Positive margins after mastectomy in patients with invasive lobular carcinoma of the breast: Incidence and management strategies

Hewitt, Kelly; Miller, Phoebe; Piper, Merisa; Prionas, Nicolas D.; Son, Jennifer D.; Alvarado, Michael; Esserman, Laura J.; Wong, Jasmine; Ewing, Cheryl A.; Mukhtar, Rita A.

doi:10.1016/j.amjsurg.2021.05.021

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…Accordingly, while the cancer stage was found to be a significant factor affecting surgical margin positivity, it was not the case for the pleomorphic variant. 25 In our study, it is noteworthy that surgical margin positivity was significantly higher in the pleomorphic group than in the lobular group (19% vs 7%; P = .004). In addition, although both groups yielded similar rates of breast conservation surgery and mastectomy, the rate of completion mastectomy was higher in the pleomorphic group (2% vs 15%; P = .001).…”

Section: Discussionmentioning

confidence: 44%

Comparison of Clinicopathological Features of Pleomorphic and Invasive Lobular Breast Carcinomas

Sağdıç,

Güler,

Subaşı

et al. 2024

The American Surgeon™

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Purpose Accounting for about 15% of invasive lobular carcinomas and 1% of breast carcinomas, pleomorphic lobular carcinoma is known to be a rare histological subtype of invasive lobular carcinoma. Yet, it is more aggressive and produces a worse prognosis than other breast cancers. Ultimately, the present study compares the clinicopathological features of pleomorphic and invasive lobular breast carcinomas. Methods In the study, we retrospectively evaluated the data of 262 patients with histological subtypes of classical and pleomorphic lobular cancers having been recruited for surgical operations. After resorting to Kolmogorov-Smirnov and Shapiro-Wilk tests to check the normality of distribution, the categorical and continuous variables were compared between the groups using the chi-square test and independent samples t test, respectively. In all analyses, we considered a P-value of <.05 to be statistically significant. Results Our findings revealed that the groups with lobular and pleomorphic groups significantly differed by Ki-67 value, estrogen receptor negativity, grade, multicentricity, multifocality, surgical margin positivity, completion mastectomy, and metachronous contralateral tumor ( P < .05). Conclusion We discovered that pleomorphic type was associated with higher grades, estrogen receptor negativity, and Ki-67 expression. The incidence of metachronous breast cancer was high in the pleomorphic group, which may be a noteworthy finding to be considered in follow-ups. In addition, the high rates of multicentricity and multifocality of tumors in the pleomorphic group may be associated with increased surgical margin positivity and a higher likelihood of mastectomy. In a nutshell, our findings may guide patients and surgeons regarding the type of intervention and reconstruction options to be adopted in prospective surgeries.

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Section: Discussionmentioning

confidence: 44%

Comparison of Clinicopathological Features of Pleomorphic and Invasive Lobular Breast Carcinomas

Sağdıç,

Güler,

Subaşı

et al. 2024

The American Surgeon™

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“…Our findings are consistent with the literature in regard to the higher risk of positive margins in patient undergoing lumpectomy [ 6 ]. Interestingly, Hewitt, et al reported that in patients with large invasive lobular carcinoma (ILC) tumors, mastectomy fails to obtain clear margins [ 30 ]. Out of the 23 patients with positive margins after mastectomy (simple/radical) in our cohort, 15 of them had invasive ductal carcinoma (IDC) and 7 had ILC.…”

Section: Discussionmentioning

confidence: 99%

Association of clinicopathologic and molecular factors with the occurrence of positive margins in breast cancer

Praveen Kumar,

Vicente,

Liu

et al. 2023

Breast Cancer Res Treat

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Purpose To explore the association of clinicopathologic and molecular factors with the occurrence of positive margins after first surgery in breast cancer. Methods The clinical and RNA-Seq data for 951 (75 positive and 876 negative margins) primary breast cancer patients from The Cancer Genome Atlas (TCGA) were used. The role of each clinicopathologic factor for margin prediction and also their impact on survival were evaluated using logistic regression, Fisher’s exact test, and Cox proportional hazards regression models. In addition, differential expression analysis on a matched dataset (71 positive and 71 negative margins) was performed using Deseq2 and LASSO regression. Results Association studies showed that higher stage, larger tumor size (T), positive lymph nodes (N), and presence of distant metastasis (M) significantly contributed (p ≤ 0.05) to positive surgical margins. In case of surgery, lumpectomy was significantly associated with positive margin compared to mastectomy. Moreover, PAM50 Luminal A subtype had higher chance of positive margin resection compared to Basal-like subtype. Survival models demonstrated that positive margin status along with higher stage, higher TNM, and negative hormone receptor status was significant for disease progression. We also found that margin status might be a surrogate of tumor stage. In addition, 29 genes that could be potential positive margin predictors and 8 pathways were identified from molecular data analysis. Conclusion The occurrence of positive margins after surgery was associated with various clinical factors, similar to the findings reported in earlier studies. In addition, we found that the PAM50 intrinsic subtype Luminal A has more chance of obtaining positive margins compared to Basal type. As the first effort to pursue molecular understanding of the margin status, a gene panel of 29 genes including 17 protein-coding genes was also identified for potential prediction of the margin status which needs to be validated using a larger sample set.

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“…Additional surgical procedures in ILC are reported in the literature at a rate of 23.1%–44.5% [ 2 , 13 ]. In their study, Hewit et al reported that 10.6% of ILC patients who underwent total mastectomy had positive surgical margins and that surgical margin positivity was associated with large tumor size and short recurrence-free survival [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

The Importance of the Pathological Perspective in the Management of the Invasive Lobular Carcinoma

Taşlı

Cavdar

Keçeci³

et al. 2022

The Breast Journal

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Background. Invasive lobular carcinomas (ILC) account for 10–15% of all breast cancers and are the second most common histological form of breast cancer. They usually show a discohesive pattern of single cell infiltration, tend to be multifocal, and the tumor may not be accompanied by a stromal reaction. Because of these histological features, which are not common in other breast tumors, radiological detection of the tumor may be difficult, and its pathological evaluation in terms of size and spread is often problematic. The SSO-ASTRO guideline defines the negative surgical margin in breast-conserving surgeries as the absence of tumor detection on the ink. However, surgical margin assessment in invasive lobular carcinomas has not been much discussed from the pathological perspective. Methods. The study included 79 cases diagnosed with invasive lobular carcinoma by a Tru-cut biopsy where operated in our center between 2014 and 2021. Clinicopathological characteristics of the cases, results of an intraoperative frozen evaluation in cases that underwent conservative surgery, the necessity of re-excision and complementary mastectomy, and consistency in radiological and pathological response evaluation in cases receiving neoadjuvant treatment were questioned. Results. The tumor was multifocal in 37 (46.8%) cases and single tumor focus in 42 (53.2%) cases. When the entire patient population was evaluated, regardless of focality, mastectomy was performed in 27 patients (34.2%) and breast-conserving surgery (BCS) was performed in 52 patients (65.8%). Of the 52 patients who underwent BCS, 26 (50%) required an additional surgical procedure (cavity revision or completion mastectomy). There is a statistical relationship between tumor size and additional surgical intervention ( p < 0.05 ). BCS was performed in 7 of 12 patients who were operated on after neoadjuvant treatment, but all of them were reoperated with the same or a second session and turned to mastectomy. Neoadjuvant treatment and the need for reoperation were statistically significant ( p < 0.05 ). Additional surgical procedures were performed in 20 (44.4%) of 45 patients in BCS cases who did not receive neoadjuvant therapy. Conclusions. Diagnostic difficulties in the intraoperative frozen evaluation of invasive lobular carcinoma are due to the different histopathological patterns of the ILC. In our study, it was determined that large tumor size and neoadjuvant therapy increased the need for additional surgical procedures. It is thought that the pathological perspective is the determining factor in order to minimize the negative effects such as unsuccessful cosmesis, an additional surgical burden on the patient, and cost increase that may occur with additional surgical procedures; for this reason, new approaches should be discussed in the treatment planning of invasive lobular carcinoma cases.

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Positive margins after mastectomy in patients with invasive lobular carcinoma of the breast: Incidence and management strategies

Cited by 7 publications

References 26 publications

Comparison of Clinicopathological Features of Pleomorphic and Invasive Lobular Breast Carcinomas

Comparison of Clinicopathological Features of Pleomorphic and Invasive Lobular Breast Carcinomas

Association of clinicopathologic and molecular factors with the occurrence of positive margins in breast cancer

The Importance of the Pathological Perspective in the Management of the Invasive Lobular Carcinoma

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