Accurate measurement of breast tumour size determines staging and prognosis. Discrepancies amongst clinical examination (CE), ultrasonography (USG), mammography, pathological examination (PE) and magnetic resonance imaging have been reported. However, few studies have evaluated changes in breast tumour size from the operating table to the laboratory.Objectives and methods:A prospective study was designed to assess the intra-operative (IO) tumour size in 29 patients of breast cancer presenting to a tertiary care centre in Delhi and to compare it with CE, USG and PE.Observations and results:Twenty-nine patients (mean age: 47 years), presenting with invasive duct carcinoma (stage IIIA: 31%, stage IIB: 28%), were included in the study. Comparison with mean IO (4.2 cm) revealed that both USG and PE underestimated tumour size by a mean of 0.35 cm (8.4%) and 0.45 cm (10.7%), respectively, in most patients. CE tended to overestimate size by 0.82 cm (19.8%). All three modalities showed statistically significant correlation with IO (maximum Pearson’s correlation coefficient for PE=0.937, p<0.001; R2=0.877, maximum for PE). Two-way analysis of variance revealed mean difference in size to be statistically significant (p=0.000) only between CE and IO.Discussion:Formalin processing causes changes in tumour dimensions in the breast, causing reduction in tumour size. It may also have a bearing on the assessment of surgical margins in breast conservation surgery. Immediate post-operative measurement of the specimen is ideal. Protocols for specimen fixation should be standardized.

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Purpose/Objective(s): Randomized trials have demonstrated that postlumpectomy radiation therapy (PLRT) can safely be omitted in elderly women with early stage breast cancer that is ER positive, PR positive, and HER2 negative. The purpose of this study was to evaluate the impact of omitting PLRT in older women (>70 years old) with early stage triplenegative breast cancer (TNBC). Materials/Methods: We queried the National Cancer Database (NCDB) for elderly women (age > 70 years old) with T1-2N0M0 TNBC (ER negative, PR negative, HER2 negative) undergoing breast conserving surgery between 2004 to 2015. PLRT included both conventionally fractionated radiation therapy (45-50.4 Gy in 25-28 fractions) and hypofractionated radiation therapy (40-42.5 Gy in 15-16 fractions). Multivariable logistic regression ascertained factors associated with radiotherapy administration. Overall survival (OS) between patients treated with either lumpectomy alone or lumpectomy with PLRT was estimated using Kaplan-Meier method amongst all patients, and then after stratifying patients by stage, age, and chemotherapy use. Cox proportional hazards modeling determined variables associated with OS. Results: A total of 8,526 patients met the selection criteria. Among these patients, 6,283 (73.69%) underwent PLRT, while 2,243 (26.31%) were observed following lumpectomy. The 5-year OS was greater for patients undergoing PLRT than for those patients who did not receive PLRT (77.2% vs. 55.3%, p < 0.001). PLRT was associated with higher OS when stratifying patients by T stage, age, and chemotherapy use (p < 0.001 for all). On multivariable logistic regression, age > 80 years old, the presence of comorbid conditions, lower socioeconomic status, and omission of chemotherapy all predicted for omission of PLRT (p<0.05 for all). On cox multivariate analysis, omission of PLRT continued to predict for worse OS (p<0.001). Conclusion: Use of PLRT was associated in improved OS for older women (>70 years old) with T1-2N0M0 TNBC amongst all patients and also when stratifying patients by age, stage, and chemotherapy use. Despite the aggressive nature of TNBC, there were still more than a quarter of the patients not receiving PLRT. Unlike patients with luminal A breast cancer, adjuvant radiotherapy after breast conserving surgery should not be omitted for older patients with TNBC, even in the setting of T1 disease or systemic chemotherapy use.