Breast conservation therapy versus mastectomy in the surgical management of invasive lobular carcinoma measuring 4 cm or greater

The Challenges of Lobular Carcinomas from a Surgeon's Point of View

Invasive lobular breast cancer (ILC) presents unique challenges and considerations in the realm of surgical management. Characterized by its distinct histological features, including the loss of E-cadherin expression and dys-cohesive growth pattern, ILC often poses diagnostic and therapeutic dilemmas for clinicians. This abstract explores the surgical landscape of ILC, focusing on its epidemiology, clinical presentation, diagnostic modalities, and surgical interventions. Emphasizing the importance of individualized treatment strategies, this narrative delves into the nuances of surgical decision-making, including the role of breast-conserving surgery versus mastectomy, axillary staging, and the significance of margin status. Additionally, advancements in surgical techniques, such as oncoplastic approaches and sentinel lymph node biopsy, are examined in the context of optimizing oncologic outcomes and preserving cosmesis. Through a comprehensive review of current literature and clinical guidelines, this overview aims to provide a nuanced understanding of the surgical considerations inherent to the management of invasive lobular breast cancer.

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience

Background

Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety.

Methods

This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed.

Results

A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups.

Conclusions

Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.

Successful Breast Conservation After Neoadjuvant Chemotherapy in Lobular Breast Cancer: The Role of Menopausal Status in Response to Treatment

BACKGROUND

While neoadjuvant chemotherapy (NAC) has been shown to increase rates of breast conservation surgery (BCS) for breast cancer, response rates in invasive lobular carcinoma (ILC) appear lower than other histologic subtypes. Some data suggest higher response rates to NAC in premenopausal versus postmenopausal patients, but this has not been studied in ILC. We evaluated the rates of successful BCS after NAC in patients with ILC stratified by menopausal status.

PATIENTS AND METHODS

We analyzed data from a single-institution cohort of 666 patients with stage I-III hormone receptor positive HER-2 negative ILC. We used t-tests, chi-squared tests, and multivariable logistic regression to investigate rates of NAC use, attempted BCS, and associations between NAC and successful BCS by menopausal status.

RESULTS

In 217 premenopausal and 449 postmenopausal patients, NAC was used more often in the premenopausal group (15.2% vs. 9.8%, respectively, p = 0.041). Among those who attempted breast conservation (51.3% of pre- and 64.8% of postmenopausal cohorts), NAC was not associated with successful BCS in either group. Interestingly, for postmenopausal patients, receipt of NAC was significantly associated with increased rates of completion mastectomy in those who had positive margins at the first attempt at BCS.

CONCLUSION

NAC was not associated with successful BCS in either premenopausal or postmenopausal patients with ILC. Although premenopausal patients were more likely to receive NAC, these data suggest that menopausal status may not be a good predictor of response to chemotherapy. Better predictors of response and more efficacious treatment for patients with ILC are needed.

PI3K-AKT-Targeting Breast Cancer Treatments: Natural Products and Synthetic Compounds

Breast cancer is the most commonly diagnosed cancer in women. The high incidence of breast cancer, which is continuing to rise, makes treatment a significant challenge. The PI3K-AKT pathway and its downstream targets influence various cellular processes. In recent years, mounting evidence has shown that natural products and synthetic drugs targeting PI3K-AKT signaling have the potential to treat breast cancer. In this review, we discuss the role of the PI3K-AKT signaling pathway in the occurrence and development of breast cancer and highlight PI3K-AKT-targeting natural products and drugs in clinical trials for the treatment of breast cancer.