Is axillary surgery beneficial for patients with adenoid cystic carcinoma of the breast?

Welsh, Jessemae L.; Keeney, Michael; Hoskin, Tanya L.; Glazebrook, Katrina N.; Boughey, Judy C.; Shah, Sejal M; Hieken, Tina J.

doi:10.1002/jso.24702

Cited by 17 publications

(16 citation statements)

References 13 publications

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“…Patients receiving lumpectomy and radiation therapy had a survival benefit of 9% at 5 years and 21% at 10 years. Therefore, radiotherapy decreases local recurrence for patients who had undergone BCT like in our case [ 3 , 6 , 8 , 10 ].…”

Section: Discussionmentioning

confidence: 84%

“…Lymph node involvement is very rare (not exceeding 2%), however, SLNB is required for ACC, as with any invasive breast primary. In a retrospective case series from with follow up of 20 years, patients with pure ACC (n = 20), out of a 15,749 total cases of invasive breast cancer, 15 of those had SLNB with pathologically node-negative lymph nodes, and no evidence of any lymph node involvement in 20 year follow up [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Adenoid cystic carcinoma of the breast - Discordant size on imaging and pathology: A case report and review of literature

Agafonoff

Sobolewski

Braverman

2019

Annals of Medicine and Surgery

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Introduction Adenoid cystic carcinoma (ACC) is an uncommon tumour of the breast. It is known for its rare lymph node involvement and distant metastasis. A triple-negative breast cancer that has a favorable prognosis compared to other triple negative ductal carcinomas, it accounts for approximately 0.1–1% of all breast cancers. Presentation of case We report a case of a 69-year-old female with a palpable left breast mass who underwent multiple imaging modalities with significant size variance between the studies. Breast conserving therapy (BCT) was performed with axillary sentinel lymph node biopsy (SLNB) followed by radiation therapy (RT). Pathological examination confirmed the tumour as ACC. Discussion ACC, known as an persistent if low-grade malignant tumour of salivary gland, is considered to have low-malignant potential in the breast. It is a very rare subtype and from this scant data, there is minimal mention about size discrepancy between imaging modalities such as ultrasound and MRI. No consistent MRI features have been demonstrated, with the exception of T2 hyperintensity in larger lesions and T2 iso-intensity in smaller lesions. Ultrasound demonstrates primarily a hypoechoic or heterogenous mass with minimum vascularity, consistent with our radiographic findings. Conclusion ACC is a rare entity in breast cancer pathology. Its size can be highly variable as measured by various radiographic modalities, and final Pathology from the surgical specimen is, as always, required for an accurate tumoral diameter. With that caveat, careful utilization of pre-operative imaging modalities is critical in pre-surgical planning to choose the appropriate surgery.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Adenoid cystic carcinoma of the breast - Discordant size on imaging and pathology: A case report and review of literature

Agafonoff

Sobolewski

Braverman

2019

Annals of Medicine and Surgery

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“…In a study using the California cancer registry, 5% of patients had lymph node involvement (13). Even in other studies, none of the cases found axillary lymph node metastasis through sentinel lymph node biopsy or axillary lymph node dissection (3,5). Thus, some studies recommend that axillary surgery might be omitted safely in patients with pure ACC and a clinically negative axilla.…”

Section: Discussionmentioning

confidence: 99%

“…Adenoid cystic carcinoma (ACC) of the breast is a rare special histological type of breast cancer, accounting for approximately 0.1% of all breast tumors (1)(2)(3). Most cases are in females, and the median age of onset is between 50 and 60 years old (4,5). However, occasional cases have been reported in male patients (6,7).…”

Section: Introductionmentioning

confidence: 99%

Management of Adenoid Cystic Carcinoma of the Breast: A Single-Institution Study

et al. 2021

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ObjectiveThe purpose of our study was to analyze the clinicopathologic features and surgical and oncological outcomes of adenoid cystic carcinoma (ACC) of the breast and to provide the basis for a clinical therapeutic schedule.MethodsA total of 14 patients with primary breast adenoid cystic carcinoma treated at Cancer Hospital of the Chinese Academy of Medical Sciences from January 2000 to December 2017 were included. Data on clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed.ResultsFourteen patients were diagnosed with ACC of the breast, out of 23205 total patients treated for breast cancer (0.06%). All but three patients were postmenopausal, with a median age at diagnosis of 60.5 years (range, 39–73 years). The most common clinical presentation was a palpable mass (85.7%), and the imaging characteristics of all patients on color Doppler ultrasound and mammography were nonspecific. Six patients (42.9%) were suspected of having ACC by fine-needle aspiration cytology (FNAC) and were confirmed by postoperative histology and immunohistochemistry. All 14 patients underwent surgery, and no patient had a positive lymph node status. Median tumor size was 1.75 cm (range, 1–3 cm). Eight/14 (57.1%) patients were hormone receptor negative (HR−) and HER-2/neu (−) (HER2−). The remaining patients were hormone receptor positive (HR+). There was no significant difference in clinicopathological characteristics between the HR+ group and the HR- group (P>0.05). The mean follow-up period was 57 months. Local recurrence occurred in 14.3% of patients, 1.7% of patients had distant metastasis, all patients with local recurrence or distant metastasis were in the HR (-) group, and all patients were alive at the last follow-up.ConclusionACC of the breast cannot be simply summarized as triple-negative breast cancer because it also includes a small number of hormone receptor-positive breast cancers. Establishing a preoperative diagnosis is difficult on the basis of clinical imaging examination, FNAC may be useful tool in the diagnosis. the final diagnosis can only be assessed based on the results of the histopathological and immunohistochemical examination. Breast-conserving surgery may be an alternative treatment strategy, and axillary lymph node dissection or sentinel node biopsy may not be necessary in some cases.

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“…Concerning favourable prognoses and low probability of the presence of metastases in the lymph nodes (0-2%), doubts arise pertaining to the necessity for biopsy of the sentinel lymph node or axillary lymphadenectomy in patients with clinically and ultrasound suspicious nodes [14]. According to some researchers, such management is not recommended [15,16].…”

Section: Treatmentmentioning

confidence: 99%

Adenoid cystic carcinoma of the breast

Olszewska¹,

Głuszek²

2017

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Adenoid cystic carcinoma is an invasive cancer accounting for less than 0.1% of all breast cancers. It most frequently occurs as a single, clearly defined, tender tumour. Mammographic and ultrasound images are non-characteristic and may be misinterpreted as benign change. This cancer shows no expression of ER, PGR, and HER-2 receptors; however, as opposed to triple-negative breast cancers, NST has a mild course and sporadically gives rise to metastases to locoregional lymph nodes and distant metastases. There is no consensus concerning the optimum treatment. The surgeries usually performed are lumpectomy with an open sentinel lymph node biopsy and mastectomy. However, considering the low probability of the presence of metastases in the lymph nodes, doubts arise pertaining to the justification for lymph node resection. Adjuvant radiotherapy is recommended after breast-conserving surgeries, especially with positive margins. The role of chemotherapy has not been well recognised, and hormone therapy is not recommended. StreszczenieRak gruczołowo-torbielowaty piersi jest nowotworem inwazyjnym stanowiącym poniżej 0,1% wszystkich raków piersi. Występuje najczęściej jako pojedynczy, dobrze odgraniczony, tkliwy guz. Obraz mammograficzny i ultrasonograficzny nie jest charakterystyczny, może być on błędnie interpretowany jako zmiana łagodna. Rak ten nie wykazuje ekspresji receptorów ER, PGR i HER-2, ale w przeciwieństwie do trójujemnych raków piersi NST ma łagodny przebieg, sporadycznie daje przerzuty do lokoregionalnych węzłów chłonnych i przerzuty odległe. Ze względu na niewielką częstość występowania tego nowotworu nie ma konsensusu dotyczącego optymalnego leczenia. Najczęściej wykonywane zabiegi to lumpektomia z otwartą biopsją węzłą wartowniczego i mastektomia. Jednak z uwagi na niewielkie prawdopodobieństwo obecności przerzutów w węzłach chłonnych pojawiają się wątpliwości dotyczące celowości resekcji węzłów chłonnych. Adiuwantową radioterapię zaleca się po wykonanych zabiegach oszczędzających, zwłaszcza przy dodatnich marginesach. Rola chemioterapii nie jest dobrze poznana, leczenie hormonalne nie jest zalecane.

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Is axillary surgery beneficial for patients with adenoid cystic carcinoma of the breast?

Cited by 17 publications

References 13 publications

Adenoid cystic carcinoma of the breast - Discordant size on imaging and pathology: A case report and review of literature

Adenoid cystic carcinoma of the breast - Discordant size on imaging and pathology: A case report and review of literature

Management of Adenoid Cystic Carcinoma of the Breast: A Single-Institution Study

Adenoid cystic carcinoma of the breast

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