Annual Meeting Proceedings Part 1 - American Society of Clinical ...

76s Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy
1109 General Poster Session (Board #32B), Sat, 8:00 AM-12:00 PM
Accuracy of breast MRI in predicting pathologic tumor size. Presenting
Author: Kimberly Anne Caprio, Yale University, New Haven, CT
Background: MRI use as a preoperative planning tool is increasing in women
with breast cancer, yet the correlation between MRI and pathologic size of
cancers is unclear. The purpose of this study was to determine the accuracy
of MRI in predicting pathologic tumor size, and factors that affect this
correlation. Methods: Clinicopathologic and imaging data from 84 patients
diagnosed with invasive or in situ breast cancer from September 2010 to
October 2011 who had preoperative MRI were reviewed. 12 patients who
had neoadjuvant chemotherapy were excluded. MRI detected 147 lesions
in the remaining 72 patients. Concordance between MRI and pathology
size was determined using Spearman rho coefficients, and factors affecting
the accuracy of MRI in predicting tumor size within �/- 0.5 cm were
determined. Results: There was a modest correlation between MRI and
pathology size for all MRI detected lesions (benign or malignant) with a
Spearman coefficient of 0.53. Of the 147 MRI detected lesions, 45
(30.6%) had pathologic and MRI size correlating within �/- 0.5 cm; 76
(51.7%) were overestimated (�0.5cm) by MRI, and 26 (17.7%) were
underestimated (�0.5cm). 101 (68.7%) of the 147 lesions were found to
be malignant (either with invasive disease or DCIS). In this subgroup, 35
lesions (34.7%) had an MRI size within �/- 0.5 cm of the pathologic size;
40 (39.6%) were overestimated by MRI and 26 (25.7%) were underestimated.
Patient age, tumor histology, LVI and grade did not predict
concordance between pathologic and MRI size. However, small MRI lesion
size more accurately correlated with pathologic tumor size. While 51.1% of
tumors that had concordant MRI and pathologic findings within 0.5 cm
were �1 cm on MRI, no tumor found to be � 5 cm on MRI was within
�/-0.5 cm on final pathology (p�0.001). Conclusions: MRI accurately
predicts pathologic tumor size only when the size of the lesion on MRI is �1
cm.
1112 General Poster Session (Board #32E), Sat, 8:00 AM-12:00 PM
Comparison of long-term results of endoscopic video-assisted breast
surgery (VABS) between transaxillary retromammary approach (TARM) and
periareolar approach. Presenting Author: Koji Yamashita, Nippon Medical
School, Tokyo, Japan
Background: The breast conserving surgery (BCS) and the sentinel node
(SN) biopsy became to be recognized as the standard treatment for early
breast cancers. We have reported about cosmetic effectiveness and lower
infestation of the video-assisted breast surgery (VABS) for the breast
diseases. We devised the trans-axillary retro-mammary (TRAM) approach of
VABS. It needs only one skin incision in the axilla and can treat any tumor
of the breast without making any injuries on the breast skin. We evaluated
the aesthetic results and the curability of this surgical method. Methods: We
have performed VABS on 300 patients since December, 2001. The newly
devised TARM was performed on 120 patients of early breast cancer, stage
I and II. After endoscopic SN biopsy, we elongated the axillary skin incision
to 2.5 cm. We dissected major pectoral muscle fascia to detach retromammary
tissue behind the tumor. We cut the mammary gland with clear
surgical margin, and removed it through the axillary port. The breast
reconstruction was made by filling absorbable oxydized cellulose. The
postoperative aesthetic results were evaluated by ABNSW. Results: BCS
was performed on 286 patients (26 after preoperative chemotherapy) and
skin-sparing mastectomy on 14. There was no serious complication after
surgery. Surgical margin was minimally positive in 2. The original shapes of
the breast were preserved well. The follow-up is 126 months at maximum
and 74 months on average. There is 3 locoregional recurrences and 14
distant metastases. 5-year survival rate is 97.3%. With regard to TARM,
The skin incision only in the axilla made better looks and shapes of the
breast. It could be applied for tumors in any area of the breast without
tumor nipple extension. The reconstruction with oxidized cellulose needs
no excessive detachment of the skin beyond the surgical margin. The
postoperative esthetic results were excellent and better. The sensory
disturbance was minimal. All patients expressed great satisfaction.
Conclusions: VABS can be considered as a good surgical procedure
concerning locoregional control and esthetics. TARM is better on the
patients without tumor nipple extension.
1111 General Poster Session (Board #32D), Sat, 8:00 AM-12:00 PM
Magnetic resonance imaging (MRI) evaluation of pathologic complete
response (pCR) in different breast cancer subtypes after neoadjuvant
chemotherapy (NAC). Presenting Author: Lucia Gonzalez-Cortijo, Hospital
Universitario Quiron Madrid, Madrid, Spain
Background: MRI is being used to address treatment response to NAC in
breast cancer patients. However, its ability to predict pCR in histologically
different tumors remains unclear. We tried to investigate the usefulness of
MRI in evaluation of pCR in different breast cancer subtypes after
treatment with NAC. Methods: Serial MRI studies were acquired before,
during and after NAC in 75 evaluable patients. MRI interpretation included
lesion size, morphology and dynamic enhanced evaluation imaging with
initial and late enhancement. On the basis of the final MRI, response was
determined to be a clinically complete response (CCR) when no residual
tumor and no late enhancement were found. By using inmunohistochemistry
and fluorescence in situ hybridization (FISH) for human epidermal
growth factor receptor 2 (HER2/neu) amplification, tumors were divided
into three subtypes: triple negative, HER2 positive, and estrogen receptor
(ER) positive/HER2 negative. Every patient received chemotherapy with
taxanes and anthracyclines and HER2 positive tumors were treated with
trastuzumab. All patients received surgery. pCR was defined as no residual
invasive tumor in the surgical specimen. Ductal carcinoma in situ residual
disease was considered pCR. Results: 22 of 75 patients (29%) achieved a
CCR on the final MRI. Of 22 patients with CCR all 22 (100%) were
confirmed pathologically. 19 were pathologic complete responses and 3
showed in situ microscopic residual disease. 12 (55%) were HER2 positive
tumors, 4 (18%) were triple negative tumors and 6 (27%) were ER
positive/HER2 negative tumors. The negative predictive value of MRI for
predicting pCR after NAC was 100%. Conclusions: Absence of both residual
tumor and late enhancement in MRI predict pCR with high accuracy in
triple negative, HER2 positive and ER positive/HER2 negative breast
cancer after NAC.
1113 General Poster Session (Board #32F), Sat, 8:00 AM-12:00 PM
The impact of primary surgery on stage IV breast cancer. Presenting Author:
Ella Harris, Breastcheck, Dublin, Ireland
Background: The role of primary surgery in metastatic breast cancer is
unclear. Here in we have performed metaanalysis on available data to
assess the role of surgery on oncological outcome in patients with stage IV
breast cancer. Methods: A comprehensive search for published trials that
examined outcome following removal of primary disease in stage IV breast
cancer was performed using MEDLINE and cross referencing available
data. Reviews of each study were conducted, and data were extracted.
Primary outcome was overall survival related to surgical removal of primary
disease. Results: We identified 15 relevant studies of which 10 were
appropriate for analysis. Data was available on 28,693 patients with stage
IV disease, of whom 52.8% underwent removal of the primary carcinoma.
Patients undergoing primary surgery in this setting were more likely to be
alive at 3 years 40% vs. 22% (OR 2.32 CI 2.08-2.6, p�0.01 (surgery vs.
no surgery)). Analysis of subgroups for selection to surgery or not, favoured
smaller tumours, fewer comorbidities, fewer metastases (p�0.01). There
was no difference between the two groups in location of metastases, grade
of tumour or receptor status. Conclusions: Patients undergoing removal of
primary carcinoma in the setting of stage IV breast cancer appear to have an
improved overall survival. However the available data suggest that these
surgical patients probably have better prognosis stage IV disease than those
patients not undergoing surgery.
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