Sonographically guided metalic clip placement for tumor localization in early breast cancer patients undergoing neoadjuvant chemotherapy

Shahzad, Rafia; Masood, Misbah; Shahid, Abia; Mirza, Zeeshan Rashid; Cheema, Faisal Ehsan; Fatima, Ismat

doi:10.5455/jpma.4864

Cited by 3 publications

(3 citation statements)

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“…The age at menarche of the study population ranged from 12 to 16 years, with a mean (± SD) of 13.29 (± 1.12) years and a median (IQR) of 13 (12,14) years. Specifically, 58.8% of the patients experienced menarche at ages 12 to 13, and 41.2% at ages 14 to 15.…”

Section: Resultsmentioning

confidence: 99%

“…Physical examination, mammography, and sonography are part of the triple assessment used for therapy assessment. Many studies have shown that MRI provides a more accurate determination of the response to chemotherapy than other modalities, and extensive research has been conducted on this [14]. The radiopaque marker is a safe and inexpensive technique used for marking the tumor bed before surgical excision in patients who have shown a complete tumor response after receiving neoadjuvant chemotherapy [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Pandurangappa,

Paruthy,

Jamwal

et al. 2023

Cureus

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BackgroundThe present study aims to evaluate the response of locally advanced breast carcinoma (LABC) to neoadjuvant chemotherapy (NACT) using image-guided clip placement based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. MethodsThirty-four patients with LABC were included in the study. Consent for three-dimensional titanium clip placement (400/300/200 mm Liga clips) under local anesthesia with USG guidance was obtained. Serial sonographic/X-ray evaluations of tumor bed size were conducted before every cycle of NACT. All data were recorded in millimeters of concentric tumor regression/non-regression. Tumor regression in a concentric or Swiss cheese pattern and non-responders were evaluated. Assessment of the response to NACT was performed using RECIST criteria, dividing it into four categories. Tumor response was confirmed with computerized tomography (CT) conducted before and after the completion of NACT. Patients underwent surgical management, mostly modified radical mastectomy (MRM), as they had locally advanced breast carcinoma. Following MRM, the clips in the specimen guided the original site of the tumor for histopathological evaluation and response to chemotherapy. ResultsTumor response was classified into four types: complete response (CR), partial response (PR), progressive disease (PD), and stable disease. RECIST 1.1 criteria were elaborated and defined. Data for all patients were entered into an Excel sheet (Microsoft Corporation, Redmond, Washington) to prepare a master chart, and the following observations were made and analyzed using SPSS software. The duration of chemotherapy for the study population ranged from 32 to 206 days, with a mean (±SD) of 111.82 (± 52.64) days and a median (IQR) of 81 (63, 158) days. The mean period between clip insertion and completion of NACT was 111.82 days. The baseline sum diameters and post-NACT diameters of the tumors were 70.50 (±13.60) mm before NACT and 17.75 (±17.20) mm after NACT. Hence, the mean size of the lump was statistically significantly lower after NACT, with a mean difference of 52.75 (p<0.05). The mean rate of reduction in tumor diameter was found to be 74.32% (±23.44%) based on RECIST 1.1 criteria. Pathological response was observed in all patients except for 8.8% of the patients. Clinical complete response was seen in 35.29% of patients, and partial response was observed in 52.92% of the patients based on RECIST 1.1 criteria. The study thus demonstrates the effectiveness of NACT in LABC, with a mean reduction in tumor diameter of 74.32%, assessed with the help of RECIST 1.1 criteria. ConclusionNACT for patients with LABC has shown a significant reduction in tumor size. NACT should be the initial mode of management for patients with LABC. RECIST 1.1 criteria are effective and can be used to assess tumor response to NACT. This has aided in the stratification of the response of NACT for further management through systemic therapy (adjuvant chemotherapy) after the surgical excision of the tumor.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Pandurangappa,

Paruthy,

Jamwal

et al. 2023

Cureus

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“…It is certainly true that the reduction in tumor load by NAT presents a distinct challenge for breast surgeons in accurately locating and completely excising the primary tumor site. Despite this, breast surgeons must remember that patients with BC who are potential candidates for BCS should have the tumor(s) marked with a metallic clip before starting NAT [ 48 , 49 ]. The metallic clip remains detectable during the entire course of NAT, facilitating precise pre-operative localization of the tumor bed and intra-operative identification [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

De-Escalation Surgery in cT3-4 Breast Cancer Patients after Neoadjuvant Therapy: Predictors of Breast Conservation and Comparison of Long-Term Oncological Outcomes with Mastectomy

Tinterri,

Barbieri,

Sagona

et al. 2024

Cancers

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Background: Neoadjuvant therapy (NAT) has become increasingly employed for the treatment of cT3-4 breast cancer (BC), enabling breast-conserving surgery (BCS) in cases traditionally considered for mastectomy. This study aims to identify predictors for breast conservation post-NAT and to evaluate whether BCS influences long-term oncological outcomes. Methods: We retrospectively analyzed data from patients with cT3-4 BC who received NAT at the Breast Unit of IRCCS Humanitas Research Hospital, Milan, Italy, from October 2009 to April 2020. Surgical outcomes and long-term oncological results, such as disease-free survival (DFS), distant DFS (DDFS), overall survival (OS), and BC-specific survival (BCSS), were compared between the BCS and mastectomy groups. Results: Among 114 patients analyzed, 37 (32.5%) underwent BCS, and 77 (67.5%) had a mastectomy. The key predictors for opting for BCS included absence of vascular invasion, reduced tumor size post-NAT, and achieving ypT0 status. No significant differences in DFS, DDFS, OS, and BCSS were observed between the two surgical groups (log-ranks, p = 0.520, p = 0.789, p = 0.216, p = 0.559, respectively). Conclusions: BCS after NAT is a feasible and safe option for patients with cT3-4 BC, without adversely affecting long-term oncological outcomes. Identifying predictors of breast conservation can guide surgical decision-making, ensuring that patients receive optimal treatment.

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1

Kravchun¹,

Samusieva²,

Zaichuk³

2021

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Surgical treatment is still one of the main methods of complex therapy of breast cancer. Due to the widespread use of non-adjuvant antitumor treatment, the issue of routine tumor labeling is becoming increasingly important. The purpose of labeling is to improve the quality of tumor control after neoadjuvant therapy and adequate surgical treatment. In this literature review, we will consider the methods for labeling to visualize a tumor site.

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Sonographically guided metalic clip placement for tumor localization in early breast cancer patients undergoing neoadjuvant chemotherapy

Cited by 3 publications

References 0 publications

Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

De-Escalation Surgery in cT3-4 Breast Cancer Patients after Neoadjuvant Therapy: Predictors of Breast Conservation and Comparison of Long-Term Oncological Outcomes with Mastectomy

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