Repeated surgeries in invasive lobular breast cancer with preoperative MRI: Role of additional carcinoma in situ and background parenchymal enhancement

OBJECTIVES

Analysing the influence of additional carcinoma in situ (CIS) and background parenchymal enhancement (BPE) in preoperative MRI on repeated surgeries in patients with invasive lobular carcinoma (ILC) of the breast.

METHODS

Retrospective analysis of 106 patients (mean age 58.6±9.9years) with 108 ILC. Preoperative tumour size as assessed by MRI, mammography and sonography was recorded and compared to histopathology. In contrast-enhanced MRI, the degree of BPE was categorised by two readers. The influence of additionally detected CIS and BPE on the rate of repeated surgeries was analysed.

RESULTS

Additional CIS was present in 45.4% of the cases (49/108). The degree of BPE was minimal or mild in 80% of the cases and moderate or marked in 20% of the cases. In 17 cases (15.7%) at least one repeated surgery was performed. In n=15 of these cases, repeated surgery was performed after BCT (n=9 re-excisions, n=6 conversions to mastectomy), in n=2 cases after initial mastectomy. The initial surgical procedure (p=0.008) and additional CIS (p=0.046) significantly influenced the rate of repeated surgeries, while tumour size, patient age and BPE did not (p=ns).

CONCLUSIONS

Additional CIS was associated with a higher rate of repeated surgeries, whereas BPE had no influence.

Abstract P3-13-06: Development and validation of a nomogram predicting pathological axillary status (ypN0 vs. ypN+) in a subgroup of patients converting from cN+ to ycN0 through neoadjuvant therapy (NAT) – A transSENTINA substudy

Background: Particularly among patients converting from cN+ to ycN0 status through neoadjuvant therapy (NAT) the optimal method and extent of axillary staging is unclear. The aim of this analysis was to develop a nomogram predicting the probability of positive axillary status (ypN+) after PST among these patients based on clinical and pathological parameters.

Methods:Patients converting from cN+ to ycN0 due to PST included in a prospective study (SENTINA, Arm C) were included. Univariate and multivariate analyses were carried out to evaluate the association between 14 clinical/pathological parameters and pathological axillary status (ypN0 vs ypN+) using logistic regression models. Model accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed applying leave-one-out cross-validation (LOOCV) and ROC analyses. Different cut-points were evaluated. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA.).

Results: Arm C contained 553 patients, 369 patients were evaluable with respect to the above parameters. Univariate analyses revealed a significant association between pathological axillary status and ER status (odds ratio (OR) 4.05, 95% confidence interval (95%CI) 2.81-5.83), PR status (OR 3.07, 95%CI 2.16-4.36), multifocality (OR 2.37, 95%CI 1.57-3.58), lymphovascular invasion (OR 8.61, 95%CI 5.12-14.46), detection of a SLN after NAT (OR .56, 95%CI .36-.87), detection method (IHC vs routine: OR .46, 95%CI .27-.78; IHC vs serial HE: OR .72, 95%CI .49-1.07; serial hematoxylin eosin (HE) vs routine: OR .639, 95%CI .39-1.04), clinical tumor size (OR 1.051, 95%CI 1.03-1.07) and pCR-status in the breast (ypT0 and ypTis vs others, OR .11, 95%CI .08-.17). A multivariate model was fitted including significant clinical parameters. Stepwise backward variable selection was carried out resulting in a model including ER status (OR 3.81, 95%CI 2.25-6.44), multifocality (OR 2.22, 95%CI 1.26-3.92), LVI (OR 9.16, 95%CI 4.68-17.90), detection of a SLN after NAT (OR .50, 95%CI .26-.95) and clinical tumor size (OR 1.03, 95%CI 1.01-1.06). In LOOCV, this model demonstrated an accuracy of 73% (sensitivity 73%, specificity 72%, PPV 75%, NPV 70%) using .5 as cut-off. Based on the performed ROC analysis an area under the curve (AUC) of 0.81 was calculated.

Conclusion: A model using ER status, multifocality, LVI, detection of a SLN after NAT and clinical tumor size was built to predict pathological axillary status (ypN+) with a high accuracy. If successfully validated based upon an independent dataset, this nomogram could allow advising patients for / against axillary surgery in case of clinical axillary conversion after NAT.

Citation Format: Liedtke C, Kolberg H-C, Kerschke L, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Staebler A, von Minckwitz G, Loibl S, Untch M, Kuehn T. Development and validation of a nomogram predicting pathological axillary status (ypN0 vs. ypN+) in a subgroup of patients converting from cN+ to ycN0 through neoadjuvant therapy (NAT) – A transSENTINA substudy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-06.

CNS metastases in breast cancer patients: prognostic implications of tumor subtype

Development of brain metastases (BM) in breast cancer leads to limited survival. The therapeutical options are limited. There are less data about the risk factors and prognostic importance in BM. Objective is to investigate predictors of central nervous system metastases and outcome after diagnosis of BM according to tumor subtype. Based on medical records, 80 consecutive patients with primary non-metastatic operable breast cancer, treated at Department of Gynecology, University of Tübingen, and who developed BM during follow-up, were retrospectively analyzed. Clinicopathological parameters and their prognostic impact were evaluated. A node involvement (40 %), ER/PR negative (53.75 vs. 61.25 %), triple negative (28.75 %) and HER2+ status (40 %) were associated with BM. BM in breast cancer patients lead to a shortened survival. In cerebral metastatic breast cancer patients with HER2-negative and triple-negative, patients had significant shorter survival after detection of BM compared with HER2-positive and non-triple-negative patients (p = 0.001; p = 0.03). Risk of BM varies significantly by subtype. Understanding the biology of metastases can help categorize patients into prognostically useful categories and tailor treatment regimens for individual patients. Prospective clinical trials would be required for evaluating the potential role of screening for asymptomatic BM and of treatment of triple-negative patients.