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Roca Navarro MJ, Oliver Goldaracena JM, Garrido Alonso D, Navarro Monforte Y, Díaz de Bustamante Durbán T, Córdoba Chicote MV, García Martínez F, Martí Álvarez C, Yébenes Gregorio L, Montes Botella JL, Martín Hervás C, Sánchez Méndez JI. Pre-surgical cryoablation in ≤ 2 cm ER + /HER2-tumors. Prognostic factors for the presence of residual invasive carcinoma. Breast Cancer Res Treat 2024; 206:561-573. [PMID: 38814508 PMCID: PMC11208270 DOI: 10.1007/s10549-024-07325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Breast cancer remains the most commonly diagnosed cancer in women. Breast-conserving surgery (BCS) is the standard approach for small low-risk tumors. If the efficacy of cryoablation is demonstrated, it could provide a minimally invasive alternative to surgery. PURPOSE To determine the success of ultrasound-guided cryoablation in achieving the absence of Residual Invasive Cancer (RIC) for patients with ER + /HER2- tumors ≤ 2cm and sonographically negative axillary nodes. MATERIALS AND METHODS This prospective study was carried out from April 2021 to June 2023, and involved 60 preoperative cryoablation procedures on ultrasound-visible, node-negative (cN0) infiltrating ductal carcinomas (IDC). Standard diagnostic imaging included mammography and tomosynthesis, supplemented by ultrasound-guided biopsy. MRI was performed in patients with associated intraductal carcinoma (DCIS) and an invasive component on core needle biopsy (18 out of 22 cases). All tumors were tagged with ferromagnetic seeds. A triple-phase protocol (freezing-thawing-freezing) with Argon was used, with an average procedure duration of 40 min. A logistic regression model was applied to determine significant correlation between RIC and the study variables. RESULTS Fifty-nine women (mean age 63 ± 8 years) with sixty low-risk unifocal IDC underwent cryoablation prior to surgery. Pathological examination of lumpectomy specimens post-cryoablation revealed RIC in only one of 38 patients with pure IDC and in 4 of 22 mixed IDC/DCIS cases. All treated tumors had clear surgical margins, with no significant procedural complications. CONCLUSIONS Cryoablation was effective in eradicating 97% of pure infiltrating ER + /HER2-tumors ≤ 2cm, demonstrating its potential as a surgical alternative in selected patients.
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MESH Headings
- Humans
- Female
- Cryosurgery/methods
- Breast Neoplasms/surgery
- Breast Neoplasms/pathology
- Breast Neoplasms/diagnostic imaging
- Middle Aged
- Aged
- Receptor, ErbB-2/metabolism
- Prospective Studies
- Prognosis
- Neoplasm, Residual
- Adult
- Receptors, Estrogen/metabolism
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Mastectomy, Segmental/methods
- Aged, 80 and over
- Preoperative Care/methods
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Affiliation(s)
- María José Roca Navarro
- Autonomous University of Madrid, Madrid, Spain.
- La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | - Carmen Martín Hervás
- Autonomous University of Madrid, Madrid, Spain
- La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - José Ignacio Sánchez Méndez
- Autonomous University of Madrid, Madrid, Spain
- La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain
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Sarikaya I, Sarikaya A, Albatineh AN, Tastekin E, Sezer YA. Is there a difference in FDG PET findings of invasive ductal carcinoma of the breast with and without coexisting DCIS? ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2020; 8:27-35. [PMID: 32064280 PMCID: PMC6994776 DOI: 10.22038/aojnmb.2019.41658.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/05/2019] [Accepted: 09/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Studies have reported that invasive ductal carcinoma (IDC) with coexisting ductal carcinoma in situ (DCIS) show lower metastatic potential and recurrence and better overall survival than pure IDC. In this study, we assessed F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images of patients with newly diagnosed IDC to determine if there is any difference in PET findings in IDC-DCIS and pure IDC cases. METHODS FDG PET/CT images of patients with newly diagnosed IDC of the breast who subsequently underwent breast surgery and had histopathology result in our records were further evaluated. Tumor grade, pathological staging, and presence of DCIS were noted from the histopathology results. Standardized uptake value (SUV) of the primary tumor (SUVmax and SULmax), other hypermetabolic foci in the breast, and ipsilateral normal breast were measured. Presence of axillary and distant metastases was noted. RESULTS Fifty seven (57) patients with IDC were included. Coexisting DCIS was present in 44 (IDC-DCIS) and not present in 13 (pure IDC) cases. Per histopathology, the primary tumor was unifocal in 33 IDC-DCIS (75%) and 12 pure IDC (92.3%) cases, and multifocal in 11 IDC-DCIS cases (25%), and 1 pure IDC case (7.7%). FDG uptake was multifocal in 20 IDC-DCIS cases (45.5%) and 1 pure IDC case (7.7%), and unifocal in 24 IDC-DCIS (54.5%), and 12 pure IDC (92.3%) cases. There was no significant difference in patient age, size of the primary tumor, SUVmax and SULmax of the primary tumor and SUVmax of the normal breast in IDC-DCIS and pure IDC cases (p>0.05). Pathology showed axillary metastasis in all 13 pure IDC (100%), and 27 IDC-DCIS (61.4%) cases. PET showed axillary uptake in 25 IDC-DCIS (56.8%), and 8 pure IDC (61.5%) cases, and abnormal/questionable distant uptake in 12 IDC-DCIS cases and 1 pure IDC case. CONCLUSION In our preliminary findings, multifocal breast FDG uptake and multifocal tumor appear to be more common in IDC-DCIS than pure IDC. There is no significant difference in SUV and size of the primary tumor in IDC-DCIS and pure IDC cases. Axillary metastases appear to be more common in pure IDC than IDC-DCIS cases.
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Affiliation(s)
- Ismet Sarikaya
- Faculty of Medicine, Department of Nuclear Medicine, Kuwait University and Mubarak Al-Kabeer Hospital, Kuwait
| | - Ali Sarikaya
- Faculty of Medicine, Department of Nuclear Medicine, Trakya University, Edirne, Turkey
| | - Ahmed N. Albatineh
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, Kuwait
| | - Ebru Tastekin
- Faculty of Medicine, Department of Pathology, Trakya University, Edirne, Turkey
| | - Yavuz Atakan Sezer
- Faculty of Medicine, Department of Surgery, Trakya University, Edirne, Turkey
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Abstract
INTRODUCTION Breast conservation is a legacy of Umberto Veronesi who laid the groundwork for the preservation of the body image of women affected by breast cancer (BC) with the Milan I study in the late 70ies of the last millennium. Breast conservative surgery (BCS) has two aspects: oncological safety of tumour resection with free margins and aesthetic preservation of the breast. Determinants of local control used to be T-size, nodal status and receptor status until biologically driven concepts defined risk of recurrence on the basis of molecular portraits. We explored whether these concepts of intrinsic subtypes prove at a large scale in the context of BCS and which surgical techniques procure best oncological and aesthetic outcomes, avoiding re-excision and necessity of conversion to mastectomy. PATIENTS AND METHODS We analyzed 1035 BCS patients with primary unilateral breast cancer (2004-2009) with regards to the local recurrence as a function of tumour location, surgical technique, resection volume, T-size, nodal status, grading, histopathological and intrinsic subtype and margins. RESULTS Five surgical techniques were applied to 944 eligible patients at a median follow-up of 5.2 years with the following frequency: Glandular rotation mammoplasty (63.8%), tumour-adapted rotation mammoplasty (20.9%), dermoglandular rotation mammoplasty (6.7%), 4.4% (lateral thoracic wall advancement), 0.7% latissimus dorsi flap (0.7%) and others (13.5%). Tumour-free margins were achieved in 88.6% of all patients at first surgery. Recurrence was independent of the surgical technique used, resection volume, T-size (in a T1/T2-cohort), nodal status (in low N-stages: NO/N1) and histopathology (inv.-ductal vs. lobular), however non-invasive subtype (DCIS), high grading (G3 vs. G1), non-luminal Her2 positive BC and triple-negative breast cancer (TNBC) were significantly associated with local recurrence. CONCLUSIONS Five defined oncoplastic principles presented in our nomogramme (targeted breast surgery) allow the reconstruction of major segmental resection defects during breast-conserving therapy with high clinical applicability and result in favorable oncological and aesthetic outcome. Recurrence was not a function of traditional prognostic factors like T-size or nodal status (in a T1/T2, N0/N1 cohort), but of grading, intrinsic subtypes and non-invasive breast cancer components. Lobular histology, multi-centricity and DCIS were predictive for breast preservation failure and conversion to mastectomy.
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Affiliation(s)
- Mahdi Rezai
- European Breast Center - Dr. Rezai, Hans-Günther-Sohl-Str.6-10, D-40235 Düsseldorf, Germany.
| | - Stefan Kraemer
- University Medical Center Cologne, Kerpener Str. 34, D-50931 Cologne, Germany.
| | - Rainer Kimmig
- University Hospital of Essen, Women's Department, Hufelandstr.55, D-45147 Essen, Germany.
| | - Peter Kern
- University Hospital of Essen, Women's Department, Hufelandstr.55, D-45147 Essen, Germany.
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Amy D, Durante E, Tot T. The lobar approach to breast ultrasound imaging and surgery. J Med Ultrason (2001) 2015; 42:331-9. [DOI: 10.1007/s10396-015-0625-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
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Rezai M, Knispel S, Kellersmann S, Lax H, Kimmig R, Kern P. Systematization of Oncoplastic Surgery: Selection of Surgical Techniques and Patient-Reported Outcome in a Cohort of 1,035 Patients. Ann Surg Oncol 2015; 22:3730-7. [PMID: 25672561 PMCID: PMC4565865 DOI: 10.1245/s10434-015-4396-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Indexed: 11/25/2022]
Abstract
Introduction Functional and aesthetic outcome after breast-conserving surgery are vital endpoints for patients with primary breast cancer. A large variety of oncoplastic techniques exist; however, it remains unclear which techniques yield the highest rates of local control at first surgery, omission of reexcision or subsequent mastectomy, and merits the highest degree of patient satisfaction. Methods In this retrospective case cohort trial with a customized investigational questionnaire for assessment of patient satisfaction with the surgical result, we analyzed 1,035 patients with primary, unilateral breast cancer and oncoplastic surgery from 2004 to 2009. Results Analysis of patient reported outcome (PRO) revealed that 88 % of the cohort was satisfied with their aesthetic result using oncoplastic techniques following the concept presented. These results also were achieved in difficult tumor localizations, such as upper inner and lower inner quadrant. Conversion rate from breast-conserving therapy to secondary mastectomy was low at 7.2 % (n = 68/944 patients). The systematization of oncoplastic techniques presented—embedded in a multimodal concept of breast cancer therapy—facilitates tumor control with a few number of uncomplicated techniques adapted to tumor site and size with a median resection of 32 (range 11–793) g. Five-year recurrence rate in our cohort was 4.0 %. Conclusions Patient´s satisfaction was independent from age, body mass index, resection volume, tumor localization, and type of oncoplastic surgery (p > 0.05). We identified postoperative pain as an important negative impact factor on patient´s satisfaction with the aesthetic result (p = 0.0001). Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-4396-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahdi Rezai
- Breast Unit, Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany
| | - Sarah Knispel
- Breast Unit, Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany.,Women's Department, University Hospital of Essen, Essen, Germany
| | - Stephanie Kellersmann
- Breast Unit, Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany.,Women's Department, University Hospital of Essen, Essen, Germany
| | - Hildegard Lax
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Rainer Kimmig
- Women's Department, University Hospital of Essen, Essen, Germany
| | - Peter Kern
- Breast Unit, Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany. .,Women's Department, University Hospital of Essen, Essen, Germany.
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Hospital and surgeon caseload are associated with risk of re-operation following breast-conserving surgery. Breast Cancer Res Treat 2013; 140:535-44. [PMID: 23893128 DOI: 10.1007/s10549-013-2652-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
Breast-conserving surgery (BCS) is increasingly used for breast cancer treatment. One of the disadvantages of BCS is the risk of re-operation, associated with additional costs to the woman, health service and society. Hospital and surgeon caseload have been associated with better outcomes in breast cancer. Whether these are related to re-operation rates is not clear. In women who underwent BCS initially, we aimed to quantify re-operation rates and identify the factors related to the risk of undergoing subsequent (i) re-operation and (ii) total mastectomy (TM). From the National Cancer Registry Ireland, we identified women diagnosed with a first invasive breast cancer during 2002-2008, and who initially had BCS. Poisson regression with robust error variance was used to identify factors significantly associated with (i) re-operation (vs no re-operation) or (ii) re-operation by TM (vs re-operation by BCS). 16,551 women were diagnosed with invasive breast cancer and 8,318 underwent initial BCS. Of these, 17 % had one or more subsequent re-operations and, of these, 62 % had TM. Surgeon and hospital volume significantly predicted subsequent re-operation after adjustment for socio-demographic and clinical variables. Women having surgery in lower-volume hospitals by low-volume surgeons significantly increased the risk of re-operation [incidence rate ratio (IRR) = 1.56; 95 % CI 1.33-1.83] compared to those operated in higher-volume hospitals by a higher-volume surgeon. Risk of subsequent TM was increased by 22 % (95 % CI 1.10-1.35) and 21 % (95 % CI 1.09-1.33), if women were operated by a lower or intermediate-volume surgeon. The fact that factors related to healthcare organisation/service provision are associated with re-operations suggests that it may be possible to reduce the overall re-operation rate. The high frequency of subsequent TM raises questions about strategies for selecting women for initial BCS. Our results may inform the development of information strategies to help ensure that women are aware of risks of re-operation following BCS and hence, make appropriate treatment choices.
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