Selective biopsy of the opposite breast

Abstract

The bilaterality of breast cancer detected by performing a contralateral biopsy has been reported to be 14%. Since the majority of cancers detected were noninfiltrating, a mastectomy was not always performed because of either the advanced stage of the presenting carcinoma or the age of the patient. This study was undertaken to determine the yield of contralateral cancers in younger patients with a better prognosis. Patients younger than 65 years with clinical Stage I and I1 initial breast cancers were selected for biopsy of the opposite breast between September 1978 and December 1984. Of 651 consecutive patients treated for breast cancer, 610 had an initial breast cancer and 258 (42%) met the criteria. Forty-three contralateral primary breast cancers were detected, for an incidence of 16.7%. In 11 of these 43 patients there was suspicion that a malignancy might be present; these were all infiltrating carcinomas. In 32 patients a truly random biopsy was performed, and the yield was 14.2%. Four (12.5%) of these were infiltrating cancers, and 28 (87.5%) were in situ carcinomas. By selecting patients for biopsy of the opposite breast, a 16.7% incidence of cancers can be detected. Since these patients were younger than 65 years and have a good prognosis in terms of their initial breast cancer, biopsy of the opposite breast is a worthwhile procedure and should be performed with the hope of improving these patients' ultimate outcome. Cancer 51577-580, 1986. HE RISK of the development of a second breast cancer T is considerably greater than that of the initial ma-lignancy. In that quadrant of the breast where an infiltrating carcinoma is diagnosed, additional infiltrating and in situ malignancy commonly coexist. Gallager and Mar-tin have demonstrated the frequent multicentric origin of breast cancer.' Since the breasts are paired organs, when this malignant potential becomes clinically evident in the opposite breast depends on the duration of follow-up of the patient. It has been accepted practice that, after the initial mas-tectomy, frequent breast palpation and periodic mam-mography are adequate for detecting a second breast cancer. However, the detection of localized breast cancer by physical examination is known to be difficult and unreliable ,* and the limitations of mammography are recog-n i ~ e d. ~ The second breast cancer is frequently found in a more advanced stage than the one for which the patient was originally treated, and may determine the ultimate fate of the patient. The contralateral breast biopsy was introduced by Urban et aL4 in an effort to detect these new cancers at an earlier, localized stage; they reported

Devenir du sein controlatéral après reconstruction mammaire pour carcinome

“…L'on observe que les taux de pré valence sont nettement plus é levé s (12 à 34,4 %) lorsqu'on associe les lé sions occultes dé tecté es par des biopsies à l'aveugle ou sur des piè ces de mammectomies [14,15]. On constate tout de même que la fré quence du cancer controlaté ral reste dans les limites des 10 % de cancers occultes retrouvé s sur les piè ces de mammectomies effectué es pour des tumeurs bé nignes [16].…”

“…Il s'agissait de biopsies de la ré gion pé riaré olaire ou du même quadrant que la tumeur primitive [14]. Ils ont constaté une augmentation du taux de dé tection de tumeurs occultes mais sans impact sur la survie globale.…”

A Clinical Oncologic Perspective on Breast Magnetic Resonance Imaging

“…Cody 47 identified contralateral cancer with mirror image biopsy in 3% of 871 women with unilateral cancer and a normal examination and mammogram treated between 1979 and 1993, and half of the cancers were invasive; Pressman 48 reported a 6.2% identification rate with contralateral biopsy in an earlier time period. To reconcile the findings of Lehman and colleagues 46 and the contralateral biopsy studies 47,48 with the low rates of cancer observed at 5 and 10 years in the SEER study of Gao and colleagues, 45 one must make the assumption that virtually all contralateral cancer that occurs in the first 5 years after diagnosis is present at the time of diagnosis, and that it is all detectable by MR imaging. This seems unlikely and also ignores clinical data that indicate that the use of endocrine therapy reduces the clinical incidence of contralateral breast cancer by 50%.…”

Treatment of Bilateral Breast Cancer

“…7 The addition of mammography increases this to 2% to 5%, [8][9][10] and by performing a selective biopsy of the opposite breast, the yield can be increased to 16.7%. 11 MRI can increase this diagnosis up to 30.8%. 12,13 When prophylactic contralateral mastectomies were performed at the time of reconstructive surgery for known unilateral breast cancer, extensive histologic examination of the tissues has shown that a range of 15% to 42.5% of the contralateral breasts contained invasive or in situ carcinomas.…”