Extent of Margin Involvement, Lymphovascular Invasion, and Extensive Intraductal Component Predict for Residual Disease After Wide Local Excision for Breast Cancer

BackgroundA number of patients treated conservatively for breast cancer will develop loco-regional and distant recurrences. Our aim was to determine how their occurrence may be linked to the evolution of the disease.MethodsWe analyzed 238 women treated by conservative breast surgery and breast irradiation in a single institution. We evaluated the prognostic factors associated with loco-regional and distant recurrences and the prognostic value of local and regional recurrences on systemic progression.ResultsAfter a median follow-up of 5 year (range 1–10), 16 (6.72 %) patients in the breast conservative surgery (BCS) groups had loco-regional recurrence. For distant recurrence, 10 (4.2 %) patients had experienced distant recurrence. Lympho-vascular invasion (HR 2.55; 95 % CI, 076 to 8.49) and an extensive intraductal component (HR, 2.22; 95 % CI, 0.69 to 7.15) and nodal status are risk factors for loco-regional recurrence (LRR) after breast conservative therapy (BCT). Tumor size, nodal status, high histologic grade, and breast cancer diagnosed at a young age (≤35 years) are correlated with higher distant recurrence rates after BCT.ConclusionsRisk factors for LRR after BCS include lympho-vascular invasion, extensive inraductal component, and high nodal status, where as risk factors for distant recurrence include tumor size, nodal status, high histologic grade, and breast cancer diagnosed at a young age (≤35 years).

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“…This result is also concordant with the observations made by Salim Alrahbi et al, Zahra MA Mohammed et al, and Bent Ejlertsen et al [ 21 – 23 ].…”

Section: Discussionsupporting

confidence: 93%

Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery

et al. 2016

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“…Intraductal carcinoma was observed within and outside of the tumors with an EIC. Previous studies revealed that mammographic calcification of liner, segmental or diffuse distribution pattern were correlated with EIC (17). Therefore, the presence of EIC in tumors of patients with different calcification distribution patterns was analyzed.…”

Section: Resultsmentioning

confidence: 95%

“…However, it was identified that patients with calcification spreading along the ducts on mammograms were more likely to have tumors with EIC. It was reported that EIC associated with an increased risk of residual disease and patients with EIC had an increased risk of in-breast recurrence (17,24–28). Numerous other studies showed that negative margins were adequately safe for patients with EIC-positive tumors (29,30).…”

Section: Discussionmentioning

confidence: 99%

Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery

Chen

Zhang

et al. 2017

Oncology Letters

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The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11–5.44; distant metastasis, 2.24 and 1.19–4.24; mortality, 2.50 and 1.06–5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26–16.98), DFS (RR=6.81; 95% CI, 2.86–16.20) and OS (RR=9.14; 95% CI, 2.53–33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.

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“…Therefore, positive resection margins, which indicate that tumor resection is incomplete, are frequently found after various kinds of cancer surgery (1). Specifically for breast cancer, in up to 37% of the 500,000 women undergoing breast-conserving surgery in the United States and Europe each year, resection margins are tumor positive (2)(3)(4)(5)(6). For these patients, additional surgery or a radiotherapy boost of the resection area is needed, which has a major impact on the cosmetic outcome, patients' quality of life, and health care costs (7,8).…”

Section: Introductionmentioning

confidence: 99%

Hyperspectral Imaging for Resection Margin Assessment during Cancer Surgery

Kho

Boer

Vijver

et al. 2019

Clinical Cancer Research

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Purpose: Complete tumor removal during cancer surgery remains challenging due to the lack of accurate techniques for intraoperative margin assessment. This study evaluates the use of hyperspectral imaging for margin assessment by reporting its use in fresh human breast specimens. Experimental Design: Hyperspectral data were first acquired on tissue slices from 18 patients after gross sectioning of the resected breast specimen. This dataset, which contained over 22,000 spectra, was well correlated with histopathology and was used to develop a support vector machine classification algorithm and test the classification performance. In addition, we evaluated hyperspectral imaging in clinical practice by imaging the resection surface of six lumpectomy specimens. With the developed classification algorithm, we determined if hyperspectral imaging could detect malignancies in the resection surface. Results: The diagnostic performance of hyperspectral imaging on the tissue slices was high; invasive carcinoma, ductal carcinoma in situ, connective tissue, and adipose tissue were correctly classified as tumor or healthy tissue with accuracies of 93%, 84%, 70%, and 99%, respectively. These accuracies increased with the size of the area, consisting of one tissue type. The entire resection surface was imaged within 10 minutes, and data analysis was performed fast, without the need of an experienced operator. On the resection surface, hyperspectral imaging detected 19 of 20 malignancies that, according to the available histopathology information, were located within 2 mm of the resection surface. Conclusions: These findings show the potential of using hyperspectral imaging for margin assessment during breastconserving surgery to improve surgical outcome.

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Extent of Margin Involvement, Lymphovascular Invasion, and Extensive Intraductal Component Predict for Residual Disease After Wide Local Excision for Breast Cancer

Cited by 20 publications

References 34 publications

Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery

Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery

Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery

Hyperspectral Imaging for Resection Margin Assessment during Cancer Surgery

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