scholarly journals Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries?

2021 ◽  
Author(s):  
Benedikt Schaefgen ◽  
Annika Funk ◽  
H.-P. Sinn ◽  
Thomas Bruckner ◽  
Christina Gomez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Predictive Value ◽  
False Negative ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Number Needed To Treat ◽  
Positive Margins ◽  
Low Sensitivity ◽  
Specimen Radiography

Abstract Purpose This is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. Methods This retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a positive predictive value (PPV) of 7.7%, and a negative predictive value (NPV) of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9%, and the NNT was 85. Conclusion Positive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR. In summary, CSR after NACT is inadequate for intraoperative margin assessment but remains useful to document removal of the biopsy site clip.

Does Conventional Specimen Radiography After Neoadjuvant Chemotherapy of Breast Cancer Help To Reduce The Rate of Second Surgeries?

2021 ◽  
Author(s):  
Benedikt Schaefgen ◽  
Annika Funk ◽  
Peter Sinn ◽  
Thomas Bruckner ◽  
Christina Gomez Andreu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
False Negative ◽  
Positive Margin ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Target Lesion ◽  
Number Needed To Treat ◽  
Positive Margins ◽  
Specimen Radiography

Abstract PurposeThis is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. MethodsThis retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration of the target lesion and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. A subgroup analysis was performed for patients with and without clinical complete response. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a PPV of 7.7% and a NPV of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9% and the NNT was 85. ConclusionPositive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR.

scholarly journals Re-Excision Rates in Breast-Conserving Surgery for Invasive Breast Cancer after Neoadjuvant Chemotherapy with and without the Use of a Radiopaque Tissue Transfer and X-ray System

Breast Care ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 302-307
Author(s):  
Suniza Jamaris ◽  
Leyla Akpolat-Basci ◽  
Miltiades Stephanou ◽  
Sarah Wetzig ◽  
Yueksel Cubuk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Invasive Breast Cancer ◽  
Breast Conserving Surgery ◽  
Control Group ◽  
Study Group ◽  
Transfer System ◽  
Tissue Transfer ◽  
Resected Tissue ◽  
Specimen Radiography

Background: Significant re-excision rates in breast-conserving surgery (BCS) after neoadjuvant systemic chemotherapy may result from difficulties in defining the surgical target particularly in cases with excellent treatment response. Devices allowing an exact topographic localisation of the lesion in the resected tissue could reduce re-excision rates by optimising the intraoperative detection of involved margins. Methods: 80 patients with invasive breast cancer receiving BCS after neoadjuvant chemotherapy were included in this non-randomized case-control study. 40 patients with specimen radiography performed in a standard approach (control group) were compared to 40 patients with use of a radiopaque tissue transfer system (study group). Results: 19/80 (23.75%) patients required re-excision because of involved margins; among those, 14/40 (35%) were in the control group and 5/40 (12.5%) in the study group. The association between the use of the radiopaque tissue transfer system and the lower re-excision rate was statistically significant (p = 0.023). Conclusion: Our analysis provides a rationale for the routine use of a radiopaque tissue transfer system for specimen radiography in BCS after neoadjuvant chemotherapy for invasive breast cancer in order to reduce re-excision rates.

scholarly journals Assessment of breast cancer surgical margins with multimodal optical microscopy: A feasibility clinical study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245334
Author(s):  
Mark T. Scimone ◽  
Savitri Krishnamurthy ◽  
Gopi Maguluri ◽  
Dorin Preda ◽  
Jesung Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Resolution ◽  
Optical Imaging ◽  
Predictive Value ◽  
Surgical Margin ◽  
Positive Margin ◽  
Breast Cancer Surgery ◽  
Preliminary Evaluation ◽  
Surgical Specimen ◽  
Positive Margins

Providing surgical margin information during breast cancer surgery is crucial for the success of the procedure. The margin is defined as the distance from the tumor to the cut surface of the resection specimen. The consensus among surgeons and radiation oncologists is that there should be no tumor left within 1 to maximum 2 mm from the surface of the surgical specimen. If a positive margin remains, there is substantial risk for tumor recurrence, which may also result in potentially reduced cosmesis and eventual need for mastectomy. In this paper we report a novel multimodal optical imaging instrument based on combined high-resolution confocal microscopy-optical coherence tomography imaging for assessing the presence of potential positive margins on surgical specimens. Since rapid specimen analysis is critical during surgery, this instrument also includes a fluorescence imaging channel to enable rapid identification of the areas of the specimen that have potential positive margins. This is possible by specimen incubation with a cancer specific agent prior to imaging. In this study we used a quenched contrast agent, which is activated by cancer specific enzymes, such as urokinase plasminogen activators (uPA). Using this agent or a similar one, one may limit the use of high-resolution optical imaging to only fluorescence-highlighted areas for visualizing tissue morphology at the sub-cellular scale and confirming or ruling out cancer presence. Preliminary evaluation of this technology was performed on 20 surgical specimens and testing of the optical imaging findings was performed against histopathology. The combination of the three imaging modes allowed for high correlation between optical image analysis and histological ground-truth. The initial results are encouraging, showing instrument capability to assess margins on clinical specimens with a positive predictive value of 1.0 and a negative predictive value of 0.83.

The value of tumor-infiltrating lymphocytes and CD8 expression as a predictor of response to anthracycline-based neoadjuvant chemotherapy in invasive breast carcinoma of no special type

2021 ◽  
pp. 1-6
Author(s):  
Upik A. Miskad ◽  
Rizki A. Rifai ◽  
Rina Masadah ◽  
Berti Nelwan ◽  
Djumadi Ahmad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Immune System ◽  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Predictive Value ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Invasive Breast Carcinoma ◽  
Study Results ◽  
Infiltrating Lymphocytes

BACKGROUND: The immune system is known to play an important role in tumor cell eradication. Although cancer cells were able to escape from the immune system, many studies showed mononuclear inflammatory cell infiltrates known as tumor-infiltrating lymphocytes (TILs) on breast cancer histopathology specimens showed better prognosis, including in disease-free survival (DFS) and chemotherapy responses. OBJECTIVE: This study aimed to reveal the predictive value of tumor-infiltrating lymphocytes (TILs) levels and CD8 expression in invasive breast carcinoma of no special type patients’ samples on response to anthracycline-based neoadjuvant chemotherapy. METHODS: 75 pre-treatment biopsy samples that were diagnosed as invasive breast carcinoma of no special type were evaluated. TILs level determined following recommendations of International TILs Working Group 2014, CD8 expression assessed semiquantitatively after immunohistochemistry staining. Response to anthracycline-based neoadjuvant chemotherapy evaluated clinically using Response Evaluation Criteria in Solid Tumours (RECIST) criteria and pathologically by evaluating hematoxylin and eosin (H&E)-stained slides from mastectomy specimens after 3 or 4 cycles of neoadjuvant chemotherapy. RESULTS: Chi-squared analysis showed a significant relationship between TILs level and CD8 expression with chemotherapy responses clinically (p = 0.011 and p = 0.017 respectively) but not pathologically. Furthermore, the logistic regression test exhibit the predictive value of TILs level was 66.7% and CD8 expression was 64%. CONCLUSIONS: This study results suggest that TILs level and CD8 expression may be added as predictive factors to the response of anthracycline-based neoadjuvant chemotherapy, and oncologists may take benefit in breast cancer patient’s management.

scholarly journals THE MODERN ASPECTS OF THE BREAST CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH BREAST CANCER CT1-3N0-3M0

2020 ◽  
Vol 66 (4) ◽  
pp. 376-380
Author(s):  
Nadezhda Volchenko ◽  
A. Bosieva ◽  
A. Zikiryakhodzhayev ◽  
M. Ermoshchenkova
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Breast Conserving Surgery ◽  
Point Of View ◽  
Medical Documentation ◽  
Oncological Safety ◽  
Lobular Cancer ◽  
Significant Difference ◽  
Disease Free

Introduction. While the “no tumor on ink” approach is generally accepted for breast-conserving surgery (BCS) in patient with breast cancer, it remains unclear whether it is oncologically safe for BCS after neoadjuvant chemotherapy therapy (NACT). The aim of the study is to investigate the optimal width of the resection edges in BCS after NALT and the influence on disease-free and overall survival in patients with breast cancer. Materials and methods. Retrospectively, the medical documentation of 76 patients with breast cancer, who were performed BCS after NACT, was studied. The distribution by stage of breast cancer was as follows: I St. -5 patients, II St. - 55, III St. - 16 (excluded IIIB St.). Invasive cancer of non-specific type was diagnosed in 81.6% of cases, in 6.5% - lobular cancer, in 1.3% - combined breast cancer. Radical breast resections in the classic version were performed in 28 cases, and oncoplastic resections in various modifications were performed in 48 Cases. Results. We present the retrospective data of 76 patients with breast cancer who underwent OSA after NALT in the Department of breast and skin cancer OF the Moscow Institute of medical research. P. A. Herzen. The results of our study demonstrated the oncological safety of OSO with respect to new sizes of tumor nodes after NALT followed by remote radiotherapy. The method of “absence of tumor cells” at the edges of resection demonstrated a high percentage of 1, 3, 5-year relapse - free and overall survival, the frequency of relapse was 2.6%. There was no statistically significant difference in 1, 3, 5-year relapse-free and overall survival when the width of the resection edges was more or less than 1 mm. Conclusion. The results of numerous studies have demonstrated that the breast- conserving surgery is the safe method of surgical treatment from an oncological point of view and is an alternative for radical mastectomies for patients with the breast cancer after neoadjuvant chemotherapy.

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