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PubMedDate not supplied

Seroma prevention by using Corynebacterium parvum in a rat mastectomy model.

Seroma formation is the most common complication after mastectomy and continues to be an important problem during the early postoperative period. Several surgical and medical methods have been developed to try to overcome this problem; however, so far none have been used successfully in the routine clinical practice. The aim of this study is to evaluate the effects of Corynebacterium parvum (CP) as a sclerosing agent in both prevention and treatment of seromas after mastectomy and axillary dissection in an animal model. Sixty female Sprague-Dawley rats underwent mastectomy and axillary dissection under general anaesthesia. Following surgery, the rats were treated in 1 of 3 ways. In the prevention group, 1 cm3 (0.35 mg) CP solution was injected beneath the skin flap just before closure of the incision after mastectomy. In the treatment group, animals in which a seroma was formed, the fluid was aspirated, and 1 cm3 CP solution was injected beneath the flap. In the control group, animals in which seromas formed, aspiration only was performed. The frequency of seroma formation decreased when CP solution was injected immediately after the operation (p < 0.01). In addition, seroma formation was effectively treated by CP injection when compared with the control group (p < 0.05). CP was effective as a prophylactic agent in the prevention group and as a therapeutic agent in the treatment group in this experimental model. CP injection may be useful for the management of this problem in a clinical setting.

Animals↗
PubMedDate not supplied

Improvements in breast cancer pathology practices among medicare patients undergoing unilateral extended simple mastectomy.

The information contained in pathology reports of breast cancer specimens is of critical importance to treating physicians for selection of local regional treatment, adjuvant therapy, evaluation of therapy, estimation of prognosis, and analysis of outcomes. This information is also of great importance to patients and their families. In 2000, a Breast Cancer Pathology Advisory Group was formed to advise on the design of a project to assess the quality of pathology reports on unilateral extended simple mastectomy (ICD-9-CM procedure code 85.43) specimens from Medicare patients in New York State. This group comprised clinical pathologists, breast surgeons, medical oncologists, clinical breast cancer specialists, and a radiation oncologist. The group suggested that the reports be examined for several elements (quality indicators) that are relevant to patient care and prognosis. Baseline random sample data assessing these elements were established from a random sample of all cases for the calendar year 1999. A random sample of 748 cases (43.5%) of unilateral extended simple mastectomy was chosen from among 1718 cases for the calendar year 1999. Of these, 555 (74.2%) were suitable for review. The remaining 193 (25.8%) cases did not satisfy the inclusion criteria. Aggregate performance on 7 quality indicators (presence of carcinoma, laterality of specimen, number of lymph nodes present, number of positive nodes, documentation of lymph nodes, histologic type, and largest dimension of the tumor) was 83.7% or better, whereas performance was 69.4% or less on 10 others (resection margin status, verification of tumor size, gross observation of the lesion, histologic grade, angiolymphatic invasion, nuclear grade, location of the tumor, mitotic rate, extent of tubule formation, and perineural invasion). The last, perineural invasion, was used as a control element and was not considered an evaluative quality indicator. Performance levels for New York State were significantly lower for histologic grade, resection margin status, and angiolymphatic invasion than in similar studies elsewhere. In addition, there were significant interhospital disparities in the performance levels for these quality indicators. Whereas some hospitals always recorded certain indicators, others never did. This in part reflects differing degrees of adoption of recommended specialty society protocols. The second phase of the project consisted of an educational feedback program involving the directors of pathology laboratories in New York State. The aggregate findings of the baseline study were shared with all the pathologists. In addition, each hospital that performed unilateral extended simple mastectomies during the study period received its own specific data so that it could compare its performance with the aggregate performance. The results of the baseline study also were shared with the New York Pathological Society and the New York State Society of Pathologists. The latter described the results in its newsletter. A postintervention review of the medical charts of a sample of 297 Medicare patients discharged from New York State acute care hospitals with an ICD-9-CM procedure code of 85.43 (unilateral extended simple mastectomy) was conducted for the 6-month period from December 1, 2001, through May 31, 2002. The 8 quality indicators, performance for which was below 84% in the baseline, were chosen for this remeasurement. Statistically significant improvements (P < .0001) occurred in all the 8 quality indicators, ranging from 12.6% to 19.9%. The results of this study indicate that the issues identified by breast cancer pathology reports are amenable to improvement. Such improvement can serve both the patients and the treating physicians better in making adjuvant treatment decisions, estimating prognosis, and evaluating outcomes. It also will be of help to patients and their families in making other life decisions.

Aged↗
PubMed2001

Expression of LRP and MDR1 in locally advanced breast cancer predicts axillary node invasion at the time of rescue mastectomy after induction chemotherapy.

BACKGROUND: Axillary node status after induction chemotherapy for locally advanced breast cancer has been shown on multivariate analysis to be an independent predictor of relapse. However, it has been postulated that responders to induction chemotherapy with a clinically negative axilla could be spared the burden of lymphadenectomy, because most of them will not show histological nodal invasion. P-glycoprotein expression in the rescue mastectomy specimen has finally been identified as a significant predictor of patient survival. MATERIALS AND METHODS: We studied the expression of the genes encoding multidrug resistance associated protein (MDR1) and lung cancer associated resistance protein (LRP) in formalin-fixed, paraffin-embedded tumor samples from 52 patients treated for locally advanced breast cancer by means of induction chemotherapy followed by rescue mastectomy. P-glycoprotein expression was assessed by means of immunohistochemistry before treatment in 23 cases, and by means of reverse-transcriptase-mediated polymerase chain reaction (RT-PCR) after treatment in 46 (6 failed). LRP expression was detected by means of immunohistochemistry, with the LRP-56 monoclonal antibody, in 31 cases before treatment. Immunohistochemistry for detecting the expression of c-erb-B2, p53, Ki67, estrogen receptor and progesterone receptor are routinely performed in our laboratory in every case, and the results obtained were included in the study. All patients had received between two and six cycles of standard 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) chemotherapy, with two exceptions [one patient received four cycles of a docetaxel-adriamycin combination, and the other four cycles of standard cyclophosphamide-methotrexate-5-fluorouracil (CMF) polychemotherapy]. Response was assessed in accordance with the Response Evaluation Criteria In Solid Tumors (RECIST). By these, 2 patients achieved a complete clinical response, 37 a partial response, and the remaining 13 showed stable disease. This makes a total clinical response rate of 75.0%. None achieved a complete pathological response. RESULTS: MDR1 mRNA expression detected by RT-PCR was associated with the presence of invaded axillary nodes at surgery in 18/22 cases (81.8%), compared with 13/24 (54.2%) in the group with undetectable MDR1 expression. This difference was statistically significant (P < 0.05). LRP expression in more than 20% of tumor cells before any treatment was associated with axillary nodal metastasis after chemotherapy and rescue mastectomy in 17/23 cases, compared with 3/8 in nonexpressors. Again, this difference was highly significant (P < 0.01). LRP expression before treatment and MDR1 mRNA expression after treatment were significantly interrelated (P < 0.001), which might reflect the presence of chemoresistant clones liable to metastasize to the regional nodes. Persistence of previously detected MDR1-positivity after treatment (7/9 compared with 0/2 cases) was significantly associated with axillary node metastasis (P < 0.05). Finally, in a logistic regression multivariate model, histology other than ductal, a Ki67 labeling index of at least 20% and the combination of LRP and MDR1 positivity emerged as independent predictors of axillary node invasion at the time of rescue mastectomy. CONCLUSION: The expression of different genes involved in resistance to chemotherapy, both before and after treatment with neoadjuvant, is associated with the presence of axillary node invasion at rescue surgery in locally advanced breast cancer. This might reflect the presence of intrinsically resistant clones before any form of therapy, which persist after it, and could be helpful both for prognosis and for the choice of individual treatment.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2001

Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.

PURPOSE: To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. PATIENTS AND METHODS: We followed the course of 745 women with a first breast cancer and a family history of breast and/or ovarian cancer who underwent contralateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. Family history information and cancer follow-up information were obtained from the medical record, a study-specific questionnaire, and telephone follow-up. Life-tables for contralateral breast cancers, which consider age at first breast cancer, current age, and type of family history, were used to calculate the number of breast cancers expected in our cohort had they not had a prophylactic mastectomy. RESULTS: Of the 745 women in our cohort, 388 were premenopausal (age < 50 years) and 357 were post- menopausal. Eight women developed a contralateral breast cancer. Six events were observed among the premenopausal women, compared with 106.2 predicted, resulting in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to 97.9%). For the 357 postmenopausal women, 50.3 contralateral breast cancers were predicted, whereas only two were observed, representing a 96.0% risk reduction (95% CI, 85.6% to 99.5%). CONCLUSION: The incidence of contralateral breast cancer seems to be reduced significantly after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.

Adult↗
PubMed2003

Use of genetic testing and prophylactic mastectomy and oophorectomy in women with breast or ovarian cancer from families with a BRCA1 or BRCA2 mutation.

PURPOSE: To analyze the use of genetic testing, prophylactic mastectomy, and oophorectomy among women with breast and/or ovarian cancer from families with a BRCA1 or BRCA2 mutation. PATIENTS AND METHODS: We examined prospectively the use of BRCA1/BRCA2 testing in all women with a primary breast or ovarian cancer from a consecutive series of 112 high-risk families in which a BRCA1/BRCA2 mutation eventually was identified. The rate of prophylactic bilateral and contralateral mastectomy and prophylactic oophorectomy was analyzed in the women who carried a BRCA1/BRCA2 mutation and who had no metastatic disease at the time of the genetic test disclosure. We examined predictors for genetic test uptake and prophylactic surgery using univariate and multivariate analysis. RESULTS: Overall, 192 of 220 women (87%) with primary tumors underwent genetic testing. Eleven of these 192 tested women (6%) appeared not to carry the family-specific BRCA1/BRCA2 mutation. Genetic testing occurred significantly more frequently at ages younger than 50 years (P =.04) and in persons with multiple primary tumors (P =.02). Among eligible women, 35 of 101 (35%) requested bilateral or contralateral mastectomy, and 47 of 95 (49%) requested oophorectomy. Women aged younger than 50 years and women who developed their first tumor after the initial identification of a BRCA1/BRCA2 mutation in the family were significantly (both P =.01) more likely to opt for prophylactic bilateral or contralateral mastectomy. CONCLUSION: In a clinical setting, we show a high demand for BRCA1/BRCA2 testing and for prophylactic surgery by women with breast and/or ovarian cancer from high-risk families.

Adult↗
PubMed2006

Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy.

PURPOSE: To understand psychosocial outcomes after prophylactic removal of the contralateral breast in women with unilateral breast cancer. METHODS: We mailed surveys to women with contralateral prophylactic mastectomy after breast cancer diagnosis between 1979 and 1999 at six health care delivery systems, and to a smaller random sample of women with breast cancer without the procedure. Measures were modeled on instruments developed to assess contentment with quality of life, body image, sexual satisfaction, breast cancer concern, depression, and health perception. We examined associations between quality of life and the other domains using logistic regression. RESULTS: The response rate was 72.6%. Among 519 women who underwent contralateral prophylactic mastectomy, 86.5% were satisfied with their decision; 76.3% reported high contentment with quality of life compared with 75.4% of 61 women who did not undergo the procedure (P = .88). Among all case subjects, less contentment with quality of life was not associated with contralateral prophylactic mastectomy or demographic characteristics, but was associated with poor or fair general health perception (odds ratio [OR], 7.0; 95% CI, 3.4 to 14.1); possible depression (OR, 5.4; 95% CI, 3.1 to 9.2); dissatisfaction with appearance when dressed (OR, 3.5; 95% CI, 2.0 to 6.0); self-consciousness about appearance (OR, 2.0; 95% CI, 1.1 to 3.7); and avoiding thoughts about breast cancer (modest: OR, 2.2; 95% CI, 1.1 to 4.5; highest: OR, 1.7; 95% CI, 0.9 to 3.2). CONCLUSION: Most women undergoing contralateral prophylactic mastectomy report satisfaction with their decision and experience psychosocial outcomes similar to breast cancer survivors without the procedure.

Adult↗
PubMedDate not supplied

Persistence of tumor DNA in plasma of breast cancer patients after mastectomy.

BACKGROUND: We investigated tumor DNA changes before and after mastectomy in the plasma of breast cancer patients with no disseminated disease and eventually investigated these changes' relationship to specific pathological parameters of the tumors. METHODS: We studied 41 patients. DNA extracted from tumor and normal breast tissues, mononuclear blood cells, and plasma was used for molecular studies. Alterations in the microsatellite markers D17S855, D17S654, D16S421, TH2, D10S197, and D9S161, as well as point mutations in the p53 gene and aberrant methylation of p16(INK4a), were used to identify and characterize tumor and plasma DNA. A number of tumor clinicopathological parameters were analyzed in each patient. RESULTS: We found that 18 (44%) of the 27 patients with alterations in tumor DNA presented the same plasma DNA alteration before mastectomy, and persistence of the same molecular features was detected in plasma DNA 4 to 6 weeks postmastectomy in 8 (19.5%) patients. Patients with vascular invasion, more than three lymph node metastases, and higher histological grade at diagnosis displayed plasma DNA after mastectomy with a significant difference. CONCLUSIONS: Persistence of plasma DNA with features of tumor DNA may be present after mastectomy in breast cancer patients, and its relation to bad-prognosis histological parameters may suggest undetectable micrometastatic disease.

Biomarkers, Tumor↗
PubMed2003

Mastectomy by inverted drip incision and immediate reconstruction: data from 510 cases.

BACKGROUND: Immediate reconstruction of the breast can be performed in selected cases after mastectomy for breast cancer or after prophylactic mastectomy in patients with a high risk of developing breast cancer. Despite the frequency with which these procedures are performed, data from large series of subpectoral implantation of silicone prostheses in combination with a skin-saving approach are lacking. METHODS: In this retrospective study, data on complications and late surgical interventions in 356 patients who underwent 510 mastectomies with an inverted drip incision and immediate reconstruction (MIDIIR) were analyzed to determine potential prognostic factors of early complications. RESULTS: In 82% of the MIDIIRs, the postoperative course was uneventful. In 18%, the complications were infection (32 cases), necrosis of the skin flap (29 cases), bleeding (31 cases), and protrusion of the prosthesis (20 cases), resulting in surgery in 9, 12, 15, and 20 cases, respectively. At the end of the follow-up period, 30 (6%) prostheses were definitively removed. Age, size of the prostheses, radiotherapy, previous lumpectomy, and indication for mastectomy were not significant factors for the prognosis of early complications. CONCLUSIONS: With the right technique and indications, MIDIIR is a very safe procedure and should be one of the surgical treatments that can be offered in the overall management of patients with, or at high risk for, breast cancer.

Adult↗
PubMed1988

The mastectomy experience: patients' perspectives.

This paper reports information gained from in-depth structured interviews of 27 women who had undergone mastectomy regarding their experiences from time of detection of the breast lump until complete recovery was achieved. Special emphasis was placed on the emotional/psychological aspects of the mastectomy experience. Although the experience was different for all of the women interviewed, some common elements emerged. Nearly all of the women discovered the breast lump themselves. Most of them recalled the reactions of significant others in their environment, including their physician, as supportive, although nearly half of them did not feel that they had been adequately prepared by health care professionals for what to expect from the mastectomy. They overwhelmingly supported the idea of a coordinated program for post-mastectomy patients to ensure that the needs of future patients are met.

Adult↗
PubMed2005

Esthetic evaluation of immediate breast reconstruction after nipple-sparing or skin-sparing mastectomy.

BACKGROUND: It has been reported that immediate autologous tissue breast reconstruction after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) is esthetically superior to autologous tissue reconstruction after conventional mastectomy (CM). We evaluated reconstructed breasts to determine whether these methods contribute to breast appearance other than skin texture. METHODS: Between April 1992 and September 2001, forty-two patients underwent immediate breast reconstruction using autologous tissue. Mastectomy options were NSM, SSM and CM. Postoperative photographs were evaluated using a subscale (volume, contour, placement, and inframammary fold) on a 0-2 point scale. Sternal notch to nipple distances of the affected and normal sides were measured with photographs to estimate nipple-areola complex (NAC) position. No corrective procedure was performed in a later phase before evaluation. RESULTS: NSM was performed in 22, SSM in 6 and CM in 14 cases. On esthetic evaluation, the NSM and SSM groups received 4.96 and the CM group received 4.63. There were no significant differences. In the NSM and SSM group, the NAC position rose in cases with partial necrosis or fat lysis compared with the no complication group (p = 0,004). CONCLUSIONS: Autologous tissue breast reconstruction after NSM or SSM is esthetically equal to autologous tissue reconstruction after CM with regard to parameters other than skin texture. Preserved or simultaneously reconstructed NAC sometimes emphasizes nipple-areola asymmetry when breast deformity has occurred.

Adult↗
PubMed1983

Breast reconstruction with submuscular prosthesis after modified radical or simple mastectomy. Surgical technique and early complications.

A series of 100 women who underwent breast reconstruction is reviewed. They had previously been treated for breast cancer with modified radical or simple mastectomy. The technique and early results of reconstruction are presented. The same surgeon performed all these operations and the technique was not varied. Emotional need for reconstruction was the main factor in patient selection. The interval between mastectomy and reconstruction was as a rule at least one year after removal of stage I cancer and 2-5 years in stage II cases. Scar correction was required significantly more often after oblique than after horizontal mastectomy incision. A submuscular pocket was created to accommodate the prosthesis and a muscle and fascia flap was used to add tissue and contour. No major early complications occurred. The submuscular implantation of prosthesis facilitated clinical follow-up. In a background population of breast cancer patients, the overall frequency of breast reconstruction was 4%. The figure for premenopausal patients with stage I breast cancer treated with modified radical mastectomy was 18%.

Adult↗
PubMed2002

Quality of life among mastectomy patients receiving radiotherapy.

A descriptive study was conducted to describe the quality of life among mastectomy patients receiving radiotherapy. There were 20 mastectomy patients receiving radiotherapy at Oncology Hospital of Peking Union Medical College, and the First, and the Second Teaching Hospital of Beijing Medical University, in Beijing according to the criteria. The instrument used for data collection was Quality of Life Index-Cancer Version (QLI-CV). Finding of the study revealed that the quality of life among mastectomy patients had changed a little during the course of radiotherapy. Within four domains,family domain received the highest satisfaction, while psychological/spiritual domain seeded to get the lowest satisfaction in this group of people. The findings of the study may provide the baseline knowledge for understand quality of life among mastectomy patients.

Adult↗
PubMed1990

The use of tissue expansion for immediate breast reconstruction after mastectomy.

A series of 139 patients who had a total mastectomy underwent breast reconstruction using the method of tissue expansion. In 127 patients a tissue expander was inserted at the time of mastectomy and in 12 patients this was done as a delayed procedure. The reconstruction was successfully completed in 87% of cases and the patient acceptance of this method of reconstruction has been high. We believe that tissue expansion should be offered to all women having immediate reconstruction after total mastectomy and that it also has a significant role in delayed breast reconstruction after mastectomy.

Adult↗
PubMed1997

HMO stirs debate with outpatient mastectomy push.

The public furor over outpatient mastectomies may have quieted for the moment, but same-day surgery managers have been left with lingering concerns. Congress currently is considering two bills addressing outpatient mastectomies. One would ensure a minimum length of stay for the procedure, while the other leaves that decision to the physician and patient. Some professionals say outpatient mastectomies fail to provide crucial emotional and psychological support. Patients of one breast center suggested routine outpatient mastectomies with preadmission educational components.

Ambulatory Surgical Procedures↗
PubMed1999

Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy.

BACKGROUND: The purpose of the current study was to evaluate the locoregional recurrence rate after treatment of patients with operable breast carcinoma with a modification of the Halsted radical mastectomy and the selective use of radiotherapy and to identify risk factors for locoregional recurrence. METHODS: Between 1979-1987, 691 consecutive patients underwent mastectomy after a negative biopsy of the axillary apical lymph nodes. The median age of the patients was 59 years (range, 26-89 years). The clinical tumor size was < 2 cm in 72 patients, 2-5 cm in 387 patients, and >5 cm in 169 patients; 16 patients had a T4 tumor. Surgery was comprised of a modification of the Halsted radical mastectomy, including at least part of the pectoralis major muscle and the entire pectoralis minor muscle, in 573 patients; 303 patients had positive axillary lymph nodes. Adjuvant radiotherapy to the chest wall and regional lymph nodes was given to 74 patients, whereas an additional 414 patients underwent irradiation to the internal mammary and medial supraclavicular lymph nodes. The median follow-up was 91 months. RESULTS: The actuarial overall survival rate was 82% at 5 years and 63% at 10 years. The 10-year chest wall and regional lymph node control rates, including patients with prior distant failures, were 95% and 94%, respectively. The only two significant prognostic factors for locoregional recurrence on multivariate analysis were lymph node status and pathologic tumor size. CONCLUSIONS: Excellent locoregional control can be achieved with a modified technique of radical mastectomy in patients with negative apical biopsy and the selective use of comprehensive radiotherapy. These results may serve as a reference outcome for comparison with other locoregional treatment strategies.

Adult↗
PubMed1999

Minimal injury mastectomy in the surgical treatment of stage I and II breast cancer patients. A 20-year experience.

The main purpose of the present study is to enhance what we coined minimal injury mastectomy (MIM) as a reliable, efficient and acceptable procedure in the surgical treatment of breast cancer besides other therapeutic options currently used in the setting of adjuvant treatment (e.g. radiation therapy, chemotherapy or hormonal manipulations). We analysed retrospectively data of 142 patients with stage I and II breast cancer. Fifty-five of them had stage I, and the remaining 87 patients had stage II disease. Patients were submitted to minimal injury mastectomy, which is a broad segmental mastectomy, with limited or no axillary lymphadenectomy, thus minimizing locoregional trauma. Radiotherapy was given on a selective basis. Postoperative follow-up period ranged from one to 19.5 years (mean 103.5 months). Cosmetic results, shoulder function, texture of the breast and patient psychology were excellent in all the patients. In 55 stage I patients, six local recurrences occurred (12.72%), a mean 49.9 months after MIM, with ultimate local control of all patients and a remarkable survival after treatment of recurrences. In 87 stage II patients, six local (6.8%) and 16 systemic recurrences (18.7%) occurred, the latter after a mean period of 54.4 months postoperatively. It is concluded that with the minimal injury mastectomy, locoregional injury is minimized, preserving the regional immunological functions and by preventing lymphedema of the remaining breast, systemic resistance mechanisms are maintained and other adverse factors are avoided.

Adult↗
PubMed2000

Primary non-Hodgkin lymphoma of the breast. Is it possible to avoid mastectomy?

Primary lymphoma of the breast is a rare disease that has been estimated to represent from 0.05% to 0.53% of all malignant breast tumors and approximately 2.2% of all extranodal lymphomas. The aim of this study is to review all cases of primary lymphoma of the breast at the Institute of Oncology and Radiology of Serbia from 1984 to 1996 in order to determine the incidence, patterns of clinical presentation, radiological features, histopathology, mode of therapy and outcome of the disease. The criteria for inclusion in this retrospective study corresponded to a revision of the original criteria suggested by Wiseman and Liao. The clinical histories of ten patients with breast lymphomas were reviewed. Clinical follow-up was obtained through a review of the patients hospital chart or by direct contact with the patients. Ten cases of primary lymphoma of the breast have been identified during the 12-yr period, presenting 0.05% of all patients with malignant breast disease. All patients were female, median age at diagnosis 58 years (range 49-69), all presented with breast lumps (3 right, 7 left) of median size 5 cm (range 3.5-8 cm). Mammography and breast echography were unable to bring a suspicion of lymphoma. Histologically, 6 cases were diffuse large cell, 3 of which with features consistent with immunoblastic lymphoma; 2 were diffuse mixed cells and 2 had small lymphocytic morphology. In 4 out of 5 patients, in the clinical stage corresponding to the "operable breast cancer" category, the ex tempore histological analysis could not differentiate lymphoma from cancer, so that all of them had mastectomy with axillary dissection. Those corresponding to the "locally advanced breast cancer" category, escaped mastectomy and a classical biopsy was performed, anticipating eventual neoadjuvant procedures. Thus, four patients underwent radical mastectomy, 1 wide local excision and 5 diagnostic biopsies. Further treatment included chemotherapy for 8 patients. The projected probability of a 10-years survival was 0,60. The rarity of this disease, and uneven treatment modalities make prognosis of breast lymphoma difficult. It seems that cooperation between the surgeon and the pathologist is necessary in order to reach the correct diagnosis during ex tempore analysis. With the limitations of available diagnostic procedures, it appears that most patients with breast lymphoma, in the stage corresponding to the "operable breast cancer" category, will unnecessarily undergo mastectomy and axillary dissection as primary treatment approach.

Aged↗
PubMed2000

Locoregional recurrence in patients with one to three positive axillary nodes after mastectomy without adjuvant radiotherapy.

PURPOSE: To retrospectively assess the risk of locoregional recurrence (LRR) and analyze the prognostic factors of this pattern of failure in patients with breast cancer and one to three positive axillary lymph nodes treated with modified radical mastectomy (MRM) without adjuvant radiotherapy. METHODS: From April 1991 through December 1997, 649 patients received a diagnosis of invasive breast cancer, and 545 were treated with MRM. Eighty-one of these patients who were found to have one to three positive axillary nodes and had a minimum follow-up of 2 years were included in this study. None of the 81 patients received adjuvant radiation therapy after mastectomy; 43 patients received adjuvant chemotherapy; and 60 patients received adjuvant hormone therapy. The median duration of follow-up was 39 months. RESULTS: Thirteen patients had LRR during follow-up, all within 2 years after mastectomy. The 3-year LRR rate was 14%. The 3-year rates of distant metastasis for patients with and without LRR were 48% and 14% (p = 0.03), respectively. The 3-year survival rates for patients with and without LRR were 73% and 87% (p = 0.01), respectively. In univariate analysis, age (p = 0.01), estrogen receptor (ER) status (p = 0.02), and the addition of hormone therapy (p < 0.001) were significant risk factors for LRR; in multivariate analysis, negative ER status (p = 0.02) was the only statistically significant risk factor. The 3-year LRR rates for ER-negative patients and those with positive or unknown ER status were 31% and 11%, respectively. CONCLUSIONS: LRR after mastectomy is a substantial clinical problem, despite the use of adjuvant chemotherapy and/or hormone therapy. Further randomized trials of postmastectomy radiotherapy for patients with one to three positive axillary nodes and specific risk factors are urgently needed to determine its potential benefit in locoregional control and survival, especially for young and ER-negative patients.

Adult↗