Breast Conserving Surgery

In a Danish nationwide prospective study of in situ carcinoma of the breast, a total of 275 women, treated with excision alone, were registered from 1982 to 1989. The series included 142 cases of ductal carcinoma in situ (DCIS), 100 cases of lobular carcinoma situ (LCIS), 26 cases of DCIS+LCIS, and seven cases of atypical hyperplasia (AH). Within a median

Background  The lack of objective documentation of pre-neoadjuvant chemotherapy (NACT) margins after chemotherapy is a major constraint in performing safe breast-conserving surgery (BCS) in patients with locally advanced breast cancer (LABC). Using a novel method of marking pre-NACT tumor margins with indigenous silver wire markers, this prospective pilot study attempted to assess the feasibility of safe BCS in LABC patients by

... El relieve del nódulo en piel se aprecia a simple vista y no existe telorrea ni telorragia. En la axila izquierda (AI) no se palpan nódulos sospechosos. ... Hum Pathol. 1995;26:965—9. 22. Middleton LP, Vlastos G, Mirza NQ, Eva S, Sahin AA. ...

The use of MRI to assess the extent of breast disease is gaining increasing popularity with the subsequent detection of multiple invasive foci within the breast that had not been identified on previous standard mammography and ultrasonography. What impact this has on subsequent surgical management and ultimately disease-free survival remains a controversial topic. Should histologically confirmed multiple foci of invasive disease within a breast steer the surgical management towards mastectomy, or is there a role in select patients for breast conserving surgery, even if two or more incisions are required? This review considers the evidence for how MRI affects the mastectomy rate and compares this to surgical outcomes for breast conserving surgery in the presence of multiple invasive foci.

To provide new insights into the genetic basis of normal tissue radiosensitivity, we evaluated the association between eight polymorphic variants located in six genes related to DNA repair mechanisms, oxidative stress, and fibroblast proliferation (XRCC1 Arg399Gln, XRCC1 Arg194Trp, TP53 Arg72Pro, GSTP1 Ile105Val, GSTA1 C-69T, eNOS G894T, TGFβ1 C-509T, and TGFβ1 T869C) and the risk of subcutaneous fibrosis in a retrospective series of patients who received radiotherapy after breast-conserving surgery.Subcutaneous fibrosis was scored according to the Late Effects of Normal Tissue—Subjective Objective Management Analytical scale in 257 breast cancer patients who underwent surgery plus adjuvant radiotherapy. Genotyping was conducted by polymerase chain reaction—restriction fragment length polymorphism analysis on genomic DNA extracted from peripheral blood. The association between genetic variants and the risk of moderate to severe fibrosis was evaluated by binary logistic regression analysis.Two hundred thirty-seven patients were available for the analysis. Among them, 41 patients (17.3%) developed moderate to severe fibrosis (Grade 2–3), and 196 (82.7%) patients displayed no or minimal fibrotic reactions (Grade 0–1). After adjustment of confounding factors, GSTP1 Ile105Val (odds ratio [OR] 2.756; 95% CI, 1.188–6.393; p = 0.018), GSTA1 C-69T (OR 3.223; 95% CI, 1.176–8.826; p = 0.022), and TGFβ1 T869C (OR 0.295; 95% CI, 0.090–0.964; p = 0.043) polymorphisms were found to be significantly associated with the risk of Grade 2–3 radiation-induced fibrosis. In the combined analysis, carriers of three risk genotypes were found to be at higher odds for the development of Grade 2–3 fibrosis than were patients with two risk genotypes (OR 4.415; 95% CI, 1.553–12.551, p = 0.005) or with no or one risk genotype (OR 8.563; 95% CI, 2.671–27.447; p = 0.0003).These results suggest that functional variations in genes involved in oxidative stress response and fibroblast proliferation may modulate the development of radiation-induced fibrosis in breast cancer patients. The results of the combined analysis support the notion that approaches based on the combination of different genetic markers have the potential to predict normal tissue responses.