Fifteen-year results of breast-conserving surgery and definitive irradiation for Stage I and II breast carcinoma: the University of Pennsylvania experience

Santiago, Roberto; Wu, Lynn; Harris, Eleanor; Fox, Kevin R.; Schultz, Delray; Glick, John H.; Solin, Lawrence J.

doi:10.1016/s0360-3016(03)01460-3

Cited by 94 publications

(44 citation statements)

References 47 publications

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“…In 1985, Holland et al (18) showed that 20% of patients with unifocal clinical or mammographic cancer smaller than 2 cm who underwent mastectomy had additional cancer that was mammographically occult and clinically unsuspected, a figure that increased to 43% among patients with primary tumors larger than 2 cm. Although additional disease was found at histologic analysis in 63% of mastectomy specimens, this finding poorly correlates with the low incidence of local treatment failure in women who undergo breast-conserving treatment because additional nonsurgical treatment of the breast is designed to sterilize any residual disease (19). In our study, although MR imaging-detected multicentric cancers were more commonly discovered in heterogeneously or extremely dense breasts (80%), these cancers occurred in many women with fatty breasts or index cancer and additional MR imaging-detected cancers (P = .381) ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Iacconi

Galman²,

Zheng³

et al. 2016

Radiology

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).q RSNA, 2015 Purpose:To review the magnetic resonance (MR) imaging and pathologic features of multicentric cancer detected only at MR imaging and to evaluate its potential biologic value. Materials and Methods:This retrospective study was institutional review board approved and HIPAA compliant; informed consent was waived. Results:Known index cancers were more likely to be invasive than MR imaging-detected multicentric cancers (88% vs 76%, P = .023). Ductal carcinoma in situ (21 of 87 lesions [24%]; 95% CI: 15, 36) represented a minority of additional MR imaging-detected multicentric cancers. Overall, the size of MR imaging-detected multicentric invasive cancers (median, 0.6 cm; range, 0.1-6.3 cm) was smaller than that of the index cancer (median, 1.2 cm; range, 0.05-7.0 cm; P = .023), although 17 of 73 (23%) (95% CI: 14, 35) patients had larger MR imaging-detected multicentric cancers than the known index lesion, and 18 of 73 (25%) (95% CI: 15, 36) had MR imaging-detected multicentric cancers larger than 1 cm. MR imaging-detected multicentric cancers and index cancers differed in histologic characteristics, invasiveness, and grade in 27 of 73 (37%) patients (95% CI: 26, 49). In four of 73 (5%) patients (95% CI: 2, 13), MR imaging-detected multicentric cancers were potentially more biologically relevant because of the presence of unsuspected invasion or a higher grade. Conclusion:Multicentric cancer detected only at MR imaging was invasive in 66 of 87 patients (76%), larger than 1 cm in 18 of 73 patients (25%), larger than the known index cancer in 17 of 73 patients (23%), and more biologically important in four of 73 women (5%). An unsuspected additional multicentric cancer seen only at MR imaging is likely clinically relevant disease.q RSNA, 2015

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Section: Discussionmentioning

confidence: 99%

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Iacconi

Galman²,

Zheng³

et al. 2016

Radiology

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“…In some series, the presence of close margins was associated with an increased local recurrence rate compared to widely negative margins [15,16,[18][19][20]. Other studies, however, failed to demonstrate this [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Studies examining whether local recurrence rates are increased when close margins are not re-excised have been mixed [15][16][17][18][19][20][21][22][23]. When reexcisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure.…”

Section: Introductionmentioning

confidence: 99%

Residual disease after re‐excision lumpectomy for close margins

Sabel

Rogers

Griffith

et al. 2008

Journal of Surgical Oncology

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Introduction: While a positive margin after an attempt at breast conservation therapy (BCT) is a reason for concern, there is more controversy regarding close margins. When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure. We sought to examine the incidence of residual disease after re-excision for close margins and to identify predictive factors that may better select patients for re-excision. Methods: Our IRB-approved prospective breast cancer database was queried for all breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCT. Close margins are defined as 2 mm for invasive carcinoma and 3 mm for DCIS. Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Three hundred three patients (32%) underwent re-operation for either close (173) or positive (130) margins. Overall, 33% had residual disease identified, 42% of DCIS patients and 29% of patients with invasive disease, nearly identical to patients with positive margins. For patients with DCIS, only younger age was significantly related to residual disease. For patients with invasive cancer, only multifocality was significantly associated with residual disease ). However, patients without multifocality still had a substantial risk of residual disease. Discussion: The presence of residual disease appears equal between re-excisions for close and positive margins. No subset of patients with either DCIS or invasive cancer could be identified with a substantially lower risk of residual disease.

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“…(7,14,24,29) In this study, the regional recurrence rate in N0 patients who received breast alone irradiation was only 1.9% when the lesion was localized to the outer quadrant of the breast. However, the regional recurrence rate was 11.2% when the lesion was in the inner quadrant.…”

Section: Discussionmentioning

confidence: 59%

Validation of Radiation Volume by Analysis of Recurrence Pattern in Breast-conserving Treatment for Early Breast Cancer

et al. 2009

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Purpose:To assess the appropriateness of radiotherapy volume for patients receiving breast-conserving treatment (BCT) through analysis of recurrence pattern and factors affecting recurrence. Methods: From 1991 to 1996, 362 patients who received BCT were retrospectively evaluated. The radiation volume was the involved breast alone in the patients with less than 4 positive axillary lymph nodes (LNs), and breast and supraclavicular fossa in patients with 4 or more positive axillary LNs. The median follow-up period was 123 months (range, 3-169 months). Results: Ten-year overall, disease-free, local recurrence-free, and regional recurrence-free survival rates were 86.2%, 82.2%, 95.9%, and 95.2%, respectively. Among 310 patients receiving radiotherapy on the breast alone, 15 (4.8%) had regional recurrence. In particular, patients with inner quadrant lesions had high regional recurrence rates (11/98, 11.2%) (p <0.001). Conclusion:These low local recurrence rates may reveal that the current radiotherapy technique was successful. However, in cases of inner quadrant lesions, there were a considerable number of regional recurrences, even in N0 cases. This may suggest a potential role for irradiation on regional LNs in this group.

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Fifteen-year results of breast-conserving surgery and definitive irradiation for Stage I and II breast carcinoma: the University of Pennsylvania experience

Cited by 94 publications

References 47 publications

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Residual disease after re‐excision lumpectomy for close margins

Validation of Radiation Volume by Analysis of Recurrence Pattern in Breast-conserving Treatment for Early Breast Cancer

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