Feasability of contrast-enhanced CT in breast conservation surgery for invasive and non-invasive breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12084-e12084
Author(s):  
Yoshihiko Kamada ◽  
Kentaro Tamaki ◽  
Kanou Uehara ◽  
Nobumitsu Tamaki
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Breast Conservation ◽  
Breast Conservation Surgery ◽  
Non Invasive ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Conservation Surgery ◽  
Average Observation

e12084 Background: MRI imaging has become the standard for planning breast conservation surgery for breast cancer. However, due partly to lack of resources of a small clinic practice, we have been utilizing contrast enhanced CT facilitated with ultrasound for this purpose. The aim of this presentation is to assess the feasability of contrast-enhanced CT in breast conservation surgery. Methods: We used GE Brightspeed-8 CT, with HP Z440 workstation (for free line masking). 100 mld of Iopamidol contrast medium was injected at a rate of 3 ml/sec and image capture was done at the 60 or 180 second phase. Images were taken with the patient in a supine position. We evaluate a total of 2057 cases operated in a ten year period between 2005.1.1 to 2014.12.31, excluding cases receiving preoperative chemotherapy. 1,757 cases (85%) were invasive and 300 cases (15%) were non-invasive breast cancer cases. Results: Lesion localization by contrast-enhance CT was acceptable by predefined criteria in 72% of invasive carcinoma cases, and 89% non-invasive carcinoma cases. The breast conservation rate was 77% and 83% for invasive and non-invasive breast cancer cases, respectively. Surgical margins were positive “on ink” for 8 cases (0.6%), and positive within 5 mm (including DCIS) in 340 cases (25.1%) of the 1,357 invasive cancer cases treated with BCT. There were 7 completion total mastectomies and 3 partial mastectomies for the patients with positive margins (11/340 = 3.2%). Surgical margins were positive for 78 cases (31.3%) of the 249 DCIS cases undergoing BCT. There was 1 completion mastectomy and 2 partial mastectomies for the patients with positive margins (3/78 = 3.8%). Local recurrence rates for invasive and non-invasive breast cancer cases undergoing BCT were 2.6% (average observation period 65.0 months) and 2.8% (average observation period 64.4 months), respectively. Conclusions: Contrast-enhanced CT facilitated with ultrasound imaging is an effective and easy to implement modality for planning breast conservation surgery in invasive and non-invasive breast cancer, possibly in part due to imaging that corresponds closely to the breast position during surgery.

scholarly journals Underuse of Radiation Therapy After Breast Conservation Surgery in Puerto Rico: A Puerto Rico Central Cancer Registry–Health Insurance Linkage Database Study

2018 ◽  
pp. 1-9
Author(s):  
William W. Chance ◽  
Karen J. Ortiz-Ortiz ◽  
Kai-Ping Liao ◽  
Diego E. Zavala Zegarra ◽  
Michael C. Stauder ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Puerto Rico ◽  
Radiation Therapy ◽  
Health Insurance ◽  
Invasive Breast Cancer ◽  
Breast Conservation ◽  
Breast Conservation Surgery ◽  
Conservation Surgery ◽  
To Receive ◽  
Central Cancer Registry

Purpose To identify rates of postoperative radiation therapy (RT) after breast conservation surgery (BCS) in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods The Puerto Rico Central Cancer Registry–Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤ .01) and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P < .01). In addition, it was found that RT was more likely to have been received in certain geographic locations, including the Metro-North (OR, 2.20; 95% CI, 1.48 to 3.28; P < .01), North (OR, 1.78; 95% CI, 1.20 to 2.64; P < .01), West (OR, 4.04; 95% CI, 2.61 to 6.25; P < .01), and Southwest (OR, 2.79; 95% CI, 1.70 to 4.59; P < .01). Furthermore, patients with tumor size > 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P = .02) and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P = .03) were found to be significantly less likely to receive RT. Conclusion Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients with Medicaid alone. There were geographic variations in the receipt of RT on the island.

scholarly journals Audit of local recurrence following breast conservation surgery with 5-mm target margin and hypofractionated 40-Gray breast radiotherapy for invasive breast cancer

2010 ◽  
Vol 92 (7) ◽  
pp. 562-568 ◽  
Author(s):  
Siong-Seng Liau ◽  
Massimiliano Cariati ◽  
David Noble ◽  
Charles Wilson ◽  
Gordon C Wishart
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Breast Conservation Surgery ◽  
Breast Cancer Specific Survival ◽  
Breast Radiotherapy ◽  
Cancer Specific Survival ◽  
Conservation Surgery

INTRODUCTION The risk of ipsilateral breast tumour recurrence (IBTR) following breast conservation surgery (BCS) for invasive breast cancer (IBC) and radiotherapy is dependent on patient-, tumour- and treatment-related variables. In the Cambridge Breast Unit, breast conserving surgery has been performed with a target radial margin of 5 mm for IBC, in combination with 40-Gy hypofractionated (15 fractions) breast radiotherapy, since 1999. PATIENTS AND METHODS An audit was performed of cases treated between 1999 and 2004. A total of 563 patients underwent BCS for invasive breast cancer with 90.4% receiving radiotherapy (RT) and 60.4% of patients receiving boost RT (3 fractions of 3-Gy). RESULTS After a median follow-up of 58 months, five of the 563 (0.9%) patients developed IBTR. The 5-year actuarial IBTR rate was 1.1%. In terms of distant disease recurrence (DDR), 29 of the 563 (5.2%) had DDR during follow-up, giving a 5-year actuarial DDR rate of 5.4%. The 5-year breast cancer specific survival was 95%, with the poorer NPI groups having worse breast cancer specific survival (Log-rank, P < 0.0001). More importantly, patients with IBTR had a shorter breast cancer-specific survival than those who were IBTR-free (Log-rank, P < 0.0001). CONCLUSIONS Our treatment regimen, combining BCS with a 5-mm target margin and hypofractionated 40-Gy RT, results in an extremely low rate of IBTR, and compares favourably with the target IBTR rate of < 5% defined by the Association of Breast Surgeons (ABS) at BASO guidelines.

scholarly journals CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
M J Wilkinson ◽  
H Snow ◽  
K Downey ◽  
K Thomas ◽  
A Riddell ◽  
...  
Keyword(s):  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Multivariable Analysis ◽  
Ct Scans ◽  
Non Invasive ◽  
Poor Predictor ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Node Metastases

Abstract Background Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement. Methods This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings. Results A total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node. Conclusion Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.

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