Ultrasound Image Features under Deep Learning in Breast Conservation Surgery for Breast Cancer

This study was to analyze the effect of the combined application of deep learning technology and ultrasound imaging on the effect of breast-conserving surgery for breast cancer. A deep label distribution learning (LDL) model was designed, and the semiautomatic segmentation algorithm based on the region growing and active contour technology (RA) and the segmentation model based on optimized nearest neighbors (ON) were introduced for comparison. The designed algorithm was applied to the breast-conserving surgery of breast cancer patients. According to the difference in intraoperative guidance methods, 102 female patients with early breast cancer were divided into three groups: 34 cases in W1 group (ultrasound guidance based on deep learning segmentation model), 34 cases in W2 group (ultrasound guidance), and 34 cases in W3 group (palpation guidance). The results revealed that the tumor area segmented by the LDL algorithm constructed in this study was closer to the real tumor area; the segmentation accuracy (AC), Jaccard, and true-positive (TP) values of the LDL algorithm were obviously greater than those of the RA and ON algorithms, while the false-positive (FP) value was significantly lower in contrast to the RA and ON algorithms, showing statistically observable differences ( P < 0.05); the actual resection volume of the patients in the W1 group was the closest to the ideal resection volume, which was much smaller in contrast to that of the patients in the W2 and W3 groups, showing statistical differences ( P < 0.05); the positive margins of the patients in the W1 group were statistically lower than those in the W2 and W3 groups ( P < 0.05). In addition, 1 patient in the W1 group was not satisfied with the cosmetic effect, 3 patients in the W2 group were not satisfied with the cosmetic effect, and 9 patients in the W3 group were not satisfied with the cosmetic effect. Finally, it was found that the ultrasound image based on the deep LDL model effectively improved the AC of tumor resection and negative margins, reduced the probability of normal tissue being removed, and improved the postoperative cosmetic effect of breast.

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Usefulness of 3D-surgical guides in breast conserving surgery after neoadjuvant treatment

Scientific Reports ◽

10.1038/s41598-021-83114-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Han Shin Lee ◽

Hee Jeong Kim ◽

Il Yong Chung ◽

Jisun Kim ◽

Sae Byul Lee ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Neoadjuvant Treatment ◽

Breast Conserving Surgery ◽

Resection Margins ◽

Breast Cancer Patients ◽

Original Tumor ◽

Surgical Guides ◽

Neoadjuvant Systemic Therapy ◽

Tumor Area

AbstractWe used 3D printed-breast surgical guides (3DP-BSG) to designate the original tumor area from the pre-treatment magnetic resonance imaging (MRI) during breast-conserving surgery (BCS) in breast cancer patients who received neoadjuvant systemic therapy (NST). Targeting the original tumor area in such patients using conventional localization techniques is difficult. For precise BCS, a method that marks the tumor area found on MRI directly to the breast is needed. In this prospective study, patients were enrolled for BCS after receiving NST. Partial resection was performed using a prone/supine MRI-based 3DP-BSG. Frozen biopsies were analyzed to confirm clear tumor margins. The tumor characteristics, pathologic results, resection margins, and the distance between the tumor and margin were analyzed. Thirty-nine patients were enrolled with 3DP-BSG for BCS. The median nearest distance between the tumor and the resection margin was 3.9 cm (range 1.2–7.8 cm). Frozen sections showed positive margins in 4/39 (10.3%) patients. Three had invasive cancers, and one had carcinoma in situ; all underwent additional resection. Final pathology revealed clear margins. After 3-year surveillance, 3/39 patients had recurrent breast cancer. With 3DP-BSG for BCS in breast cancer patients receiving NST, the original tumor area can be identified and marked directly on the breast, which is useful for surgery. Trial Registration: Clinical Research Information Service (CRIS) Identifier Number: KCT0002272. First registration number and date: No. 1 (27/04/2016).

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Axillary Metastasis with Occult Primary Breast Cancer

10.2310/cgso.16023 ◽

2017 ◽

Author(s):

Anne Kuritzky ◽

Laila Khazai ◽

Roberto Diaz ◽

Christine Laronga

Keyword(s):

Breast Cancer ◽

Primary Breast Cancer ◽

Breast Conservation ◽

Radical Mastectomy ◽

Clinical Trial Data ◽

Breast Conserving Surgery ◽

Endocrine Treatment ◽

Axillary Lymph ◽

Axillary Metastasis ◽

Cancer Breast

The identification of an axillary metastasis in the absence of a primary breast cancer can pose a diagnostic and therapeutic dilemma. The clinician should first use more sensitive imaging modalities, such as breast magnetic resonance imaging, to attempt to find the primary index lesion. If the primary cancer remains occult and the molecular markers are consistent with a breast origin, then the recommended treatment includes multimodality therapy including surgery, chemotherapy/endocrine treatment, and radiation. Historically, the modified radical mastectomy was the standard of practice. Recently, in the era of improved adjuvant therapies, breast-conserving surgery with irradiation is also being considered. Multiple retrospective reviews have shown no difference in survival or recurrence with these two surgical pathways. However, due to the rare nature of this clinical presentation, no multiinstitutional or prospective clinical trial data are available. Key words: axillary lymph node dissection, axillary metastasis, breast cancer, breast conservation, local recurrence, occult primary tumor, radiotherapy

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Multifocal and multicentric breast cancer, is it time to think again?

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0109 ◽

2020 ◽

Vol 102 (1) ◽

pp. 62-66 ◽

Cited By ~ 2

Author(s):

YA Masannat ◽

A Agrawal ◽

L Maraqa ◽

M Fuller ◽

SK Down ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Disease Recurrence ◽

Locoregional Control ◽

Current Evidence ◽

Multicentric Breast Cancer ◽

Risk Of Disease ◽

Short Narrative

Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.

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Impact of Neoadjuvant Chemotherapy in Stage II–III Triple Negative Breast Cancer on Eligibility for Breast-conserving Surgery and Breast Conservation Rates

Annals of Surgery ◽

10.1097/sla.0000000000001417 ◽

2015 ◽

Vol 262 (3) ◽

pp. 434-439 ◽

Cited By ~ 69

Author(s):

Mehra Golshan ◽

Constance T. Cirrincione ◽

William M. Sikov ◽

Donald A. Berry ◽

Sara Jasinski ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Stage Ii

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Ten-Year Multi-Institutional Results of Breast-Conserving Surgery and Radiotherapy in BRCA1/2-Associated Stage I/II Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.7888 ◽

2006 ◽

Vol 24 (16) ◽

pp. 2437-2443 ◽

Cited By ~ 244

Author(s):

Lori J. Pierce ◽

Albert M. Levin ◽

Timothy R. Rebbeck ◽

Merav A. Ben-David ◽

Eitan Friedman ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Breast Conservation Surgery ◽

Breast Cancers ◽

Mutation Status ◽

High Risk Women ◽

Mutation Carriers ◽

Significant Difference

Purpose We compared the outcome of breast-conserving surgery and radiotherapy in BRCA1/2 mutation carriers with breast cancer versus that of matched sporadic controls. Methods A total of 160 BRCA1/2 mutation carriers with breast cancer were matched with 445 controls with sporadic breast cancer. Primary end points were rates of in-breast tumor recurrence (IBTR) and contralateral breast cancers (CBCs). Median follow-up was 7.9 years for mutation carriers and 6.7 years for controls. Results There was no significant difference in IBTR overall between carriers and controls; 10- and 15-year estimates were 12% and 24% for carriers and 9% and 17% for controls, respectively (hazard ratio [HR], 1.37; P = .19). Multivariate analyses for IBTR found BRCA1/2 mutation status to be an independent predictor of IBTR when carriers who had undergone oophorectomy were removed from analysis (HR, 1.99; P = .04); the incidence of IBTR in carriers who had undergone oophorectomy was not significantly different from that in sporadic controls (P = .37). CBCs were significantly greater in carriers versus controls, with 10- and 15-year estimates of 26% and 39% for carriers and 3% and 7% for controls, respectively (HR, 10.43; P < .0001). Tamoxifen use significantly reduced risk of CBCs in mutation carriers (HR, 0.31; P = .05). Conclusion IBTR risk at 10 years is similar in BRCA1/2 carriers treated with breast conservation surgery who undergo oophorectomy versus sporadic controls. As expected, CBCs are significantly increased in carriers. Although the incidence of CBCs was significantly reduced in mutation carriers who received tamoxifen, this rate remained significantly greater than in controls. Additional strategies are needed to reduce contralateral cancers in these high-risk women.

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Letrozole Is More Effective Neoadjuvant Endocrine Therapy Than Tamoxifen for ErbB-1– and/or ErbB-2–Positive, Estrogen Receptor–Positive Primary Breast Cancer: Evidence From a Phase III Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.18.3808 ◽

2001 ◽

Vol 19 (18) ◽

pp. 3808-3816 ◽

Cited By ~ 800

Author(s):

Matthew J. Ellis ◽

Andrew Coop ◽

Baljit Singh ◽

Louis Mauriac ◽

Antonio Llombert-Cussac ◽

...

Keyword(s):

Breast Cancer ◽

Tyrosine Kinases ◽

Primary Breast Cancer ◽

Breast Conservation ◽

Growth Factor Receptor ◽

Tamoxifen Resistance ◽

Breast Conserving Surgery ◽

Phase Iii ◽

Neoadjuvant Endocrine Therapy ◽

Double Blinded

PURPOSE: Expression of ErbB-1 and ErbB-2 (epidermal growth factor receptor and HER2/neu) in breast cancer may cause tamoxifen resistance, but not all studies concur. Additionally, the relationship between ErbB-1 and ErbB-2 expression and response to selective aromatase inhibitors is unknown. A neoadjuvant study for primary breast cancer that randomized treatment between letrozole and tamoxifen provided a context within which these issues could be addressed prospectively. PATIENTS AND METHODS: Postmenopausal patients with estrogen– and/or progesterone receptor–positive (ER+ and/or PgR+) primary breast cancer ineligible for breast-conserving surgery were randomly assigned to 4 months of neoadjuvant letrozole 2.5 mg daily or tamoxifen 20 mg daily in a double-blinded study. Immunohistochemistry (IHC) for ER and PgR was conducted on pretreatment biopsies and assessed by the Allred score. ErbB-1 and ErbB-2 IHC were assessed by intensity and completeness of membranous staining according to published criteria. RESULTS: For study biopsy-confirmed ER+ and/or PgR+ cases that received letrozole, 60% responded and 48% underwent successful breast-conserving surgery. The response to tamoxifen was inferior (41%, P = .004), and fewer patients underwent breast conservation (36%, P = .036). Differences in response rates between letrozole and tamoxifen were most marked for tumors that were positive for ErbB-1 and/or ErbB-2 and ER (88% v 21%, P = .0004). CONCLUSION: ER+, ErbB-1+, and/or ErbB-2+ primary breast cancer responded well to letrozole, but responses to tamoxifen were infrequent. This suggests that ErbB-1 and ErbB-2 signaling through ER is ligand-dependent and that the growth-promoting effects of these receptor tyrosine kinases on ER+ breast cancer can be inhibited by potent estrogen deprivation therapy.

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Review of Breast Conservation Therapy: Then and Now

ISRN Oncology ◽

10.5402/2011/617593 ◽

2011 ◽

Vol 2011 ◽

pp. 1-13 ◽

Cited By ~ 4

Author(s):

Susan Hoover ◽

Elizabeth Bloom ◽

Sunil Patel

Keyword(s):

Breast Cancer ◽

State Of The Art ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Breast Conserving Surgery ◽

Breast Irradiation ◽

Improved Outcomes ◽

Breast Preservation ◽

Hormonal Therapies ◽

Local Regional Recurrence

Breast conservation therapy (BCT), which is the marriage of breast conserving surgery and radiation therapy to the breast, has revolutionized the treatment of breast cancer over the last few decades. Surgical direction had seen a heightened interest in the performance of cosmetically superior partial and segmental resections in breast conservation as well as increased demand by patients for breast preservation. The broadening of approaches to delivery of breast irradiation from whole breast to accelerated partial breast has allowed more patients to opt for breast conservation and allowed for what appears to be comparable measurable outcomes in emerging data. As well, the addition of state-of-the-art chemotherapeutic and hormonal therapies has allowed improved outcomes of patients from both local regional recurrence and overall survival standpoints. This paper will provide an overview of BCT and review some of the newest developments in optimizing this therapy for patients with breast cancer from a surgical-, medical-, and radiation-oncology standpoint.

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Inequalities in breast-conserving surgery for female breast cancer in Świętokrzyskie Province, Poland

Polish Annals of Medicine ◽

10.29089/2020.20.00169 ◽

2021 ◽

Author(s):

Agnieszka Paszko ◽

Dominik Maślach ◽

Małgorzata Żendzian-Piotrowska ◽

Michalina Krzyżak

Keyword(s):

Breast Cancer ◽

Rural Women ◽

Rural Areas ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Female Breast Cancer ◽

Breast Conservation Surgery ◽

Disease Stage ◽

Age Group ◽

Breast Radiotherapy

Introduction: Breast cancer is the most common cancer among women in the world. Differences in the treatment of breast cancer may be observed by age, disease stage, place of residence and comorbid conditions. Aim: The aim of the study was to analyse the differences in the use of breast-conserving surgery among women in the Świętokrzyskie Province. Material and methods: The study included 483 female residents of Świętokrzyskie Province who were diagnosed with invasive breast cancer in 2013. Following indicators, recommended to evaluate the compliance with the best oncology practice, were calculated: a proportion of patients receiving post-operative breast radiotherapy after the breast-conserving surgery and a proportion of the breast-conservation surgery in pT1 cases. Results and discussion: The difference in the distribution of surgical procedures by age group (breast-conserving surgery vs. mastectomy) in pT1 cases was statistically significant (P = 0.006). The highest values of both indicators were observed in the age group recommended for breast cancer screening in Poland, while the lowest in women 70 years of age and older. Our study revealed a non-significantly higher proportion of patients receiving post-operative breast radiotherapy after breast conserving-surgery in urban than in rural women, amounting to 36.5% and 29.4%, respectively. Conclusions: Existing inequalities in the use of breast-conserving surgery indicate the need to consider the recommended breast cancer treatment to the highest possible proportion of patients residing in rural areas.

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Preoperative dose-dense sequential chemotherapy of epirubicin/cyclophosphamide followed by docetaxel/capecitabine in patients with early breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10598 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10598-10598

Author(s):

S. Iacobelli ◽

E. Cianchetti ◽

C. Ficorella ◽

D. Angelucci ◽

S. Grossi ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Preoperative Chemotherapy ◽

Pathologic Complete Response ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

High Rate ◽

Response To Treatment ◽

Sequential Chemotherapy ◽

Dose Dense

10598 Background: The use of preoperative chemotherapy for breast cancer has been shown to result in similar disease-free and overall survival as postoperative adjuvant chemotherapy. Additionally, the rate of pathologic complete response (pCR) in the breast after preoperative chemotherapy has been shown to correlate with survival. The objective of this study was to evaluate the activity and safety of a dose-dense and sequential chemotherapy of epirubicin/cyclophosphamide (EC) followed by docetaxel/capecitabine (DXe) given preoperatively in patients with early breast cancer not candidate to breast-conserving surgery. Methods: Forty-one women with histologically/cytologically confirmed primary breast cancer (T2–3, N0–2, M0) received 4 cycles of EC (cyclophosphamide, 600 mg/m2 and epirubicin, 90 mg/m2) q2 weeks followed by two cycles of DXe (docetaxel, 36 mg/m2 days 1, 8, and 15 and capecitabine, 1250 mg/m2 days 5–18) q 28 days, with pegfilgrastim support. The study was designed as a Simon’s two-step phase II study. The primary end point of the study was the incidence of pCR defined as the absence of invasive cancer in the breast at definitive surgery. Results: Thirty-nine out of 41 enrolled patients were evaluable for response to treatment (one patient withdrew from the study for G4 neutropenia after the first EC cycle, and the other for therapy refusal after the 4 EC cycles). A pCR was observed in 10 patients for a total pCR rate of 25.6%. Interestingly, all but one of the 10 pCR cases showed ER/PR-negative/Her2-positive tumors. A clinical response (CR or PR) detected by palpation and by imaging was observed in 37 patients, for an overall response rate of 95%. Twenty-nine patients (75%) underwent breast-conserving surgery. The treatment was well tolerated: one patient experienced G3 mucositis and another patient required a 25% dose reduction of capecitabine because of hand-foot syndrome. There was no case of cardiac toxicity, thrombocytopenia or any other serious adverse event. Conclusions: The dose-dense sequential combination EC/DXe is endowed with good antitumor activity and limited toxicity, allowing a high rate of pCR and breast conservation. Thus, this regimen can be considered for further clinical trial. No significant financial relationships to disclose.

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