Positive predictive factors for residual disease in re-excision specimens of early stage breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10604-10604 ◽  
Author(s):  
N. A. Haideri ◽  
J. Moormeier ◽  
N. Arora
Keyword(s):  
Breast Cancer ◽  
Residual Disease ◽  
Early Stage ◽  
Univariate Analysis ◽  
Early Stage Breast Cancer ◽  
Comprehensive Treatment ◽  
Extensive Intraductal Component ◽  
Positive Margins ◽  
Receptor Status ◽  
Intraductal Component

10604 Background: Breast conservation followed by radiation is the treatment in patients with Stage 0, 1, 2, breast cancer. Patients with positive, close or indeterminate margins on excisional biopsy typically undergo reexcision. Residual tumor is identified in 32% to 62% of reexcision specimens as reported in several studies. Such patients undergo subsequent surgery. This study analyzed the pathological specimens of patients undergoing reexcision, to identify characteristics that may predict residual disease. Methods: Patients with the AJCC Stage 0, 1, 2, were identified from Jan 95–Dec 02 with positive, close or indeterminate/unknown margins. All specimens were inked and patients undergoing reexcision were included. Pathological specimens with positive margins, undergoing reexcision were reviewed. Of the 211 patients studied, 159 were eligible. Age, stage, pathologic type, differentiation, microclacifications, extensive intraductal component, lymphovascular invasion, estrogen receptor status, progesterone receptor status, Her 2 neu, S phase and lymph node involvement were evaluated to predict residual disease. Univariate analysis was performed to evaluate the different variables independently. The P values obtained were 2 sided. Results: 131 (82.3%) specimens with positive margins underwent reexcision. Residual cancer was identified in 66 (41.5%) patients. Well differentiated tumors can be an independent predictor of residual disease based on the P value of 0.025 found in this study. Stage 2B, DCIS, microcalcifications and extensive intraductal component was frequent in re-excision specimens, but not significant. Conclusions: Incidence of residual carcinoma is significant in patients undergoing reexcision, making it difficult to identify a group with positive margins where a reexcision can be avoided. Therefore patients with positive margins should typically undergo reexcision, followed by radiation for comprehensive treatment of their early stage breast cancer. [Table: see text] No significant financial relationships to disclose.

Factors Affecting Choice of Treatment for Early-Stage Breast Cancer in West Virginia: A 10-Year Experience from a Rural Tertiary Care Center

2017 ◽  
Vol 83 (7) ◽  
pp. 709-716
Author(s):  
Patrick D. Suggs ◽  
Tyler L. Holliday ◽  
Stephanie N. Thompson ◽  
Bryan K. Richmond
Keyword(s):  
Breast Cancer ◽  
West Virginia ◽  
Early Stage ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Breast Conservation ◽  
Early Stage Breast Cancer ◽  
Treatment Modalities ◽  
Insurance Status ◽  
Care Hospital

Recent literature shows changing trends in use of breast conservation surgery (BCS), mastectomy, and contralateral prophylactic mastectomy (CPM) in women with early-stage breast cancer (ESBC). We analyzed factors associated with selection of these treatment modalities in a rural West Virginia tertiary care hospital. We conducted a 10-year analysis of women treated for ESBC at our institution from the institutional cancer registry. Variables were compared between patients choosing BCS versus mastectomy. In women who chose mastectomy, predictors for choice of CPM were also examined. Variables with P < 0.05 on univariate analysis were entered into a multivariate logistic regression model to define independent predictors of treatment choice. The mastectomy rate increased from 18.0 per cent in 2006 to 40.2 per cent in 2013. On multivariate analysis, insurance status (P < 0.001), comorbidities (P = 0.001), and surgeon graduation after 1987—a surrogate for surgeon age—(P = 0.010) predicted receipt of mastectomy. Of those receiving mastectomy, 106 (25.1%) elected CPM. CPM rates increased from 8.0 per cent in 2006 to 45.0 per cent in 2013. Younger age at diagnosis (P < 0.001) and use of preoperative MRI (P = 0.012) independently predicted use of CPM versus unilateral mastectomy. Rates of mastectomy and CPM in ESBC have increased in West Virginia over time. Independent predictors of selecting mastectomy over BCS included insurance status, surgeon age, and associated comorbidities. Younger patients and patients receiving preoperative MRI were more likely to choose CPM. Awareness of these factors will aid in counseling women with ESBC and allow clinicians to address potential biases or disparities that may affect treatment choices. Further prospective study of these findings is warranted.

scholarly journals Outcomes after Mastectomy and Lumpectomy in Octogenarians and Nonagenarians with Early-Stage Breast Cancer

2017 ◽  
Vol 83 (8) ◽  
pp. 887-894 ◽  
Author(s):  
Ameliay Merrill ◽  
Doris R. Brown ◽  
Heidi D. Klepin ◽  
Edward A. Levine ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Local Treatment ◽  
Breast Conservation ◽  
Early Stage Breast Cancer ◽  
Risk Of Death ◽  
Increased Risk

Prospective studies have shown equal outcomes after mastectomy or breast conservation in patients with invasive breast cancer; however, many of these studies excluded elderly patients. We identified patients in their eighties and nineties with clinical stage 0 to II breast cancer undergoing mastectomy or lumpectomy with or without radiation from the prospective sentinel lymph node database at Wake Forest Baptist Health and analyzed their treatment and survival. Of 92 patients, 24 (26.1%) underwent mastectomy, 22 (23.9%) lumpectomy with radiation, and 46 (50.0%) lumpectomy alone. Significant differences were noted in tumor size (P = 0.018), nodal status (P = 0.013), and stage (P = 0.011) between the groups. Only 7.6 per cent of patients had chemotherapy, whereas 51.1 per cent took antiestrogen therapy. Recurrence occurred in 11 patients. In univariate analysis, overall survival did not differ by surgery. Age was the only factor that increased risk of death (HR = 1.19, P = 0.028). In this age group, neither tumor factors nor the type of local treatment significantly influenced overall survival. Octogenarians and nonagenarians with early-stage breast cancer undergoing breast-conserving surgery with or without radiation have equivalent survival to patients having a mastectomy.

scholarly journals Outcome of Patients With Early-Stage Breast Cancer Treated With Doxorubicin-Based Adjuvant Chemotherapy As a Function ofHER2andTOP2AStatus

2009 ◽  
Vol 27 (24) ◽  
pp. 3881-3886 ◽  
Author(s):  
Raymond Tubbs ◽  
William E. Barlow ◽  
G. Thomas Budd ◽  
Eric Swain ◽  
Peggy Porter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Univariate Analysis ◽  
Menopausal Status ◽  
Disease Free Survival ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Her2 Amplification ◽  
Amplification Ratio

PurposeAmplification and deletion of the TOP2A gene have been reported as positive predictive markers of response to anthracycline-based therapy. We determined the status of the HER2 and TOP2A genes in a large cohort of breast cancer patients treated with adjuvant doxorubicin (A) and cyclophosphamide (C).Patients and MethodsTOP2A/CEP17 and HER2/CEP17 fluorescent in situ hybridization (FISH) were performed on tissue microarrays (TMAs) constructed from 2,123 of the 3,125 women with moderate-risk primary breast cancer who received equivalent doses of either concurrent adjuvant chemotherapy with A plus C (n = 1,592) or sequential A followed by C (n = 1,533).ResultsAn abnormal TOP2A genotype was identified for 153 (9.4%) of 1,626 patients (4.0% amplified; 5.4% deleted). An abnormal HER2 genotype was identified for 303 (20.4%) of 1,483 patients (18.8% amplified; 1.6% deleted). No significant differences in either overall survival (OS) or disease-free survival (DFS) were identified for TOP2A. In univariate analysis, OS and DFS rates were strongly and adversely associated only with higher levels of HER2 amplification (ratio ≥ 4.0). Survival was not associated with low-level HER2 amplification (ratio ≥ 2; OS hazard ratio [HR], 1.14; P = .39; DFS HR, 1.07; P = .62), but it was associated for a ratio ≥ 4 (OS HR, 1.45; P = .03; DFS HR, 1.38; P = .033), in which analysis was adjusted for menopausal status, hormone receptor status, treatment, number of positive nodes, and tumor size.ConclusionIn this population of patients with early-stage breast cancer who were treated with adjuvant AC chemotherapy, TOP2A abnormalities were not associated with outcome. HER2 high-level amplification was a prognostic marker in anthracycline-treated patients.

Association between US features of primary tumor and axillary lymph node metastasis in patients with clinical T1–T2N0 breast cancer

2017 ◽  
Vol 59 (4) ◽  
pp. 402-408 ◽  
Author(s):  
Min Sun Bae ◽  
Sung Ui Shin ◽  
Sung Eun Song ◽  
Han Suk Ryu ◽  
Wonshik Han ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Early Stage ◽  
Univariate Analysis ◽  
Nodal Metastasis ◽  
Early Stage Breast Cancer ◽  
Architectural Distortion ◽  
Axillary Lymph ◽  
Node Negative ◽  
The Us

Background Most patients with early-stage breast cancer have clinically negative lymph nodes (LNs). However, 15–20% of patients have axillary nodal metastasis based on the sentinel LN biopsy. Purpose To assess whether ultrasound (US) features of a primary tumor are associated with axillary LN metastasis in patients with clinical T1–T2N0 breast cancer. Material and Methods This retrospective study included 138 consecutive patients (median age = 51 years; age range = 27–78 years) who underwent breast surgery with axillary LN evaluation for clinically node-negative T1–T2 breast cancer. Three radiologists blinded to the axillary surgery results independently reviewed the US images. Tumor distance from the skin and distance from the nipple were determined based on the US report. Association between US features of a breast tumor and axillary LN metastasis was assessed using a multivariate logistic regression model after controlling for clinicopathologic variables. Results Of the 138 patients, 28 (20.3%) had nodal metastasis. At univariate analysis, tumor distance from the skin ( P = 0.019), tumor size on US ( P = 0.023), calcifications ( P = 0.036), architectural distortion ( P = 0.001), and lymphovascular invasion ( P = 0.049) were associated with axillary LN metastasis. At multivariate analysis, shorter skin-to-tumor distance (odds ratio [OR] = 4.15; 95% confidence interval [CI] = 1.01–16.19; P = 0.040) and masses with associated architectural distortion (OR = 3.80; 95% CI = 1.57–9.19; P = 0.003) were independent predictors of axillary LN metastasis. Conclusion US features of breast cancer can be promising factors associated with axillary LN metastasis in patients with clinically node-negative early-stage breast cancer.

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