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Trigonal versus extratrigonal botulinum toxin-A: a systematic review and meta-analysis of efficacy and adverse events. Int Urogynecol J 2014; 26:313-9. [PMID: 25216630 DOI: 10.1007/s00192-014-2499-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Botulinum toxin-A (BoNT-A) is a potent neurotoxin that is an effective treatment for patients with pharmacologically refractory detrusor overactivity (DO). Data assessing the effectiveness of trigonal BoNT-A are limited. This study evaluates adverse events (AEs) and short-term efficacy associated with trigonal and extratrigonal BoNT-A. METHODS Electronic databases (PubMed, EMBASE, and the Cochrane database) were searched for studies comparing trigonal and extratrigonal BoNT-A for DO. Meta-analyses were performed using the random effects model. Outcome measures included incidence of AEs and short-term efficacy. RESULTS Six studies describing 258 patients met the inclusion criteria. The meta-analysis did not show significant differences between trigonal and extratrigonal BoNT-A for acute urinary retention (AUR; 4.2 vs 3.7 %; odds ratio [OR]: 1.068, 95 % confidence interval [CI]: 0.239-4.773; P = 0.931) or high post-void residual (PVR; 25.8 vs 22.2 %; OR: 0.979; 95 % CI: 0.459-2.088; P = 0.956). The incidence of urinary tract infection (UTI; 7.5 vs 21.0 %; OR: 0.670; 95 % CI: 0.312-1.439; P = 0.305), haematuria (15.8 vs 25.9 %; OR: 0.547; 95 % CI: 0.264-1.134; P = 0.105) and post-operative muscle weakness (9.2 vs 11.3 %; OR: 0.587; 95 % CI: 0.205-1.680, P = 0.320) was similar in both groups. Finally, differences in short-term cure rates between two study arms were not statistically significant (52.9 vs 56.9 %; OR: 1.438; 95 % CI: 0.448-4.610; P = 0.542). CONCLUSIONS Although data are limited, no significant differences between trigonal and extratrigonal BoNT-A in terms of AEs and short-term efficacy were observed. Additional randomised controlled trials are required to define optimal injection techniques and sites for administering intra-vesical BoNT-A.
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Landercasper J, Whitacre E, Degnim AC, Al-Hamadani M. Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol 2014; 21:3185-91. [PMID: 25047472 DOI: 10.1245/s10434-014-3905-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is marked variability of re-excision rates after initial lumpectomy for breast cancer. Reasons for re-excision and variability across surgeons have not been well documented. We hypothesized the American Society of Breast Surgeons (ASBrS) Mastery(SM) Program can identify reasons for re-excision. METHODS Data from January 1 to 7 November 2013 were evaluated in the ASBrS Mastery(SM) Program to determine re-excision lumpectomy rate (RELR). On 1 June 2013, a tool to track reasons for re-excision was developed. Variation in re-excision rate by surgeon and patient characteristics was performed by Chi square test and Fisher's test for univariate analysis, then logistic regression with backwards elimination method for multivariate analysis. RESULTS For 6,725 patients undergoing initial lumpectomy for cancer, 328 surgeons reported 1,451 (21.6 %) patients had one or more re-excisions. The most common reasons for re-excision were ink positive margins in 783 (49.7 %), margin <1 mm (34.3 %), and margin 1-2 mm (7.2 %). By multivariate analysis, re-excision rates were lower in patients aged less than 35 years, with White (non-) Hispanic ethnicity, and, among surgeons in solo practice, more years in practice and higher-volume practice. CONCLUSION Half of re-excisions after initial lumpectomy were performed for margins that are positive. Most of the remainder were for negative close (<1-2 mm) margins. This information corroborates surgeon survey data regarding reasons for re-excision and provides proof of concept the Mastery(SM) Program can capture surgical outcome data in real time, providing opportunity and a method for future performance improvement.
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Radiotherapy in DCIS, an underestimated benefit? Radiother Oncol 2014; 112:1-8. [DOI: 10.1016/j.radonc.2014.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/18/2014] [Accepted: 06/15/2014] [Indexed: 12/28/2022]
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104
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Heil J, Fuchs V, Golatta M, Schott S, Wallwiener M, Domschke C, Sinn P, Lux MP, Sohn C, Schütz F. Extent of primary breast cancer surgery: standards and individualized concepts. ACTA ACUST UNITED AC 2014; 7:364-9. [PMID: 24647774 DOI: 10.1159/000343976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
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Affiliation(s)
- Joerg Heil
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Valerie Fuchs
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Michael Golatta
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Sarah Schott
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | | | | | - Peter Sinn
- Institut für Pathologie, Universität Heidelberg, Germany
| | - Michael P Lux
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Germany
| | - Christof Sohn
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Florian Schütz
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
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105
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Influence of boost radiotherapy in patients with ductal carcinoma in situ breast cancer: a multicenter, retrospective study in Korea (KROG 11-04). Breast Cancer Res Treat 2014; 146:341-5. [PMID: 24939061 DOI: 10.1007/s10549-014-3025-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
To estimate the effect of boost radiotherapy on local recurrence-free survival (LRFS) in patients with ductal carcinoma in situ (DCIS) breast cancer. We included patients from nine institutions who met the following criteria: having Tis, age 18 years or older, having breast conserving surgery (BCS) and radiotherapy within 12 weeks after surgery. From 1995 through 2006, 728 patients were analyzed retrospectively by the Korean Radiation Oncology Group. All patients received whole-breast radiation therapy (WBRT) after BCS. 232 patients (31.9 %) also received boost radiation therapy (RT) (median 10 Gy). After median follow-up of 82 months, 5-year LRFS was 98.4 % and 10-year LRFS was 95.8 % for all patients. There was no statistically significant difference of LRFS between the boost and no-boost groups. Nineteen (2.6 %) patients had ipsilateral breast recurrences, including 12 of invasive recurrence and 7 DCIS. The presence of the HER2 receptor was associated with more invasive recurrences. Nine (1.2 %) patients developed contralateral breast cancer, including six invasive breast cancer and three DCIS. In the multivariate analysis, only the margin status was a significant prognostic factor for LRFS. Boost RT was not associated with further improvement of local control in DCIS after BCS and WBRT. HER2 receptor-positive patients may need further treatment with the anti-HER2 agents.
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106
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Kell MR. Breast cancer: from Halsted to Harney. Ir J Med Sci 2014; 184:77-80. [PMID: 24890450 DOI: 10.1007/s11845-014-1142-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/05/2014] [Indexed: 12/14/2022]
Abstract
The management of breast cancer has evolved in the last 40 years to now encompass not only treating the cancer in the most effective way, but also to detect and treat cancers before they can pose a risk to patients. This evolution in therapy and diagnostics has moved away from treating patients with the maximum amount of therapy they can tolerate towards a new paradigm where patents receive the minimum treatment to be most efficacious.
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Affiliation(s)
- Malcolm R Kell
- Breastcheck, Mater Misericordiae University Hospital, Dublin, Ireland,
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107
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Kantor O, Winchester DJ. Breast conserving therapy for DCIS-Does size matter? J Surg Oncol 2014; 110:75-81. [DOI: 10.1002/jso.23657] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/26/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Olga Kantor
- University of Chicago, Pritzker School of Medicine; Chicago Illinois
| | - David J. Winchester
- University of Chicago, Pritzker School of Medicine; Chicago Illinois
- NorthShore University HealthSystem; Evanston Illinois
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108
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Nederend J, Duijm LEM, Louwman MWJ, Roumen RMH, Jansen FH, Voogd AC. Trends in surgery for screen-detected and interval breast cancers in a national screening programme. Br J Surg 2014; 101:949-58. [DOI: 10.1002/bjs.9530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/12/2022]
Abstract
Abstract
Background
This population-based study aimed to evaluate trends in surgical approach for screen-detected cancer versus interval breast cancer, and to determine the factors associated with positive resection margins.
Methods
Screening mammograms of women aged 50–75 years, who underwent biennial screening in a Dutch breast-screening region between 1997 and 2011, were included. Patient and tumour characteristics were compared between women who underwent mastectomy or breast-conserving surgery (BCS) for screen-detected or interval cancer, and women with a negative or positive resection margin after BCS.
Results
Some 417 013 consecutive screening mammograms were included. A total of 2224 screen-detected and 825 interval cancers were diagnosed. The BCS rate remained stable (mean 6·1 per 1000 screened women; P = 0·099), whereas mastectomy rates increased significantly during the study from 0·9 (1997–1998) to 1·9 (2009–2010) per 1000 screened women (P < 0·001). The proportion of positive resection margins for invasive cancer was 19·6 and 7·6 per cent in 1997–1998 and 2009–2010 respectively (P < 0·001), with significant variation between hospitals. Dense breasts, preoperative magnetic resonance imaging, microcalcifications, architectural distortion, tumour size over 20 mm, axillary lymph node metastasis and treating hospital were independent risk factors for mastectomy. Interval cancer, image-guided tumour localization, microcalcifications, breast parenchyma asymmetry, tumour size greater than 20 mm, lobular tumour histology, low tumour grade, extensive invasive component and treating hospital were independent risk factors for positive resection margins.
Conclusion
Mastectomy rates doubled during a 14-year period of screening mammography and the proportion of positive resection margins decreased, with variation among hospitals. The latter observation stresses the importance of quality control programmes for hospitals treating women with breast cancer.
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Affiliation(s)
- J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - L E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M W J Louwman
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | - R M H Roumen
- Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands
| | - F H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
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109
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Tsang JYS, Tse GMK. Narrowing down the focus: what are the main predictive markers for ductal carcinoma in situ? BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Ductal carcinoma in situ accounts for approximately a quarter of newly diagnosed breast cancer nowadays. It is not life threatening per se, but confers an increased risk for subsequent invasive cancers. Optimal management should be based on the tumor characteristics and tailored to the risk of subsequent recurrence and invasive events. Prediction for recurrence risk has been determined mainly with clinical and histopathologic factors. However, they are imperfect, probably owing to the lack of standardized methods for assessment. Ongoing efforts have been shifted to the use of molecular factors, as well as prediction of noninvasive and invasive recurrences separately. These molecular factors seem to be more powerful in predicting invasive and noninvasive recurrence. However, their emerging roles still need to be validated.
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Affiliation(s)
- Julia YS Tsang
- Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary MK Tse
- Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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110
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Lim YJ, Kim K, Chie EK, Han W, Noh DY, Ha SW. Treatment outcome of ductal carcinoma in situ patients treated with postoperative radiation therapy. Radiat Oncol J 2014; 32:1-6. [PMID: 24724045 PMCID: PMC3977126 DOI: 10.3857/roj.2014.32.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/23/2013] [Accepted: 01/02/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). Materials and Methods We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. Results The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or ≥1 mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). Conclusion Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.
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Affiliation(s)
- Yu Jin Lim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung W Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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111
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Schnabel F, Boolbol SK, Gittleman M, Karni T, Tafra L, Feldman S, Police A, Friedman NB, Karlan S, Holmes D, Willey SC, Carmon M, Fernandez K, Akbari S, Harness J, Guerra L, Frazier T, Lane K, Simmons RM, Estabrook A, Allweis T. A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol 2014; 21:1589-95. [PMID: 24595800 PMCID: PMC3975090 DOI: 10.1245/s10434-014-3602-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Indexed: 12/17/2022]
Abstract
Background The presence of tumor cells at the margins of breast lumpectomy specimens is associated with an increased risk of ipsilateral tumor recurrence. Twenty to 30 % of patients undergoing breast-conserving surgery require second procedures to achieve negative margins. This study evaluated the adjunctive use of the MarginProbe device (Dune Medical Devices Ltd, Caesarea, Israel) in providing real-time intraoperative assessment of lumpectomy margins. Methods This multicenter randomized trial enrolled patients with nonpalpable breast malignancies. The study evaluated MarginProbe use in addition to standard intraoperative methods for margin assessment. After specimen removal and inspection, patients were randomized to device or control arms. In the device arm, MarginProbe was used to examine the main lumpectomy specimens and direct additional excision of positive margins. Intraoperative imaging was used in both arms; no intraoperative pathology assessment was permitted. Results
In total, 596 patients were enrolled. False-negative rates were 24.8 and 66.1 % and false-positive rates were 53.6 and 16.6 % in the device and control arms, respectively. All positive margins on positive main specimens were resected in 62 % (101 of 163) of cases in the device arm, versus 22 % (33 of 147) in the control arm (p < 0.001). A total of 19.8 % (59 of 298) of patients in the device arm underwent a reexcision procedure compared with 25.8 % (77 of 298) in the control arm (6 % absolute, 23 % relative reduction). The difference in tissue volume removed was not significant. Conclusions Adjunctive use of the MarginProbe device during breast-conserving surgery improved surgeons’ ability to identify and resect positive lumpectomy margins in the absence of intraoperative pathology assessment, reducing the number of patients requiring reexcision. MarginProbe may aid performance of breast-conserving surgery by reducing the burden of reexcision procedures for patients and the health care system.
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Affiliation(s)
- Freya Schnabel
- Department of Surgery, NYU Langone Medical Center, NYU Clinical Cancer Center, New York, NY, USA,
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Souchon R, Sautter-Bihl ML, Sedlmayer F, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Wenz F, Sauer R. DEGRO practical guidelines: radiotherapy of breast cancer II. Strahlenther Onkol 2013; 190:8-16. [DOI: 10.1007/s00066-013-0502-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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113
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Clancy C, Burke JP, Kalady MF, Coffey JC. BRAF mutation is associated with distinct clinicopathological characteristics in colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 2013; 15:e711-8. [PMID: 24112392 DOI: 10.1111/codi.12427] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/18/2013] [Indexed: 12/22/2022]
Abstract
AIM Colorectal cancer is a heterogeneous disease with multiple underlying genetic mutations resulting in different phenotypes. Mutation in the v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) proto-oncogene is an important event in the methylator pathway. There is no consensus, however, on the clinicopathological characteristics associated with BRAF mutation. METHOD A comprehensive search for published studies examining the effect of BRAF mutation on colorectal cancer was performed. Random effects methods were used to combine data. RESULTS Data were retrieved from 21 studies describing 9885 patients. BRAF associated colorectal cancer is associated with proximal tumour location (OR 5.222, 95% CI 3.801-7.174, P < 0.001), T4 tumours (OR 1.761, 95% CI 1.164-2.663, P = 0.007) and poor differentiation (OR 3.816, 95% CI 2.714-5.365, P < 0.001) and is negatively associated with male sex (OR 0.623, 95% CI 0.505-0.769, P < 0.001), age of diagnosis under 60 years (OR 0.453, 95% CI 0.280-0.733, P = 0.001) and rectal cancer (OR 0.266, 95% CI 0.122-0.422, P < 0.001). CONCLUSION BRAF mutation appears to be associated with distinct, unfavourable clinicopathological characteristics in colorectal cancer.
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Affiliation(s)
- C Clancy
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
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114
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Boxer M, Delaney G, Chua B. A review of the management of ductal carcinoma in situ following breast conserving surgery. Breast 2013; 22:1019-25. [DOI: 10.1016/j.breast.2013.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/13/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022] Open
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115
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Korb ML, Hartman YE, Kovar J, Zinn KR, Bland KI, Rosenthal EL. Use of monoclonal antibody-IRDye800CW bioconjugates in the resection of breast cancer. J Surg Res 2013; 188:119-28. [PMID: 24360117 DOI: 10.1016/j.jss.2013.11.1089] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Complete surgical resection of breast cancer is a powerful determinant of patient outcome, and failure to achieve negative margins results in reoperation in between 30% and 60% of patients. We hypothesize that repurposing Food and Drug Administration-approved antibodies as tumor-targeting diagnostic molecules can function as optical contrast agents to identify the boundaries of malignant tissue intraoperatively. MATERIALS AND METHODS The monoclonal antibodies bevacizumab, cetuximab, panitumumab, trastuzumab, and tocilizumab were covalently linked to a near-infrared fluorescence probe (IRDye800CW) and in vitro binding assays were performed to confirm ligand-specific binding. Nude mice bearing human breast cancer flank tumors were intravenously injected with the antibody-IRDye800 bioconjugates and imaged over time. Tumor resections were performed using the SPY and Pearl Impulse systems, and the presence or absence of tumor was confirmed by conventional and fluorescence histology. RESULTS Tumor was distinguishable from normal tissue using both SPY and Pearl systems, with both platforms being able to detect tumor as small as 0.5 mg. Serial surgical resections demonstrated that real-time fluorescence can differentiate subclinical segments of disease. Pathologic examination of samples by conventional and optical histology using the Odyssey scanner confirmed that the bioconjugates were specific for tumor cells and allowed accurate differentiation of malignant areas from normal tissue. CONCLUSIONS Human breast cancer tumors can be imaged in vivo with multiple optical imaging platforms using near-infrared fluorescently labeled antibodies. These data support additional preclinical investigations for improving the surgical resection of malignancies with the goal of eventual clinical translation.
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Affiliation(s)
- Melissa L Korb
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yolanda E Hartman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joy Kovar
- LI-COR Biosciences, Lincoln, Nebraska
| | - Kurt R Zinn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kirby I Bland
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eben L Rosenthal
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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116
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Does the volume of ductal carcinoma in situ impact the positive margin rate in patients undergoing breast conservation for invasive breast cancer? J Surg Res 2013; 184:228-33. [DOI: 10.1016/j.jss.2013.03.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/17/2013] [Accepted: 03/20/2013] [Indexed: 11/23/2022]
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117
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Adkisson CD, McLaughlin SA, Vallow LA, Heckman MG, Diehl NN, Bagaria SP, Howe N, Gibson T, Pockaj B. Is Postexcision, Preradiation Mammogram Necessary in Patients After Breast-Conserving Surgery with Negative Margins. Ann Surg Oncol 2013; 20:3205-11. [DOI: 10.1245/s10434-013-3148-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Indexed: 11/18/2022]
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118
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Schwartz T, Degnim AC, Landercasper J. Should Re-excision Lumpectomy Rates Be a Quality Measure in Breast-Conserving Surgery? Ann Surg Oncol 2013; 20:3180-3. [DOI: 10.1245/s10434-013-3206-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Indexed: 01/17/2023]
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119
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Predictors of recurrence for ductal carcinoma in situ after breast-conserving surgery. Lancet Oncol 2013; 14:e348-57. [DOI: 10.1016/s1470-2045(13)70135-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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120
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Bijker N, Donker M, Wesseling J, den Heeten GJ, Rutgers EJT. Is DCIS breast cancer, and how do I treat it? Curr Treat Options Oncol 2013; 14:75-87. [PMID: 23239193 DOI: 10.1007/s11864-012-0217-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ductal carcinoma in situ (DCIS) is a pre-invasive stage of breast cancer with a heterogeneous clinical behaviour. Since the introduction of mammographic screening programmes, the incidence of DCIS has shown a dramatic increase. Treatment should focus on the prevention of progression to invasive disease. If progression occurs, poorly differentiated DCIS frequently gives rise to grade III invasive breast cancer, whereas well differentiated DCIS more often recurs as grade I invasive disease. However, at present, validated diagnostic test are lacking to predict progression accurately. The majority of women with DCIS are suitable for breast conserving therapy. Obtaining clear surgical margins is the most important goal of a local excision. Radiotherapy is effective in reducing the risk of local recurrence with about 50 % in all subgroups of patients with DCIS. (Breast cancer specific) survival of women with DCIS is excellent, and radiotherapy does not further improve this. Future research should be directed in enabling to select women who have a high risk of--invasive--recurrence, so in which radiotherapy should be standard part of the breast conserving approach, and those women with a more indolent lesion, in which after surgery a watchful waiting approach can be followed.
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Affiliation(s)
- N Bijker
- Department of Radiation Oncology, Academic Medical Center, P.O. Box 22700, 1100DE, Amsterdam, The Netherlands.
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Pang JMB, Dobrovic A, Fox SB. DNA methylation in ductal carcinoma in situ of the breast. Breast Cancer Res 2013; 15:206. [PMID: 23826974 PMCID: PMC3707020 DOI: 10.1186/bcr3420] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) is a non-obligate precursor lesion of invasive carcinoma of the breast. Current prognostic markers based on histopathological examination are unable to accurately predict which DCIS cases will progress to invasive carcinoma or recur after surgical excision. Epigenetic changes have been shown to be a significant driver of tumorigenesis, and DNA methylation of specific gene promoters provides predictive and prognostic markers in many types of cancer, including invasive breast cancer. In general, the spectrum of genes that are methylated in DCIS strongly resembles that seen in invasive ductal carcinoma. The identification of specific prognostic markers in DCIS remains elusive and awaits additional work investigating a large panel of methylatable genes by using sensitive and reproducible technologies. This review critically appraises the role of methylation in DCIS and its use as a biomarker.
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Mammakarzinom: aktuelle Empfehlungen für Pathologen auf Basis der S3-Leitlinie. DER PATHOLOGE 2013; 34:293-302; quiz 303-4. [DOI: 10.1007/s00292-013-1763-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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123
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Kreienberg R, Albert US, Follmann M, Kopp IB, Kühn T, Wöckel A. Interdisciplinary GoR level III Guidelines for the Diagnosis, Therapy and Follow-up Care of Breast Cancer: Short version - AWMF Registry No.: 032-045OL AWMF-Register-Nummer: 032-045OL - Kurzversion 3.0, Juli 2012. Geburtshilfe Frauenheilkd 2013; 73:556-583. [PMID: 24771925 PMCID: PMC3963234 DOI: 10.1055/s-0032-1328689] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - U.-S. Albert
- Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik
für Gynäkologie, Gynäkologische Endokrinologie und Onkologie,
Marburg
| | - M. Follmann
- Deutsche Krebsgesellschaft e. V., Bereich Leitlinien,
Berlin
| | - I. B. Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, c/o
Philipps-Universität, Marburg
| | - T. Kühn
- Klinikum Esslingen, Klinik für Frauenheilkunde und Geburtshilfe,
Esslingen
| | - A. Wöckel
- Universitätsklinikum Ulm, Klinik für Frauenheilkunde und Geburtshilfe,
Ulm
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124
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Cutuli B, Lemanski C, Le Blanc-Onfroy M, de Lafontan B, Cohen-Solal-Le-Nir C, Fondrinier É, Mignotte H, Giard S, Charra-Brunaud C, Auvray H, Gonzague-Casabianca L, Quétin P, Fay R. Local recurrence after ductal carcinoma in situ breast conserving treatment. Analysis of 195 cases. Cancer Radiother 2013; 17:196-201. [DOI: 10.1016/j.canrad.2013.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 11/20/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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125
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Clancy C, Burke JP, Coffey JC. KRAS mutation does not predict the efficacy of neo-adjuvant chemoradiotherapy in rectal cancer: A systematic review and meta-analysis. Surg Oncol 2013; 22:105-11. [DOI: 10.1016/j.suronc.2013.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/30/2013] [Accepted: 02/03/2013] [Indexed: 01/12/2023]
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Grobmyer SR, Cowher MS, Crowe JP. Optimizing clinical management of surgical margins in breast-conserving therapy for breast cancer. Am Soc Clin Oncol Educ Book 2013:66-71. [PMID: 23714459 DOI: 10.14694/edbook_am.2013.33.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There has been, and continues to be, significant controversy over the definition of an "optimal" surgical margin in breast-conserving therapy (BCT). The historic basis of this controversy stems from the original trials documenting the safety of BCT and many conflicting retrospective studies that have sought to define the association between surgical margin width and outcomes over the last 20 years. It is important to understand that margin assessment is an inexact science, and current laboratory approaches to surgical-margin assessment represent only a sampling of the surgical margin. Currently available evidence suggests that decisions regarding surgical margins in BCT should be made in the context of what is known about the biology of breast cancer, as well the interactions of tumor biology, adjuvant treatment for breast cancer, and outcomes. Achieving consensus on management of surgical margins in BCT should be a clinical priority as it offers the opportunity to reduce the burden of breast cancer treatment on patients without compromising cancer-related outcomes.
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127
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Bayraktar S, Arun B, Glück S. Ductal carcinoma in situ: how should we treat it? BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The observed incidence of ductal carcinoma in situ (DCIS) has increased because of the increasing use of sensitive imaging modalities. While the clinical course of DCIS is quite variable, it is considered a precursor lesion to invasive breast cancer. The current focus of DCIS treatment is on the prevention of progression to invasive disease. However, at present, validated diagnostic tests to predict progression accurately are lacking. Additionally, important clinical questions arise during DCIS management. For example, optimal margins of excision or axillary lymph node sampling have not been addressed in randomized clinical trials. May whole-breast radiation after lumpectomy be omitted in selected patients? What is the role of adjuvant tamoxifen if it does not impact overall survival rates? This review aims to describe the natural history of DCIS and highlights the current therapeutic options and challenges in patient management.
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Affiliation(s)
- Soley Bayraktar
- Department of Medical Oncology, Mercy Cancer Center, Ardmore, OK, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan Glück
- Department of Medicine, Division of Hematology/Medical Oncology, University of Miami & Sylvester Comprehensive Cancer Center, Miami, FL, USA
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128
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Reprise chirurgicale des carcinomes canalaires in situ pour exérèse non in sano : existe-t-il des facteurs de risque ? ACTA ACUST UNITED AC 2013; 41:228-34. [DOI: 10.1016/j.gyobfe.2013.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 02/21/2013] [Indexed: 11/20/2022]
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The effect of NOD2 polymorphism on postsurgical recurrence in Crohn's disease: a systematic review and meta-analysis of available literature. Inflamm Bowel Dis 2013; 19:1099-105. [PMID: 23493074 DOI: 10.1097/mib.0b013e3182813391] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Up to 70% of patients requiring surgery for Crohn's disease (CD) develop recurrence within 10 years. Unequivocal markers predicting recurrence are needed to tailor postoperative therapy appropriately. NOD2 (nucleotide-binding oligomerization domain 2) polymorphisms increase the risk of developing CD; however, their ability to predict recurrence is uncertain. This study aims to determine the association between NOD2 variants and surgical recurrence after initial disease-modifying surgery. METHODS A comprehensive search for published series comparing the effect of NOD2 polymorphisms on postoperative surgical recurrence in patients with CD was performed. Random-effects methods were used to combine data. RESULTS Six cohort studies comprising 1003 patients with CD were included. A total of 340 patients (33.9%) expressed at least 1 of the 3 common NOD2 polymorphisms. The 1003 patients underwent surgical resection with 335 (33%) developing surgical recurrence. Of 340 NOD2-expressing patients, 130 (39%) required further resection, whereas 202 of 663 patients (30.5%) without the variant underwent repeat resection. NOD2 was not significantly associated with surgical recurrence (odds ratio: 1.58, 95% confidence interval: 0.97-2.57, P = 0.064), most likely because of study heterogeneity (Cochran Q: 12.36, P = 0.030, I: 59.6%). The sensitivity of any mutation in predicting disease recurrence was 39.7% and specificity was 69%, with the area under the receiver operating characteristic curve being 0.64. CONCLUSIONS Patients with CD with a NOD2 polymorphism do not have an increased risk of surgical recurrence compared with patients without the variant. These data provide insufficient evidence to support postoperative medical prophylaxis based solely on the presence of NOD2 polymorphism.
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130
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Morrow M, Winograd JM, Freer PE, Eichhorn JH. Case records of the Massachusetts General Hospital. Case 8-2013. A 48-year-old woman with carcinoma in situ of the breast. N Engl J Med 2013; 368:1046-53. [PMID: 23484832 DOI: 10.1056/nejmcpc1214221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
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131
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Chang KH, Burke JP, Coffey JC. Infliximab versus cyclosporine as rescue therapy in acute severe steroid-refractory ulcerative colitis: a systematic review and meta-analysis. Int J Colorectal Dis 2013; 28:287-93. [PMID: 23114475 DOI: 10.1007/s00384-012-1602-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Acute severe colitis affects 25 % of patients with ulcerative colitis (UC). Up to 30-40 % of these patients are resistant to intensive steroid therapy and therefore require rescue therapy to prevent emergent colectomy. Data comparing rescue therapy using infliximab and cyclosporine are limited and equivocal. This study evaluates the outcomes of UC patients receiving infliximab or cyclosporine as rescue therapy in acute severe steroid-refractory exacerbations. METHODS Electronic databases (PubMed, EMBASE, and Cochrane database) were searched for studies directly comparing infliximab and cyclosporine in UC, and references of included studies were screened. Two independent reviewers identified relevant studies and extracted data. Meta-analyses were performed using the random effect model. Outcome measures included 3- and 12-month colectomy rates, adverse drug reactions, and postoperative complications. RESULTS Six retrospective cohort studies describing 321 patients met the inclusion criteria. The meta-analysis did not show significant differences between infliximab and cyclosporine in the 3-month colectomy rate (odds ratio (OR) = 0.86, 95 % confidence interval (CI) = 0.31-2.41, p = 0.775), in the 12-month colectomy rate (OR = 0.60, 95 % CI = 0.19-1.89, p = 0.381), in adverse drug reactions (OR = 0.76, 95 % CI = 0.34-1.70, p = 0.508), and in postoperative complications (OR = 1.66, 95 % CI = 0.26-10.50, p = 0.591). Funnel plot revealed no publication bias. CONCLUSIONS Infliximab and cyclosporine are comparable when used as rescue therapy in acute severe steroid-refractory UC. Randomized trials are required to further evaluate these agents.
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Affiliation(s)
- Kah Hoong Chang
- Department of Colorectal Surgery, Limerick University Hospital, Dooradoyle, Limerick, Ireland
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132
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Chen SA, Schuster DM, Mister D, Liu T, Godette K, Torres MA. Radiation Field Design and Patterns of Locoregional Recurrence Following Definitive Radiotherapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2013; 85:309-14. [DOI: 10.1016/j.ijrobp.2012.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/01/2012] [Accepted: 06/06/2012] [Indexed: 10/27/2022]
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133
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Hassani A, Griffith C, Harvey J. Size does matter: High volume breast surgeons accept smaller excision margins for wide local excision--a national survey of the surgical management of wide local excision margins in UK breast cancer patients. Breast 2013; 22:718-22. [PMID: 23313329 DOI: 10.1016/j.breast.2012.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/19/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Optimal margins for wide local excision (WLE) have not been clearly established. Larger margins lead to lower recurrence rates but at the expense of cosmetic appearance. NICE guidelines recommend a 2 mm margin for ductal carcinoma in-situ (DCIS), whilst the British Association of Surgical Oncology (BASO) recommend units develop local guidelines. There are presently no specific guidelines for invasive cancer. We surveyed members of the Association of Breast Surgeons (ABS) in order to establish current practice nationally. We hypothesised that larger units may accept narrower excision margins to the benefit of better cosmesis. MATERIALS AND METHODS A postal questionnaire was sent to all ABS members in October 2010. This consisted of questions about the current practice of the surgeon and their unit. 481 questionnaires were posted in total, all questionnaires returned by April 2011 were analysed. RESULTS Questionnaire response rate was 60% (281). Surgeons operating on over 50 cancers per year accepted smaller margins than those operating on less than 50 (p < 0.02). Acceptable adequate anterior and radial margins ranged from 0 to 10 mm for DCIS and 0 to 5 mm for invasive cancer. A variety of approaches to re-excising anterior margins were reported. CONCLUSIONS This survey suggests that substantial variations exist in current practice with regard to the approach to WLE. Operator workload appears to influence what is deemed to be an acceptable margin. There is a need for standardised national and international guidelines.
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Affiliation(s)
- Adam Hassani
- Department of Breast Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, United Kingdom.
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134
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Assessing breast cancer margins ex vivo using aqueous quantum-dot-molecular probes. Int J Surg Oncol 2012; 2012:861257. [PMID: 23320158 PMCID: PMC3540809 DOI: 10.1155/2012/861257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/16/2012] [Accepted: 11/26/2012] [Indexed: 11/28/2022] Open
Abstract
Positive margins have been a critical issue that hinders the success of breast- conserving surgery. The incidence of positive margins is estimated to range from 20% to as high as 60%. Currently, there is no effective intraoperative method for margin assessment. It would be desirable if there is a rapid and reliable breast cancer margin assessment tool in the operating room so that further surgery can be continued if necessary to reduce re-excision rate. In this study, we seek to develop a sensitive and specific molecular probe to help surgeons assess if the surgical margin is clean. The molecular probe consists of the unique aqueous quantum dots developed in our laboratory conjugated with antibodies specific to breast cancer markers such as Tn-antigen. Excised tumors from tumor-bearing nude mice were used to demonstrate the method. AQD-Tn mAb probe proved to be sensitive and specific to identify cancer area quantitatively without being affected by the heterogeneity of the tissue. The integrity of the surgical specimen was not affected by the AQD treatment. Furthermore, AQD-Tn mAb method could determine margin status within 30 minutes of tumor excision, indicating its potential as an accurate intraoperative margin assessment method.
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135
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Nguyen BT, Deb S, Fox S, Hill P, Collins M, Chua BH. A Prospective Pathologic Study to Define the Clinical Target Volume for Partial Breast Radiation Therapy in Women With Early Breast Cancer. Int J Radiat Oncol Biol Phys 2012; 84:1116-22. [DOI: 10.1016/j.ijrobp.2012.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/24/2022]
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Abstract
PURPOSE To examine, in a large, population-based cohort of women, the risk factors for recurrence after mastectomy for pure ductal carcinoma in situ (DCIS) and to identify which patients may benefit from postmastectomy radiation therapy. METHODS AND MATERIALS Data were analyzed for 637 subjects with pure DCIS, diagnosed between January 1990 and December 1999, treated initially with mastectomy. Locoregional relapse (LRR), breast cancer-specific survival, and overall survival were described using the Kaplan-Meier method. Reported risk factors for LRR (age, margins, size, Van Nuys Prognostic Index, grade, necrosis, and histologic subtype) were analyzed by univariate (log-rank) and multivariate (Cox modeling) methods. RESULTS Median follow-up was 12.0 years. Characteristics of the cohort were median age 55 years, 8.6% aged ≤ 40 years, 30.5% tumors >4 cm, 42.5% grade 3 histology, 37.7% multifocal disease, and 4.9% positive margins. At 10 years, LRR was 1.0%, breast cancer-specific survival was 98.0%, and overall survival was 90.3%. All recurrences (n=12) involved ipsilateral chest wall disease, with the majority being invasive disease (11 of 12). None of the 12 patients with recurrence died of breast cancer; all were successfully salvaged (median follow-up of 4.4 years). Ten-year LRR was higher with age ≤ 40 years (7.5% vs 1.5%; P=.003). CONCLUSION Mastectomy provides excellent locoregional control for DCIS. Routine use of postmastectomy radiation therapy is not justified. Young age (≤40 years) predicts slightly higher LRR, but possibly owing to the small number of cases with multiple risk factors for relapse, a subgroup with a high risk of LRR (ie, approximately 15%) was not identified.
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137
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Ruidíaz ME, Blair SL, Kummel AC, Wang-Rodriguez J. Computerized decision support system for intraoperative analysis of margin status in breast conservation therapy. ISRN SURGERY 2012; 2012:546721. [PMID: 23213570 PMCID: PMC3505663 DOI: 10.5402/2012/546721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/08/2012] [Indexed: 11/23/2022]
Abstract
Background. Breast conservation therapy (BCT) is the standard treatment for breast cancer; however, 32–63% of procedures have a positive margin leading to secondary procedures. The standard of care to evaluate surgical margins is based on permanent section. Imprint cytology (IC) has been used to evaluate surgical samples but is limited by excessive cauterization thus requiring experienced cytopathologist for interpretation. An automated image screening process has been developed to detect cancerous cells from IC on cauterized margins. Methods. IC was prospectively performed on margins during lumpectomy operations for breast cancer in addition to permanent section on 127 patients. An 8-slide training subset and 8-slide testing subset were culled. H&E IC automated analysis, based on linear discriminant analysis, was compared to manual pathologist interpretation. Results. The most important descriptors, from highest to lowest performance, are nucleus color (23%), cytoplasm color (15%), shape (12%), grey intensity (9%), and local area (5%). There was 100% agreement between automated and manual interpretation of IC slides. Conclusion. Although limited by IC sampling variability, an automated system for accurate IC cancer cell identification system is demonstrated, with high correlation to manual analysis, even in the face of cauterization effects which supplement permanent section analysis.
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Affiliation(s)
- Manuel E Ruidíaz
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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138
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Rua C, Lebas P, Michenet P, Ouldamer L. Evaluation of lumpectomy surgical specimen radiographs in subclinical, in situ and invasive breast cancer, and factors predicting positive margins. Diagn Interv Imaging 2012; 93:871-7. [PMID: 23021868 DOI: 10.1016/j.diii.2012.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the diagnostic performance of radiological evaluation of the margins of surgical specimens from lumpectomies for subclinical malignant breast lesions. MATERIALS AND METHODS Retrospective study in two French hospitals including all patients who had a non-palpable in situ (ISDC) or invasive (IDC) ductal carcinoma treated by lumpectomy after radiological localisation. For the analysis, the lesions were divided into two groups depending on the majority component in the definitive histological examination: ISDC or IDC. The radiological margin considered was 10mm. RESULTS For the 178 lumpectomies studied, the sensitivity of the radiographs of the surgical specimen was 33.3% for ISDC and 50% for IDC. The surgical revision rate was 27.41% for ISDC and 12.64% for IDC. The significant predictive factors for positive margins were the radiological size of the lesions (>10mm) for ISDC (P=0.02) and radiologically positive margins for IDC (P=0.01). Correlation was found between the histological and radiological sizes of the lesion for IDC, but not for ISDC. CONCLUSION Radiological examination of surgical specimens does not provide a satisfactory evaluation of the histological margins, in particular for ISDC, even with a radiological threshold of 10mm.
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Affiliation(s)
- C Rua
- Gynaecology Department, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnelé, Tours cedex, France.
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139
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Childs SK, Chen YH, Duggan MM, Golshan M, Pochebit S, Punglia RS, Wong JS, Bellon JR. Impact of margin status on local recurrence after mastectomy for ductal carcinoma in situ. Int J Radiat Oncol Biol Phys 2012; 85:948-52. [PMID: 22975615 DOI: 10.1016/j.ijrobp.2012.07.2377] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/25/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the rate of local recurrence according to the margin status for patients with pure ductal carcinoma in situ (DCIS) treated by mastectomy. METHODS AND MATERIALS One hundred forty-five consecutive women who underwent mastectomy with or without radiation therapy for DCIS from 1998 to 2005 were included in this retrospective analysis. Only patients with pure DCIS were eligible; patients with microinvasion were excluded. The primary endpoint was local recurrence, defined as recurrence on the chest wall; regional and distant recurrences were secondary endpoints. Outcomes were analyzed according to margin status (positive, close (≤2 mm), or negative), location of the closest margin (superficial, deep, or both), nuclear grade, necrosis, receptor status, type of mastectomy, and receipt of hormonal therapy. RESULTS The primary cohort consisted of 142 patients who did not receive postmastectomy radiation therapy (PMRT). For those patients, the median follow-up time was 7.6 years (range, 0.6-13.0 years). Twenty-one patients (15%) had a positive margin, and 23 patients (16%) had a close (≤2 mm) margin. The deep margin was close in 14 patients and positive in 6 patients. The superficial margin was close in 13 patients and positive in 19 patients. One patient experienced an isolated invasive chest wall recurrence, and 1 patient had simultaneous chest wall, regional nodal, and distant metastases. The crude rates of chest wall recurrence were 2/142 (1.4%) for all patients, 1/21 (4.8%) for those with positive margins, 1/23 (4.3%) for those with close margins, and 0/98 for patients with negative margins. PMRT was given as part of the initial treatment to 3 patients, 1 of whom had an isolated chest wall recurrence. CONCLUSIONS Mastectomy for pure DCIS resulted in a low rate of local or distant recurrences. Even with positive or close mastectomy margins, the rates of chest wall recurrences were so low that PMRT is likely not warranted.
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140
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Casey WJ, Rebecca AM, Silverman A, Macias LH, Kreymerman PA, Pockaj BA, Gray RJ, Chang YHH, Smith AA. Etiology of Breast Masses after Autologous Breast Reconstruction. Ann Surg Oncol 2012; 20:607-14. [DOI: 10.1245/s10434-012-2605-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Indexed: 11/18/2022]
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141
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Cutuli B. [Radiotherapy for breast cancer: which strategy in 2012?]. Cancer Radiother 2012; 16:493-502. [PMID: 22925489 DOI: 10.1016/j.canrad.2012.07.185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
Postoperative radiotherapy remains essential in breast cancer in 2012. After conserving surgery, it reduces local recurrence risks from 50 to 70%, both for ductal carcinoma in situ and invasive cancers. This was confirmed in several randomized trials and three meta-analyses. The boost increases local control in invasive cancers, but its role should be better defined in ductal carcinoma in situ. Among the latter, there is no clearly identified subgroup for which radiotherapy could be avoided. Local recurrence risk factors are now well-identified both for ductal carcinoma in situ and invasive cancers, with an inclusion, for the latter, of new molecular subgroups. After mastectomy, radiotherapy reduces local recurrence rates from 60 to 70%, especially among patients with axillary nodal involvement, with, in parallel, a 7 to 9% increased survival rate. In order to reduce the waiting list and to avoid under treatment, especially in the elderly, several hypofractionated radiotherapy schemes have been developed for several years. Three randomized trials confirmed similar results to classical radiotherapy. For ten years, several techniques of partial breast irradiation have been developed, with various doses and treated volumes. The optimal indications should be defined according to the new international guidelines.
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Affiliation(s)
- B Cutuli
- Institut du cancer Courlancy radiothérapie-oncologie, Reims, France.
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142
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Layfield D, May D, Cutress R, Richardson C, Agrawal A, Wise M, Yiangou C. The effect of introducing an in-theatre intra-operative specimen radiography (IOSR) system on the management of palpable breast cancer within a single unit. Breast 2012; 21:459-63. [DOI: 10.1016/j.breast.2011.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 10/05/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022] Open
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143
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Long-Term Outcome in Patients With Ductal Carcinoma In Situ Treated With Breast-Conserving Therapy: Implications for Optimal Follow-up Strategies. Int J Radiat Oncol Biol Phys 2012; 83:e305-12. [DOI: 10.1016/j.ijrobp.2011.12.092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/28/2011] [Accepted: 12/29/2011] [Indexed: 11/19/2022]
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144
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Wei S, Kragel CP, Zhang K, Hameed O. Factors associated with residual disease after initial breast-conserving surgery for ductal carcinoma in situ. Hum Pathol 2012; 43:986-93. [DOI: 10.1016/j.humpath.2011.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/09/2011] [Accepted: 09/14/2011] [Indexed: 11/29/2022]
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145
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Nomogram for predicting positive resection margins after breast-conserving surgery. Breast Cancer Res Treat 2012; 134:1115-23. [DOI: 10.1007/s10549-012-2124-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 05/28/2012] [Indexed: 01/11/2023]
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146
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Cutuli B. Cancers canalaires in situ de moins de 5mm : Pour la radiothérapie postopératoire. ACTA ACUST UNITED AC 2012; 40:384-6. [DOI: 10.1016/j.gyobfe.2012.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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147
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Dunst J, Dellas K. Margins! Margins. Margins? How Important Is Margin Status in Breast-Preserving Therapy? Breast Care (Basel) 2012; 6:359-362. [PMID: 22619645 DOI: 10.1159/000333145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Margin status is surely a prognostic factor in patients undergoing breast-conserving therapy, but its impact is probably overestimated in case of adequate adjuvant radiotherapy. Radiotherapy improves local control after excision of the primary tumor in all subgroups of patients. There is, in contrast, no evidence that a certain margin width or a re-resection improves local control.
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Affiliation(s)
- Jürgen Dunst
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Strahlentherapie, Lübeck, Germany
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148
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Lambert K, Patani N, Mokbel K. Ductal carcinoma in situ: recent advances and future prospects. Int J Surg Oncol 2012; 2012:347385. [PMID: 22675624 PMCID: PMC3362914 DOI: 10.1155/2012/347385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 02/22/2012] [Indexed: 01/15/2023] Open
Abstract
Introduction. This article reviews current management strategies for DCIS in the context of recent randomised trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment. Methods. Literature review facilitated by Medline, PubMed, Embase and Cochrane databases. Results. DCIS should be managed in the context of a multidisciplinary team. Local control depends upon clear surgical margins (at least 2 mm is generally acceptable). SLNB is not routine, but can be considered in patients undergoing mastectomy (Mx) with risk factors for occult invasion. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions should be treated by Mx and immediate reconstruction should be discussed. Adjuvant hormonal treatment may reduce the risk of LR in selected cases with hormone sensitive disease. Conclusion. Further research is required to determine the role of new RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of tumour biology in DCIS to rationalise treatment. Reliable identification of low-risk lesions could allow treatment to be less radical.
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Affiliation(s)
- Kelly Lambert
- The Breast Unit, University Hospitals Leicester, Leicester LE3 9QP, UK
| | - Neill Patani
- The London Breast Institute, The Princess Grace Hospital, London W1U 5NY, UK
| | - Kefah Mokbel
- The London Breast Institute, The Princess Grace Hospital, London W1U 5NY, UK
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149
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Orsaria P, Granai AV, Venditti D, Petrella G, Buonomo O. Investigational Paradigms in Downscoring and Upscoring DCIS: Surgical Management Review. Int J Surg Oncol 2012; 2012:560493. [PMID: 22666571 PMCID: PMC3362033 DOI: 10.1155/2012/560493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/14/2012] [Indexed: 11/21/2022] Open
Abstract
Counseling patients with DCIS in a rational manner can be extremely difficult when the range of treatment criteria results in diverse and confusing clinical recommendations. Surgeons need tools that quantify measurable prognostic factors to be used in conjunction with clinical experience for the complex decision-making process. Combination of statistically significant tumor recurrence predictors and lesion parameters obtained after initial excision suggests that patients with DCIS can be stratified into specific subsets allowing a scientifically based discussion. The goal is to choose the treatment regimen that will significantly benefit each patient group without subjecting the patients to unnecessary risks. Exploring the effectiveness of complete excision may offer a starting place in a new way of reasoning and conceiving surgical modalities in terms of "downscoring" or "upscoring" patient risk, perhaps changing clinical approach. Reexcison may lower the specific subsets' score and improve local recurrence-free survival also by revealing a larger tumor size, a higher nuclear grade, or an involved margin and so suggesting the best management. It seems, that the key could be identifying significant relapse predictive factors, according to validated risk investigation models, whose value is modifiable by the surgical approach which avails of different diagnostic and therapeutic potentials to be optimal. Certainly DCIS clinical question cannot have a single curative mode due to heterogeneity of pathological lesions and histologic classification.
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Affiliation(s)
- P. Orsaria
- Division of Surgical Oncology, Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
| | - A. V. Granai
- Division of Surgical Oncology, Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
| | - D. Venditti
- Division of Surgical Oncology, Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
| | - G. Petrella
- Division of Surgical Oncology, Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
| | - O. Buonomo
- Division of Surgical Oncology, Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
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150
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Radiotherapy after conservative surgery in ductal carcinoma in situ of the breast: a review. Int J Surg Oncol 2012; 2012:635404. [PMID: 22655186 PMCID: PMC3359679 DOI: 10.1155/2012/635404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/06/2012] [Indexed: 12/02/2022] Open
Abstract
Several large prospective and retrospective studies have demonstrated excellent long-term outcomes after breast conservative treatment with radiation in invasive breast cancer. Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an accepted management strategy for patients with DCIS. Adding radiation treatment after conservative surgery enables to reduce, without any significant risks, the rate of local recurrence (LR) by approximately 50% in retrospective and randomized clinical trials. As about 50% of LRs are invasive and have a negative psychological impact, minimizing recurrence is important. Local and local-regional recurrences after initial breast conservation treatment with radiation can be salvaged with high rates of survival and freedom from distant metastases.
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