Breast Multidisciplinary Team Research Articles

Breast Cancer Molecular Subtyping in Practice: A Real-World Study of the APIS Breast Cancer Subtyping Assay in a Consecutive Series of Breast Core Biopsies.

The APIS Breast Cancer Subtyping Kit is an mRNA-based assessment of the seven parameters including three biomarkers routinely assessed in all the newly diagnosed breast cancers (BC), oestrogen receptor (ER), progesterone receptor (PR) and HER-2 and an additional four genes that create a novel proliferation signature, MKI67, PCNA, CCNA2 and KIF23. Taken together, the data are used to produce a molecular subtype for every sample. The kit was evaluated against the current standard protocol of immunohistochemistry (IHC) and/or in situ hybridisation (ISH) in breast cancer patients. The data were presented at the weekly breast multidisciplinary team (MDT) meeting. A total of 98 consecutive cases of pre-operative breast cancer core biopsies and two core biopsies of nodal metastases yielding 100 cases were assessed. IHC and APIS results were available for 100 and 99 cases. ER was concordant in 97% cases, PR was concordant in 89% and HER-2 results were concordant with IHC/ISH in 100% of the cases. Ki-67 IHC was discordant in 3% of cases when compared with MK167 alone but discordant in 24% when compared with the four-gene proliferation signature. In conclusion, our study indicates that the APIS Breast Cancer Subtyping Kit is highly concordant when compared to the results produced for ER/PR/HER-2 by IHC and/or ISH. The assay could play a role in the routine assessment of newly diagnosed breast cancer (BC) specimens.

Targeted Lung Health Check: breast related incidental findings-imaging appearances and lessons learned.

The introduction of Targeted Lung Health Checks (TLHC) to screen for lung cancer has highlighted that incidental findings are common and require management strategies. This study analyses retrospectively, incidentally detected breast lesions reported as part of the TLHC referred to the Breast Cancer clinicians. All participants with incidental breast nodules referred to the Breast Cancer team in the first year of screening were reviewed. Fifty-two participants (48 female; 92.3%) were referred to the Breast Multidisciplinary Team Meeting for assessment of 43 breast nodules, 8 breast asymmetry/dense breasts, and 2 likely breast related metastatic disease. One participant declined breast team referral. For the 42 breast nodules investigated, the final diagnoses were 5 breast carcinomas, 10 normal breast tissue, and 27 benign nodules. One male patient was diagnosed with breast carcinoma. The 29 breast nodules classified as smooth and well defined were all benign. No malignancy was demonstrated in the group with asymmetric or dense breast tissue. Metastatic breast carcinoma was confirmed in two participants. Twenty-six out of thirty-seven (54%) females had prior breast screening mammograms precluding further investigation. Incidental breast nodules are common on THLC scans. Smooth, sharply defined breast nodules are likely to be benign but low-dose CT is poor at accurately assessing breast nodules. Agreed breast referral pathways prior to starting the Lung Cancer Screening programme are recommended. Access to screening mammograms can reduce referrals to the Breast clinic. Lessons learned from TLHC pilot studies can be useful to sites commencing national TLHC programme.

Idiopathic granulomatous mastitis with extramammary manifestations: a case report

Introduction and Importance: Granulomatous mastitis is a rare inflammatory disorder of the breast, which can be either idiopathic or due to secondary etiology. This disease affects women of reproductive age. The exact pathophysiology underlying idiopathic granulomatous mastitis (IGM) remains unclear, but it is believed to be mediated by immunological processes. Establishing a diagnosis of this condition could be challenging due to the long list of differential diagnoses that it creates. Case Presentation: We report a 24-year-old Syrian female presented to the clinic complaining of a 2-week history of fatigue, fever and chills, swelling, and localized pain in her left breast. Physical examination revealed erythema nodosum, episcleritis, and arthralgia in the wrists, ankles, and elbows. An excisional biopsy was done and a microscopic examination of the lesion confirmed granulomatous perilobular mastitis. Symptoms had resolved after the surgical excision and follow-up evaluation showed no signs of recurrence. Clinical Discussion: IGM typically presents as an enlarging breast mass that can be mistaken for breast cancer or an abscess. The diagnostic approach should consider the presence of extramammary symptoms such as fever, arthralgia, and fatigue. Treatment options include corticosteroids, surgical excision, or steroid-sparing agents, but relapse rates vary. Conclusions: Episcleritis should be considered as a potential extramammary manifestation in cases of IGM. We highlight the importance of recognizing and investigating the potential systemic involvement in patients with IGM. Accurate interpretation of pathological and radiological findings by a multidisciplinary breast team can facilitate the diagnosis and reduce unnecessary interventions.

The Oncotype DX Recurrence Score's Impact on the Management of Oestrogen-Positive/Human Epidermal Growth Factor Receptor 2-Negative, Low-Burden Axillary Status Breast Cancer (REHAB Study): Results of a Single Centre.

BackgroundThe Oncotype DX Recurrence Score (ODX-RS) is increasingly utilized in oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, low-burden axillary disease early operable breast cancer. It has been demonstrated to predict the benefits of adjuvant chemotherapy, hence supporting individualized decisions on adjuvant therapy.AimTo investigate the application of ODX-RS as an adjuvant treatment decision tool in breast cancer operated in our unit.MethodsA total of 107 eligible patients who were operated on between 2017 and 2021 in Basildon University Hospital, UK were enrolled in this study. In this retrospective study, the clinical data, including patient’s age, tumour size, ER status, HER2 status, Ki67 proliferative index (Ki67-PI), nodal status, tumour grade, and ODX-RS, were collected. In the study design, the oncologist had the opportunity to assess the need for adjuvant chemotherapy for patients with ER-positive, HER2-negative, low-burden axillary lymph node disease, early breast cancer by using tumour characteristics and the PREDICT tool without knowing the ODX-RS results. The clinician's decision was matched against the breast multidisciplinary team's recommendations after ODX-RS utilisation, and the results were explored.ResultsThe median ODX-RS of cohort tumours was 18 in the age group > 50 years, with ODX-RS ≥ 26 found in 18% of the group (n = 12). In the age group ≤ 50 years, 17% (n = 7) had ODX-RS between 21 and 25 and only 7% (n = 3) had ODX-RS ≥ 26. Without using ODX-RS, only 16% of the patients had been offered adjuvant chemotherapy in addition to the hormonal manipulation therapy; however, after using ODX-RS, up to 33% of the cohort was suitable for adjuvant chemotherapy in addition to the hormonal manipulation therapy. The changes in the recommendations after ODX-RS utilisation have been noticed in 29% of the cohort.ConclusionThis study revealed that ODX-RS supported decision-making regarding postoperative adjuvant chemotherapy, especially when other tumour biomarkers, such as tumour size, grading, or Ki-67, indicated lower risk criteria. Patients with a high ODX-RS were offered chemotherapy where appropriate and its use led to a 15% rate of initial decision change in adjuvant treatment decisions; this involved either recommending chemotherapy or its omission.

Breast Digital Pathology: Way of the Future

This review provides a summary of the development and current use of digital pathology in routine practice, with specific relevance to breast disease. It aims to be of interest to all members of the breast multidisciplinary team. Digital pathology is being increasingly used across many institutions internationally. It is gaining increased acceptance amongst pathologists due to improvements in technology, and there are published guidelines to assist in the validation of its use in routine practice. The adoption of digital pathology brings advantages to the pathologist, to the pathology laboratory, and to the multidisciplinary team. It also offers the potential for the development and use of artificial intelligence tools in pathology reporting. The use of digital pathology increases the efficiency of the pathology reporting of specimens, with the potential for more efficiency savings and improved accuracy with the use of artificial intelligence.

SA 9.4 - Neoadjuvant chemotherapy. How to work together – the coordination of the multidisciplinary breast team: a logistical challenge

SA 9.4 - Neoadjuvant chemotherapy. How to work together – the coordination of the multidisciplinary breast team: a logistical challenge

P148: The introduction of a pre-multidisciplinary team triage meeting as an approach to improving the effectiveness of the breast multidisciplinary team meeting

Introduction: Multidisciplinary team (MDT) working is considered gold standard for cancer care. With increasing workload and patient complexity, the concept of streamlining MDMs has been suggested to improve efficiency and facilitate more in-depth discussion of complex patients.

P040: Changes to the breast MDTM for benign breast lumps

Background: There has been constant increase in pressure and demand on the breast multidisciplinary team meeting (MDTM) to discuss every patient that undergoes needle biopsy as recommended by the Association of Breast Surgery. Our study aims to identify the number of benign breast cases discussed at our breast MDTM and establish how many were upgraded to the cancer pathway.

Changing practice: moving to a specialist nurse-led service for BRCA gene testing.

Some 5-10% of all breast cancers are associated with a pathogenic variant in a breast cancer-associated gene (BRCA1/BRCA2). Historically, with referral to the Nottingham University Hospitals NHS Trust's clinical genetics department for genetic testing, waiting times were on average 12-14 weeks for an initial appointment and 4-6 months to obtain results from the date of testing. A specialist, nurse-led mainstreaming cancer genetics (MCG) service was set up in the trust's Nottingham Breast Institute (NBI) to: reduce waiting times for the initial consultation, counselling, consent and obtaining results for BRCA1/BRCA2 gene testing; and to ensure appropriate patients with breast cancer were offered genetic testing. Two breast clinical nurse specialists were trained so they could counsel, consent and give results for the BRCA1/BRCA2 gene testing directly to patients. Average waiting times for results from the time of testing were reduced to 35.8 days under the nurse-led service, which enabled oncologists and patients to consider individual treatment options at an earlier time. The MCG service reduced waiting times, resulting in an improved, more streamlined service for patients undergoing genetic testing. The MCG service extended the scope of practice of the breast nurse clinical specialists, embedded an expert advanced nursing role in the breast multidisciplinary team and developed nurse mentoring opportunities.

Impact of family history risk assessment on surgical decisions and imaging surveillance at breast cancer diagnosis.

In June 2013, the National Institute for Health and Care Excellence (NICE) published guidance on the management of women with a family history (FH) of breast cancer (BC) and a personal diagnosis of BC. When diagnosed with BC, pressure of timely treatment takes priority and there is potential for a significant FH to be overlooked. This can affect treatment options and follow-up imaging (FUI) surveillance. The practice in our breast unit was compared with the NICE guidance with regard to arranging appropriate FUI and referral to the genetics team for women diagnosed with BC with a FH of BC. Data were obtained retrospectively on 200 women with BC, identified from the breast multidisciplinary team meetings from January to March 2014. Initial audit showed poor compliance with recording of FH. A standardised history taking proforma was produced for clinic use. A re-audit was conducted on a further 200 women between May and July 2016. In the initial audit, FH was taken in 151 women (76%) compared with 174 women (87%) in the re-audit. Thirty-seven women (25%) were thought to be of moderate risk (MR) or high risk (HR) based on FH in the first audit. Re-audit identified 35 women (20%) with MR or HR FH. Under half (43%) of the women of HR were referred to the genetics team initially; this increased to 70% in the second audit. While almost half (46%) of the women with MR or HR had inappropriate FUI in the initial audit, this fell to 11% in the re-audit. A proportion of women diagnosed with BC would fall into the MR or HR categories as defined in the NICE FH guidance. Inadequate recording of FH could result in inadequate FUI surveillance and in some cases missing the opportunity for a genetic referral to assess suitability for gene testing.

Making the breast multidisciplinary team meeting relevant again.

Making the breast multidisciplinary team meeting relevant again.

Genetic Counseling in the Follow-up of Breast Cancer patients; Conversion of a Luminal Tumor to TNBC

Background: Triple-negative subtype does not have any of the receptors that are commonly found in breast cancer. Patients suffering from Triple-negative breast cancer are at risk of early metastasis and BRCA mutation. The conversion of the receptors during the metastatic progression or local recurrence of breast cancer is a well-known topic that affects the therapeutic measures and outcome. Confirmation of immunohistochemistry is essential in these conditions, but genetic evaluation is controversial. Case presentation: A woman suffering from primary luminal breast cancer presented with femoral bone metastasis in the follow-up after two years. Bone metastasis was compatible with the triple-negative subtype. This case was discussed at the weekly breast multidisciplinary team session of the Department of Breast Surgery, Tehran University of Medical Sciences.Question: Does the patient need genetics counseling in a conversion setting? And does the new specimen need CISH/FISH techniques to confirm TNBC tumors?Conclusion: There are no strong guidelines to recommend genetic counseling and BRCA testing for patients with breast cancer biomarkers conversion. Re-assessing the specimen for ER, PR, and HER-2 is necessary for this setting.

Minimally Invasive Breast Procedures: Practical Tips and Tricks.

OBJECTIVE. The purpose of this article is to review the literature regarding image-guided breast procedures, including helpful tips and tricks to guide the practicing interventional breast radiologist. CONCLUSION. The successful diagnosis and treatment of breast cancer involves coordination of the multidisciplinary breast team. Optimal procedural skills for image-guided biopsy and preoperative lesion localization are paramount to the radiologists' success.

Management of Carcinoma of Unknown Primary Involving Axillary Lymph Node (CUPAx)

Background: Cancer of unknown primary involving axillary lymph nodes (CUPAx) is a very rare type of cancer. There are still many challenges about the management and outcome of the disease. This retrospective study is an attempt to assess the overall survival and the outcome of CUPAx in Iranian women. Methods: Based on inclusion and exclusion criteria, 20 patients primarily diagnosed with CUPAx referred to our breast multidisciplinary team (MDT) sessions between July 2010 and December 2016 were evaluated. The patients were categorized into three groups based on the types of treatment: mastectomy and radiation therapy, radiation therapy, and observation group. Results: The mean age of the subjects was 52 ± 7.91 years (range: 42-74). The results manifested significant differences between the outcomes of three types of treatments. The patients who received both mastectomy and radiotherapy had a higher survival rate and no sign of the disease compared with other groups (P= 0.03). The median survival time in the mastectomy group was 78 months and 23 months for the group with no mastectomy (95% CI: 7.64-38.36) (P <0.001).Conclusion: The result suggested that mastectomy was effective in lowering the risk of disease progression in Iranian women diagnosed with CUPAx and highly suspicious breast origin. More studies on larger sample groups are needed.

Abstract P5-14-09: Integration of primary care practitioners in a breast multidisciplinary team meeting- A pilot study

Abstract Primary care practitioners are key to integrated patient care, as they often have an established relationship with patient and family, with knowledge of comorbidities and psychosocial factors. They can encourage compliance with cancer treatments and manage transition from acute care through survivorship. Communication with primary care however has often been unsatisfactory, with information not helpful to that practitioner or not provided in a timely manner. We recruited a general practitioner (GP) to attend the weekly breast cancer multidisciplinary meeting, with a responsibility to make contact with the primary care practitioner of patients presented prior to the meeting, so that relevant information from a primary care perspective could be taken into consideration for team deliberations. This also meant that the primary doctor was aware the patient was being discussed. Recommendations were fed back to that doctor after the meeting so that information was timely, and, being given by a peer, more useful. The GP attended 12 consecutive MDTs where 105 patients were discussed. In 55% contact was able to be made with the patient's GP prior to the meeting. This was perceived as not usually changing management plans, but reinforced known medical and social concerns. Feedback to the patients GP was regarded favourably, with reported greater confidence in managing the patient, particularly those with complex needs, as well as improving hospital to community communication in general. This pilot has shown that it is feasible to include primary care practitioners in a multidisciplinary meeting and improve interdisciplinary communication. Citation Format: Pitcher ME, Hornung I, Rangarajan P. Integration of primary care practitioners in a breast multidisciplinary team meeting- A pilot study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-14-09.

Negotiating jurisdictional boundaries in response to new genetic possibilities in breast cancer care: The creation of an ‘oncogenetic taskscape’

Changes in the nature and structure of healthcare pathways have implications for healthcare professionals' jurisdictional boundaries. The introduction of treatment focused BRCA1 and 2 genetic testing (TFGT) for newly diagnosed patients with breast cancer offers a contemporary example of pathway change brought about by technological advancements in gene testing and clinical evidence, and reflects the cultural shift towards genomics. Forming part of an ethnographically informed study of patient and practitioner experiences of TFGT at a UK teaching hospital, this paper focuses on the impact of a proposal to pilot a mainstreamed TFGT pathway on healthcare professionals' negotiations of professional jurisdiction. Based upon semi-structured interviews (n = 19) with breast surgeons, medical oncologists and members of the genetics team, alongside observations of breast multidisciplinary team meetings, during the time leading up to the implementation of the pilot, we describe how clinicians responded to the anticipated changes associated with mainstreaming. Interviews suggest that mainstreaming the breast cancer pathway, and the associated jurisdictional reconfigurations, had advocates as well as detractors. Medical oncologists championed the plans, viewing this adaptation in care provision and their professional role as a logical next step. Breast surgeons, however, regarded mainstreaming as an unfeasible expansion of their workload and questioned the relevance of TFGT to their clinical practice. The genetics team, who introduced the pilot, appeared cautiously optimistic about the potential changes. Drawing on sociological understandings of the negotiation of professional jurisdictions our work contributes a timely, micro-level examination of the responses among clinicians as they worked to renegotiate professional boundaries in response to the innovative application of treatment-focused BRCA testing in cancer care – a local and dynamic process which we refer to as an ‘oncogenetic taskscape in the making’.

528 (PB-161) - A 6-months review of breast multidisciplinary team meeting records in a tertiary care cancer hospital in Pakistan

528 (PB-161) - A 6-months review of breast multidisciplinary team meeting records in a tertiary care cancer hospital in Pakistan

Five-year experience with the multidisciplinary evaluation of breast lesions according to the Decker radio-pathologic correlation system

Lesions identified during breast imaging often require microscopic verification. Current recommendations imply the classification of radiological, clinical, cytology and core biopsy findings into one of five predefined categories. The Decker system also includes a classification of both the correlation between radiology and pathology and the actions required on this basis. To report on the five-year results of the implementation of the Decker system in our pretreatment multidisciplinary breast team. Retrospective analysis of patients operated on because of breast diseases or appearing at the multidisciplinary breast team during the period between 2000 and 2014. Of 1716 cases discussed, 1531 were solved by non-operative diagnostics, 157 required diagnostic excisions; 1122 cases (65%) proved to be malignant. Malignancy was diagnosed by core needle biopsies in 69% of the cases. The non-operative approach was unsuccessful, delayed or wrong in 14 cases. Breast lesions need to be evaluated in a multidisciplinary setting. The Decker-system is suitable for the recording and analysis of the correlation between radiologic/physical and microscopy findings, and of the ensuing diagnostic/therapeutic actions. Orv Hetil. 2017; 158(28): 1100-1108.

249. Oncoplastic breast surgery in Egypt: The impact on the breast multidisciplinary team service and on the patients' pre- and postoperative peace of mind as a multicenter experience

249. Oncoplastic breast surgery in Egypt: The impact on the breast multidisciplinary team service and on the patients' pre- and postoperative peace of mind as a multicenter experience

Omission of axillary dissection after a positive sentinel lymph-node: Implications in the multidisciplinary treatment of operable breast cancer.

Omission of axillary dissection in women with breast cancer and one or two positive sentinel-node biopsy is a major advancement in the management of this disease. Supported by a sound rationale and confirmed by prospective, randomized trials, omission of axillary dissection is now recommended in women who have undergone breast conserving surgery and who are candidate to adjuvant radiotherapy. Because breast cancer is best managed in the context of a multidisciplinary team, this surgical shift in the paradigm is expected to have implications that extend also to the other specialties involved in the team. In fact, the full evaluation of the axillary tumor burden has been historically considered an essential part of tumor staging and the absolute number of involved node critical information to tailor post-surgical treatments. Lack of this information in a patient with axillary involvement documented by a positive sentinel lymph-node biopsy may represent a challenge when deciding on further, post-surgical treatments. This review will address the critical aspects and the potential implications of omission of axillary dissection in the context of the multidisciplinary breast team.