Does failed mapping predict sentinel lymph node metastasis in cN0 breast cancer?

Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.

Mixed mucinous carcinoma of breast – A case report

In females breast carcinoma is the most common cancer worldwide. Globally, 2.3 million women were diagnosed and 685 000 deaths due to breast cancer were reported in year 2020. Even in the era of immunohistochemistry (IHC) and molecular studies, the aggressive nature of the breast cancer can be determined by its histological type, grade, nodal status, and metastasis. Mucinous carcinoma (MC) is a rare variant of invasive breast cancer accounting for 1-7%. It is represented by the presence of large extracellular mucin pools. Based on the mucin content two main subtypes are identified: Pure Mucinous Carcinoma (PMC) and Mixed Mucinous Carcinoma (MMC). Pure Mucinous Carcinoma (PMC) is localized in most of the cases, whereas the mixed forms tend to metastasize to lymph nodes. Hence the mixed forms often require an axillary dissection during surgery. We are presenting a case of 70 year old female who presented with the complaints of lump in the right breast since 2 months and on ultrasound work up a score of BIRADS V was given. She underwent right modified mastectomy with right axillary dissection and was diagnosed as mixed type of mucinous adenocarcinoma breast by histopathological examination. It was confirmed by IHC which showed positivity for ER, PR & Synaptophysin and negativity for Her2neu. Prognostically MC is better compared to other variants of invasive ductal carcinoma as they respond to hormone therapy.

EP.TH.879Does ‘fast -track’ axillary node clearance following positive core biopsy lead to overtreatment of axilla?

Aims Axillary node clearance (ANC) can cause lifelong disability and conservative axillary dissection is increasingly preferred. However, direct (fast-track) ANC after preoperative axillary biopsy is still performed, which may be overtreating the patients with low axillary burden. This study aims to identify if direct (fast- track) ANC leads to overtreatment of axilla. Methods Retrospective data for all breast cancer patients who underwent surgery between 1 January 2017 and 31 December 2018 were included in this study. The histopathology results of ANC were correlated with axillary ultrasound findings, axillary biopsy or SLNB results and effect of neoadjuvant treatment. These were analysed against the available guidelines to evaluate the current practice. Results 82 patients out of 520 had ANC (15.7%). Four groups were identified. 35.5% of patients diagnosed with nodal infiltration on preoperative biopsy (Group A) had only 1- 2 positive nodes following ANC. Complete pathological response was observed in 37.5% patients with nodal infiltration who had ANC following neoadjuvant chemotherapy (NACT) (Group B). No further nodes were subsequently found in 63.6% of patients who underwent ANC following positive SLNB (Group C). Group D included 2 patients with axillary recurrence. Conclusions 15.7% of breast cancer patients required ANC. The practice of direct (fast-track) ANC after axillary biopsy leads to overtreatment of the axilla, which needs re-evaluation. Targeted axillary dissection could avoid unnecessary axillary dissection in patients with abnormal nodes. This is now recommended in patients who have received NACT but has not been evaluated yet in patients with up front surgery.

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+CNB stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.

Subcutaneous Quadrantectomy Is A Safe Procedure in Management of Early Stage Breast Cancer.

Background: Surgical treatment of breast cancer, the most frequent cancer in women, is deeply changed in the last years turning towards a progressive minimally invasion, both in extend of demolition and in axillary dissection completeness. This is due to the flexibility of the concept of radicality that today is taylored on the patient, rather than on the disease; If oncologic radicality is preserved, a less invasive operation on the breast is mandatory. In the era of mini-invasive surgery, a patient may ask for an aesthetic care without any additional health risk.Methods: In this article, we compared two groups of 75 consecutive patients undergoing conservative surgery for early stage breast cancer; the two groups were randomized for standard quadrantectomy and totally subcutaneous quadrantectomy. Statistical analysis was carried out for comparing data.Results: No difference in oncologic outcome was found with the different surgical procedures; the length of hospital stay and the incidence of late breast deformities were significantly less in subcutaneous quadrantectomy group. Conclusions: We conclude that, in early breast cancer, a totally subcutaneous surgical procedure of resection is feasible and safe and ensures an absolutely better aesthetical result, that involves patient’s quality of life.