Surgical margins in breast conservation Chiappa, Corrado; Rovera, Francesca; Corben, Adriana Dionigi ...
International journal of surgery,
12/2013, Volume:
11
Journal Article
Peer reviewed
Open access
Abstract Breast cancer is the most common tumor affecting women worldwide. Breast-conserving therapy (BCT) followed by irradiation nowadays is the treatment of choice for early-stage disease; there ...is no difference in long-term survival between mastectomy and BCT combined with external radiotherapy. A positive margin is associated with increased risk of local recurrences after BCT for invasive breast cancer and ductal carcinoma in situ. The exact definition of an adequate surgical margin after breast cancer resection has long been debated among physicians and represents an area of considerable variation in clinical practice. There is a lack of standardization in the pathology methods of margin evaluation, which yields little consensus regarding what constitutes an adequate negative margin. As a consequence, patient management varies widely based on the threshold that surgeons accept for adequate margins and the subsequent need for re-excision. We analyze and discuss recent literature about this topic both from the pathological and from the surgical point of view.
Our objective was to determine whether imaging with a human epidermal growth factor receptor 2 (HER2)-targeted PET tracer can detect HER2-positive metastases in patients with HER2-negative primary ...breast cancer.
Patients with HER2-negative primary breast cancer and evidence of distant metastases were enrolled in an Institutional Review Board-approved prospective clinical trial. Archived pathologic samples from the patient's primary breast cancer were retested to confirm HER2-negative disease. Patients with confirmed HER2-negative primary breast cancer underwent
Zr-trastuzumab PET/CT to screen for
Zr-trastuzumab metastases. Metastases avid for
Zr-trastuzumab by PET/CT were biopsied and pathologically examined to define HER2 status. Patients with pathologically proven HER2-positive metastases subsequently received off-protocol HER2-targeted therapy to evaluate treatment response.
Nine patients were enrolled, all of whom had pathologic retesting that confirmed HER2-negative primary breast cancer. Five demonstrated suggestive foci on
Zr-trastuzumab PET/CT. Of these 5 patients, 2 had biopsy-proven HER2-positive metastases and went on to benefit from HER2-targeted therapy. In the other 3 patients, biopsy showed no evidence of HER2-positive disease, and their foci on
Zr-trastuzumab PET were considered false-positive.
In this proof-of-concept study, we demonstrated that
Zr-trastuzmab PET/CT detects unsuspected HER2-positive metastases in patients with HER2-negative primary breast cancer. Although these are only initial results in a small sample, they are a proof of the concept that HER2-targeted imaging can identify additional candidates for HER2-targeted therapy. More specific HER2-targeted agents will be needed for clinical use.
Management of breast cancer during pregnancy Rovera, Francesca; Chiappa, Corrado; Coglitore, Alessandra ...
International journal of surgery (London, England),
12/2013, Volume:
11
Journal Article
Peer reviewed
Open access
Abstract Introduction Pregnancy-associated breast cancer (PABC) is one of the most common malignancies during pregnancy. Since maternal age at the time of pregnancy is increasing, PABC rate is ...expected to increase. Diagnostic delays are common. Methods Retrospective observational study analysing twelve pregnant patients with breast cancer who underwent surgical treatment during the period of February 2006 to June 2013 at the Department of Surgery I, University of Insubria Varese. Results The median age of pregnant patients was 34 y (range 28–44 y). Three patients were affected by BRCA1 mutation. In six patients diagnosis was made during gestation, in the other six patients breast cancer was discovered during breastfeeding. Ten patients underwent breast-conserving surgery. Sentinel lymph node biopsy was performed in six patients; in one of them it was positive so axillary dissection was simultaneuosly performed. Six patients underwent axillary dissection ab initio. In all cases the histological type was invasive ductal carcinoma; grade 3 in ten patients and grade 2 in two patients. Eleven of twelve patients received adjuvant chemotherapy, one patient both adjuvant and neoadjuvant. In three cases also radiation therapy was performed after delivery. In all cases healthy babies were born. Nine of twelve patients are still alive and disease free, after a median follow-up of 20 months (range 3–52 months). Three patients died from systemic progression of the disease. Conclusion There are no significant series of patients in worldwide literature to develop standard protocols. Pregnant women must be followed by a multidisciplinary team.
Abstract ‘Radio-guided occult lesion localization’ is a new technique in the breast conservative surgery performed for the localization and resection of non-palpable breast lesions. The purpose of ...this study is to evaluate the results of this breast surgical procedure provided by several published papers.
Axillary sentinel lymph node biopsy: An overview Rovera, Francesca; Frattini, Francesco; Marelli, Marina ...
International journal of surgery,
2008, 2008-00-00, 20080101, Volume:
6
Journal Article
Peer reviewed
Open access
Abstract The sentinel lymph node biopsy has become the standard procedure in the staging and management of axillary lymph nodes in early breast cancer. This procedure has been validated by several ...studies with an accuracy of 95% and a false-negative rate ranging from 5 to 15%. Aim of this study is to analyze the most updated results and open problems reported in literature in the use of sentinel node biopsy in breast surgery.
Breast cancer surgery in an ambulatory setting Rovera, Francesca; Ferrari, Alberta; Marelli, Marina ...
International journal of surgery,
2008, 2008-00-00, 20080101, Volume:
6
Journal Article
Peer reviewed
Open access
Abstract Aim To evaluate the feasibility and efficacy of outpatient surgery for early breast cancer in an Italian ambulatory setting and to assess its benefits. Patients and methods A review of 88 ...women treated for breast cancer from an outpatient facility was undertaken from July 2003 to December 2006. The patients were selected for ambulatory surgery according to specific social, environmental, physical and oncological criteria. Results Eighty-eight women underwent a total of 107 surgical interventions in an ambulatory setting. Sixty out of the eighty-eight patients (68%) received a one-day conclusive surgical treatment, and the remaining 28 patients were promptly treated in two phases. Among this latter group, 18 patients (68%) were treated only in an outpatient facility, whereas the other 10 patients require reintervention with hospitalization. There were no intraoperative complications. In the postoperative period, 14 complications were observed: 6 wound infections, 3 hematomas, 1 axillary seroma and 4 readmissions. The patients' readmissions were due to nausea and emesis in one case, disphnoea in another case, and only two readmissions were due to surgical complications (hematoma in both cases). Patients that were interviewed exhibited a high level of satisfaction from the treatments they received. Discussion This study confirms the feasibility, efficacy and safety of the outpatient setting regime, which is highly appreciated by women and is more cost effective than surgery in a hospital setting.
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