgroup (27), followed by triple negative (ER/PR-, HER2) subgroup (16). There was no disease related mortality in ER/PR+, HER2+ and ER/PR+, HER2- subgroups. There were 1 and 2 disease related mortality in ER/PR-, HER2+ and triple negative subgroups respectively.Conclusions: In the present study the worst prognosis was observed in triple negative (ER/PR-,HER2-) IHC subgroup followed by the HER2 enriched (ER/PR-, HER2+) subgroup. 

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