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PubMed1993

Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol 4). Discriminants for 15-year survival. National Surgical Adjuvant Breast and Bowel Project Investigators.

Twenty-one pathologic and five clinical features of Stage I and II invasive breast cancers from 620 patients enrolled in National Surgical Adjuvant Breast Project Protocol B-04 were analyzed to determine their predictive value for 15-year survival. Ten pathologic features had a statistically significant univariate prognostic relationship with long-term survival. These were analyzed further using a Cox regression model that found only the number of nodal metastases (0, 1-3, 4-9, or 10+), tumor size (< or = 2.0 cm versus 2.1-4 and 4.1 + cm), and the presence or absence of nipple involvement to be significant independent prognostic discriminants. Combinations of these three characteristics modestly increased their individual prognostic value. Differences in the findings in this study from those observed in the same patient population at 5 and 10 postoperative years and their relationship to other markers detected by ancillary pathologic techniques briefly are discussed.

Aged↗
PubMed1993

Chest wall recurrence of ductal carcinoma in situ of the breast after mastectomy.

BACKGROUND: Optimal management of ductal carcinoma in situ (DCIS) of the breast is a problem that is occurring with greater frequency, mostly because of the increasing use of mammographic screening. The traditional role of mastectomy for DCIS has been challenged by breast-conserving procedures. Regardless of the method of treatment used, local control with complete tumor eradication is the major goal in the management of DCIS. METHODS AND RESULTS: A patient is reported in whom DCIS recurred in residual breast tissue in the chest wall several years after mastectomy. CONCLUSIONS: Chest wall recurrence of DCIS within residual breast tissue probably is caused by failure of tumor excision, new primary tumor, or both. This observation underscores that (1) mastectomy may not result in complete removal of breast tissue, and (2) this residual breast tissue may be the substrate for "chest wall recurrences" in some patients with breast cancer.

Adult↗
PubMed1993

The order of administration of chemotherapy and radiation and its effect on the local control of operable breast cancer.

BACKGROUND: A delay in administration of radiation therapy has been suggested to increase the risk of local recurrence after breast-conserving surgery. METHODS: The data were retrospectively reviewed from 552 patients in whom treatment consisted of total mastectomy (n = 467) or segmental mastectomy (n = 85), irradiation, and combination chemotherapy. Of these, 463 patients received radiation therapy first, and 89 received chemotherapy first. The pattern of failures was compared between the subgroups according to the order of administration chemotherapy and irradiation and its effect on the local control of disease. RESULTS: The median follow-up time of the local mastectomy subgroup was 133 months; of the segmental mastectomy subgroup, it was 39 months. The incidence of locoregional failure within each subgroup was not affected by the order in which the chemotherapy and irradiation were administered. CONCLUSIONS: These data suggest that delaying irradiation in an effort to reduce the risk of systemic relapse does not increase the risk of local failure.

Breast Neoplasms↗
PubMed1994

Ductal carcinoma in situ of the male breast.

BACKGROUND: Ductal carcinoma in situ (DCIS) of the male breast is an uncommon disease, accounting for approximately 7% of all male breast carcinomas. Compared with invasive carcinomas of the breast, the prognosis associated with DCIS in men is excellent; however, clinical features, pathology, and treatment of this disease are not well defined in the literature. METHODS: Records of 23 men with carcinoma of the breast treated at the Lahey Clinic from 1968 to 1991 were reviewed, revealing 4 patients with pure DCIS (17%). The reported management of DCIS in women is discussed in comparison with that of DCIS in men. RESULTS: Of the four patients with DCIS, the presenting complaint was a retroareolar mass in three patients and a bloody nipple discharge in one patient. The pathologic subtype was papillary in one patient and intracystic papillary in three patients. Two patients were treated with partial mastectomy alone. Disease recurred locally as DCIS in both patients, requiring mastectomy at 30 and 108 months. No lymph node metastases were found in the three patients who underwent axillary dissection. All four patients were alive without disease at 133, 120, 36, and 32 months of follow-up, respectively. CONCLUSIONS: Although the sample size was small, our patients and a review of the literature suggest that most DCIS in men is of the papillary type and that mastectomy without axillary dissection is the preferred treatment.

Adenocarcinoma↗
PubMed1994

Management of ductal carcinoma in situ with nipple discharge. Intraductal spreading of carcinoma is an unfavorable pathologic factor for breast-conserving surgery.

BACKGROUND: Surgical management of ductal carcinoma in situ (DCIS) has been a controversial issue in the selection of breast-conserving surgery as a method of treatment. The definition of intraductal spreading of carcinoma becomes an important factor in the decision making process, but little is known about how much intraductal extension influences the spreading of tumor in the whole breast. To define any unfavorable pathologic factors existing in limited surgery for patients with DCIS, the authors investigated histopathologic characteristics using a sequential slicing of tissues. METHODS: Duct-lobular segmentectomy, a limited surgery, was performed on 110 patients with a bloody nipple discharge. Six patients with invasive carcinoma and 17 patients with DCIS subsequently received a total mastectomy. The specimens obtained by segmentectomy and mastectomy were histopathologically examined. Using subserial sections, the authors examined the relationship between intraductal spreading of carcinoma in the segmentectomy specimens and carcinoma residue in the mastectomy specimens. RESULTS: Among 16 mastectomy specimens, the authors found residual DCIS in 6, and atypical ductal hyperplasia in 4. Intraductal spreading of carcinoma was detected in 8 of 16 segmentectomy specimens. Six of eight patients with intraductal spreading had residual DCIS. The other two patients had atypical hyperplasia in breasts. No residual DCIS was detected in the other eight patients without intraductal spreading. Among 12 patients under observation who did not have a mastectomy, invasive carcinoma subsequently developed in 3. Two of three patients had intraductal spreading in segmentectomy specimens. Only 1 of 10 patients without intraductal spreading, however, developed carcinoma. CONCLUSIONS: Intraductal spreading of carcinoma is an unfavorable pathologic factor in breast-conserving surgery for patients with ductal carcinoma in situ with nipple discharge.

Adolescent↗
PubMed1995

Predictors of recurrence for patients with small (one centimeter or less) localized breast cancer (T1a,b N0 M0).

BACKGROUND: The frequency of small (< or = 1 cm) axillary lymph node negative invasive breast cancers (T1a,b N0 M0) is increasing because of wider implementation of breast cancer screening. Identification of prognostic factors for these patients has been based largely on retrospective pathology review. The authors analyzed histologic factors recorded in the original pathology reports to determine predictors of recurrence for patients with T1a,b N0 M0 breast cancer. METHODS: Two hundred eighteen patients were studied. Potential prognostic factors including measured millimeter tumor size in three dimensions, histologic grade, nuclear grade, and presence or absence of lymphatic vessel invasion were documented prospectively in routine surgical pathology reports of a large community (nonuniversity based) hospital. Follow-up was performed annually by the tumor registry. RESULTS: With a median follow-up of 6.9 years (range, 3-15.8 years), overall recurrence free survival was 93%. Poor nuclear grade (hazard ratio, 5.8; 95% confidence interval, 1.70-19.82; P = 0.004) and lymphatic vessel invasion (hazard ratio, 4.6; 95% confidence interval, 1.34-15.61; P = 0.01) were independent predictors of recurrence. Only 10% of patients had cancers with both poor nuclear grade and lymphatic vessel invasion and their 67% 7-year recurrence free survival (RFS) rate was significantly lower than the 92% RFS rate observed for patients with one of these two factors (P = 0.007) and the 99% RFS for patients with neither poor risk factor (P = 0.0001). CONCLUSIONS: The combination of poor nuclear grade and lymphatic vessel invasion identifies a very small subset (10%) of patients with T1a,b N0 M0 breast cancer with a significant relapse risk that warrants consideration of adjuvant systemic therapy. However, the majority of patients with T1a,b N0 M0 breast cancer have an exceptionally good prognosis.

Adult↗
PubMed1990

Reduced psychological morbidity after breast conservation.

Psychological morbidity was compared in 52 patients treated by mastectomy and 67 patients treated by lumpectomy for early breast cancer. An informal counselling service was provided for all patients. Morbidity was measured at 6, 9 and 12 months after surgery with two self-rating scales: the general health questionnaire and the Leeds depression and anxiety scales. There was a significant excess of severe depression in the mastectomy group. In contrast to the findings of previous research, this result suggests that breast conservation reduces psychological morbidity.

Adult↗
PubMed1994

Management of non-palpable breast lesions detected mammographically.

A total of 212 consecutive fine-wire localization breast biopsies in 202 patients were performed on impalpable mammographically suspicious lesions. Preoperative fine-needle aspiration cytology was performed on 159 lesions and was valuable in planning the extent of the fine-wire localization biopsy. All 212 target lesions were accurately biopsied during the initial surgery. Overall, 134 lesions were malignant and 78 benign (benign:malignant ratio 1:1.72), with fewer biopsies for benign lesions performed in screened patients (benign:malignant ratio 1:2.43) than in those with symptoms (ratio 1:1). Breast conservation was achieved in 72 patients (80 per cent) with screen-detected in situ or invasive carcinoma and in 19 of 37 presenting via a symptomatic clinic. In 160 of 202 patients (79 per cent) the initial fine-wire localization biopsy was diagnostic and therapeutic.

Biopsy, Needle↗
PubMed2006

Radiofrequency ablation of small breast cancer followed by surgical resection.

BACKGROUND: With the growing demand from patients for less-invasive procedures, the shift from surgical extirpation to ablative local control of breast tumors is an emerging focus in breast cancer care. This study was performed to determine the feasibility and safety of treating small breast cancer with radiofrequency (RF) ablation. METHODS: Patients with biopsy-proven invasive or non-invasive breast cancer underwent RF ablation under general anesthesia. Before RF ablation, all patients were confirmed to have a localized lesion using imaging modalities. Wide excision or total mastectomy with sentinel lymph node biopsy or axillary lymph node dissection was performed. The resected tumor was examined histologically with hematoxylin-eosin (H&E) and nicotinamide adenine dinucleotide-diaphorase (NADH) staining. RESULTS: Ten patients completed the treatment without RF ablation-related complications. The mean tumor size was 1.1 cm (range: 0.5-2.0 cm). Histological evaluation of the ablated tissue using H&E staining revealed a spectrum of changes ranging from complete coagulation necrosis of tumor cells to normal-appearing tumor cells. However, NADH-diaphorase showed no staining of viable tumor cells in the RF-ablated region in all of the patients. CONCLUSIONS: RF ablation is promising as a minimally invasive ablation technique in the local treatment of invasive or non-invasive breast cancer. However, further study is necessary before RF ablation can replace conventional breast conservation therapy for patients with small breast cancer.

Adult↗
PubMed1989

Treatment of breast cancer in women older than 70 years.

Do age, associated diseases, general state, or the stage of tumor determine the operability of breast cancer in the elderly? Risk factors are studied on the basis of data on 465 patients over 70 years of age who had breast cancer surgery between 1977 and 1986. Operative mortality of patients is analyzed, and according to the results, the outcome of the surgery is mainly influenced by patients' performance status (Karnofsky/Zubrod index) and stage of disease and not by the associated diseases or patient age.

Age Factors↗
PubMed1989

Evaluation of a short-stay program for patients undergoing mastectomy.

Two hundred twenty-eight patients were included in a retrospective study to evaluate the morbidity and feasibility of early discharge after mastectomy. Group I (early discharge, n = 75) patients were given pre- and postoperative instruction related to wound and drain care. Group II (concurrent control, n = 44) was given similar postoperative instruction, but received no preoperative teaching. Group III (historical controls, n = 109) underwent surgery during a period of more liberal hospitalization and discharge policies. The groups were similar in age, cultural background, operations performed, and pathologic diagnosis. Length of stay for groups I, II, and III was 5.5 +/- 0.4, 3.5 +/- 0.2, and 8.6 +/- 0.3 days, respectively. Groups I and II had a significantly shorter stay than group III. There was no difference among the groups for the presence of wound erythema, rate of primary healing, seroma formation, or wound infection. The practice of same-day admission and early discharge to limit length of stay for patients undergoing mastectomy is safe and effective.

Breast Neoplasms↗
PubMed1994

Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer.

A retrospective study was done to evaluate the frequency and severity of wound complications in 112 patients with breast cancer who received adjuvant chemotherapy following mastectomy with immediate breast reconstruction. Data on wound complications were available for 120 mastectomies. The rate of complications in 36 mastectomies treated with chemotherapy after mastectomy and immediate reconstruction was compared to that in 84 mastectomies not receiving adjuvant therapy. There were 25 wound complications (20.8%) in the entire group. The rate of wound complications was 27.8% (10 of 36 mastectomies) in the group treated with adjuvant chemotherapy and 17.9% (15 of 84 mastectomies) in the group that did not receive adjuvant therapy (P = 0.13). No patient had a delay in the initiation of adjuvant therapy because of wound complications secondary to immediate reconstruction. Logistic regression analysis found no correlation between age, type of operation, tumor pathology, stage, number of lymph nodes harvested, type of prosthesis or chemotherapy, and wound complications in patients undergoing immediate breast reconstruction after mastectomy. The frequency of wound complications was not increased in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction. The administration of adjuvant chemotherapy does not need to be delayed in patients who have had immediate breast reconstruction following mastectomy for breast cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Management of the high-risk patient.

While breast cancer is affecting American women at an epidemic rate, certain patients are identified as being at particularly high risk because of environmental, endocrine, genetic, and pathologic risk factors. Risk assessment, dietary, and psychological counseling, as well as breast cancer screening, are the function of a high-risk breast cancer program. Our own program is discussed.

Breast Neoplasms↗
PubMedDate not supplied

Role of radiotherapy following total mastectomy in patients with early breast cancer. The Closed Trials Working Party of the CRC Breast Cancer Trials Group.

Between June 1970 and April 1975 the CRC (King's/Cambridge) Trial for early breast cancer randomized 2800 patients following mastectomy to immediate prophylactic radiotherapy (DXT group, n = 1376) or control (WP group, n = 1424). Although no difference in overall survival has been demonstrated, there is an increase in mortality in the irradiated patients from nonbreast cancer causes beyond 5 years. It is because of an increase in the number of deaths due to new nonbreast malignancies [RR V 1.89 (1.18-3.05)] and to cardiac-related disease [RR = 1.52 (1.01-2.29)]. This increased cardiac death rate may be related to the use of orthovoltage, which has greater scatter. There was a significant increase in risk for those with left-sided rather than right-sided tumors in this subgroup [chi 2 (int) = 5.08; p = 0.02]. Local relapse was significantly reduced in those patients randomized to radiotherapy [RR = 0.44 (0.39-0.51)]. Median survival following local relapse was 1.35 years in the DXT group and 2.66 years in the WP group (logrank p < 0.001). Patients with the first relapse in the supraclavicular nodes had a particularly poor prognosis (median survival: DXT 0.69 years; WP 1.37 years). Almost 50% of patients who have had a recurrence on the chest wall or in the axilla and subsequently died have had disease at the same site at death, regardless of whether they had radiotherapy immediately following surgery. However, the actual number of patients dying with persistent disease is halved by the use of prophylactic radiotherapy (DXT 66; WP 143). Classic pathological features such as tumor size, tumor grade, and nodal involvement help define those patients at high risk of local failure who should be recommended for immediate radiotherapy.

Breast Neoplasms↗
PubMed1994

A comparison of body image, self-esteem and social support in total mastectomy and breast-conserving therapy in Turkish women.

As well as the medical outcomes of two distinct operations, namely total mastectomy and breast-conserving therapy, their impact on the psychic structuring of the patient may differ. A group of 40 woman with who had undergone mastectomy were therefore compared with another 40 with who had received breast-conserving therapy, with regard to the variables of body image, self-esteem and social support. The women who underwent breast-conserving therapy had a more positive body image (P < 0.001). The two groups showed a negligible difference with respect to self-esteem and social support (P > 0.05). A negative correlation was found between body image and social support (P < 0.05). Patients with total mastectomy therefore do have a more negative body image than patients receiving breast-conserving therapy. Self-esteem and social support in the postoperative period in two groups are comparable.

Adult↗