Biomarkers for local recurrence after breast‐conservation — a nested case‐control study

Dalberg, Kristina; Eriksson, Ejnar; Kanter, Lena; Sandelin, Kerstin; Liedberg, Anette; Auer, Gert; Thorstensson, Sten; Fredriksson, Irma; Johansson, Ulla; Rutqvist, Lars Erik

doi:10.1023/a:1006281718793

Cited by 5 publications

(4 citation statements)

References 64 publications

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“…For some surgeons and patients, these or other prognostic variables may weigh into such decisions as whether to attempt breast-conservation therapy, 21,22 use sentinel lymph node biopsy, or perform axillary lymph node dissection. 23 Prospective information afforded by CNBx clearly facilitates complex treatment planning.…”

Section: Malignant Resultsmentioning

confidence: 99%

Impact of Core-Needle Breast Biopsy on the Surgical Management of Mammographic Abnormalities

White

Halperin²,

Olson³

et al. 2001

Annals of Surgery

113

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ObjectiveTo evaluate the accuracy of percutaneous, image-guided core-needle breast biopsy (CNBx) and to compare the surgical management of patients with breast cancer diagnosed by CNBx with patients diagnosed by surgical needle-localization biopsy (SNLBx). Summary Background DataPercutaneous, image-guided CNBx is a less invasive alternative to SNLBx for the diagnosis of nonpalpable mammographic abnormalities. CNBx potentially spares patients with benign lesions from unnecessary surgery, although false-negative results can occur. For patients with malignant lesions, preoperative diagnosis by CNBx allows definitive treatment decisions to be made before surgery and may affect surgical outcomes. MethodsBetween 1992 and 1999, 939 patients with 1,042 mammographically detected lesions underwent biopsy by stereotactic CNBx or ultrasound-guided CNBx. Results were categorized pathologically as benign or malignant and, further, as invasive or noninvasive malignancies. Only biopsy results confirmed by excision or 1-year-minimum mammographic follow-up were included in the analysis. Patients with breast cancer diagnosed by CNBx were compared with a matched control group of patients with breast cancer diagnosed by SNLBx. ResultsBenign results were obtained in 802 lesions (77%), 520 of which were in patients with adequate follow-up. Ninety-five of the 520 evaluable lesions (18%) were subsequently excised because of atypical hyperplasia, mammographic-histologic discordance, or other clinical indications. There were 17 falsenegative CNBx results in this group; 15 of these lesions were correctly diagnosed by excisional biopsy within 4 months of CNBx. In two patients (0.9%), delayed diagnoses of ductal carcinoma in situ were made at 15 and 19 months after CNBx. Malignant results were obtained in 240 lesions (23%), 220 of which were surgically excised from 202 patients at our institution. Two lesions diagnosed as ductal carcinoma in situ were reclassified as atypical ductal hyperplasia and considered false-positive results (0.4%). For malignant lesions, the sensitivity and specificity of CNBx for the detection of invasion were 89% and 96%, respectively. During the first surgical procedure, 115 of 199 patients (58%) diagnosed by CNBx underwent local excision; 194 of 199 patients (97%) evaluated by SNLBx underwent local excision. For patients whose initial surgery was local excision, those diagnosed before surgery by CNBx had larger excision specimens and were more likely to have negative surgical margins than were patients initially evaluated by SNLBx. Overall, patients diagnosed by CNBx required fewer surgical procedures for definitive treatment than did patients diagnosed by SNLBx. ConclusionsDiagnosis by CNBx spares most patients with benign mammographic abnormalities from unnecessary surgery. With the selective use of SNLBx to confirm discordant results, missed diagnoses are rare. When compared with SNLBx, preoperative diagnosis of breast cancer by CNBx facilitates wider initial margins of excision, fewer positive margins, and f...

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Section: Malignant Resultsmentioning

confidence: 99%

Impact of Core-Needle Breast Biopsy on the Surgical Management of Mammographic Abnormalities

White

Halperin²,

Olson³

et al. 2001

Annals of Surgery

113

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“…Although the majority of patients receiving post-lumpectomy radiation therapy have good cosmetic outcome when treated by modern radiation therapy techniques (Dalberg et al, 1999), the therapy may contribute to breast fibrosis and cause nipple retraction. Thus omission of radiotherapy through careful patient selection might improve the cosmetic outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The lowest local relapse rates were seen in the QUART study where there was the most extensive surgery (Veronesi et al, 1985). Although evidence regarding other risk factors is more controversial, it has been suggested that young age at presentation (Clark et al, 1992;Kurtz, 1992;de la Rochefordiere et al, 1993;Fowble et al, 1994), high nuclear grade, high tumour proliferation rate, presence of vascular invasion (Kurtz et al, 1990;Clark et al, 1992;Dalberg et al, 1999) and multifocality predict local recurrence.…”

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confidence: 98%

Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

et al. 2001

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SummaryThe aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction ≤7 and be excised with at least 1 cm margin. During a mean follow-up time of 6.7 years, 13 (18.1%) cancers recurred locally in the no-XRT and 6 (7.5%) in the XRT group (P = 0.03). There was no difference between the groups in the ultimate breast preservation rate (95.0% vs. 94.4% in XRT and no-XRT, respectively, P = 0.88), distant metastasis-free survival (P = 0.36), or 5-year cancer-specific survival (97.1% in XRT and 98.6 in no-XRT). Radiation therapy given after lumpectomy reduces the frequency of ipsilateral breast recurrences even in women with small breast cancer with several favourable clinical and biological features. However, the breast preservation rate may not increase due to more frequent use of salvage mastectomies in patients treated with postoperative radiotherapy.

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“… 26 Core-needle biopsy also has the benefit of provision of adequate tissue for determination of histologic grade; vascular and lymphatic invasion; estrogen and progesterone receptor statuses; and the presence of molecular tumor markers, such as HER2 / neu . 27 These prognostic variables may help triage surgical interventions, such as breast-conservation therapy, 28 use of SLN biopsy, or axillary lymph node dissection. 27 …”

Section: Discussionmentioning

confidence: 99%

Leverage of an Existing Cervical Cancer Prevention Service Platform to Initiate Breast Cancer Control Services in Zambia: Experiences and Early Outcomes

Pinder

Henry‐Tillman

Linyama

et al. 2018

JGO

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PurposeIn 2005, the Cervical Cancer Prevention Program in Zambia (CCPPZ) was implemented and has since provided cervical cancer screen-and-treat services to more than 500,000 women. By leveraging the successes and experiences of the CCPPZ, we intended to build capacity for the early detection and surgical treatment of breast cancer.MethodsOur initiative sought to build capacity for breast cancer care through the (1) formation of a breast cancer advocacy alliance to raise awareness, (2) creation of resource-appropriate breast cancer care training curricula for mid- and high-level providers, and (3) implementation of early detection and treatment capacity within two major health care facilities.ResultsSix months after the completion of the initiative, the following outcomes were documented: Breast health education and clinical breast examination (CBE) services were successfully integrated into the service platforms of four CCPPZ clinics. Two new breast diagnostic centers were opened, which provided access to breast ultrasound, ultrasound-guided core needle biopsy, and needle aspiration. Breast health education and CBE were provided to 1,955 clients, 167 of whom were evaluated at the two diagnostic centers; 55 of those evaluated underwent core-needle biopsy, of which 17 were diagnosed with invasive cancer. Newly trained surgeons performed six sentinel lymph node mappings, eight sentinel lymph node dissections, and 10 breast conservation surgeries (lumpectomies).ConclusionThis initiative successfully established clinical services in Zambia that are critical for the early detection and surgical management of breast cancer.

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Biomarkers for local recurrence after breast‐conservation — a nested case‐control study

Cited by 5 publications

References 64 publications

Impact of Core-Needle Breast Biopsy on the Surgical Management of Mammographic Abnormalities

Impact of Core-Needle Breast Biopsy on the Surgical Management of Mammographic Abnormalities

Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

Leverage of an Existing Cervical Cancer Prevention Service Platform to Initiate Breast Cancer Control Services in Zambia: Experiences and Early Outcomes

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