Predictors of local recurrence after conservative surgery and whole-breast irradiation

Cèfaro, Giampiero Ausili; Genovesi, Domenico; Marchese, Rita; Ursini, Lucia Anna; Cianchetti, Ettore; Ballone, Enzo; Nicola, Marta Di

doi:10.1007/s10549-006-9169-0

Cited by 35 publications

(23 citation statements)

References 33 publications

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“…The end point evaluated was death from any cause in this study, so the competing risk should be taken into consideration because the patients in western countries are at higher risk of dying from other causes than older age. The incidence of relapse was smaller as compared with some other studies (4% versus 4–9%) (8–10). Five‐year cumulative incidences of loco‐regional recurrence and contra‐lateral recurrence were 2.9% (95% CI: 1.9–3.9) and 0.7% (95% CI: 0.2–1.2), respectively.…”

Section: Characteristics and Treatment Of Breast Cancer Patients N =contrasting

confidence: 67%

The Clinical Characteristics and Prognosis of Chinese Early Stage Breast Cancer Patients: A Retrospective Study

Li²,

Qian³

et al. 2010

The Breast Journal

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Section: Characteristics and Treatment Of Breast Cancer Patients N =contrasting

confidence: 67%

The Clinical Characteristics and Prognosis of Chinese Early Stage Breast Cancer Patients: A Retrospective Study

Li²,

Qian³

et al. 2010

The Breast Journal

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“…To minimize morbidity and improve cosmetic outcomes, it is important to minimize the resection of normal tissue around the tumor margin [7]. However, local recurrence following BCT is strongly correlated with margin status as determined by postoperative histopathology, making complete resection of cancerous tissue essential [8,9]. Similar challenges occur in surgical scenarios such as prostate cancer where positive surgical margins on postoperative histopathology are associated with an increased risk of biochemical recurrence (increasing prostate specific antigen) as well as the need for postoperative adjuvant radiation therapy [10].…”

Section: Introductionmentioning

confidence: 99%

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

Giacomelli¹,

Yoshitake²,

Cahill³

et al. 2018

Biomed. Opt. Express

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The ability to histologically assess surgical specimens in real-time is a long-standing challenge in cancer surgery, including applications such as breast conserving therapy (BCT). Up to 40% of women treated with BCT for breast cancer require a repeat surgery due to postoperative histological findings of close or positive surgical margins using conventional formalin fixed paraffin embedded histology. Imaging technologies such as nonlinear microscopy (NLM), combined with exogenous fluorophores can rapidly provide virtual H&E imaging of surgical specimens without requiring microtome sectioning, facilitating intraoperative assessment of margin status. However, the large volume of typical surgical excisions combined with the need for rapid assessment, make comprehensive cellular resolution margin assessment during surgery challenging. To address this limitation, we developed a multiscale, real-time microscope with variable magnification NLM and real-time, co-registered position display using a widefield white light imaging system. Margin assessment can be performed rapidly under operator guidance to image specific regions of interest located using widefield imaging. Using simulated surgical margins dissected from human breast excisions, we demonstrate that multi-centimeter margins can be comprehensively imaged at cellular resolution, enabling intraoperative margin assessment. These methods are consistent with pathology assessment performed using frozen section analysis (FSA), however NLM enables faster and more comprehensive assessment of surgical specimens because imaging can be performed without freezing and cryo-sectioning. Therefore, NLM methods have the potential to be applied to a wide range of intra-operative applications.

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“…A positive margin, the presence of disease on the inked surface, occurs in at least 30-35% of cases, and an additional 10-15% are classified as close margins (< 2 mm)(15). Local recurrence rates for breast conserving therapy followed by radiation were reported in 2-28% of cases with positive margins, 2-16% with close margins (<2 mm), and 2-8% with negative margins (15) which would be higher in the absence of radiation therapy (6, 8, 17, 18). …”

Section: Introductionmentioning

confidence: 99%

Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

et al. 2009

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As breast cancer screening rates increase, smaller and more numerous lesions are being identified earlier, leading to more breast-conserving surgical procedures. Achieving a clean surgical margin represents a technical challenge with important clinical implications. Optical coherence tomography (OCT) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface. In a study of 37 patients split between training and study groups, OCT images covering 1 cm 2 regions were acquired from surgical margins of lumpectomy specimens, registered with ink, and correlated with corresponding histologic sections. A 17-patient training set used to establish standard imaging protocols and OCT evaluation criteria showed that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue in contrast to lower scattering adipocytes found in normal breast tissue. The remaining 20 patients were enrolled into the feasibility study. Of these lumpectomy specimens, 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT. Based on histologic findings, 9 true positives, 9 true negatives, 2 false positives, and 0 false negatives were found, yielding a sensitivity of 100% and specificity of 82%. These results show the potential of OCT as a real-time method for intraoperative margin assessment in breast-conserving surgeries. [Cancer Res 2009;69(22):8790-6]

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Predictors of local recurrence after conservative surgery and whole-breast irradiation

Abstract: Age and tumor size were the most important and statistically significant factors that correlated independently with higher rates of LR. Women <50 years old and with a tumor size >3 cm had a higher risk of LR. Also margin status and systemic therapy could influence LR risk.

Cited by 35 publications

References 33 publications

The Clinical Characteristics and Prognosis of Chinese Early Stage Breast Cancer Patients: A Retrospective Study

The Clinical Characteristics and Prognosis of Chinese Early Stage Breast Cancer Patients: A Retrospective Study

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

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