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225. Effects of neoadjuvant chemotherapy for highly ER positive and HER2 negative early breast cancer patients
806 guidance. A temperature of 85 ¡C was maintained for 10 min. All resected specimens were processed & examined histopathologically using conventional methods searching for viable tumor cells. Results: In 11 patients (84.6%), a complete ablation of the tumor was achieved. No extensive para-tumoural necrosis was detected in any case. Conclusion: Ultrasound-guided radiofrequency ablation of breast carcinoma is feasible and safe. The success rate depends on accurate preoperative diagnostic imaging as well as the exact position of the needle electrode.
224. The diagnosis of non-palpable malignant breast lesions with guide-wire localization and safety of resection margins L. Dogan1, M.A. Gulcelik1, M. Yuksel1, O. Uyar1, E. Reis1 1 Oncology Hospital, General Surgery, Ankara, Turkey Background: Due to the widespread implementation of breast screening programs and improvements in diagnostic imaging, approximately 2535% of breast cancers are non-palpable at diagnosis. Guide-wire localization (GWL) has been the standard technique used for many years. Excision of the non-palpable malignant breast lesions with clear surgical margins relieves the patient undergoing a re-excision. Re-excision as a cost increase factor has a higher morbidity and makes cosmetic results worser as well. The objective of the present study is to evaluate the achievement of GWL biopsy technique about surgical margins and the effective factors on positive margins. Material and methods: This is a retrospective study concerning 53 patients who received GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination in the year 2011. The lesions excised for microcalcifications were excluded. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. All of the lesions were displayed in specimen radiography. Factors that may have any effect on surgical margin status were evaluated by chi-square test. Logistic regression test was carried out for effective factors. Results: Median age of the patients was 53.3 years, median tumour size was 1.5 cm and median specimen volume was 71.5 cm3. In fifteen patients (%28) DCIS and in 38 patients (%72) invasive ductal carcinoma was diagnosed. There were positive surgical margins in twenty eight (%52.8) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant effective factors on surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p¼0.04). % 79 of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification so it was %48 in the patients who had negative margins (p¼0.03). 38 patients who had positive or close surgical margins received re-excision (%72). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.
225. Effects of neoadjuvant chemotherapy for highly ER positive and HER2 negative early breast cancer patients T. Morimoto1, T. Nomura1, M. Takeda2, I. Shiba2 1 Yao Municipal Hospital, Breast Surgery, Yao, Japan 2 Yao Municipal Hospital, Pathology, Yao, Japan Background: Recently, it is reported that highly ER positive and HER2 negative breast cancer is less effective for chemotherapy rather than other type. We evaluated the effect of preoperative chemotherapy for such type early breast cancer. Material and methods: From Jan 2010 to Aug.2011, forty patients received neoadjuvant chemotherapy in our hospital. Sixteen of them had
ABSTRACTS both ER>50% and HER2 negative. They received four cycles FEC100 followed by same cycles docetaxel. After that, all patients received operation. We evaluated the pathological effects and clinical features in these 16 cases. Some of them were counted Ki-67 score. Results: After chemotherapy, clinical response was CR 3 cases, PR 10 cases and NC 3 cases (Response Rate 81%). Breast conserved operation was performed in 8 cases(50%) and mastectomy was done in same cases. Ten cases with clinical node positive before chemotherapy were done axillary dissection and six cases were seen LN metastasis. Pathological effect was grade3 2 cases, grade2a 2 cases, grade2a 3 cases, grade1b 6 cases and grade1a 3 cases. Four cases showed grade2b and grade3. Ki-67 was 20% 40% 40% 50% and histological grade was 2 or 3 in these four cases. There was no relation between PgR expression and histological effect. Conclusions: Preoperative chemotherapy for highly ER positive and HER2 negative early breast cancer patients showed that clinical response rate was 81% and pCR was 13.5%. High histological grade and high value of Ki-67 may be indicator of chemotherapy response. However, another predictive factor for chemotherapy response is needed.
226. Can irradiation suppress multicentric cancers in conserved breast? S. Nishimura1, M. Tanabe1, T. Sakai1, K. Kimura1, H. Morizono1, K. Iijima1, M. Makita1, T. Iwase1, R. Horii2, F. Akiyama2 1 Cancer Institute Hospital, Breast Surgery, Tokyo, Japan 2 Cancer Institute, Breast pathology, Tokyo, Japan Background: Although previous retrospective studies have shown that irradiation can lower the incidence of cancer in conserved breast (including recurrence of primary tumor; true recurrence, TR and multicentric cancers; new primary cancer, NP) to approximately one third, whether radiation therapy can suppress newly developing cancers is not well understood. Objective: Based on the incidence of cancer in breasts after breast conserving therapy (BCT) with or without radiotherapy, we assessed the possible indirect indications of cancer suppressing effect of radiation therapy. Materials: 196 female patients with DCIS who underwent BCT without post-operative adjuvant therapy in our institution between 1993 and 2002 at the age of 20 to 79 years. Patients with metachronous and synchronous bilateral breast cancer and those with cancer of other visceral organs within the previous five years were excluded. Methods: Surgery: A cylindrical partial mastectomy was performed, from superficial fascia to fascia of pectoralis major muscle with a surgical margin of 1 to 2 cm from the tumor. Pathological assessment: Whole resected specimen was serially sliced with a width of 5 mm which were used for microscopic examination. Negative surgical margin was defined as absence of cancer cells within 5mm from the resection stump. Vertical invasion was considered to be negative if intact superficial fascia and fascia of pectoralis major muscle were observed. In addition, when reoperation against cancer in the ipsilateral conserved breast was performed, cancers which were located separately more than 3cm from the primary tumor, and which had no continuity of intraductal cancer with primary tumor, were considered to be multicentric cancers (NP). Indication of radiation therapy: Irradiation was omitted in patients with histopathologically negative margins. By contrast, irradiation was performed in patients with positive or indeterminate margins. The median follow-up period was nine years and eleven months, and the incidence of cancer in conserved breast and contralateral breast cancer was assessed. The incidence was calculated using the Kaplan-Meier method, and statistical significance was assessed using the log-rank method. Results: Of the 196 patients, 82 were in the irradiation group and 114 were in the non-irradiation group. Overall incidence of cancer in conserved breast over 10 years in the RT group 8.7% as compared with
224. The diagnosis of non-palpable malignant breast lesions with guide-wire localization and safety of resection margins L. Dogan1, M.A. Gulcelik1, M. Yuksel1, O. Uyar1, E. Reis1 1 Oncology Hospital, General Surgery, Ankara, Turkey Background: Due to the widespread implementation of breast screening programs and improvements in diagnostic imaging, approximately 2535% of breast cancers are non-palpable at diagnosis. Guide-wire localization (GWL) has been the standard technique used for many years. Excision of the non-palpable malignant breast lesions with clear surgical margins relieves the patient undergoing a re-excision. Re-excision as a cost increase factor has a higher morbidity and makes cosmetic results worser as well. The objective of the present study is to evaluate the achievement of GWL biopsy technique about surgical margins and the effective factors on positive margins. Material and methods: This is a retrospective study concerning 53 patients who received GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination in the year 2011. The lesions excised for microcalcifications were excluded. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. All of the lesions were displayed in specimen radiography. Factors that may have any effect on surgical margin status were evaluated by chi-square test. Logistic regression test was carried out for effective factors. Results: Median age of the patients was 53.3 years, median tumour size was 1.5 cm and median specimen volume was 71.5 cm3. In fifteen patients (%28) DCIS and in 38 patients (%72) invasive ductal carcinoma was diagnosed. There were positive surgical margins in twenty eight (%52.8) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant effective factors on surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p¼0.04). % 79 of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification so it was %48 in the patients who had negative margins (p¼0.03). 38 patients who had positive or close surgical margins received re-excision (%72). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.
225. Effects of neoadjuvant chemotherapy for highly ER positive and HER2 negative early breast cancer patients T. Morimoto1, T. Nomura1, M. Takeda2, I. Shiba2 1 Yao Municipal Hospital, Breast Surgery, Yao, Japan 2 Yao Municipal Hospital, Pathology, Yao, Japan Background: Recently, it is reported that highly ER positive and HER2 negative breast cancer is less effective for chemotherapy rather than other type. We evaluated the effect of preoperative chemotherapy for such type early breast cancer. Material and methods: From Jan 2010 to Aug.2011, forty patients received neoadjuvant chemotherapy in our hospital. Sixteen of them had
ABSTRACTS both ER>50% and HER2 negative. They received four cycles FEC100 followed by same cycles docetaxel. After that, all patients received operation. We evaluated the pathological effects and clinical features in these 16 cases. Some of them were counted Ki-67 score. Results: After chemotherapy, clinical response was CR 3 cases, PR 10 cases and NC 3 cases (Response Rate 81%). Breast conserved operation was performed in 8 cases(50%) and mastectomy was done in same cases. Ten cases with clinical node positive before chemotherapy were done axillary dissection and six cases were seen LN metastasis. Pathological effect was grade3 2 cases, grade2a 2 cases, grade2a 3 cases, grade1b 6 cases and grade1a 3 cases. Four cases showed grade2b and grade3. Ki-67 was 20% 40% 40% 50% and histological grade was 2 or 3 in these four cases. There was no relation between PgR expression and histological effect. Conclusions: Preoperative chemotherapy for highly ER positive and HER2 negative early breast cancer patients showed that clinical response rate was 81% and pCR was 13.5%. High histological grade and high value of Ki-67 may be indicator of chemotherapy response. However, another predictive factor for chemotherapy response is needed.
226. Can irradiation suppress multicentric cancers in conserved breast? S. Nishimura1, M. Tanabe1, T. Sakai1, K. Kimura1, H. Morizono1, K. Iijima1, M. Makita1, T. Iwase1, R. Horii2, F. Akiyama2 1 Cancer Institute Hospital, Breast Surgery, Tokyo, Japan 2 Cancer Institute, Breast pathology, Tokyo, Japan Background: Although previous retrospective studies have shown that irradiation can lower the incidence of cancer in conserved breast (including recurrence of primary tumor; true recurrence, TR and multicentric cancers; new primary cancer, NP) to approximately one third, whether radiation therapy can suppress newly developing cancers is not well understood. Objective: Based on the incidence of cancer in breasts after breast conserving therapy (BCT) with or without radiotherapy, we assessed the possible indirect indications of cancer suppressing effect of radiation therapy. Materials: 196 female patients with DCIS who underwent BCT without post-operative adjuvant therapy in our institution between 1993 and 2002 at the age of 20 to 79 years. Patients with metachronous and synchronous bilateral breast cancer and those with cancer of other visceral organs within the previous five years were excluded. Methods: Surgery: A cylindrical partial mastectomy was performed, from superficial fascia to fascia of pectoralis major muscle with a surgical margin of 1 to 2 cm from the tumor. Pathological assessment: Whole resected specimen was serially sliced with a width of 5 mm which were used for microscopic examination. Negative surgical margin was defined as absence of cancer cells within 5mm from the resection stump. Vertical invasion was considered to be negative if intact superficial fascia and fascia of pectoralis major muscle were observed. In addition, when reoperation against cancer in the ipsilateral conserved breast was performed, cancers which were located separately more than 3cm from the primary tumor, and which had no continuity of intraductal cancer with primary tumor, were considered to be multicentric cancers (NP). Indication of radiation therapy: Irradiation was omitted in patients with histopathologically negative margins. By contrast, irradiation was performed in patients with positive or indeterminate margins. The median follow-up period was nine years and eleven months, and the incidence of cancer in conserved breast and contralateral breast cancer was assessed. The incidence was calculated using the Kaplan-Meier method, and statistical significance was assessed using the log-rank method. Results: Of the 196 patients, 82 were in the irradiation group and 114 were in the non-irradiation group. Overall incidence of cancer in conserved breast over 10 years in the RT group 8.7% as compared with