National Cancer Institute®
Last Modified: June 1, 2002
UI - 11923128
AU - Newman LA; Buzdar AU; Singletary SE; Kuerer HM; Buchholz T; Ames FC;
TI - Ross MI; Hunt KK A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility.
SO - Ann Surg Oncol 2002 Apr;9(3):228-34
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
BACKGROUND: The role of preoperative chemotherapy for breast cancer is evolving. We initiated a prospective trial of sequential preoperative paclitaxel and doxorubicin-based combination chemotherapy in patients with stage I (tumor >1 cm), II, or IIIA disease and evaluated its effect on breast-conservation therapy (BCT) eligibility. METHODS: Pathology findings for the initial 100 consecutive patients who underwent surgery were analyzed. RESULTS: The median tumor size at presentation was 2.4 cm, and 39% of patients were deemed eligible for BCT. After chemotherapy, the median tumor size decreased to 1.0 cm (P <.001), and 59% of patients seemed BCT eligible (BCT conversion rate 34% among patients initially assessed as BCT ineligible; P <.001). Final pathology confirmed BCT feasibility in 90% of patients assessed as BCT candidates before surgery. The pathology from mastectomy specimens revealed BCT feasibility in 11 (27%) of 41 patients deemed BCT ineligible. Multivariate analysis revealed lobular histology, multicentricity, and calcifications, but not age, initial tumor size, or nodal status to predict final pathology indicating BCT ineligibility. CONCLUSIONS: Induction chemotherapy improves BCT eligibility for breast cancer patients. Improved breast imaging methods after chemotherapy are necessary to improve accuracy in predicting the feasibility of BCT, especially in patients presenting with diffuse calcifications or multicentricity.
UI - 11923132
AU - Mirza NQ; Vlastos G; Meric F; Buchholz TA; Esnaola N; Singletary SE;
TI - Kuerer HM; Newman LA; Ames FC; Ross MI; Feig BW; Pollock RE; McNeese M; Strom E; Hunt KK Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy.
SO - Ann Surg Oncol 2002 Apr;9(3):256-65
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
BACKGROUND: Our aim was to identify predictors of locoregional recurrence (LRR) in patients with early-stage breast cancer treated with breast-conserving therapy (BCT) and long-term follow-up. METHODS: From 1970 to 1994, 1153 patients with stage I to II breast cancer underwent BCT and radiotherapy at our institution. Patients with prior breast cancer or other primary malignancies were excluded. Clinical and pathologic characteristics evaluated were age, race, tumor size, stage, pathologic tumor margins, axillary nodal involvement, estrogen and progesterone receptor status, Black's nuclear grade, type of surgery, and use of adjuvant therapy. RESULTS: Of 1083 patients, 54% presented with stage I disease and 46% with stage II disease. Median age was 50 years, and median follow-up was 9 years. Axillary nodes were positive in 31% of the patients who underwent axillary dissection. LRR developed in 6%, LRR followed by systemic recurrence in 5%, and systemic recurrence alone in 13%; 76% had no evidence of recurrence at last follow-up. Age, tumor size, positive lymph nodes, and not receiving chemotherapy or hormonal therapy were independent predictors of LRR. Disease-specific survival among patients with LRR was similar to that among patients with no recurrence. CONCLUSIONS: Multidisciplinary treatment strategies should be used to accomplish durable locoregional control after BCT.
UI - 12013281
AU - Proulx GM; Loree T; Edge S; Hurd T; Stomper P
TI - Outcome with postmastectomy radiation with transverse rectus abdominis musculocutaneous flap breast reconstruction.
SO - Am Surg 2002 May;68(5):410-3
AD - Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
The effects of radiation on the outcome of patients undergoing transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction have not been extensively studied. Concern still exists of a possible negative impact secondary to irradiation as related to control of disease, cosmetic outcome, and flap viability. Thirty-six patients underwent both a modified radical mastectomy (MRM) with TRAM flap reconstruction and irradiation to the chest wall to include the TRAM flap and/or regional nodes either before reconstruction or after TRAM flap reconstruction. Fifteen patients had all of their treatment and follow-up at our institution and were retrospectively reviewed to assess treatment and outcome. During a median follow-up of 36 months there were no local-regional failures. One patient at Stage IIIA failed with distant metastases 3 years after treatment. One patient had a flap loss from a nonhealing wound after reconstruction performed 2 years after MRM and radiotherapy. Only one patient expressed dissatisfaction with the cosmetic outcome. Patients undergoing MRM with TRAM flap reconstruction and irradiation before or after reconstruction can achieve excellent local-regional control and satisfactory cosmesis. Risk of flap loss is low. Further follow-up is needed for assessing longer-term outomes in this patient group. Larger prospective studies are necessary for more definitive conclusions.
UI - 12018824
AU - Fentiman IS
TI - 12. Timing of surgery for breast cancer.
SO - Int J Clin Pract 2002 Apr;56(3):188-90
AD - Hedley Atkins Breast Unit, Guy's Hospital, London, UK.
Several studies have now shown that premenopausal women with early breast cancer have a significantly better prognosis if their tumours are excised during the luteal phase of the cycle. The 10-year survival for node positive cases undergoing follicular phase surgery was 33% compared with 78% in those having surgery at other times of the menstrual cycle. Further work has shown that there is an improved survival in those with plasma progesterone levels >4 ng/ml(-1), associated with the luteal phase. Luteal phase surgery is also associated with a decreased risk of vascular invasion, implying that the tumour is more cohesive at that time. Similarly, in the heaviest quartile of postmenopausal patients, with the highest endogenous oestrogen levels, there was vascular invasion around tumours in 45% compared with only 11% of the lightest quartile. Changing the hormonal milieu at the time of surgery for breast cancer may have the ability to improve the prognosis for some patients with early breast cancer.
UI - 12011136
AU - Love RR; Duc NB; Allred DC; Binh NC; Dinh NV; Kha NN; Thuan TV; Mohsin
TI - SK; Roanh le D; Khang HX; Tran TL; Quy TT; Thuy NV; The PN; Cau TT; Tung ND; Huong DT; Quang le M; Hien NN; Thuong L; Shen TZ; Xin Y; Zhang Q; Havighurst TC; Yang YF; Hillner BE; DeMets DL Oophorectomy and tamoxifen adjuvant therapy in premenopausal Vietnamese and Chinese women with operable breast cancer.
SO - J Clin Oncol 2002 May 15;20(10):2559-66
AD - University of Wisconsin Comprehensive Cancer Center, 610 Walnut Street, Madison, WI 53705-2397, USA. firstname.lastname@example.org
PURPOSE: In 1992, the Early Breast Cancer Trialists' Collaborative Group reported that a meta-analysis of six randomized trials in European and North American women begun from 1948 to 1972 demonstrated disease-free and overall survival benefit from adjuvant ovarian ablation. Approximately 350,000 new cases of breast cancer are diagnosed annually in premenopausal Asian women who have lower levels of estrogen than western women. PATIENTS AND METHODS: From 1993 to 1999, we recruited 709 premenopausal women with operable breast cancer (652 from Vietnam, 47 from China) to a randomized clinical trial of adjuvant oophorectomy and tamoxifen (20 mg orally every day) for 5 years or observation and this combined hormonal treatment on recurrence. At later dates estrogen- and progesterone-receptor protein assays by immunohistochemistry were performed for 470 of the cases (66%). RESULTS: Treatment arms were well balanced. With a median follow-up of 3.6 years, there have been 84 events and 69 deaths in the adjuvant treatment group and 127 events and 91 deaths in the observation group, with 5-year disease-free survival rates of 75% and 58% (P =.0003 unadjusted; P =.0075 adjusted), and overall survival rates of 78% and 70% (P =.041 unadjusted) for the adjuvant and observation groups, respectively. Only patients with hormone receptor-positive tumors benefited from the adjuvant treatment. In Vietnam, for women unselected for hormone receptor status, a cost-effectiveness analysis suggests that this intervention costs $350 per year of life saved. CONCLUSION: Vietnamese and Chinese women with hormone receptor-positive operable breast cancer benefit from adjuvant treatment with surgical oophorectomy and tamoxifen.
UI - 11930535
AU - Obrist P; Brunhuber T; Ensinger C; Zelger BG; Dunser M; Buchberger W
TI - [Pathological examination of breast biopsy specimens]
SO - Radiologe 2002 Jan;42(1):1-5
AD - Institut fur Pathologische Anatomie, Mullerstrasse 44, 6020 Innsbruck/Osterreich.
No differences for long-term disease free survival could be found between breast conserving surgery and mastectomy. Most importantly is the fact that this therapy presents a significantly higher risk for local recurrence. The characterisation of this risk is one of the most important things to do. These findings result in a widespread change in treatment of breast cancer patients. Consequently an increase in interdisciplinary working between radiologists, surgeons and pathologists could be found. Histological examinations are necessary for diagnosis and exactly evaluation of the tumor extension. Microscopic evaluation of the resection margin is of most important interest, because there is a direct connection between local recurrence and tumor infiltration of the resection margin. We performed our investigations by the use of a standardized complete embedding method with the possibility of three-dimensional reconstruction, on a cohort of 280 patients. Additionally this method allowed the detection of all relevant findings on one hand and on the other hand an evaluation of all resection margins. Our results showed a breast conserving therapy including tumor free margins was performed in 67% of the patients. But there was a second resection necessary in 57% of the cases. An extensive tumor distribution as the detection of multifocal tumor spread was the reason for mastectomy in 33%. Our findings point out the necessarily of the histological examination in the line of the complete embedding method of the breast biopsy material in order to analyse the tumor including resection margin evaluation.
UI - 12038112
AU - Burelli P; Marinelli P; Borsato N; Bedin N
TI - [Combined ROLL and sentinel lymph node: a new strategy in radio-guided surgery]
SO - Chir Ital 2002 Mar-Apr;54(2):209-12
AD - U.O. di Chirurgia Generale, O.C. di Conegliano Veneto, TV.
Radioguided surgery for the treatment of breast cancer is becoming the gold standard for both diagnosis and therapy. The main rule in using ROLL is perfect localization of non-palpable lesions and minimal invasiveness of excision. The same criteria apply to the sentinel lymph node technique. Clinically occult breast lesions, which require an exact histological diagnosis, are most frequently detected as the result of mammographic screening. The authors show that the ROLL technique for histological diagnosis may alter the subdermal lymphatic drainage so that the sentinel node cannot be found at later surgery. The aim of this study was to report the authors' experience with a combined ROLL and sentinel lymph node biopsy technique for the diagnosis and treatment of occult cancer of the breast.
UI - 11774860
AU - Takeda Y; Nonaka Y; Yanagie H; Yoshizaki I; Eriguchi M
TI - Correlation between timing of surgery in relation to the menstrual cycle and prognosis of premenopausal breast cancer patients.
SO - Biomed Pharmacother 2001;55 Suppl 1():133s-137s
AD - Department of Surgery, Institute of Medical Science, University of Tokyo, Japan. email@example.com
The timing of surgery in relation to menstrual phase might affect the progress of disease in premenopausal women with operable breast cancer. In the present study, the records were examined of 28 such cases treated between 1990 and 1999, and compared for recurrence-free survival with reference to the phases of the menstrual cycle defined by Hrushesky and Senie. During the follow-up period, breast cancer relapse occurred in five patients, and one patient died of another disease unconnected with recurrent breast cancer. The recurrence rate was not significantly different between two phases classified by either Hrushesky or Senie. However, patients with early-stage breast cancer operated during the perimenstrual phase and those with advanced breast cancer which was resected during the peri-ovulatory phase appeared to have a better prognosis than patients operated on during the other phases. Since the prognosis for breast cancer patients is dependent not only on the menstrual cycle but also on many other factors, it is concluded that the menstrual cycle cannot constitute an absolute prognostic factor.
UI - 11905711
AU - Smith IE; Lipton L
TI - Preoperative/neoadjuvant medical therapy for early breast cancer.
SO - Lancet Oncol 2001 Sep;2(9):561-70
AD - Breast Unit, Royal Marsden NHS Trust, London, UK. firstname.lastname@example.org
Preoperative (neoadjuvant) medical therapy has emerged over the past decade as a new approach for the treatment of early breast cancer. Results show it has high activity, but survival is no better than with conventional adjuvant treatment. The need for mastectomy is reduced but not abolished; in some studies this effect is associated with a small increase in risk of local recurrence, but without any detriment to survival. Predictive factors for improved outcome include clinical response, and especially pathological complete remissions. However, persisting pathological axillary node involvement is associated with poor outcome. Biological changes in apoptosis or proliferation pathways may prove to be more sensitive surrogate markers than clinical or pathological responses for assessing treatment outcome. The main long-term aim of preoperative medical treatment must be to establish such surrogate predictive markers. This would lead to individualised treatment for each patient, and would allow much more rapid assessment of new drugs than is currently possible with adjuvant therapy trials.
UI - 11989238
AU - Kitamura K; Ishida M; Tokunaga E; Ono S; Kuwano H
TI - [Departmental review of surgical cases in the last 17 years: Breast neoplasms]
SO - Fukuoka Igaku Zasshi 2002 Mar;93(3 Suppl):28-33
UI - 12036001
AU - Lantz PV; Zemencuk JK; Katz SJ
TI - Is mastectomy overused? A call for an expanded research agenda.
SO - Health Serv Res 2002 Apr;37(2):417-31
AD - Department of Health Management and Policy, School of Public Health, University of Michigan SPH, Ann Arbor 48109, USA.
UI - 12017895
AU - Sulkes A
TI - [The use of adjuvant chemotherapy in stage II breast cancer in the last 25 years--a brief review]
SO - Harefuah 2002 Apr;141(4):374-8, 408
AD - Institute of Oncology, Rabin Medical Center Beilinson Campus, Israel.
This review summarizes more than 25 years of experience with the use of systemic chemotherapy in the adjuvant setting in patients suffering from stage II breast cancer. The use of the CMF combination in the early 70's marks the onset of the modern era of this modality. Adjuvant chemotherapy must be given at optimal doses and schedule, usually for a period lasting about six months, beginning shortly after the resection of the primary tumor. The incorporation of the anthracyclines, adriamycin and epirubicin represent an important milestone in the developmental history of the adjuvant chemotherapy of breast cancer. The sequential administration of adriamycin followed by CMF in patients with 4 or more involved axillary lymph nodes deserves particular emphasis. Meta-analysis of multiple clinical trials including several tens of thousands of patients with stage II breast cancer indicate that adjuvant chemotherapy results in a significant increase in both recurrence-free and overall survival as compared to locoregional treatment only. This holds true with long-term follow-up of 20 years and more as illustrated by the CMF experience, showing about a 35% decrease in the relative risk of recurrence. Efforts in recent years are investigating the role of newer cytotoxic agents such as the taxanes in the adjuvant setting. Furthermore, clinical trials are now ongoing with the use of the monoclonal antibody herceptin in patients with stage II breast cancer whose tumor over-expresses the oncogene Her2neu. The administration of adjuvant chemotherapy has the potential for undesirable side effects such as an increased risk of osteoporosis and ischemic heart disease in younger patients in whom amenorrhea develops, or cardiotoxicity from anthracyclines. Most clinical trials to date have not shown an increase in the occurrence of second primary tumors among patients receiving adjuvant chemotherapy for breast cancer. Adjuvant chemotherapy has become an integral part of the treatment of stage II breast cancer.
UI - 11294401
AU - Lucci A Jr; Kelemen PR; Miller C 3rd; Chardkoff L; Wilson L
TI - National practice patterns of sentinel lymph node dissection for breast carcinoma.
SO - J Am Coll Surg 2001 Apr;192(4):453-8
AD - Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
BACKGROUND: The sentinel node is the first regional lymph node to receive tumor cells that metastasize through the lymphatic channel from a primary tumor. The tumor status of the sentinel node should reflect the tumor status of the entire regional node basin. Sentinel lymph node dissection (SLND) has recently been investigated for use in patients with early breast carcinoma to avoid the sequelae of complete axillary lymph node dissection (ALND). Published studies of SLND in breast cancer patients identify marked variations in technique, and there are few guidelines for credentialing surgeons to perform SLND. STUDY DESIGN: The purpose of this study was to assess the current practice of SLND for breast cancer in the United States. A 27-item questionnaire was mailed to 1,000 randomly selected Fellows of the American College of Surgeons. Responses were anonymous. Statistical analysis was performed using SAS software (SAS Institute, Cary, NC). RESULTS: Response rate was 41% (n = 410), and 77% of those who responded performed SLND for breast cancer. The majority (60%) of surgeons responding routinely ordered preoperative lymphoscintigraphy. Of those who did lymphoscintigraphy, 28% removed internal mammary lymph nodes when lymphoscintigraphy showed drainage to these nodes. Ninety percent of surgeons used both blue dye and radiocolloid. Eighty percent of centers responding performed routine immunohistochemistry on sentinel lymph nodes, and 15% performed reverse transcription polymerase chain reaction. Ninety-six percent of surgeons performed SLND for primary tumors 5 cm or smaller, and 95% performed SLND for an excisional cavity 6 cm and smaller. Twenty-eight percent performed SLND for high-grade ductal carcinoma in situ, and 28% of respondents performed 10 or fewer SLND procedures with subsequent ALND before performing SLND alone. Surgeons learned SLND through courses (35%), oncology fellowships (26%), observation of other surgeons (31%), or were self-taught (26%). CONCLUSIONS: The majority of surgeons in the United States use similar technique for SLND breast cancer. But, there was marked variation in the number of SLND cases validated by an ALND before performing SLND only.
UI - 12029907
AU - Murphy A; Holcombe C
TI - Effects of early discharge following breast surgery.
SO - Prof Nurse 2001 Feb;16(5):1087-90
AD - Royal Liverpool University Hospital.
A small group of breast cancer surgery patients were discharged early with axillary drains in situ. The group was examined for wound infection, seroma formation and depression, and compared to a group who stayed in hospital. There was no indication that early discharge increased seroma formation or infection. Anxiety and depression appeared to be less in the early discharge group.
UI - 12035037
AU - Medina-Franco H; Vasconez LO; Fix RJ; Heslin MJ; Beenken SW; Bland KI;
TI - Urist MM Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer.
SO - Ann Surg 2002 Jun;235(6):814-9
AD - Department of Surgery, Section of Surgical Oncology, University of Alabama at Birmingham, USA.
OBJECTIVE: To examine the incidence of local recurrence (LR) and factors associated with it in a population of patients who underwent skin-sparing mastectomy (SSM) and immediate reconstruction for invasive carcinoma. SUMMARY BACKGROUND DATA: The efficacy of SSM has been challenged by concerns about increased risks of LR. METHODS: A consecutive series of 173 patients (176 cancers) with invasive carcinoma 1997). Data were analyzed by the Kaplan-Meier method, the log-rank statistic test, and the Cox proportional hazards model. RESULTS: Mean patient age was 47 +/- 9 years (27% were 40 or younger). The AJCC stages were 1 = 43%, 2 = 52%, and 3 = 5%. Thirty percent of tumors were poorly differentiated. With a median follow-up of 73 months, the LR rate was 4.5%. The mean local relapse-free interval was 26 months. Seventy-five percent of patients who presented with LR developed distant metastases and died of disease within a mean of 21 months. On univariate analysis, factors associated with higher LR rate were tumor stage 2 or 3, tumor size larger than 2 cm, node-positive disease, and poor tumor differentiation. Actuarial 1-, 3-, and 5-year overall survival rates were 98%, 94%, and 88%, respectively. On multivariate analysis, factors associated with decreased survival were advanced stage, presence of LR, and absence of hormone therapy. LR was a highly significant predictor of tumor-related death. CONCLUSIONS: There is a low incidence of LR after SSM, and it is associated with advanced disease at presentation. LR is an independent risk factor for tumor-related death.
UI - 12039936
AU - Vicini FA; Recht A
TI - Age at diagnosis and outcome for women with ductal carcinoma-in-situ of the breast: a critical review of the literature.
SO - J Clin Oncol 2002 Jun 1;20(11):2736-44
AD - Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA. email@example.com
PURPOSE: Patients younger than 35 to 45 years old at the time of diagnosis of invasive breast cancer have been found to have a worse prognosis than older patients in many studies. However, the impact of patient age at diagnosis on the outcome of treatment with either lumpectomy and radiation therapy (RT) or mastectomy for patients with ductal carcinoma-in-situ (DCIS) of the breast has not been extensively analyzed. MATERIALS AND METHODS: Articles addressing the effect of patient age at diagnosis on the outcome of treatment of DCIS with lumpectomy and RT or mastectomy were identified through the MEDLINE and CancerLit databases and reference lists of relevant articles. Studies were reviewed to determine the impact of patient age at diagnosis on clinical and pathologic features of DCIS, the influence of age on outcome after lumpectomy and RT, and the impact of age on outcome after mastectomy. RESULTS: DCIS in younger patients more frequently contains adverse prognostic pathologic factors and extends over a greater distance in the breast than in older patients. In series with adequate follow-up, younger patients treated with lumpectomy and RT had a significantly higher rate of local recurrence than older patients, especially for invasive local recurrences. Some studies have suggested that careful attention to margin status and excising larger volumes of tissue can reduce this difference substantially. No available data show that younger patients have better long-term cancer-free survival rates if treated by mastectomy rather than lumpectomy and RT. CONCLUSION: Successful treatment of younger patients with DCIS with lumpectomy and RT requires careful attention to patient evaluation, selection, and surgical technique. When this is done, age at diagnosis should not be a contraindication to breast-conserving therapy.
UI - 11948295
AU - Osanai T; Nihei Z; Ichikawa W; Sugihara K
TI - Endoscopic resection of benign breast tumors: retromammary space approach.
SO - Surg Laparosc Endosc Percutan Tech 2002 Apr;12(2):100-3
AD - Second Department of Surgery, Tokyo Medical and Dental University, Japan. firstname.lastname@example.org
Endoscopic surgery is characterized by the creation of a working space. At our department, we have obtained good results with a retromammary space approach in which the tumor is resected after creation of a working space in the retromammary space. The special instruments used for this purpose comprise an endoscopic vein harvesting system to dissect the retromammary space, a dissecting balloon to compress the space to achieve hemostasis, and laparosonic coagulating shears to incise the tumor. This surgical technique provides a superior cosmetic result, and the level of patient satisfaction has been high.
UI - 11304779
AU - Morrow M; White J; Moughan J; Owen J; Pajack T; Sylvester J; Wilson JF;
TI - Winchester D Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma.
SO - J Clin Oncol 2001 Apr 15;19(8):2254-62
AD - American College of Surgeons Commission on Cancer, Chicago, IL, USA.
PURPOSE: To define patterns of care for the local therapy of stage I and II breast cancer and to identify factors used to select patients for breast-conserving therapy (BCT). PATIENTS AND METHODS: A convenience sample of 16,643 patients with stage I and II breast cancer treated in 1994 was obtained from hospital-based tumor registries. Histologic variables were determined from original pathology reports. RESULTS: BCT was performed in 42.6% of patients. Multivariate analysis demonstrated that living in the Northeast United States (odds ratio [OR], 2.48; 95% confidence interval [CI], 2.16 to 2.84), having a clinical T1 tumor (OR, 2.51; 95% CI, 2.27 to 2.78), and having a tumor without an extensive intraductal component (OR, 2.07; 95% CI, 1.81 to 2.37) were the strongest predictors of breast-conserving surgery. Radiation therapy was given to 86% of patients who had breast-conserving surgery. Age less than 70 years was the most significant predictor of receiving radiation (OR, 2.11; 95% CI, 1.77 to 2.25). Tumor variables did not correlate with the use of radiation, but favorable tumor characteristics were associated with the use of breast-conserving surgery. CONCLUSION: Despite strong evidence supporting the use of BCT, the majority of women continue to be treated with mastectomy. Predictors of the use of BCT do not correspond to those suggested in guidelines.
UI - 11952442
AU - Koivusalo AM; Von Smitten K; Lindgren L
TI - Sentinel node mapping affects intraoperative pulse oximetric recordings during breast cancer surgery.
SO - Acta Anaesthesiol Scand 2002 Apr;46(4):411-4
AD - Department of Anesthesia, The Fourth Department of Surgery, Helsinki University Hospital, Finland. email@example.com
BACKGROUND: In invasive breast cancer lymphatic mapping with patent blue vital dye (PBV) is used intraoperatively to identify the sentinel lymph nodes: the first axillary node draining the mammary lymphatic basin and first involved by the metastatic growth in breast cancer. Patent blue vital dye spreads to tissues giving a bluish tinge to patients. We have noted the possibility that intraoperative peripheral pulse oximetric (SpO2) values are artificially low when intradermal PBV is used. METHODS: Twenty patients with normal pulmonary function undergoing breast cancer surgery in standardized anesthesia either did or did not receive intradermal PBV sentinel node marking. The radial artery was cannulated for blood-gas-analysis; arterial oxygen tension (PaO2); and arterial oxygen saturation (SaO2). Peripheral oxygen saturation was measured using the light absorption technique. Red and infrared light (660 and 900 nm), used by pulseoxymetry, is partially absorbed when passing through the tissue. The amount of light absorbed is sensed and saturation calculated. The color of the skin was evaluated. RESULTS: Peripheral oxygen saturation decreased only immediately after the injection of PBV, and remained at a significantly lower level (P<0.001) throughout the operation and up to 90 min postoperatively. Arterial oxygen tension and SaO2 values did not decrease after intradermal PBV. Patent blue vital dye made patients' skin more bluish (P<0.001). No changes in SpO2, PaO2 and SaO2 were found in control patients. CONCLUSION: The spectrum of PBV has a peak absorption at 640 nm, thus making the SpO2 values incorrect. Peripheral oxygen saturation values are falsely low and true arterial oxygenation is not impaired when PBV is used during sentinel node mapping.
UI - 10749640
AU - Kim DH; Glazer PA
TI - Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report.
SO - Spine 2000 Mar 1;25(5):622-5
AD - Harvard Combined Orthopaedics Residency Program, and the Boston Orthopaedics Group, Boston, Massachusetts 02446, USA.
STUDY DESIGN: A report of a patient in whom progressive symptomatic thoracolumbar scoliosis developed after breast reconstruction with a latissimus dorsi myocutaneous flap. OBJECTIVES: To present the first reported case of progressive symptomatic scoliosis after breast reconstruction with a latissimus dorsi myocutaneous flap and to suggest that latissimus flap harvest may be contraindicated in patients with preexisting scoliosis. SUMMARY OF BACKGROUND DATA: Latissimus dorsi myocutaneous flap harvest incorporated into several surgical operations including breast reconstruction has been presented as a relatively benign procedure without significant biomechanical consequence. Nevertheless, various anatomic and animal studies have suggested an important role for balanced latissimus function in terms of proper spinal alignment. Long-term follow-up evaluation of patients after latissimus flap harvest is insufficient and fails to address the specific issue of spinal deformity. METHODS: Postoperative radiographs demonstrated significant progression of the patient's thoracolumbar scoliosis as compared with radiographs taken before her latissimus harvest. Curve progression accompanied by development of severe and disabling back pain were considered indications for surgical curve correction and stabilization. RESULTS: At the time of 1-year follow-up assessment after posterolateral spinal fusion and instrumentation, the patient had experienced complete relief from her back pain and satisfactory spinal fusion. CONCLUSIONS: Although a cause and effect relation cannot be established, this case study suggests that latissimus harvest may have a destabilizing effect on the thoracolumbar spine in the long term, especially in patients with preexisting scoliosis. Alternative procedures should be considered in these patients.
UI - 11074688
AU - King AG
TI - Re: Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report (Spine 2000; 25: 622-5).
SO - Spine 2000 Nov 15;25(22):2968
UI - 11004327
AU - Palit TK; Miltenburg DM; Brunicardi FC
TI - Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction.
SO - Am J Surg 2000 Jun;179(6):441-5
AD - Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
BACKGROUND: Breast conservation surgery (BCS), consisting of lumpectomy, axillary lymph node dissection, and radiation therapy, is as effective as modified radical mastectomy (MRM) for the treatment of early stage breast cancer. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruction. The purpose of this study is to determine differences in treatment costs among BCS, MRM alone, and MRM with reconstruction. METHODS: Patients with stage I and II breast cancer receiving inpatient treatment at a private university-affiliated Charges were determined as follows: inpatient and radiotherapy charges from the hospital billing department, surgeon fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was obtained from hospital medical records. RESULTS: Average hospital inpatient charge for BCS was $4,748 (n = 74), $6,280 for MRM alone (P <0.001, n = 132), and $11,946 for MRM with reconstruction (P <0.001, n = 24). Surgeons' fees for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P <0.001), and 3.71 days for MRM with reconstruction (P <0. 001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P <0.001) or MRM with reconstruction ($22,720, P <0.001). CONCLUSIONS: BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost of CS.
UI - 11773304
AU - Pierce LJ
TI - Treatment guidelines and techniques in delivery of postmastectomy radiotherapy in management of operable breast cancer.
SO - J Natl Cancer Inst Monogr 2001;(30):117-24
AD - Department of Radiation Oncology, University of Michigan School of Medicine UHB2C490, Box 0010, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA. firstname.lastname@example.org
Radiation therapy has been shown to statistically significantly reduce the risk of locoregional recurrence in high-risk patients with operable breast cancer following mastectomy and systemic therapy. Recent trials have also demonstrated a significant survival benefit following radiotherapy in high-risk patients. Therefore, it is important to identify the patients who could potentially derive that survival benefit and to not offer treatment to those patients who are not at increased risk for failure. Established risk factors that predict for increased rates of locoregional recurrence include axillary lymph node involvement and T3 (or T4) disease. While treatment-related factors, such as the extent of the axillary dissection and extent of lymph nodal positivity, also undoubtedly affect locoregional recurrence, additional studies are needed to define the magnitude of their risk. Locoregional patterns of failure have identified the chest wall and supraclavicular/infraclavicular regions to be the most common sites of locoregional failure following mastectomy, which justifies treatment to these regions. While long-term complications are uncommon following locoregional radiotherapy, careful treatment planning is critical to minimize cardiac (and pulmonary) toxicity.
UI - 11773300
AU - Wolmark N; Wang J; Mamounas E; Bryant J; Fisher B
TI - Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18.
SO - J Natl Cancer Inst Monogr 2001;(30):96-102
AD - National Surgical Adjuvant Breast and Bowel Project (NSABP), 320 E. North Ave., Pittsburgh, PA 15212, USA. email@example.com
National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-18 was initiated in 1988 to determine whether four cycles of doxorubicin/cyclophosphamide given preoperatively improve survival and disease-free survival (DFS) when compared with the same chemotherapy given postoperatively. Secondary aims included the evaluation of preoperative chemotherapy in downstaging the primary breast tumor and involved axillary lymph nodes, the comparison of lumpectomy rates and rates of ipsilateral breast tumor recurrence (IBTR) in the two treatment groups, and the assessment of the correlation between primary tumor response and outcome. Initially published findings were based on a follow-up of 5 years; this report updates results through 9 years of follow-up. There continue to be no statistically significant overall differences in survival or DFS between the two treatment groups. Survival at 9 years is 70% in the postoperative group and 69% in the preoperative group (P =.80). DFS is 53% in postoperative patients and 55% in preoperative patients (P =.50). A statistically significant correlation persists between primary tumor response and outcome, and this correlation has become statistically stronger with longer follow-up. Patients assigned to preoperative chemotherapy received notably more lumpectomies than postoperative patients, especially among patients with tumors greater than 5 cm at study entry. Although the rate of IBTR was slightly higher in the preoperative group (10.7% versus 7.6%), this difference was not statistically significant. Marginally statistically significant treatment-by-age interactions appear to be emerging for survival and DFS, suggesting that younger patients may benefit from preoperative therapy, whereas the reverse may be true for older patients.
UI - 12034393
AU - Moonka R; Hunter JA; Cray WK Jr; Duncan M; Wechter DG
TI - A comparison of rates of lymph node metastases between patients undergoing sentinel and axillary lymphadenectomy.
SO - Am J Surg 2002 May;183(5):558-61
AD - Department of Surgery, Virginia Mason Medical Center, C6-GSUR, 1100 Ninth Ave., P.O. Box 900, Seattle, WA 98111, USA.
BACKGROUND: Recommendations regarding credentialing for sentinel lymphadenectomy in the staging of breast cancer emphasize the need for a trial period during which novice surgeons remove both the sentinel lymph node and the axillary packet, to demonstrate acceptably low rates of both operative failure and inaccuracy. METHODS: We initiated sentinel lymph node mapping in our institution without planned axillary dissection. To establish our ability to accurately stage patients using sentinel lymphadenectomy, we compared 225 patients who underwent that procedure and 343 patients previously staged with axillary lymph node dissection. RESULTS: No differences in node positivity were found between the two groups. Among sentinel lymphadenectomy patients, no differences were found between patients in the first and second half of the institutional experience. CONCLUSIONS: We question the need for a trial period of planned axillary node dissection with sentinel lymph node mapping, and review the evidence from other investigators regarding its necessity.
UI - 12057132
AU - Khan SA; Badve S
TI - Phyllodes tumors of the breast.
SO - Curr Treat Options Oncol 2001 Apr;2(2):139-47
AD - Division of Surgical Oncology, Northwestern Medical School, 675 N. St. Clair Street, Galter-10, Chicago IL 60611, USA.
Phyllodes tumor is a rare fibroepithelial neoplasm of the breast with a very variable, but usually benign, course. Formerly known as cystosarcoma phyllodes, the designation "phyllodes tumor" with appropriate qualification regarding malignant potential based on pathologic features is now the agreed-upon term. The most important diagnostic distinction is from fibroadenoma--phyllodes tumors require complete excision with free margins even when pathologic features suggest benignity because of a proclivity to local recurrence. The most important component of therapy is wide surgical excision, and mastectomy is necessary only when free margins cannot be achieved without it. Involvement of axillary nodes is rare, and axillary dissection is not indicated. The role of radiation therapy and chemotherapy is not established and has not been studied in randomized trials due to the rarity of the tumor. At present, there is no consensus that patients with high-grade phyllodes tumors of the breast will benefit from either of these modalities.
UI - 12057133
AU - Brill KL; Brenin DR
TI - Occult breast cancer and axillary mass.
SO - Curr Treat Options Oncol 2001 Apr;2(2):149-55
AD - Comprehensive Breast Center, Columbia-Presbyterian Medical Center, Atchley Pavilion 10, 161 Fort Washington Avenue, New York, NY 10032-3784, USA.
Occult breast cancer presenting with axillary metastases is an unusual presentation and can be a diagnostic and therapeutic challenge. A comprehensive work-up, including mammogram, sonogram, magnetic resonance imaging, and even pathologic examination of the mastectomy specimen may not disclose the primary tumor in up to one third of patients. Traditionally, occult breast cancer is treated with total mastectomy and axillary dissection, but accumulating data suggest that primary breast irradiation following axillary dissection may provide an equivalent survival with the advantage of breast conservation. Occult breast cancer patients are eligible for adjuvant chemotherapy and radiation as stage II/ III node-positive patients would be treated. Overall, the prognosis for occult breast cancer is equivalent to or slightly better than staged counterparts with detectable primary breast tumors.
UI - 12057134
AU - Cianfrocca M; Goldstein LJ
TI - Operable breast cancer.
SO - Curr Treat Options Oncol 2001 Apr;2(2):157-67
AD - Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111, USA.
Breast cancer is the most common malignancy among American women. As a result of widespread screening, most patients present with operable breast cancer that is treated with curative intent. It is well established that the appropriate use of adjuvant therapy improves the disease-free and overall survival of patients with breast cancer. Adjuvant systemic therapy options include tamoxifen for hormone receptor-positive patients, and systemic polychemotherapy. It is standard clinical practice to administer adjuvant systemic therapy to patients with node-positive and high-risk, node-negative breast cancer.
UI - 12057135
AU - Trent II JC 2nd; Benjamin RS; Valero V
TI - Primary soft tissue sarcoma of the breast.
SO - Curr Treat Options Oncol 2001 Apr;2(2):169-76
AD - The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Box 10, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Primary soft tissue sarcoma (STS) of the breast is a rare and heterogeneous disease. The rarity of this tumor limits most studies to small retrospective case reviews and case reports. The optimal treatment of primary STS of the breast can best be determined through multidisciplinary discussions prior to the initiation of therapy. Whether chemotherapy is indicated is primarily determined by tumor size. There is evidence that tumors larger than 5 cm are associated with an elevated risk of systemic failure and a poor prognosis. Negative surgical margins are more important for local recurrence and overall survival than is the extent of surgical resection. Thus, neoadjuvant chemotherapy should be considered in order to shrink the tumor and help obtain negative surgical margins. After surgical resection, patients with chemosensitive tumors should undergo additional adjuvant chemotherapy to treat micrometastatic disease. Patients with tumors less than 5 cm that are easily resectable should undergo complete resection to the extent required to provide negative surgical margins. Radiation therapy should be used to improve local control in cases in which the tumor is larger than 5 cm and in cases with positive surgical margins. The appropriate treatment of primary STS of the breast requires a multidisciplinary approach necessitating experienced surgeons, pathologists, radiotherapists, and medical oncologists.
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