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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2009

Open Access 01-08-2009 | Breast Oncology

Surgical Outcome of Patients with Core-Biopsy-Proven Nonpalpable Breast Carcinoma: A Large Cohort Follow-Up Study

Authors: S. van Esser, MD, N. H. G. M. Peters, MD, PhD, M. A. A. J. van den Bosch, MD, PhD, W. P. Th. M. Mali, MD, PhD, P. H. M. Peeters, MD, PhD, I. H. M. Borel Rinkes, MD, PhD, R. van Hillegersberg, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2009

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Abstract

Background

Breast-conserving surgery (BCS) is the preferred treatment for nonpalpable breast carcinoma. The outcome, however, may be disappointing. In this study surgical outcome in a large cohort of patients diagnosed with nonpalpable breast carcinoma is evaluated.

Methods

In 833 patients with 841 nonpalpable breast carcinomas the number of re-excisions and type of surgical procedures was calculated and summed per patient. Subsequently, the number of conversions to mastectomy and the number of days until complete tumor removal were analyzed. In a subgroup analysis the patients with an in situ carcinoma were compared with the patients with an invasive carcinoma.

Results

The initial surgery consisted of BCS for 589 tumors (70%) and of mastectomy for 242 tumors (29%). For ten tumors (1%) the initial surgery was unknown. After BCS, 158/589 tumors (27%) required a re-excision: 116/337 (34%) for the in situ carcinomas and 63/504 (13%) for the invasive carcinomas (p = 0.0001). The number of conversions from BCS to mastectomy was 106/589 (18%): 66/241 (28%) in patients diagnosed with an in situ carcinoma versus 40/348 (11%) in patients with an invasive carcinoma (p = 0.0001). The median number of days until complete tumor removal was 28, being 38 days for the in situ carcinomas and 25 days for the invasive carcinomas (p = 0.0001).

Conclusions

There is room for improvement in the surgical treatment of nonpalpable breast carcinoma, especially the relatively favorable in situ carcinoma, as it requires significantly more excisions, mastectomies, conversions to mastectomy, and days for complete removal.
Literature
1.
Mann BA, Samet JM, Hunt WC, Key CR, Goodwin JM, Goodwin JS. Changing treatment of breast cancer in New Mexico from 1969 through 1985. JAMA. 1988;259(23):3413–17.PubMedCrossRef
2.
Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989;320(13):822–8.PubMed
3.
Fisher B. From Halsted to prevention and beyond: advances in the management of breast cancer during the twentieth century. Eur J Cancer. 1999;35(14):1963–73.PubMedCrossRef
4.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.PubMedCrossRef
5.
Verkooijen HM. Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation. Int J Cancer. 2002;99(6):853–9.PubMedCrossRef
6.
Verkooijen HM, Borel RI, Peeters PH, et al. Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of nonpalpable breast cancer. Eur J Surg Oncol. 2001;27(3):244–9.PubMedCrossRef
7.
Hoorntje LE, Peeters PH, Mali WP, Borel RI. Is stereotactic large-core needle biopsy beneficial prior to surgical treatment in BI-RADS 5 lesions? Breast Cancer Res Treat. 2004;86(2):165–70.PubMedCrossRef
8.
Peters N, Hoorntje L, Mali W, Borel RI, Peeters P. Diagnostic performance of stereotactic large core needle biopsy for nonpalpable breast lesions in routine clinical practice. Int J Cancer. 2008;122(2):468–71.PubMedCrossRef
9.
Anttinen J, Kautiainen H, Kuopio T. Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients. Br J Cancer. 2006;94(1):147–51.PubMedCrossRef
10.
De Cicco C, Pizzamiglio M, Trifiro G, et al. Radioguided occult lesion localisation (ROLL) and surgical biopsy in breast cancer. Technical aspects. Q J Nucl Med. 2002;46(2):145–51.PubMed
11.
Nadeem R, Chagla LS, Harris O, et al. Occult breast lesions: a comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL). Breast. 2005;14(4):283–9.PubMedCrossRef
12.
Rahusen FD, Bremers AJ, Fabry HF, van Amerongen AH, Boom RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol. 2002;9(10):994–8.PubMedCrossRef
13.
Florentine BD, Kirsch D, Carroll-Johnson RM, Senofsky G. Conservative excision of wire-bracketed breast carcinomas: a community hospital’s experience. Breast J. 2004;10(5):398–404.PubMedCrossRef
14.
Besic N, Zgajnar J, Hocevar M, et al. Breast biopsy with wire localization: factors influencing complete excision of nonpalpable carcinoma. Eur Radiol. 2002;12(11):2684–9.PubMed
15.
Thind CR, Desmond S, Harris O, Nadeem R, Chagla LS, Audisio RA. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience. Clin Radiol. 2005;60(6):681–6.PubMedCrossRef
16.
Wallace AM, Daniel BL, Jeffrey SS, et al. Rates of reexcision for breast cancer after magnetic resonance imaging-guided bracket wire localization. J Am Coll Surg. 2005;200(4):527–37.PubMedCrossRef
17.
Zgajnar J, Hocevar M, Frkovic-Grazio S, Hertl K, Schweiger E, Besic N. Radioguided occult lesion localization (ROLL) of the nonpalpable breast lesions. Neoplasma. 2004;51(5):385–9.PubMed
18.
Hoorntje LE, Peeters PH, Mali WP, Borel RI. Stereotactic large core needle biopsy for the diagnosis of nonpalpable breast lesions: reliable without additional excision biopsy. Ned Tijdschr Geneeskd. 2003;147(18):868–73PubMed
19.
Kurniawan ED, Wong MH, Windle I, et al. Predictors of surgical margin status in breast-conserving surgery within a breast screening program. Ann Surg Oncol. 2008.
20.
Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383–93.PubMedCrossRef
21.
Karasawa K, Mitsumori M, Yamauchi C, et al. Treatment outcome of breast-conserving therapy in patients with positive or close resection margins: Japanese multi institute survey for radiation dose effect. Breast Cancer. 2005;12(2):91–8.PubMedCrossRef
22.
McIntosh A, Freedman G, Eisenberg D, Anderson P. Recurrence rates and analysis of close or positive margins in patients treated without re-excision before radiation for breast cancer. Am J Clin Oncol. 2007;30(2):146–51.PubMedCrossRef
23.
Van Esser S, Hobbelink M, Van der Ploeg IM, et al. Radio guided occult lesion localization (ROLL) for non-palpable invasive breast cancer. J Surg Oncol. 2008.
24.
Layeequr RR, Iuanow E, Crawford S, Quinlan R. Sonographic hematoma-guided vs wire-localized lumpectomy for breast cancer: a comparison of margins and volume of resection. Arch Surg. 2007;142(4):343–6.CrossRef
25.
Medina-Franco H, Abarca-Perez L, Ulloa-Gomez JL, Romero C. Radioguided localization of clinically occult breast lesions (ROLL): a pilot study. Breast J. 2007;13(4):401–5.PubMedCrossRef
26.
Tafra L, Fine R, Whitworth P, et al. Prospective randomized study comparing cryo-assisted and needle-wire localization of ultrasound-visible breast tumors. Am J Surg. 2006;192(4):462–70.PubMedCrossRef
27.
Cleffken B, Postelmans J, Olde DS, Nap M, Schreutelkamp I, van der Bijl H. Breast-conserving therapy for palpable and nonpalpable breast cancer: can surgical residents do the job irrespective of experience? World J Surg. 2007;31(9):1731–6.PubMedCrossRef
28.
Zork NM, Komenaka IK, Pennington RE Jr, et al. The effect of dedicated breast surgeons on the short-term outcomes in breast cancer. Ann Surg. 2008;248(2):280–5.PubMedCrossRef
29.
Martin MA, Meyricke R, O’Neill T, Roberts S. Breast-conserving surgery versus mastectomy for survival from breast cancer: the Western Australian experience. Ann Surg Oncol. 2007;14(1):157–64.PubMedCrossRef
30.
Collins ED, Moore CP, Clay KF, et al. Can women with early-stage breast cancer make an informed decision for mastectomy? J Clin Oncol. 2009;27(4):519–25.PubMedCrossRef
31.
Golshan M, Fung BB, Wiley E, Wolfman J, Rademaker A, Morrow M. Prediction of breast cancer size by ultrasound, mammography and core biopsy. Breast. 2004;13(4):265–71.PubMedCrossRef
32.
Braun M, Polcher M, Schrading S, et al. Influence of preoperative MRI on the surgical management of patients with operable breast cancer. Breast Cancer Res Treat. 2008;111(1):179–87.PubMedCrossRef
33.
Mann RM, Veltman J, Barentsz JO, Wobbes T, Blickman JG, Boetes C. The value of MRI compared to mammography in the assessment of tumour extent in invasive lobular carcinoma of the breast. Eur J Surg Oncol. 2008;34(2):135–42.PubMed
34.
Peters NH, van den Bosch MA, Peeters PH, Mali WM, Borel RI. Breast magnetic resonance imaging in early-stage breast cancer: is there really no value? J Clin Oncol. 2008;26(20):3465–6.PubMedCrossRef
35.
Kennedy T, Stewart AK, Bilimoria KY, Patel-Parekh L, Sener SF, Winchester DP. Treatment trends and factors associated with survival in T1aN0 and T1bN0 breast cancer patients. Ann Surg Oncol. 2007;14(10):2918–27.PubMedCrossRef
Metadata
Title
Surgical Outcome of Patients with Core-Biopsy-Proven Nonpalpable Breast Carcinoma: A Large Cohort Follow-Up Study
Authors
S. van Esser, MD
N. H. G. M. Peters, MD, PhD
M. A. A. J. van den Bosch, MD, PhD
W. P. Th. M. Mali, MD, PhD
P. H. M. Peeters, MD, PhD
I. H. M. Borel Rinkes, MD, PhD
R. van Hillegersberg, MD, PhD
Publication date
01-08-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0513-6

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