Selecting patients for breast‐conserving therapy

Abstract

Objective Urgent evaluation and treatment of transient ischemic attack (TIA) patients in a dedicated TIA clinic may reduce the 90‐day stroke risk by 80%. ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) score and magnetic resonance imaging abnormalities help to identify patients at high risk of stroke. Our aim was to determine whether the use of transcranial Doppler (TCD) examination on arrival at the TIA clinic yields additional information that facilitates the identification of patients at high risk of stroke recurrence. Methods Between January 2003 and December 2007, 1,881 patients were admitted to SOS‐TIA clinic (a TIA clinic with around‐the‐clock access). Clinical and vascular assessment included TCD performed by a neurologist immediately after admission. Stroke prevention measures were initiated on arrival, in accordance with guidelines. All patients were followed for 1 year after presentation to the SOS‐TIA clinic. Results A total of 1,823 TCD examinations were performed within 4 hours of admission. Intracranial narrowing or occlusion was found in 8.8% of patients, and was independently associated with age, hypertension, and diabetes. After 1‐year follow‐up on best preventive therapy, the incidence of recurrent vascular events (intracranial revascularization for TIA recurrence, stroke, myocardial infarction, and vascular death combined) was 7.0% in patients with intracranial narrowing or occlusion and 2.4% in those without (log‐rank, p = 0.007). The hazard ratio of combined outcome for the presence of intracranial narrowing or occlusion was 2.29 (95% confidence interval [CI], 1.15‐4.56; p = 0.02) in multivariate analysis including age, gender, hypertension, and diabetes, and was 2.50 (95%CI, 1.24–5.05; p = 0.01) in multivariate analysis including ABCD2 score ≥4. Interpretation Immediate TCD examination on arrival at the TIA clinic is feasible and could help to identify patients at high risk of vascular events recurrence. This study supports a systematic intracranial vascular examination in the initial management of TIA. ANN NEUROL 2010;68:9–17

Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer

“…The reported risks of tumour-positive resection margins vary between 18 and 63% and appear to be higher than the risk for patients with ductal carcinoma [8-10, 20, 21]. However, these findings were not confirmed in a recent study by Morrow et al, who found that patients with ILC did not require more operations to obtain negative margins than those with ductal carcinoma, after controlling for age and stage [22].…”

The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma

“…Patients with ILC frequently have higher rates of involved margins, with some reports in excess of 50%, 26 , 27 and conversion to mastectomy after BCS has been reported as between 16% and 48% of cases. 28 - 30 This is partly due to the underestimation of tumour size with standard imaging modalities, mainly due to the lack of a desmoplastic reaction for ILC. Preoperative assessment with MRI has been shown to improve size estimation.…”

Selective magnetic resonance imaging (MRI) in invasive lobular breast cancer based on mammographic density: does it lead to an appropriate change in surgical treatment?

“…[1][2][3] Conversion to mastectomy after breast-conserving surgery (BCS) has been reported in 16-48%. 1,[3][4][5] Mammography, ultrasound and MRI are all used in assessing the extent of ILC. Whilst mammography has primarily served as a screening test, it has limited potential in young patients with dense breasts.…”