Breast Reconstruction With Postmastectomy Radiation: Choices and Tradeoffs

2017 ◽  
Vol 35 (22) ◽  
pp. 2467-2470 ◽  
Author(s):  
Matthew M. Poppe ◽  
Jayant P. Agarwal
Keyword(s):  
Computed Tomography ◽  
Lymph Nodes ◽  
Ductal Carcinoma ◽  
Treatment Plan ◽  
Multidisciplinary Treatment ◽  
Muscle Flap ◽  
Axillary Node ◽  
Axillary Lymph Nodes ◽  
Autologous Reconstruction ◽  
Axillary Lymph

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 45-year-old premenopausal woman presented with multifocal cancer in the right breast, with lesions at 1:00 and 4:00, the largest measuring approximately 3 cm on exam, and multiple palpable right axillary lymph nodes. A core biopsy confirmed invasive ductal carcinoma, grade 2 of 3, that was estrogen receptor positive, progesterone receptor positive, and HER2 negative. Fine needle aspiration of a right axillary node confirmed metastatic carcinoma. A positron emission tomography (PET)/ computed tomography done before starting chemotherapy demonstrated an absence of metastatic disease with expected avidity in two separate breast masses and multiple conglomerated 1-2 cm level I and II axillary lymph nodes. She received neoadjuvant chemotherapy with doxorubicin plus cyclophosphamide, followed by paclitaxel, and had a complete clinical response with resolution of the breast and axillary masses on exam. A repeat PET/computed tomography demonstrated reduced size of the breast and axillary disease, and no significant residual PET avidity. Her breast surgeon recommended a right mastectomy with axillary node dissection. As part of her multidisciplinary treatment plan, she consulted with two plastic surgeons to discuss reconstruction options. Plastic Surgeon A advised placement of an implant at the time of mastectomy while Surgeon B contrasted the pros and cons of an autologous transverse rectus abdominis muscle flap reconstruction with an implant based reconstruction. Surgeon B believed that autologous reconstruction would yield the best long-term cosmetic outcome. Before making her surgery decision, the patient consulted with a radiation oncologist to discuss the effect radiation may have on her reconstruction outcome.

scholarly journals Intra-mammary lymph nodes, an overlooked breast cancer prognostic tool?

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tarek Hashem ◽  
Ahmed Abdelmoez ◽  
Ahmed Mohamed Rozeka ◽  
Hazem Abdelazeem
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Ductal Carcinoma ◽  
Percutaneous Biopsy ◽  
Preoperative Imaging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Surgical Data

Abstract Background Due to the high variability of incidence and prevalence of intra-mammary lymph nodes (IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer might aid in proper therapeutic decision-making and could be of possible prognostic value. Methods Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013 and 2019. Radiological, pathological, and surgical data were studied. Results Intra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phyllodes tumors and two cases had ductal carcinoma in situ (DCIS). All ten cases were excluded. The remaining 90 cases all had invasive breast cancer and were divided into two groups: one group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumor size in pathology (4.7 cm), larger mean size of the IMLN in pathology (1.7 cm), higher incidence of lympho-vascular invasion (65.9%), and higher rate of extracapsular extension in axillary lymph nodes (57.4%). In addition, the pathological N stage was significantly higher in the malignant IMLN group. Conclusion Clinicians frequently overlook intra-mammary lymph nodes. More effort should be performed to detect them during preoperative imaging and during pathological processing of specimens. A suspicious IMLN should undergo a percutaneous biopsy. Malignant IMLNs are associated with advanced pathological features and should be removed during surgery.

scholarly journals Unusual Occurrence of Rare Lipid-Rich Carcinoma and Conventional Invasive Ductal Carcinoma in the One Breast: Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Katarina Machalekova ◽  
Karol Kajo ◽  
Marian Bencat
Keyword(s):  
Lymph Nodes ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma ◽  
Frozen Section ◽  
Histological Grade ◽  
Resection Margins ◽  
Axillary Lymph Nodes ◽  
Positive Staining ◽  
Axillary Lymph ◽  
Palpable Mass

A 56-year-old woman noticed a palpable mass in her left breast during self-examination. Patient was admitted to our hospital and malignant bifocal tumour was diagnosed by ultrasonography, digital mammography, magnetic resonance, and core-cut biopsy. The patient underwent planned conservative surgery (biquadrantectomy) with a sentinel node examination, but after results of the frozen section with positive resection margins and positive sentinel lymph nodes subsequent mastectomy with axillary lymph node dissection were realized. Histology in the resection specimen revealed two isolated and distinct tumours. One of the lesions represented conventional invasive ductal carcinoma of histological grade 3, and the second tumour was evaluated as invasive lipid-rich carcinoma, containing tumour cells with clear and foamy cytoplasm. Lipids in neoplastic cells were detected by Oil Red O staining and ultrastructural examination. Immunohistochemical analysis of both carcinomas was almost identical with negative steroid receptors, positive staining of HER-2, and p53 and with high proliferation activity (Ki-67). Mastectomy specimen contained residual foci of invasive ductal carcinoma and dissected axillary lymph nodes were free of metastasis. Patient underwent first cycles of chemotherapy with paclitaxel and Herceptin together with local radiotherapy and two month after surgery is without any evidence of the disease.

scholarly journals Multidetector Computed Tomography with Dedicated Protocol for Breast Cancer Locoregional Staging: Feasibility Study

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 479
Author(s):  
Vinicius C. Felipe ◽  
Luciana Graziano ◽  
Paula N. V. P. Barbosa ◽  
Vinicius F. Calsavara ◽  
Almir G. V. Bitencourt
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Lymph Nodes ◽  
Multidetector Computed Tomography ◽  
Cancer Patients ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Substantial Agreement ◽  
Locoregional Staging

Background: The aim of this study was to demonstrate the feasibility of performing multidetector computed tomography (MDCT) with a dedicated protocol for locoregional staging in breast cancer patients. Methods: This prospective single-center study included newly diagnosed breast cancer patients submitted to contrast-enhanced chest MDCT and breast magnetic resonance imaging (MRI). MDCT was performed in prone position and using subtraction techniques. Fleiss’ Kappa coefficient (K) and intraclass correlation coefficient (ICC) were used to assess agreement between MRI, MDCT, and pathology, when available. Results: Thirty-three patients were included (mean age: 47 years). Breast MRI and MDCT showed at least substantial agreement for evaluation of tumor extension (k = 0.674), presence of multifocality (k = 0.669), multicentricity (k = 0.857), nipple invasion (k = 1.000), skin invasion (k = 0.872), and suspicious level I axillary lymph nodes (k = 0.613). MDCT showed higher number of suspicious axillary lymph nodes than MRI, especially on levels II and III. Both methods had similar correlation with tumor size (MRI ICC: 0.807; p = 0.008 vs. MDCT ICC: 0.750; p = 0.020) and T staging (k = 0.699) on pathology. Conclusions: MDCT with dedicated breast protocol is feasible and showed substantial agreement with MRI features in stage II or III breast cancer patients. This method could potentially allow one-step locoregional and systemic staging, reducing costs and improving logistics for these patients.

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