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Maseki H, Jimbo K, Watase C, Murata T, Shiino S, Takayama S, Yamamoto N, Satomi K, Maeshima A, Yoshida M, Suto A. Clinical significance of tumor cell seeding associated with needle biopsy in patients with breast cancer. Asian J Surg 2023; 46:3700-3704. [PMID: 36732183 DOI: 10.1016/j.asjsur.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/17/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/OBJECTIVE The occurrence of iatrogenic tumor cell seeding (seeding) in needle tract scars formed by core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) is well known. Some risk factors for seeding have been reported, but the clinicopathological risk factors and its prognosis have not been fully investigated. We evaluated the clinical features and prognosis of seeding. METHODS We included 4405 patients who had undergone surgery (lumpectomy or mastectomy) with a diagnosis of breast cancer by preoperative CNB or VAB at our hospital between January 2012 and February 2021. Data of patients with confirmed presence of seeding in resected specimens were collected from pathological records. We analyzed the risk factors of seeding using logistic regression analysis and compared the ipsilateral breast tumor recurrence (IBTR) rate between cases based on the presence or absence of seeding in the lumpectomy group. RESULTS Of the 4405 patients, 133 (3.0%) had confirmed seeding. Univariate analysis revealed the association of clinicopathological features of seeding with lower nuclear grade (NG1 vs NG2-3; p = 0.043), lower Ki-67 (<30 vs. ≥30; p = 0.049), estrogen receptor (ER) positivity (positive vs negative; p<0.01), and human epidermal growth factor receptor 2 (HER2) negativity (negative vs positive; p = 0.016). Multivariate analysis showed ER positivity (odds ratio, 5.23; p<0.05) as an independent risk factor of seeding. The IBTR rate was not significantly different between the seeding and non-seeding groups. CONCLUSIONS Seeding was more likely to occur in ER positive, HER2 negative carcinomas with less aggressive features, and may remain subclinical if adequate adjuvant treatments are administered.
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Affiliation(s)
- Haruhi Maseki
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenjiro Jimbo
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
| | - Chikashi Watase
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Murata
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Sho Shiino
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shin Takayama
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nami Yamamoto
- Diagnostic Pathology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kaishi Satomi
- Diagnostic Pathology Division, National Cancer Center Hospital, Tokyo, Japan; Department of Pathology Medicine, Kyorin University School of Medicine, Japan
| | - Akiko Maeshima
- Diagnostic Pathology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masayuki Yoshida
- Diagnostic Pathology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Suto
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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Tan MP. Breast conservation treatment and frozen section analysis of margins. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:432-434. [PMID: 38920173 DOI: 10.47102/annals-acadmedsg.2023105209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
I read with interest the article by Woon et al. published in a recent issue of the Annals on the reduction of re-excision rates with the use of intraoperative frozen section (FS) analysis.1 This certainly has the potential to improve patient outcomes after surgery as their study has demonstrated. It is also likely that a decrease in re-operation rates would have a positive influence on patients choice to undergo breast conservation treatment (BCT) rather than mastectomy.
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Affiliation(s)
- Mona P Tan
- Breast Surgical Oncology, JHPL, Singapore
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3
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Ozaki Y, Yoshimura A, Sawaki M, Hattori M, Kotani H, Adachi Y, Kataoka A, Sugino K, Horisawa N, Endo Y, Nozawa K, Sakamoto S, Takatsuka D, Okumura S, Maruyama Y, Iwata H. The significance of biopsy scar excision at the time of skin- or nipple-sparing mastectomy with immediate breast reconstruction. Jpn J Clin Oncol 2021; 51:1212-1218. [PMID: 33942068 PMCID: PMC8326383 DOI: 10.1093/jjco/hyab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neoplastic seeding (NS) can occur after tissue biopsy, which is a clinical issue especially in mastectomy with immediate reconstruction. This is because postoperative radiation is not usually given and local recurrence of preserved skin flap may increase. The purpose of this study is to investigate the importance of preoperative evaluation of NS and the validity of biopsy scar excision. PATIENTS AND METHODS We retrospectively analysed 174 cases of mastectomy with immediate breast reconstruction. The primary endpoint is the frequency of clinical and pathological NS and the secondary endpoint is the problem of excision of needle biopsy site. RESULTS Three cases (1.7%) had preoperative clinical findings of NS. Pathological examination revealed NS in all three cases. Biopsy scars could be excised in 115 cases among 171 cases without clinical NS. Pathological NS was found in 1 of 66 (1.5%) cases of which pathological examination was performed. Biopsy scars could not be excised in the remaining 56 cases: the biopsy scar could not be identified in 41 cases, and there was concern about a decrease in flap blood flow after excision in 15 cases. In 12 of these 15 cases, the scars were close to the skin incision; excision of these scars might have triggered skin necrosis between the incision and the biopsy scar excision site. No postoperative complications were observed. CONCLUSIONS It is important to preoperatively evaluate clinical NS, and biopsy scars should be excised in clinical NS cases. Even in cases without clinical NS, biopsy scar excision should be considered. It is also important to perform a biopsy in consideration of the incision design for reconstructive surgery.
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Affiliation(s)
- Yuri Ozaki
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yuka Endo
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Kazuki Nozawa
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Shoko Sakamoto
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Daiki Takatsuka
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Seiko Okumura
- Department of Plastic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Yoko Maruyama
- Department of Plastic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
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4
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K Szabo B, Ojo A, Al-Okati D. MRI Diagnosis of Needle Tract Tumor Seeding Following Core Biopsy of Mucinous Carcinoma of the Breast. Cureus 2021; 13:e14493. [PMID: 34079656 PMCID: PMC8159341 DOI: 10.7759/cureus.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Displacement or seeding of malignant cells into the needle tract following percutaneous biopsy is a known phenomenon, although it does not affect disease recurrence or overall survival of patients with breast cancer. It has, however, been previously hypothesized that needle tract seeding may occasionally progress to clinical tumor recurrence, and there have been case reports of breast cancer recurrence that are likely to be related to needle tract seeding. We are presenting a case of invasive mucinous carcinoma of the breast with associated malignant cell seeding within the biopsy tract, which was diagnosed preoperatively on contrast-enhanced MR imaging. A needle tract can often be visualized on contrast-enhanced MRI post biopsy and these changes may reflect tissue damage and regeneration only. In our case, an unusual nodular enhancement pattern was demonstrated along the biopsy needle tract, which was consistent with the histopathological finding of tumor seeding.
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Affiliation(s)
- Botond K Szabo
- Radiology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Akinyede Ojo
- Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Dhafir Al-Okati
- Pathology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
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5
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Wen S, Liang Y, Kong X, Liu B, Ma T, Zhou Y, Jiang L, Li X, Yang Q. Application of preoperative computed tomographic lymphography for precise sentinel lymph node biopsy in breast cancer patients. BMC Surg 2021; 21:187. [PMID: 33836721 PMCID: PMC8033684 DOI: 10.1186/s12893-021-01190-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Background In light of the extensive application of sentinel lymph node biopsy (SLNB) in clinically node-negative breast cancer patients and the recently investigated failure of SLNB after lumpectomy, it has become important to explore methods for preoperative mapping of sentinel lymph nodes (SLNs) and their lymphatics to direct precise SLNB and improve the identification rate of SLNs. Methods Twenty-seven patients with suspected breast cancer based on the results of the clinical examination and imaging were enrolled in the study. Computed tomographic lymphography (CTLG) followed by CT three-dimensional reconstruction was performed to determine the localization of SLNs and lymphatics on the body surface preoperatively. Intraoperatively combined staining with methylene blue and indocyanine green was used to evaluate the accuracy and feasibility of CTLG. Results SLNs and lymphatics from the breast were identified using CTLG in all patients, and preoperative SLNs and lymphatics localization on the body surface showed a significant role in the selection of operative incision and injection points. The accuracy rate of SLN and lymphatic detection by CTLG was 92.6% compared with intraoperatively combined staining. Moreover, preoperative CTLG performed well in SLN number detection, and the accuracy rate was 95.2%. Conclusion We evaluate the procedure and application of preoperative CTLG in the superficial localization of SLNs and lymphatics, which may lead to a decreased incidence of cutting off the lymphatics of SLNs and consequently more rapid and accurate SLN detection. This method promotes personalized SLN mapping, providing detailed information about the number and anatomical location of SLNs and lymphatics for adequate surgical planning for breast cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01190-7.
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Affiliation(s)
- Shishuai Wen
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Xiaoli Kong
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Baofeng Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Tingting Ma
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Yeqing Zhou
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Liyu Jiang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Xiaoyan Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China. .,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China. .,Research Institute of Breast Cancer, Shandong University, Jinan, China.
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6
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Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, Borbély K, Brkljacic B, Carbonaro LA, Clauser P, Cassano E, Colin C, Esen G, Evans A, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Herranz M, Kinkel K, Kilburn-Toppin F, Kuhl CK, Lesaru M, Lobbes MBI, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Schiaffino S, Sella T, Thomassin-Naggara I, Tardivon A, Ongeval CV, Wallis MG, Zackrisson S, Forrai G, Herrero JC, Sardanelli F. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11:12. [PMID: 32025985 PMCID: PMC7002629 DOI: 10.1186/s13244-019-0803-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.
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Affiliation(s)
- Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Enrico Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Gul Esen
- School of Medicine, Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Eva M Fallenberg
- Diagnostic and Interventional Breast Imaging, Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Michel Herranz
- CyclotronUnit, GALARIA-SERGAS, Nuclear Medicine Department and Molecular ImagingGroup, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224 Chêne-Bougeries, Genève, Switzerland
| | - Fleur Kilburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unit of Radiodiagnostics ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie, Paris, France
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | | | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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Kong YC, Bhoo-Pathy N, O’Rorke M, Subramaniam S, Bhoo-Pathy NT, See MH, Jamaris S, Teoh KH, Bustam AZ, Looi LM, Taib NA, Yip CH. The association between methods of biopsy and survival following breast cancer: A hospital registry based cohort study. Medicine (Baltimore) 2020; 99:e19093. [PMID: 32028433 PMCID: PMC7015568 DOI: 10.1097/md.0000000000019093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 01/31/2023] Open
Abstract
Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (Pinteraction < .001). Following multivariable analysis, excision biopsy was consistently associated with lower risk of mortality compared to FNAC in women receiving adjuvant radiotherapy (adjusted hazard ratio: 0.81, 95%CI: 0.66-0.99), but not in those who did not receive adjuvant radiotherapy (adjusted hazard ratio: 0.87, 95%CI: 0.65-1.17). While the risk of mortality was not different between patients undergoing FNAC and CNB when radiotherapy is administered, in the absence of radiotherapy, CNB was associated with higher risk of mortality than FNAC (adjusted hazard ratio: 1.57, 95%CI: 1.16-2.12). Given that our results contradict with findings of previous clinical studies assessing the prognostic impact of method of biopsy in women with breast cancer, further studies are warranted.
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Affiliation(s)
- Yek-Ching Kong
- Clinical Epidemiology Unit, National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital
| | - Nirmala Bhoo-Pathy
- Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael O’Rorke
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital Site, Belfast, UK
| | - Shridevi Subramaniam
- Clinical Epidemiology Unit, National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital
| | - Nanthini T. Bhoo-Pathy
- Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Anita Z. Bustam
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur
| | | | | | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
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8
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Bagger M, Smidt-Nielsen I, Andersen MK, Jensen PK, Heegaard S, Andersen KK, Friis S, Kiilgaard JF. Long-Term Metastatic Risk after Biopsy of Posterior Uveal Melanoma. Ophthalmology 2018; 125:1969-1976. [PMID: 29705056 DOI: 10.1016/j.ophtha.2018.03.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Biopsy of posterior uveal melanoma continues to be intensely debated in terms of the clinical benefits and safety profile. Although several studies have reported a low frequency of ocular complications after tumor biopsy, the potential long-term risk of iatrogenic dissemination remains unresolved. The purpose of this study was to assess the risk of metastatic disease after biopsy of posterior uveal melanoma. DESIGN Retrospective nationwide cohort study linking clinical and histopathologic records to pathology, cancer, and mortality registries. PARTICIPANTS All patients with posterior uveal melanoma treated in Denmark between January 1985 and December 2016. METHODS For each patient, we recorded detailed information on age, gender, tumor characteristics, and diagnostic and therapeutic measures, including tumor biopsy, if any, and the primary treating hospital. Absolute risk of melanoma-specific death was presented by cumulative incidence curves that accounted for competing risks. Cox regression models were used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and melanoma-specific mortality of patients who underwent biopsy during primary treatment compared with nonbiopsied patients through November 1, 2017. Fine and Gray risk regression was used as a sensitivity analysis to evaluate the impact of competing risks. MAIN OUTCOME MEASURES All-cause and melanoma-specific mortality. RESULTS Among 1637 patients, 567 (35%) underwent biopsy during primary treatment. At diagnosis, biopsied patients exhibited better prognostic characteristics, including smaller tumor size (P < 0.001) and younger age (P < 0.001), than nonbiopsied patients. In the adjusted analyses, we observed no apparent differences in all-cause mortality (HR, 1.07; 95% CI, 0.89-1.26; P = 0.47) or melanoma-specific mortality (HR, 1.11; 95% CI, 0.89-1.39; P = 0.35) among biopsied patients compared with nonbiopsied patients. CONCLUSIONS All-cause and melanoma-specific mortality after primary treatment were similar among biopsied and nonbiopsied patients with posterior uveal melanoma. Our findings do not support an increased metastatic risk after intraocular tumor biopsy.
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Affiliation(s)
- Mette Bagger
- Department of Clinical Genetics, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Isabel Smidt-Nielsen
- Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette K Andersen
- Department of Clinical Genetics, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter K Jensen
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark; Department of Pathology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus K Andersen
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Søren Friis
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jens F Kiilgaard
- Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
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Breast cancer neoplastic seeding in the setting of image-guided needle biopsies of the breast. Breast Cancer Res Treat 2017; 166:29-39. [PMID: 28730339 DOI: 10.1007/s10549-017-4401-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/13/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To identify clinicopathologic, technical, and imaging features associated with neoplastic seeding (NS) following image-guided needle breast biopsy. METHODS We performed an institutional review board-approved retrospective review of patients presenting with a new diagnosis of breast cancer or suspicious breast findings requiring biopsy with subsequent diagnosis of NS. The time from biopsy to NS diagnosis was calculated. Histology, grade, estrogen receptor (ER) status, progesterone receptor (PR) status, HER2 status, T category, and N category were recorded. Biopsy guidance method, needle gauge, and number of passes were reviewed in addition to the mammographic and sonographic features of the primary tumors and the NS. RESULTS Eight cases of NS were identified in 4010 patients. The mean time from biopsy to NS diagnosis was 60.8 days. The most frequent histology was invasive ductal carcinoma (7/8). Six cases were grade 3 (75.0%). Five primary breast cancers were ER, PR, and HER2 negative (62.5%). Seven patients underwent biopsy with ultrasound guidance. Multiple-insertion, non-coaxial ultrasound-guided core-needle biopsy was done in 6 cases. Mammographic presentation of NS was focal asymmetry (3/7 cases), mass (1/7), calcifications only (1/7), or occult (2/7). Sonographic presentation of NS was most often a mass (7/8) with irregular shape (5/7) and without circumscribed margins (6/7) and was occult in 1 case (1/8). NS distribution was subdermal and intradermal. CONCLUSION High-grade, triple-negative breast cancers and multiple-insertion, non-coaxial biopsies may be risk factors for NS. NS should be suspected on the basis of the superficial and linear pattern of disease progression in these patients.
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10
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Siddiqi MA, Kim HS, Jede F, Han I. Association of core needle biopsy tract resection with local recurrence in extremity soft tissue sarcoma. Skeletal Radiol 2017; 46:507-512. [PMID: 28175961 DOI: 10.1007/s00256-017-2579-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Due to minimal tissue violation in percutaneous core needle biopsy (CNB), in contrast to open biopsy, the risk of tumor seeding and subsequent local recurrence (LR) along the biopsy tract remains unclear in extremity soft tissue sarcoma (STS). This study sought to examine the association of CNB tract resection on LR in a large STS institutional database. MATERIALS AND METHODS After a retrospective review of the 116 patients who underwent CNB prior to surgery for previously untreated non-metastatic extremity STS, 36 patients who did not have CNB tracts resected (CNB-NR) were matched with 36 who had CNB tracts resected (CNB-R) for the factors that are known to affect LR. RESULTS Two patients (6%) developed LR in the CNB-R group, whereas three patients (8%) developed LR in the CNB-NR group (P = 0.643). On Kaplan-Meier analysis, there was no significant difference in LR-free survival between the two groups (94.3% ± 3.9 for the CNB-R group vs. 93.8% ± 4.3 for the CNB-NR group, P = 0.747). CONCLUSION Our data suggest any influence of a CNB tract resection on LR, within the limitations of this study, is likely to be of minor clinical importance in extremity STS. Although it would be prudent to resect the CNB tract in most cases, not resecting the CNB tract is a feasible option if identification or removal of the CNB tract proves difficult.
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Affiliation(s)
- M Ather Siddiqi
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, South Korea
- Department of Orthopaedic Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, South Korea
| | - Felix Jede
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, South Korea.
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Szalayova G, Ogrodnik A, Spencer B, Wade J, Bunn J, Ambaye A, James T, Rincon M. Human breast cancer biopsies induce eosinophil recruitment and enhance adjacent cancer cell proliferation. Breast Cancer Res Treat 2016; 157:461-74. [PMID: 27249999 PMCID: PMC5026505 DOI: 10.1007/s10549-016-3839-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/19/2016] [Indexed: 12/30/2022]
Abstract
Chronic inflammation is known to facilitate cancer progression and metastasis. Less is known about the effect of acute inflammation within the tumor microenvironment, resulting from standard invasive procedures. Recent studies in mouse models have shown that the acute inflammatory response triggered by a biopsy in mammary cancer increases the frequency of distal metastases. Although tumor biopsies are part of the standard clinical practice in breast cancer diagnosis, no studies have reported their effect on inflammatory response. The objective of this study is to (1) determine whether core needle biopsies in breast cancer patients trigger an inflammatory response, (2) characterize the type of inflammatory response present, and (3) evaluate the potential effect of any acute inflammatory response on residual tumor cells. The biopsy wound site was identified in the primary tumor resection tissue samples from breast cancer patients. The inflammatory response in areas adjacent (i.e., immediately around previous biopsy site) and distant to the wound biopsy was investigated by histology and immunohistochemistry analysis. Proliferation of tumor cells was also assayed. We demonstrate that diagnostic core needle biopsies trigger a selective recruitment of inflammatory cells at the site of the biopsy, and they persist for extended periods of time. While macrophages were part of the inflammatory response, an unexpected accumulation of eosinophils at the edge of the biopsy wound was also identified. Importantly, we show that biopsy causes an increase in the proliferation rate of tumor cells located in the area adjacent to the biopsy wound. Diagnostic core needle biopsies in breast cancer patients do induce a unique acute inflammatory response within the tumor microenvironment and have an effect on the surrounding tumor cells. Therefore, biopsy-induced inflammation could have an impact on residual tumor cell progression and/or metastasis in human breast cancer. These findings may carry relevance in the clinical management of breast cancer.
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Affiliation(s)
- Gabriela Szalayova
- Department of Surgery, University of Vermont, Burlington, VT 05405
- Department of Surgery, Danbury Hospital, CT 06810
- Department of Medicine, Division of Immunobiology, University of Vermont, Burlington, VT 05405
| | - Aleksandra Ogrodnik
- Department of Surgery, University of Vermont, Burlington, VT 05405
- Department of Surgery, Danbury Hospital, CT 06810
- Department of Medicine, Division of Immunobiology, University of Vermont, Burlington, VT 05405
| | - Brianna Spencer
- Department of Surgery, University of Vermont, Burlington, VT 05405
- Department of Medicine, Division of Immunobiology, University of Vermont, Burlington, VT 05405
| | - Jacqueline Wade
- Department of Surgery, University of Vermont, Burlington, VT 05405
- Department of Medicine, Division of Immunobiology, University of Vermont, Burlington, VT 05405
| | - Janice Bunn
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT 05405
| | - Abiy Ambaye
- Department of Pathology, University of Vermont, Burlington, VT 05405
| | - Ted James
- Department of Surgery, University of Vermont, Burlington, VT 05405
| | - Mercedes Rincon
- Department of Medicine, Division of Immunobiology, University of Vermont, Burlington, VT 05405
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12
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Liikanen J, Leidenius M, Joensuu H, Vironen J, Heikkilä P, Meretoja T. Breast cancer prognosis and isolated tumor cell findings in axillary lymph nodes after core needle biopsy and fine needle aspiration cytology: Biopsy method and breast cancer outcome. Eur J Surg Oncol 2015; 42:64-70. [PMID: 26427542 DOI: 10.1016/j.ejso.2015.08.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/11/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND It is unknown whether performing a core needle biopsy (CNB) to diagnose breast cancer increases the incidence of isolated tumor cells (ITC) in the axillary sentinel lymph nodes. METHODS Patients diagnosed with unilateral invasive pT1 breast cancer (≤2 cm in diameter, n = 1525) at a single center between February 2001 and August 2005 were included in this prospective observational cohort study. The patients were categorized into two groups according to the type of the preoperative breast needle biopsy performed, the CNB and the fine needle aspiration cytology (FNAC) groups, and followed up for a median of 9.5 years after breast surgery. RESULTS 868 (56.9%) patients had FNAC and 657 (43.2%) CNB. In the subset of patients with no axillary metastases (pN0, n = 1005) 70 patients had ITC, 37 (4.3%) out of the 546 patients in FNAC group and 33 (5.0%) out of the 459 patients in the CNB group (p = 0.798). The type of tumor biopsy did not influence breast cancer-specific survival (p = 0.461) or local recurrence-free survival (p = 0.814) in univariable survival analyses. Overall, survival favored the CNB group in a univariable analysis, but no difference in survival emerged in a multivariable analysis (p = 0.718). CONCLUSIONS CNB was not associated with a greater incidence of ITC in axillary lymph nodes as compared with FNAC, and did not have an adverse effect on survival outcomes in a patient population treated with modern adjuvant therapies.
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Affiliation(s)
- J Liikanen
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
| | - M Leidenius
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
| | - H Joensuu
- Helsinki University Central Hospital, Comprehensive Cancer Center, Department of Oncology, P.O. Box 180, FI-00029 Helsinki, Finland.
| | - J Vironen
- Helsinki University Central Hospital, Jorvi Hospital, Breast Surgery Unit, P.O. Box 800, FIN-00029 HUS, Finland.
| | - P Heikkilä
- Helsinki University Central Hospital, Department of Pathology, P.O. Box 400, FIN-00029 HUS, Finland.
| | - T Meretoja
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
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13
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Novoa E, Gürtler N, Arnoux A, Kraft M. Diagnostic value of core needle biopsy and fine-needle aspiration in salivary gland lesions. Head Neck 2015; 38 Suppl 1:E346-52. [DOI: 10.1002/hed.23999] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Eva Novoa
- Department of Otorhinolaryngology; Head and Neck Surgery; Kantonsspital AG; Aarau Switzerland
| | - Nicolas Gürtler
- Department of Otorhinolaryngology; Head and Neck Surgery; University Hospital of Basel; Basel Switzerland
| | - André Arnoux
- Department of Otorhinolaryngology; Head and Neck Surgery; Kantonsspital AG; Aarau Switzerland
| | - Marcel Kraft
- Department of Otorhinolaryngology; Head and Neck Surgery; Kantonsspital Baselland; Liestal Switzerland
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14
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McClelland S, Weiss P. Tumor cell dissemination secondary to surgical interventions in the breast. Clin J Oncol Nurs 2015; 17:667-8. [PMID: 24305489 DOI: 10.1188/13.cjon.667-668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dissemination secondary to surgical interventions is an issue that arises in conversations between patients and providers prior to breast biopsy. Research supports needle biopsies over incisional or excisional biopsies in most situations. Tumor cell dissemination is a rare occurrence. However, the fear of dissemination as experienced by the patient is very real. That fear may influence the patient's decision to proceed with a recommended biopsy.
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15
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Zhang YJ, Wei L, Li J, Zheng YQ, Li XR. Status quo and development trend of breast biopsy technology. Gland Surg 2014; 2:15-24. [PMID: 25083451 DOI: 10.3978/j.issn.2227-684x.2013.02.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/18/2013] [Indexed: 11/14/2022]
Abstract
Triple assessment is a standard method for assessment of breast diseases, which includes clinical evaluation, radiographic assessment and pathological assessment. Biopsy for breast disease is the gold standard for pathological assessment, including incisional biopsy, excisional biopsy, core needle biopsy, vacuum-assisted biopsy and bite biopsy. With the continuous advancement of diagnostic and treatment technology for breast cancer, collection of diseased tissue has also undergone a gradual transition from traditional open surgery to biopsy. This review summarizes the current situation and development of breast biopsy technology to provide an insight into the latest details such as the safety and reliability as the basis for selection of the most appropriate techniques for specific settings.
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Affiliation(s)
- Yan-Jun Zhang
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lichun Wei
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jie Li
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yi-Qiong Zheng
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xi-Ru Li
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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16
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Microbiopsie mammaire : fiabilité en fonction du BIRADS. IMAGERIE DE LA FEMME 2014. [DOI: 10.1016/j.femme.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Binitie O, Tejiram S, Conway S, Cheong D, Temple HT, Letson GD. Adult soft tissue sarcoma local recurrence after adjuvant treatment without resection of core needle biopsy tract. Clin Orthop Relat Res 2013; 471:891-8. [PMID: 22968531 PMCID: PMC3563812 DOI: 10.1007/s11999-012-2569-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Core needle biopsies of sarcomas allow a diagnosis in a high percentage of patients with few complications. However, it is unclear whether the tract needs to be excised to prevent recurrences. QUESTIONS/PURPOSES We therefore determined the rates of recurrence and metastases in patients with Stage III extremity sarcomas, who underwent wide local resection without excision of the needle tract and also received adjuvant treatment. METHODS We retrospectively reviewed 59 adult patients with deep, larger than 5 cm, high-grade soft tissue sarcomas of the upper or lower extremity treated between January 1999 and April 2009. All the patients underwent a core needle biopsy. Resection was performed with wide margins. The biopsy tract was not resected during the definitive surgery. Fifty-seven patients (97%) received preoperative and/or postoperative radiation, whereas 49 patients (83%) received chemotherapy. Local recurrence and distant recurrence rates were determined. The minimum followup was 24 months (median, 56 months; range, 24-122 months). RESULTS The local recurrence rate was 9%. Fifteen patients (25%) developed metastasis after diagnosis. Seven of the 59 patients (12%) had microscopic positive margins at resection. CONCLUSIONS Our data demonstrate no increase in local recurrence rates or rates of metastatic disease compared with previously published studies when resection of the core biopsy tract was not performed. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Odion Binitie
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Shawn Tejiram
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Sheila Conway
- />Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - David Cheong
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - H. Thomas Temple
- />Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - G. Douglas Letson
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
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18
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Abstract
This article discusses the most common small glandular proliferations, namely sclerosing lesions (sclerosing adenosis and radial scar), tubular carcinoma, and epithelial displacement after needle core biopsy, as well as less common entities, such as low-grade adenosquamous carcinoma, microglandular adenosis, and syringomatous adenoma. Due to significant morphologic overlap, these entities are easily mistaken for one another. The similarities and differences among these lesions in their clinicopathologic features, radiologic findings, and immunohistochemical profiles are emphasizesd.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA.
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19
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Kasprowicz N, Bauerschmitz GJ, Schönherr A, Baldus SE, Janni W, Mohrmann S. Recurrent Mastitis after Core Needle Biopsy: Case Report of an Unusual Complication after Core Needle Biopsy of a Phyllodes Tumor. Breast Care (Basel) 2012; 7:240-244. [PMID: 22872800 DOI: 10.1159/000339689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: In the routine work-up of suspect breast lesions, ultrasound-controlled core needle biopsy (CNB) is the most common tool to acquire tissue for histopathologic analysis in a safe, quick and convenient way. Complications are generally rare. The most common complications are hematoma and infection, each with less than 1 in 1000 cases. CASE REPORT: Here, we present a case of a 48-year-old patient who underwent CNB for several lesions that were assessed as Breast Imaging Report and Data System (BI-RADS) IV in breast ultrasound and mammography. In the past, she had had 2 bilateral breast reduction surgeries and 1 open biopsy of a fibroadenoma. Histology revealed a phyllodes tumor. Following this, mastitis occurred which was resistant to common conservative measurements such as intravenous antibiotics over months. Finally, mastectomy was performed, followed by adequate wound healing. CONCLUSIONS: In the presented case, the prolonged course of breast infection after CNB was not as expected. If this occurs, conservative treatment with antibiotics can be initiated. Possible additional risk factors such as diabetes mellitus, steroid therapy, or immunosuppression should be identified. However, in case of missing recovery, wide surgical excision is recommended.
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Affiliation(s)
- Nikola Kasprowicz
- Breast Center, Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
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20
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Tseng HS, Chan SE, Kuo SJ, Chen DR. Acupuncture-related rapid dermal spread of breast cancer: a rare case. J Breast Cancer 2011; 14:340-4. [PMID: 22323924 PMCID: PMC3268934 DOI: 10.4048/jbc.2011.14.4.340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/31/2011] [Indexed: 12/04/2022] Open
Abstract
Many ethnic Chinese patients seek second or adjuvant alternative therapies after breast cancer is diagnosed. Chinese herbs and acupuncture are the most popular methods in East Asia. We present a case of acupuncture manipulation-related cutaneous spread that no literature reported before. Post-acupuncture cutaneous spread was noted in a 54-year-old woman with left neck lymph node recurrence after complete surgery, chemotherapy and radiotherapy treatment. The results of chest computed tomography and skin biopsy showed the metastatic breast cancer in the dermis. Six courses of paclitaxel and gemcitabine followed by trastuzumab were given as therapeutic chemotherapy. The neck mass and cutaneous lesions subsided after 2 courses of chemotherapy. Direct puncture of a metastatic lymph node might increase the incidence of tumor spread on the skin. Therefore, despite the efficacy of complementary and alternative medicine, its safety and possible side effects should be more emphasized.
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Affiliation(s)
- Hsin-Shun Tseng
- Comprehensive Breast Cancer Center, Department of Medical Research, Changhua Christian Hospital, Changhua, Taiwan
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21
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Vega Bolívar A. Diagnostic intervention in breast disease. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Vega Bolívar A. [Diagnostic intervention in breast disease]. RADIOLOGIA 2011; 53:531-43. [PMID: 21924750 DOI: 10.1016/j.rx.2011.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 05/31/2011] [Accepted: 06/01/2011] [Indexed: 10/17/2022]
Abstract
Imaging-guided percutaneous biopsy techniques have been developed to diagnose the lesions detected in breast cancer screening programs based on mammography. Although traditional fine-needle aspiration cytology continues to be indicated in some cases, in many others it has been supplanted by more modern techniques like core biopsy or vacuum-assisted biopsy guided by ultrasonography, stereotaxy, or magnetic resonance imaging. These highly reliable techniques have minimized the need for surgical biopsy. Radiologists play a key role in the histological diagnosis of breast cancer in the early stages of disease and in the evaluation of its local and regional extension through magnetic resonance imaging and sentinel node biopsy.
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Affiliation(s)
- A Vega Bolívar
- Sección de diagnóstico por imagen mamaria, Hospital Universitario Marqués de Valdecilla, Santander, España.
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23
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Klopfleisch R, Sperling C, Kershaw O, Gruber AD. Does the taking of biopsies affect the metastatic potential of tumours? A systematic review of reports on veterinary and human cases and animal models. Vet J 2011; 190:e31-e42. [PMID: 21723757 DOI: 10.1016/j.tvjl.2011.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/08/2011] [Accepted: 04/09/2011] [Indexed: 02/06/2023]
Abstract
Clinicians and pathologists are sporadically asked by owners whether the taking of tumour biopsies may affect the behaviour of the tumour, including its potential to metastasise. Unfortunately, systematic studies on this subject are unavailable in veterinary medicine, and the aim of this study was to estimate the risk of adverse effects of biopsy taking on tumour progression in animals. A systematic review of veterinary and human case reports and clinical studies as well as experimental animal models of biopsy-induced tumour metastasis was undertaken. There were only two veterinary case reports of needle tract metastases (NTM) following the taking of needle biopsies from urogenital and pulmonary tumours. Seventeen experimental studies found a high incidence of NTM but only a rat osteosarcoma and a hamster squamous carcinoma model showed an increased incidence of distant or regional metastases after incision or excision biopsy. In human medicine, the occurrence of NTM has been reported after the taking of biopsies from mesotheliomas (15%), melanomas (11%) and gall bladder tumours (11%), liver metastases of colon carcinomas (4%) and mammary carcinomas (4%) but an incidence of only <1% for all other tumours. Circulating tumour cells increased immediately after the taking of biopsies from human squamous cell, prostate, breast and hepatocellular carcinomas. Although no increased risk of biopsy-induced distant metastasis has been reported for any type of tumour, this is inconclusive due to a lack of non-biopsied control groups in human studies. Reports of biopsy-induced metastasis in animal tumours indicate that the taking of transcutaneous biopsies from urogenital tumours may be associated with a risk of NTM. However, there is no evidence of a general increase in risk of distant metastases in any tumour type in people or animals. The overall risk therefore appears to be negligible when compared to the valuable information obtained from biopsies in veterinary practice.
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Affiliation(s)
- R Klopfleisch
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany.
| | - C Sperling
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany
| | - O Kershaw
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany
| | - A D Gruber
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany
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Newman LA. Local control of ductal carcinoma in situ based on tumor and patient characteristics: the surgeon's perspective. J Natl Cancer Inst Monogr 2011; 2010:152-7. [PMID: 20956822 DOI: 10.1093/jncimonographs/lgq018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) is a disease whose manifestations are largely confined to in-breast pathology. Management strategies therefore focus on various combinations of local therapy: mastectomy, lumpectomy alone, and lumpectomy followed by breast irradiation. Although DCIS does not carry an inherent risk of distant organ metastasis, optimal local control is essential because any in-breast or chest wall recurrence may occur as an invasive lesion. Local recurrence has been reported following breast-conserving surgery as well as mastectomy. Breast radiation is therefore generally recommended following breast-conserving surgery, and in selected circumstances, mastectomy may be the preferred treatment strategy. This article reviews the surgical and associated clinicopathologic issues related to initial biopsy and perioperative planning that should be considered for all DCIS cases to optimize local control.
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Affiliation(s)
- Lisa A Newman
- Department of Surgery, Breast Care Center, University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Dr, 3308 Cancer Center, Ann Arbor, MI 48109-0932, USA.
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25
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Preoperative cytological and histological diagnosis of breast lesions: A critical review. Eur J Surg Oncol 2010; 36:934-40. [PMID: 20709485 DOI: 10.1016/j.ejso.2010.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/20/2010] [Accepted: 06/07/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-operative pathology diagnoses constitute an essential part of the work-up of breast lesions. With fine needle aspiration (FNA) and core needle biopsy (CNB) both having unique advantages, there is an increasing acceptance of CNB. This paper aims to outline the scientific basis of this trend. Additionally, we provide an update on novel techniques that derive cytological specimens from CNB (i.e., touch imprint (TI) and core wash (CW) cytology) in an attempt to get the best of both worlds. METHODS In addition to using the authors' experience, we performed a search of the Medline database combining the search terms "breast cancer diagnosis", "core needle biopsy", "fine needle aspiration", "touch imprint cytology", "core wash cytology" and "complications". We defined a conclusive non-operative diagnosis as "malignant" in lesions that were malignant on follow-up and "benign" in lesions that were benign on follow-up. RESULTS CNB was more often conclusive than FNA in benign and malignant lesions in 4 prospective studies. Although the more rapid diagnoses by FNA result in less patient anxiety during diagnostic work-up, CNB allows for fairly reliable estimation of invasion, histological type, grade, and receptor expression. CW and TI cytology seem promising techniques with conclusiveness rates that are roughly comparable to that of FNA. CONCLUSIONS All new suspicious breast lesions require careful non-operative investigation by CNB. However, additional cytological assessment by FNA can still be useful as a same-day diagnosis decreases patient anxiety and facilitates surgical treatment planning. TI and CW cytology techniques are promising same-day diagnosis modalities.
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Cho E, Kim MH, Cha SH, Cho SH, Oh SJ, Lee JD. Breast cancer cutaneous metastasis at core needle biopsy site. Ann Dermatol 2010; 22:238-40. [PMID: 20548926 DOI: 10.5021/ad.2010.22.2.238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/21/2009] [Accepted: 10/13/2009] [Indexed: 11/08/2022] Open
Abstract
Cutaneous metastasis from breast cancer can occur by direct invasion, lymphatic and vascular spread as well as iatrogenic implantation. Metastasis that occurs by iatrogenic implantation after needle biopsy is very rare but the potential risk must be considered. In this report, we describe a case of breast cancer cutaneous metastasis that occurred by iatrogenic implantation following core needle biopsy. A 53-year-old woman presented with a 1x1 cm sized erythematous nodule at the biopsy site after breast conserving surgery for primary cancer. Histopathological findings confirmed cutaneous metastasis. The possibility of this consequence must be considered when performing needle biopsies.
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Affiliation(s)
- Eujin Cho
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tada K, Ogiya A, Kimura K, Morizono H, Iijima K, Miyagi Y, Nishimura S, Makita M, Horii R, Akiyama F, Iwase T. Ductal carcinoma in situ and sentinel lymph node metastasis in breast cancer. World J Surg Oncol 2010; 8:6. [PMID: 20105298 PMCID: PMC2837658 DOI: 10.1186/1477-7819-8-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/27/2010] [Indexed: 02/07/2023] Open
Abstract
Background The impact of sentinel lymph node biopsy on breast cancer mimicking ductal carcinoma in situ (DCIS) is a matter of debate. Methods We studied the rate of occurrence of sentinel lymph node metastasis in 255 breast cancer patients with pure DCIS showing no invasive components on routine pathological examination. We compared this to the rate of occurrence in 177 patients with predominant intraductal-component (IDC) breast cancers containing invasive foci equal to or less than 0.5 cm in size. Results Most of the clinical and pathological baseline characteristics were the same between the two groups. However, peritumoral lymphatic permeation occurred less often in the pure DCIS group than in the IDC-predominant invasive-lesion group (1.2% vs. 6.8%, p = 0.002). One patient (0.39%) with pure DCIS had two sentinel lymph nodes positive for metastasis. This rate was significantly lower than that in patients with IDC-predominant invasive lesions (6.2%; p < 0.001). Conclusions Because the rate of sentinel lymph node metastasis in pure DCIS is very low, sentinel lymph node biopsy can safely be omitted.
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Affiliation(s)
- Keiichiro Tada
- Department of Breast Surgery, Cancer Institute Hospital, Tokyo, Japan.
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Ma K, Kornecki A, Bax J, Mundt Y, Fenster A. Development and validation of a new guidance device for lateral approach stereotactic breast biopsy. Med Phys 2009; 36:2118-29. [DOI: 10.1118/1.3130017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Uematsu T, Kasami M. The use of positive core wash cytology to estimate potential risk of needle tract seeding of breast cancer: directional vacuum-assisted biopsy versus automated core needle biopsy. Breast Cancer 2009; 17:61-7. [PMID: 19360459 DOI: 10.1007/s12282-009-0109-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 03/04/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND A disadvantage of the image-guided core needle biopsy is that needle tract seeding may occur and affect the local recurrence and overall survival rates of patients after breast-conserving surgery, although the chance is small. The purpose of this study was to compare the potential risk of needle tract seeding of breast cancer from ultrasonographically guided needle biopsies that were performed with a directional vacuum-assisted device and an automated core needle gun. METHODS The study compared the biopsies of 148 breast cancers performed using ultrasonographically guided core needle biopsy with the biopsies of 105 breast cancers performed using the vacuum suction probe. The potential risk of needle tract seeding of the breast cancer was defined by the cytological results derived from the needle wash material. The atypical/indeterminate, suspicious/probably malignant, and malignant categories were considered to represent positive cases. RESULTS There were significantly fewer positive cytological findings derived from the needle wash material with the directional vacuum-assisted device (33%) than with the automated core needle gun (69%) (P < 0.0001). CONCLUSION The use of the directional vacuum-assisted device significantly decreases the potential risk of needle tract seeding of breast cancer after an ultrasonographically guided needle biopsy.
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Affiliation(s)
- Takayoshi Uematsu
- Department of Clinical Physiology, Shizuoka Cancer Center Hospital, Naga-izumi, Japan.
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Liebens F, Carly B, Cusumano P, Van Beveren M, Beier B, Fastrez M, Rozenberg S. Breast cancer seeding associated with core needle biopsies: A systematic review. Maturitas 2009; 62:113-23. [DOI: 10.1016/j.maturitas.2008.12.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 11/30/2008] [Accepted: 12/01/2008] [Indexed: 11/30/2022]
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Fitzal F, Riedl O, Jakesz R. Recent developments in breast-conserving surgery for breast cancer patients. Langenbecks Arch Surg 2008; 394:591-609. [DOI: 10.1007/s00423-008-0412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
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Uematsu T, Kasami M. Risk of needle tract seeding of breast cancer: cytological results derived from core wash material. Breast Cancer Res Treat 2007; 110:51-5. [PMID: 17674195 DOI: 10.1007/s10549-007-9685-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 07/09/2007] [Indexed: 11/28/2022]
Abstract
Needle track seeding has been recognized as a possible, albeit rare, complication of breast core needle biopsy. The purpose of this study was to assess the risk of needle tract seeding of breast cancer from cytological results derived from core needle wash material. The study included biopsies of 207 breast cancers performed using ultrasonographically guided 18-gauge core needles. Each core needle without exposed sample notch was washed in saline solution immediately after removing the needles. Cytology derived from core wash material was performed by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant and unsatisfactory. Atypical/indeterminate, suspicious/probably malignant and malignant categories were considered to represent positive cases of needle track seeding of breast cancer, whereas benign and unsatisfactory categories were counted as negative cases. Cytological diagnoses of the 207 lesions were as follows: 26 lesions (12%) were benign, 18 lesions (9%) were atypical/indeterminate, 37 lesions (18%) were suspicious/probably malignant, 79 lesions (38%) were malignant, and 47 lesions (23%) were unsatisfactory. The incidence of positive cases of cytology derived from core wash material was 65% (134/207). The 25% frequency of positive cases of invasive lobular carcinoma was significantly lower than the frequencies of DCIS (74%) and invasive ductal carcinoma (69%) (P = 0.001 and P < 0.01). The frequency of positive cases in the multiple passes group was 75%, which was slightly, although not significantly, higher than the 66% frequency in the single pass group (P = 0.3). In conclusion, the incidence of positive cases of cytology derived from ultrasonographically guided breast core needles' wash material was 65%. The clinical significance is debatable; however, there may be a theoretical risk of local recurrence if the tract is not excised or radiotherapy not given.
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Affiliation(s)
- Takayoshi Uematsu
- Breast Imaging Section, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, 411-8777, Japan.
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Kim BM, Kim EK, Kim MJ, Yang WI, Park CS, Park SI. Sonographically guided core needle biopsy of cervical lymphadenopathy in patients without known malignancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:585-91. [PMID: 17460000 DOI: 10.7863/jum.2007.26.5.585] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the efficacy of sonographically guided core needle biopsy (core biopsy) for diagnosing the causes of cervical lymphadenopathy in patients without known malignancy. METHODS One hundred fifty-five sonographically guided core biopsies performed in 155 patients with cervical lymphadenopathy were retrospectively evaluated. None of the 155 patients had any known primary malignancy. Final diagnoses were determined by the histologic examination from excision biopsy when performed or by the clinical and sonographic follow-up for more than 12 months. When a lymph node diagnosed as benign by sonographically guided core biopsy regressed spontaneously or by subsequent management, the diagnosis made by the sonographically guided core biopsy was considered correct. When a lymph node diagnosed as benign by sonographically guided core biopsy was unchanged or increased in size with subsequent management, excision biopsy was performed. Diagnostic yield, sensitivity, specificity, accuracy, and complications of core biopsy were evaluated. RESULTS Histologic diagnosis could be made by sonographically guided core biopsy in 146 (94%) of the 155 patients. The histologic diagnoses were reactive hyperplasia in 44 patients, tuberculosis in 37, Kikuchi disease in 25, metastasis in 16, lymphoma in 16, normal in 7, and toxoplasmosis in 1. Sensitivity, specificity, and accuracy of sonographically guided core biopsy were 97.9%, 99.1%, and 97.9%, respectively. There were no procedure-related complications. CONCLUSIONS Sonographically guided core biopsy is a safe and efficient tool for diagnosing the cause of cervical lymphadenopathy in patients without known malignancy and may obviate unnecessary excisional biopsy.
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Affiliation(s)
- Byung Moon Kim
- Department of Diagnostic Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Abstract
The surgical strategy for breast cancer has changed considerably over the last decade. Breast-conserving therapy (BCT) is now standard treatment. Today, at least three out of four breast cancer patients are, in principle, eligible for BCT. However, several specific factors must be considered to choose the correct surgical strategy. This review provides a scientific overview of the history, surgical methodology, and specific aspects of BCT.
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Affiliation(s)
- Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria
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