Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval

Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N=168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as frst event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the diferent staging methods had no signifcant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically signifcant impact of the diferent imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18F-FDG PET-CT over conventional imaging technique

Lymphatic mapping after previous breast surgery

BACKGROUND: To assess the feasibility of lymphatic mapping and determine the lymphatic drainage pathways in patients previously treated with breast conserving therapy (BCT). METHODS: We included patients without current breast cancer that previously received BCT with sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND) for primary breast cancer. The study population consisted of 44 patients and was divided into two groups according to previous surgical treatment of the axilla: 22 patients after previous SNB and 22 patients after previous ALND. Standard lymphatic mapping was performed and the lymphatic drainage pattern was registered. Drainage located outside the ipsilateral axilla was recorded as aberrant. RESULTS: Lymphoscintigraphy revealed a drainage pattern in 17 of 44 patients (39%). The identification rate in the SNB-group was 41% and 36% in the ALND-group (P=0.760). 8 patients (18%) showed aberrant drainage, which tended to be more frequent in the ALND-group than in the SNB-group (27% versus 9%, P=0.122). Lymphatic drainage to the contralateral axilla was observed in 2 patients, both previously treated with ALND. CONCLUSIONS: Lymphatic mapping seems feasible after previous BCT with axillary treatment, in spite of a relatively low identification rate. Aberrant drainage tends to be more frequent after previous treatment with ALND

Axillary and systemic treatment of patients with breast cancer and micrometastatic disease or isolated tumor cells in the sentinel lymph node

BACKGROUND: After introduction of sentinel node biopsy (SNB) in patients with breast cancer a higher proportion of micrometastases and isolated tumor cells are being detected. Prognostic impact and clinical relevance of this minimal nodal involvement is under debate and substantial variation in the use of axillary surgery and/or systemic adjuvant treatment could be expected. METHODS: Data from the population-based Eindhoven Cancer Registry were used on all (n = 9038) women who underwent SNB for invasive breast cancer from 1996 to 2008 and medical files were studied to determine the role of minimal nodal involvement in the decision to use adjuvant systemic treatment. RESULTS: Forty-five percent of 172 patients with isolated tumor cells and 76% of 605 patients with micrometastases received adjuvant systemic treatment. Thirty-five of 59 patients with isolated tumor cells and 153 of 193 patients with micrometastases received systemic therapy based on primary tumor characteristics. The remainder probably received adjuvant therapy based on presence of minimal nodal involvement. Thirty-seven percent of the patients with isolated tumor cells underwent an axillary lymph node dissection compared to 75% when micrometastases were present. Multivariate analyses showed a significantly higher chance of receiving systemic treatment when isolated tumor cells (OR 1.5 (95% CI, 1.05-2.15)) or micrometastases (OR 10.7 (95% CI, 8.56-13.27)) were present, compared to a negative lymph node status. CONCLUSION: The debate on necessity of performing completion ALND and administration of systemic therapy in patients with minimal nodal involvement is reflected by the treatment patterns observed in our population-based study. SYNOPSIS: Describing time-trends and predictors of axillary and systemic treatment of patients with breast cancer and micrometastases or isolated tumor cells in their sentinel lymph node(s)

What you should know about the low anterior resection syndrome - Clinical recommendations from a patient perspective

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