Triple-negative breast cancer: correlation between imaging and pathological findings

Triple-negative breast cancer: correlation between imaging and pathological findings
Eun Sook Ko, Byung Hee Lee, Hyun-A Kim, Woo-Chul Noh, Min Suk Kim & Sang-Ah Lee
European Radiology 2010; 20;5:1111-1117

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Results: 
Triple-negative breast cancers showed a high histological grade. On mammography, triple-negative breast cancers usually presented with a mass (43/87, 49%) or with focal asymmetry (19/87, 22%), and were less associated with calcifications. On ultrasound, the cancers were less frequently seen as non-mass lesions (12/87, 14%), more likely to have circumscribed margins (43/75, 57%), were markedly hypoechoic (36/75, 57%) and less likely to show posterior shadowing (4/75, 5%). Among the three types of breast cancers, ER-negative/PR-negative/HER2-positive breast cancers most commonly had associated calcifications (52/65, 79%) on mammography and were depicted as non-mass lesions (21/65, 32%) on ultrasound

Conclusion: 
Our results suggest that the imaging findings might be useful in diagnosing triple-negative breast cancer

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures
Fritz K. W. Schaefer, A. Waldmann, A. Katalinic, C. Wefelnberg, M. Heller, W. Jonat & I. Schreer
European Radiology 2010; 20;5:1085-1092

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Results:
In total, 62,006 additional USs were performed, in which 116 mammographically and clinically occult breast cancers were diagnosed (detection rate: 1.9/1,000 examinations), while mammography alone (40,551 examinations) revealed 903 cancers (22.3/1,000). Of all 1,019 breast cancer findings, 12.8% were detected because of the combination of mammography and US. In the group with ACR III/IV, 15.9% of cancers were found by supplemental US compared with mammography alone.

Conclusion:
The addition of US to mammography vs. mammography alone resulted in a significant (P  < 0.01) increase in breast cancer detection rate

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes Marie L. De Bruin, Judith Sparidans, Mars B.

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes
Marie L. De Bruin, Judith Sparidans, Mars B. van't Veer, Evert M. Noordijk, Marieke W.J. Louwman, Josée M. Zijlstra, Hendrik van den Berg, Nicola S. Russell, Annegien Broeks, Margreet H.A. Baaijens, Berthe M.P. Aleman, and Flora E. van Leeuwen
Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp. 4239-4246

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Reduction of radiation volume appears to decrease the risk for Breast Cancer after Hodgkin's Lymphoma.

In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for Breast Cancer

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes
Marie L. De Bruin, Judith Sparidans, Mars B. van't Veer, Evert M. Noordijk, Marieke W.J. Louwman, Josée M. Zijlstra, Hendrik van den Berg, Nicola S. Russell, Annegien Broeks, Margreet H.A. Baaijens, Berthe M.P. Aleman, Flora E. van Leeuwen
Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp. 4239-4246

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Reduction of radiation volume appears to decrease the risk for BC after HL. In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for BC

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?
C. Simmons, N. Miller, W. Geddie, D. Gianfelice, M. Oldfield, G. Dranitsaris, and M. J. Clemons

Ann Oncol 2009 20: 1499-1504

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This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence

Follow-up may not be beneficial after treatment of grade 1 breast cancer

Follow-up may not be beneficial after treatment of grade 1 breast cancer

M. Kontos, D. Allen, D. T. Trafalis, G. Jones, H. Garmo, L. Holmberg, H. Hamed
British Journal of Surgery 2009; 96: 999 – 1004

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Identification of women treated for breast cancer who have a low risk of locoregional recurrence or contralateral breast cancer, and who can be discharged safely from follow-up, would lower costs without compromising prognosis. This study investigated the risk of locoregional recurrence and contralateral breast cancer in women treated for grade 1 breast cancer

Some 1143 women who had surgery for breast cancer were followed, and the rate of locoregional recurrence or contralateral breast cancer was determined. The risk was compared to the tumour grade

At a mean follow-up of 9·1 years, 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2 and 3 breast cancer were 0·03 (95 per cent confidence interval (c.i.) 0·01 to 0·08), 0·12 (0·09 to 0·15) and 0·16 (0·13 to 0·20) respectively. Grade 1 tumours had a risk of locoregional recurrence or contralateral breast cancer of 285 (95 per cent c.i. 93 to 670) per 100 000 person-years

Women treated for grade 1 breast cancer could be discharged from follow-up after completion of the primary treatment, without compromising their quality of care

Breast Cancer in the Elderly

Led by Professor Bob Leonard from the Royal Marsden Hospital, a number of excellent articles on breast oncology issues in the elderly

How Age affects the biology of breast cancer
Breast Cancer in Older Women: Trials and Tribulations
The Role of Surgery in the Treatment of Older Women with Breast Cancer
Breast Radiotherapy: Considerations in Older Patients
Quality of Life and Patient-reported Outcomes in the Older Breast Cancer Patient

The feasibility of sentinel node biopsy in the previously treated breast

The feasibility of sentinel node biopsy in the previously treated breast
M. Koizumi, M. Koyama, K. Tada, S. Nishimura, Y. Miyagi, M. Makita, M. Yoshimoto, T. Iwase, R. Horii, F. Akiyama and T. Saga
European Journal of Surgical Oncology (EJSO) Volume 34, Issue 4, April 2008, Pages 365-368

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Previous axillary dissection or irradiation to the breast greatly influences lymphatic flow. Irradiation to the breast may be a strong factor for the visualization of contralateral axillary nodes. Despite the frequent alteration of lymphatic flow, SNB seems to be feasible in secondary or recurrent breast cancer patients.

High Risk Screening - adding US to Mammography - ACRIN Results

Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer
Wendie A. Berg; Jeffrey D. Blume; Jean B. Cormack; Ellen B. Mendelson; Daniel Lehrer; Marcela Bohm-Velez; Etta D. Pisano; Roberta A. Jong; W. Phil Evans; Marilyn J. Morton; Mary C. Mahoney; Linda Hovanessian Larsen; Richard G. Barr; Dione M. Farria; Helga S. Marques; Karan Boparai; for the ACRIN 6666 Investigators
JAMA 2008;299 2151-2163

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Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives.

Results of the ACRIN 6666 trial, whose results were presented at RSNA 2007. As expected ultrasound is good at picking up additional cancers, not visualized on mammography, BUT at a significant cost of false positivies and unnecessary biopsies.

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?
G C Wishart, D C Greenberg, P D Britton, P Chou, C H Brown, A D Purushotham & S W Duffy
British Journal of Cancer (2008) 98, 1741-1744

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An interesting paper from Cambridge. The authors suggest that tumours picked up at screening are biologically different enough that current methods for estimating prognosis and therefore treatment, overestimate the benefit of systemic treatments in screen-detected cancers and lead to overtreatment of these patients.

Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory

Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory
F. Gilissen, R. Oostenbroek, R. Storm, P. Westenend and P. Plaisier
European Journal of Surgical Oncology (EJSO 34, Issue 5, May 2008, Pages 497-500

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By preoperative US and FNA of the axilla in patients with breast cancer, half of the axillary metastases can be detected prior to surgery. In more than a quarter of breast cancer patients, a futile SNP can be prevented.

Therefore, preoperative US of the axilla plus FNA are obligatory in patients with breast carcinoma.