Advantages of intraoperative digital specimen radiography (IDSR) in breast surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12613-e12613
Author(s):  
Lyudmila Zhukova ◽  
Nikita Maksimov ◽  
Gurami Kvetenadze ◽  
Evgeniy Shivilov ◽  
Khalil Arslanov ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Breast Conserving Surgery ◽  
Resection Margins ◽  
Positive Margins ◽  
Results Of Treatment ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

e12613 Background: Breast cancer is in first place among malignant diseases in women in Russia. We can provide, in most cases, breast-conserving surgery (BCS), due to progress in early diagnosis. Evaluation of positive margins is still one of the most important objectives in breast-conserving surgery. Objectives: To assess the benefits of IDSR in BCS of patients with “carcinoma in situ”. Methods: The results of treatment of 55 patients with breast cancer “carcinoma in situ” in our clinic were evaluated in two comparable groups. Group A included 28 patients, who were operated on from January 2019 to June 2019 and had breast-conserving surgery without IDSR. Group B included 27 patients, who were operated on from June 2019 to January 2020 and had breast-conserving surgery with the evaluation of margins by IDSR. Results: In a planned histological examination positive margins were detected in group A in 4 cases (14%) and required reoperation. In group B all margins were clear. After IDSR, 6 (22%) patients out of 27 in this group showed microcalcifications in the resection margins or at a distance of less than 1 mm and required intraoperative additional excision to obtain clean margins. Conclusions: IDSR reduces the frequency of reoperation due to increased detection of positive margins, allows to correct scope and duration of surgery because of impact on the time of the surgical decision-making process.

scholarly journals Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

2021 ◽  
Vol 186 (3) ◽  
pp. 617-624
Author(s):  
Kate R. Pawloski ◽  
Audree B. Tadros ◽  
Varadan Sevilimedu ◽  
Ashley Newman ◽  
Lori Gentile ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Advanced Disease ◽  
Breast Conserving Surgery ◽  
Risk Profile ◽  
High Grade ◽  
Group A ◽  
First Recurrence

Abstract Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.

scholarly journals Magnetic resonance imaging based 3-dimensional printed breast surgical guide for breast-conserving surgery in ductal carcinoma in situ: a clinical trial

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhen-Yu Wu ◽  
Aisha Alzuhair ◽  
Heejeong Kim ◽  
Jong Won Lee ◽  
Il Yong Chung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Resonance Imaging ◽  
Surgical Guide

Abstract Breast-conserving surgery (BCS) is performed in patients with ductal carcinoma in situ (DCIS) because of the small size of the tumor. It is essential to know the quantitative extent of the tumor before performing this precise partial resection surgery. A three-dimensional printed (3DP) breast surgical guide (BSG) was developed using information obtained from supine magnetic resonance imaging (MRI) and 3D printing technology and it was used for treating patients with breast cancer. Here, we report our experience with the application of the BSG for patients with DCIS. Patients with breast cancer who underwent BCS from July 2017 to February 2019 were included in this study. The patients underwent partial resection with a supine-MRI based 3DP-BSG. A total of 102 BCS using 3DP-BSG were conducted, and 11 cases were DCIS. The patients’ median age was 56 years (range, 38–69 years). The mean tumor diameter was 1.3 ± 0.9 cm. The median surgical time was 70 min (range, 40–88 min). All patients had tumor-free resection margins. The median distance from the tumor to the margin was 11 mm (range, 2–35 mm). Direct demarcation of the tumor extent in the breast and a pain-free procedure are the advantages of using 3DP-BSG in patients with DCIS. Trial registration: Clinical Research Information Service (CRIS) Identifier Number: KCT0002375, KCT0003043.

Indication of sentinel lymph node biopsy with breast-conserving surgery for ductal carcinoma in situ considering lymphatic flow.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 192-192
Author(s):  
Ayane Yamaguchi ◽  
Shigeru Tsuyuki ◽  
Miru Okamura ◽  
Yukiko Kawata ◽  
Kosuke Kawaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Outer Quadrant ◽  
Lymphatic Flow ◽  
Node Biopsy

192 Background: Ductal carcinoma in situ (DCIS) has been regarded as curable with resection, but axillary lymph node metastases have been reported in 2% of DCIS patients. Even when DCIS has been diagnosed by preoperative core needle biopsy (CNB), 8% to 38% of the patients have been found to have invasive ductal carcinoma (IDC) on the basis of pathological diagnosis after surgical treatment. The indication of sentinel lymph node biopsy (SLNB) and breast-conserving surgery (BCS) for DCIS is still controversial. Methods: SLNB is a standard surgical technique for early breast cancer treatment, and indocyanine green (ICG) fluorescence method is remarkable in terms of the visualization of lymphatic flow. We analyzed the variation in lymphatic drainage routes from the nipple to the SLN (sentinel lymphatic routes) by using the ICG florescence method in early breast cancer patients and investigated the effects on the localization of the tumor to the sentinel lymphatic routes after BCS. Results: From November 2010 to April 2012, we recorded the sentinel lymphatic routes in 118 patients. All the routes passed through the upper outer quadrant (UOQ) area, and there were more than 2 routes in 53 cases. Of these routes, 73% passed through only the UOQ area and 27% passed through the UOQ via the upper inner, lower inner, and/or lower outer quadrant area. Conclusions: We should confirm the sentinel lymphatic routes by using the ICG florescence method before BCS for preoperatively diagnosed DCIS. If the lymphatic routes do not pass over the extent of resection of BCS, we can omit SLNB in the first surgical treatment and await the final pathological result. However, we should perform SLNB in addition to BCS in cases in which the lymphatic routes pass over the tumor in the region except the UOQ area.

Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ (DCIS): Comparison of patients with and without index surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 519-519
Author(s):  
Marc D Ryser ◽  
Laura Hendrix ◽  
Samantha M. Thomas ◽  
Thomas Lynch ◽  
Anne McCarthy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Absolute Risk ◽  
Breast Conserving Surgery ◽  
Absolute Difference ◽  
Locoregional Treatment ◽  
Increased Risk

519 Background: Most women diagnosed with ductal carcinoma in situ (DCIS) undergo surgical resection, potentially leading to overtreatment of patients who would not develop clinically significant breast cancer in the absence of locoregional treatment. We compared the risk of ipsilateral invasive breast cancer (iIBC) between DCIS patients who received breast conserving surgery (BCS) for their index diagnosis of DCIS (BCS group) and patients who did not receive any locoregional treatment within 6 months of diagnosis (surveillance [SV] group). Methods: A treatment-stratified random sample of patients diagnosed with screen-detected and biopsy-confirmed DCIS in 2008-14 was selected from 1,330 Commission on Cancer-accredited facilities (20/site). Excluding patients who received a mastectomy ≤6 months, the final analytic cohort contained 14,245 (88.2%) BCS and 1,914 (11.8%) SV patients. Subsequent breast events were abstracted up to 10 years after diagnosis. Primary outcome was the 8-year absolute difference in iIBC risk between BCS and SV; a subgroup analysis was performed for grade I/II patients. A propensity score (PS) model for treatment was fitted with sampling design (SD) weighting and random effects for patients within facilities. Absolute risk differences were estimated using PS-SD-weighted Kaplan Meier estimators. Results: Overall, median age at diagnosis was 61 years (IQR: 52-69) and median follow-up was 5.8 years (95% CI 5.7-6.1). The majority of patients were Caucasian (81.9%), with estrogen receptor-positive (80.6%), and nuclear grade I/II (54.5%) DCIS. The fraction of patients with a Charlson comorbidity score of ≥2 was higher in SV (14.2%) compared to BCS (6.4%, p < 0.001). The 8-year risk of iIBC was 3.0% (95% CI: 2.4%-3.6%) for BCS and 7.7% (95% CI: 4.9%-10.5%) for SV, with an absolute risk difference of 4.7% (95% CI: 4.5%-4.9%; log-rank p < 0.001). Among patients with grade I/II tumors, the 8-year risk of iIBC was 3.1% (95% CI: 2.3%-4.0%) for BCS and 6.1% (95% CI: 2.5%-9.8%) for SV; difference: 3.0% (95% CI: 2.7%-3.2%; p = 0.005). Conclusions: Despite an increased risk of iIBC in SV patients compared to BCS patients, the 8-year risk did not exceed 10% in either group. The risk of recurrence in BCS patients was comparable to previously reported estimates. These data demonstrate a considerable degree of overtreatment among patients with non-high grade DCIS. Prospective clinical trials will help determine the tradeoffs between universally directed as opposed to selectively applied surgery for low risk DCIS.

scholarly journals R1 resection margin after organ-sparing/oncoplastic surgeries for breast cancer

2021 ◽  
Vol 17 (1) ◽  
pp. 12-19
Author(s):  
E.  A. Rasskazova ◽  
A.  D. Zikiryakhodzhaev ◽  
N.  N. Volchenko ◽  
Sh.  G. Khakimova
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Resection Margin ◽  
Invasive Cancer ◽  
Resection Margins ◽  
Histological Structure ◽  
R1 Resection ◽  
Repeated Surgery ◽  
Organ Sparing

The recurrence rate after organ-sparing surgeries for breast cancer depends on the resection margins: R1 status is associated with a higher risk of recurrence than R0.We analyzed a group of breast cancer patients with an R1 resection margin who underwent organ-sparing/oncoplastic surgeries. The R1 resection margin was detected in 62 out of 1279 patients who had organ-sparing/oncoplastic surgeries (4.9 % ± 0.6 %). In the group with invasive cancer and R1 resection margin, 80 % of patients were diagnosed with lobular carcinoma, whereas 14.8 % of patients had invasive cancer with no specific signs.We divided the group of repeated surgeries according to their histological structure at the resection margin: 28 patients were found to have carcinoma in situ, while 13 patients had invasive cancer.Among patients with carcinoma in situ, the resection margin after repeated surgery had no signs of malignancy in 14 women (50 %), while 10 (35.7 %) and 4 (14.3 %) women were diagnosed with carcinoma in situ and invasive cancer, respectively.In case of invasive cancer, 4 patients (30.8 %) had no signs of malignancy in their resection margins, while 1 (7.7 %) and 8 (61.5 %) patients were found to have carcinoma in situ and invasive cancer, respectivelyFollow-up of patients with an R1 resection margin after repeated surgery or radiotherapy revealed no cases of local recurrence between 3 and 65 months.

scholarly journals Efficacy of breast MRI for surgical decision in patients with breast cancer: ductal carcinoma in situ versus invasive ductal carcinoma

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jeeyeon Lee ◽  
Jin Hyang Jung ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Ryu Kyung Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Partial Mastectomy

Abstract Background Preoperative breast magnetic resonance imaging (MRI) provides more information than mammography and ultrasonography for determining the surgical plan for patients with breast cancer. This study aimed to determine whether breast MRI is more useful for patients with ductal carcinoma in situ (DCIS) lesions than for those with invasive ductal carcinoma (IDC). Methods A total of 1113 patients with breast cancer underwent mammography, ultrasonography, and additional breast MRI before surgery. The patients were divided into 2 groups: DCIS (n = 199) and IDC (n = 914), and their clinicopathological characteristics and oncological outcomes were compared. Breast surgery was classified as follows: conventional breast-conserving surgery (Group 1), partial mastectomy with volume displacement (Group 2), partial mastectomy with volume replacement (Group 3), and total mastectomy with or without reconstruction (Group 4). The initial surgical plan (based on routine mammography and ultrasonography) and final surgical plan (after additional breast MRI) were compared between the 2 groups. The change in surgical plan was defined as group shifting between the initial and final surgical plans. Results Changes (both increasing and decreasing) in surgical plans were more common in the DCIS group than in the IDC group (P <  0.001). These changes may be attributed to the increased extent of suspicious lesions on breast MRI, detection of additional daughter nodules, multifocality or multicentricity, and suspicious findings on mammography or ultrasonography but benign findings on breast MRI. Furthermore, the positive margin incidence in frozen biopsy was not different (P = 0.138). Conclusions Preoperative breast MRI may provide more information for determining the surgical plan for patients with DCIS than for those with IDC.

Impact of trastuzumab on the pathological complete response (pCR) rates in primary systemic therapy for breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11000-11000
Author(s):  
N. Mizuta ◽  
H. Nakajima ◽  
K. Sakaguchi ◽  
Y. Hachimine ◽  
I. Fujiwara
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Pathological Complete Response ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Primary Systemic Therapy ◽  
Group A ◽  
Group B

11000 Background: Various regimens of primary systemic therapy (PST) have been performed to patients with locally advanced breast cancer to decrease the size of the primary tumor and allow for effective local and distant control. In terms of pathological complete response (pCR) rate, however, satisfactory results were not obtained. Therefore, in this study, we have tried to determine whether the addition of trastuzumab on PST could increase pCR rate. Methods: Two prospective nonrandomized studies were performed that used different regimens as PST, followed by breast conserving surgery. Group-A ; Eighty-fore HER2-negative patients with operable breast cancer were assigned to 4 cycles of epirubicin and cyclophosphamide followed by 12 cycles of weekly paclitaxel. GroupB; Eighteen HER2-positive patients were assigned to 4 cycles of epirubicin and cyclophosphamide followed by 12 cycles of weekly paclitaxel and trastuzumab. Results: A total of 102 assessable patients were enrolled, and all the patients have completed the above 2 regimens of PST. Pathological complete response (pCR) rates were 12% in Group-A and 61.1% in Group-B, respectively. Following the PST, 75% of Group-A and all of Group-B patients were able to be subjected to breast conserving surgery. All the toxicities happened in both groups were well controlled in grade 1 or 2. Conclusion: These results indicate that both the PST regimens were safely performed in women with locally advanced breast cancer and allow breast conserving surgery in a high fraction of patients (90%). In addition, significantly high rates of pCR were obtained in patients with use of trastuzumab (p<0.01). No significant financial relationships to disclose.

scholarly journals Long-Term Outcomes of Sentinel Lymph Node Biopsy for Ductal Carcinoma in Situ

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Peiyin Hung ◽  
Shi-Yi Wang ◽  
Brigid K Killelea ◽  
Sarah S Mougalian ◽  
Suzanne B Evans ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Cancer Mortality ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Long Term Outcomes ◽  
Node Biopsy

Abstract The use of sentinel lymph node biopsy (SLNB) for ductal carcinoma in situ (DCIS) is controversial. Using population-cohort data, we examined whether SLNB improves long-term outcomes among patients with DCIS who underwent breast-conserving surgery. We identified 12 776 women aged 67–94 years diagnosed during 2001–2013 with DCIS who underwent breast-conserving surgery from the US Surveillance, Epidemiology, and End Results-Medicare dataset, 1992 (15.6%) of whom underwent SLNB (median follow-up: 69 months). Tests of statistical significance are two-sided. Patients with and without SLNB did not differ statistically significantly regarding treated recurrence (3.9% vs 3.7%; P = .62), ipsilateral invasive occurrence (1.4% vs 1.7%, P = .33), or breast cancer mortality (1.0% vs 0.9%, P = .86). With Mahalanobis-matching and competing-risks survival analyses, SLNB was not statistically significantly associated with treated recurrence, ipsilateral invasive occurrence, or breast cancer mortality (P ≥ .27). Our findings do not support the routine performance of SLNB for older patients with DCIS amenable to breast conservation.

scholarly journals Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma

2021 ◽  
Vol 15 ◽  
pp. 117822342199345
Author(s):  
Caroline Koopmansch ◽  
Jean-Christophe Noël ◽  
Calliope Maris ◽  
Philippe Simon ◽  
Marième Sy ◽  
...  
Keyword(s):  
Invasive Carcinoma ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Resection Margins ◽  
Margin Assessment ◽  
Positive Margins ◽  
Intraoperative Assessment ◽  
Intraoperative Margin Assessment

Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment ( P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment ( P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.

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