Small Size Breast Research Articles

Preoperative diagnosis of carcinoma of the breast: Is a "cost-cutter" algorithm tenable?

Decision making in favor of conservative breast surgery is dependent upon the accuracy of preoperative evaluation of tumor stage, of which imaging modalities occupy a pivotal role. Systematic studies correlating the relative accuracy of various evaluating strategies are few, but remain vital means of making the optimal selection of diagnosis and subsequent treatment option. In this study, we evaluated the relative efficacy of: (1) palpation (P), (2) ultrasonography (US), and (3) bilateral mammography (MG) of the breast and axilla. In a prospective study, 109 female patients undergoing a modified radical mastectomy were subjected to a preoperative diagnostic assessment protocol involving palpation, ultrasonography, and bilateral mammography of the breast and axilla. Subsequently the preoperative findings were correlated to the postoperative histopathological reports. Cancer-specific criteria evaluated were tumor size, location, histologic type, histoarchitecture, and calcification, as well as status of regional nodes. Patient-specific criteria included age, size, and density of the breast and presence of associated benign breast disease. Percentage sensitivity, specificity, and positive and negative predictive values were determined for MG, US, and P as well as MG + P and US + P. In assessment of the primary tumor, P, MG, and US showed an overall sensitivity of 88%, 92%, and 90%, respectively; MG + P and US + P had a sensitivity of 99% each. In nodal assessment, P, MG, and US showed an overall sensitivity of 88%, 69%, and 77%, respectively; MG + P and US + P had a sensitivity of 90% and 94%, respectively. Mammography understaged the tumor, whereas US and P overstaged tumors as well as nodes. US was particularly better than MG in younger women, smaller breast size, denser breast consistency, with or without associated benign breast disease, and cystic or necrotic tumors with invasive ductal histology. In addition, US was comparable to MG in most of the other criteria as well. Disadvantages of US over MG were its complete inability to detect microcalcification and certain intraductal cancers. We conclude that: (1) the combination of US and P provides equivalent preoperative efficacy as MG, (2) the combination is more cost-effective preoperative assessment for subsequent selection of therapeutic modality, and (3) in certain well-defined circumstances discussed by us, mammography is most useful and should be considered as the imaging modality of choice.

Preoperative Chemotherapy Alone and Combined with Preoperative Radiotherapy in Small-Size Breast Cancer

Abstract: Breast conservation surgery is an effective and safe treatment for many breast carcinomas. It may be possible to further limit the extent of resection (or expand the indication for breast conservation) by the application of preoperative chemotherapy and radiotherapy. We explored the feasibility of this in a pilot study. Seventy-three patients (mean age 48, 63% premenopausal) with confirmed breast cancer, less than 2.5 cm, received chemotherapy (Group A) or chemotherapy plus radiotherapy (Group B) prior to limited resection (tumorectomy). Axillary dissection was always performed. Results: In 6/31 (19%) Group A and 17/42 (40%) Group B patients the tumor was not palpable after preoperative treatment, with complete pathological remission in 1 and 3 cases respectively. Histologic grading, mitosis, cellular alteration, and cellularity evaluations indicated a consistently greater therapeutic effect with chemoradiotherapy than with chemotherapy alone. In conclusion, radiotherapy appears useful in the preoperative treatment of breast cancer and its use in association with various drug combinations should be further explored.

Breast cancer surgery: a century after Halsted.

In the early years of this century prevailing currents of medical opinion led to the imposition of surgery even more aggressive than the radical mastectomy proposed by Halsted to treat breast cancer. More recently breast conservation surgery has become established but is always flanked by additional local treatment, and often by systemic therapy. Studies conducted in Milan were the first to demonstrate that conservative surgery plus an adjuvant therapy such as radiotherapy is efficacious in treating small-size breast cancer. As the year 2000 approaches it has become clear that breast cancer is curable in a high proportion of cases and attention is turning to improving the aesthetic outcome of the surgery, and to investigating the biological and genetic factors that influence the disease.

130 P - Breast conservation without axillary dissection

Starting from the evidence that surgical treatment of the axilla does not in itself improve the survival of patients with small size breast cancer (

How to overcome the problem of nipple and areola involvement in central small size breast cancer?

How to overcome the problem of nipple and areola involvement in central small size breast cancer?

Central small size breast cancer: How to overcome the problem of nipple and areola involvement

Central small size breast cancer: How to overcome the problem of nipple and areola involvement

Central small size breast cancer: how to overcome the problem of nipple and areola involvement.

For centrally located small tumours we have sought, with the aid of a plastic surgeon, to achieve the same radicality as in the other quadrants, while achieving a good cosmetic result. We considered 37 patients with small centrally located breast carcinoma, in whom we performed a new surgical technique. From analysis of this series it emerged that a high percentage (54.1%) had nipple and areolar involvement, suggesting their removal; it is no problem to sacrifice these when a good cosmetic result can be achieved by plastic remodelling.

Factors Affecting Mammographic Visualization of the Breast After Augmentation Mammaplasty

To measure the effect of various parameters on mammographic visualization of the breast after augmentation mammaplasty. Preoperative and postoperative mammography was performed in patients undergoing augmentation mammaplasty. The area of breast tissue visualized on each film was measured. Changes in the area visualized were correlated with a variety of different parameters. The Breast Center, Van Nuys, Calif, a free-standing multidisciplinary breast diagnostic and treatment facility. The 68 women (126 breasts) represent a consecutive sample of patients undergoing augmentation mammaplasty for whom preoperative and postoperative mammograms were available. Area visualized was correlated with degree of capsular contracture, implant position, type of mammography, preoperative breast size, implant size, and implant type. The major factor affecting mammography is capsular contracture. Little or no capsular contracture results in a 30% reduction in the area visualized; moderate or severe contracture results in a 50% reduction. Other important factors include implant position (improved visualization with implant beneath pectoral muscle) and type of mammography performed (slightly more tissue seen with displacement technique). Very small preoperative breast size yields increased visualization. Implant size and type have little or no effect. In most women with breast implants, there is a decrease in measurable breast tissue on the postaugmentation mammogram. Capsular contracture and implant position exert a profound effect; type of mammography performed and preoperative breast size are also significant.

Quadrantectomy versus lumpectomy for small size breast cancer

Between 1985 and 1987 quadrantectomy plus external radiotherapy and lumpectomy plus external and interstitial radiotherapy were compared in a randomized trial of patients with small carcinomas of the breast. Quadrantectomy involves excision of 2–3 cm of normal tissue around the tumour plus the removal of a sufficiently large portion of overlying skin and underlying fascia whilst lumpectomy removes only the tumour mass with a narrow margin of normal tissue. Patients in both groups also received total axillary dissection. 705 cases were evaluable, 360 quadrantectomies and 345 lumpectomies. No differences in distant metastases and survival were observed in the two groups. However, lumpectomy patients had a much higher frequency of local recurrences (7.0 vs. 2.2%). Since a local recurrence needs a second operation and creates severe psychological distress to the patient, conservative surgical procedures should include generous excision of normal tissue around the primary carcinoma plus intensive postoperative radiotherapy.

Biopsy and definitive radiation therapy in Stage I and II adenocarcinoma of the female breast: Analysis of cosmesis and the role of electron beam supplementation

The cosmetic and functional outcome in 130 patients with Stages I and II carcinoma of the breast treated by biopsy and radiation therapy were evaluated. The cosmetic outcome was excellent in 107 patients (82%), acceptable in 17 patients (13%), and unacceptable in six patients (5%). Complete axillary dissection (CAD) was more morbid than limited axillary dissection (LAD) as a means of preradiotherapy staging of the axilla. The former was more often associated with breast edema, hematoma formation, and subsequent development of arm edema than the latter. A multivariate analysis revealed that the four most dominant variables associated with the attainment of an excellent cosmetic outcome were: 1) the performance of a conservative biopsy procedure; 2) small breast size (cup size A and B); 3) the use of electron energies equal to or less than 12 MeV; and 4) the presence of primary tumors less than or equal to 4 cm in diameter when adjusted for breast size. Postexternal beam supplementation to the area of the primary tumor was accomplished with electrons in 107 patients (82%) and with interstitial implantation in 23 patients (18%). Excellent cosmetic results were achieved in 97 of the 107 patients (91%) treated with electrons. The use of electrons appears to produce local control and cosmesis equal to that of interstitial implantation if specific indications and guidelines are followed, and is superior to implantation in certain clinical settings.