We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.

International audienceOne of the benefits of neoadjuvant chemotherapy (NAC) is its ability to convert patients ineligible for breast conservative treatment (BCT) to be candidates for this treatment, although questions have been raised regarding the effectiveness of BCT in terms of loco-regional recurrence (LRR). The objective of this study is to evaluate LRR in this group and the influence of tumor characteristics in recurrence

No abstract

A 61-year-old patient underwent surgery for infiltrating ductal carcinoma of her left breast. Breast-conserving surgery and sentinel node biopsy (SNB) were performed. Specimen analysis revealed an 18-mm invasive ductal carcinoma with the following immunohistochemical features: histologic grade 3, estrogen receptor (ER) 100%, progesterone receptor (PR) 70%, human epidermal growth factor receptor 2 (her2 neu) negative (0+), and a Ki67 > 15%; sentinel node biopsy was positive on intraoperative analysis (1/1), and axillary lymph node dissection was performed (0/16). Final-stage IIA adjuvant chemotherapy was given with 4 cycles of doxorubicin and cyclophosphamide followed by 4 cycles of taxane. Using 12 Mev electrons, adjuvant radiotherapy (RTP) was given to the whole breast and the supraclavicular lymphatic basin (50 Gy) with a tumor bed boost (16 Gy), during 6 weeks. The procedure was well tolerated.Tamoxifen (20 mg/d) was administered in concomitance with the RTP.Five months after finishing RTP, the patient came to our clinic with breast pain. Upon examination, the left breast showed erythema, edema, and fibrosis corresponding to the previous radiation port (Figures 1 and 2). The patient also complained of heavy and increasingly warm breast. Neither fever nor local infection signs were present. A blood test was ordered showing no infection parameters. A mammogram and breast ultrasound were performed showing skin edema and echogenic changes related to the previous RTP treatment (Figure 3). No solid lesions or other imaging changes were reported, and local relapse was ruled out. A radiation recall dermatitis (RRD) was suspected, and a close follow-up was established. After 15 days of oral corticosteroids (prednisone) in conjunction with tamoxifen withdrawal, partial relief was seen. Radiation recall dermatitis findings almost disappeared in a 3-month period (Figure 4). As an alternatively adjuvant treatment, the patient was given letrozole. The patient had refused it as a first option because she suffered mildmoderate arthritis.Radiation recall dermatitis is defined as an acute inflammatory reaction of a previously radiated skin, triggered by the administration of certain drugs. Anticancer agents are responsible for 20%-30% of reported cases. No exact cause has been clearly identified, although an idiosyncratic drug hypersensitivity reaction seems to be the preferred mechanism, given the rarity, speed of onset, and extreme drug specificity of RRD. The overall frequency of this condition seems to be around 6%-8.8%.Time lapse between radiotherapy (RTP) and the drug administration is usually short in cases of RRD, often <2 months, but some cases have been reported with a late onset. Most cases show up as a painful reddish area located at a previously radiation field.Breast edema and swelling are also frequent. To improve this condition, withdrawal or delaying of eliciting drugs is usually offered, although is not always possible. Corticosteroids play a role by providing symptoms relief and preventing recurrence as well....