Abstract
Background
Tumor downstaging by preoperative neoadjuvant chemotherapy in patients with locally advanced breast tumors allows breast conservation in women who were previously candidates for mastectomy. Nevertheless, lumpectomy success in such cases cannot be fully achieved. The aim of this study was to create a quantitative tool for preoperative evaluation of the success of breast conservation in such patients.
Methods
The study population included 100 consecutive patients with stage II and III breast cancer who were designated for lumpectomy and 19 patients who were designated for mastectomy. All patients received neoadjuvant therapy. Breast-conserving surgery was offered in accordance with clinical and esthetic criteria. Demographic details and clinical, imaging, and pathologic information were collected from medical files. A decision protocol for classifying patients to lumpectomy or mastectomy was built by using the Classification and Regression Trees procedure based on preoperative characteristics.
Results
Three factors were found to be the main predictors for successful breast conservation: absence of diffuse microcalcifications as seen in the pretreatment mammogram, a postchemotherapy tumor size of < 25 mm, and the existence of a circumscribed lesion on mammography.
Conclusions
The use of these criteria as a basis for decision on the type of surgery may decrease the performance of unnecessary procedures.
Similar content being viewed by others
References
GN Hortobagyi E Singletary EA Strom (2000) Treatment of locally advanced and inflammatory breast cancer J Harris (Eds) Diseases of the Breast EditionNumber2 Lippincott Williams & Wilkins Philadelphia 645–60
B Fisher J Bryant N Wolmark et al. (1998) ArticleTitleEffect of preoperative chemotherapy on the outcome of women with operable breast cancer J Clin Oncol 16 2672–85 Occurrence Handle1:CAS:528:DyaK1cXlsFCgurg%3D Occurrence Handle9704717
SM Scholl A Fourquet B Asselain et al. (1994) ArticleTitleNeoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6 Eur J Cancer 30A 645–52 Occurrence Handle10.1016/0959-8049(94)90537-1 Occurrence Handle1:STN:280:ByuA287os1E%3D Occurrence Handle8080680
L Mauriac M Durand A Avril JM Dilhuydy (1991) ArticleTitleEffect of primary chemotherapy in conservative treatment of breast cancer patients with operative tumors larger than 3 centimeters: results of a randomized trial in a single center Ann Oncol 2 347–54 Occurrence Handle1:STN:280:By2D283mt1Y%3D Occurrence Handle1954179
L Mauriac G Macgrogan A Avril et al. (1999) ArticleTitleNeoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicenter randomized trial with a 124 month median follow up Ann Oncol 10 47–52 Occurrence Handle10.1023/A:1008337009350 Occurrence Handle1:STN:280:DyaK1M7ns1SitQ%3D%3D Occurrence Handle10076721
SE Singletary (2001) ArticleTitleNeoadjuvant chemotherapy in treatment of stage II and III breast cancer Am J Surg 182 341–6 Occurrence Handle10.1016/S0002-9610(01)00724-3 Occurrence Handle1:CAS:528:DC%2BD3MXosFKqtbw%3D Occurrence Handle11720667
C Gajdos PI Tartter A Estabrook MA Gistrak S Jaffer IJ Bleiweiss (2002) ArticleTitleRelationship of clinical and pathologic response to neoadjuvant chemotherapy and outcome of locally advanced breast cancer J Surg Oncol 80 4–11 Occurrence Handle10.1002/jso.10090 Occurrence Handle11967899
JA van der Hage CJ Valde Particlevan der JP Julien M Tubiana-Hulin C Vandervelden L Duchateau (2001) ArticleTitlePreoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902 J Clin Oncol 19 4224–37 Occurrence Handle1:STN:280:DC%2BD3MnmtlyjsQ%3D%3D Occurrence Handle11709566
L Breiman JH Friedman RA Olshen CJ Stone (1984) Classification and Regression Trees Boca Raton, FL CRC Press
G Bonadonna U Veronesi C Brambilla (1990) ArticleTitlePrimary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more J Natl Cancer Inst 82 1539–45 Occurrence Handle1:STN:280:By%2BA1czoslw%3D Occurrence Handle2402015
MM Khanna RJ Mark MJ Silverstein G Juillard B Lewinsky AE Giuliano (1992) ArticleTitleBreast conservation management of breast tumors 4cm or larger Arch Surg 127 1038–41 Occurrence Handle1:STN:280:By2A1cvmvFE%3D Occurrence Handle1514905
RG Margolese (1998) ArticleTitleSurgical considerations in preoperative chemotherapy of breast cancer Recent Results Cancer Res 152 193–201 Occurrence Handle1:STN:280:DyaK1M7islGiuw%3D%3D Occurrence Handle9928558
HM Kuerer SE Singletary AU Buzdar et al. (2001) ArticleTitleSurgical conservation after neoadjuvant chemotherapy for stage 2 and operable stage 3 breast carcinoma Am J Surg 182 601–8 Occurrence Handle10.1016/S0002-9610(01)00793-0 Occurrence Handle1:STN:280:DC%2BD387ktVOjtQ%3D%3D Occurrence Handle11839324
CS Giess DM Keating MP Osborne R Rosenblatt (1999) ArticleTitleLocal tumor recurrence following breast conserving therapy: correlation of histopathologic findings with detection method and mammographic findings Radiology 212 829–35 Occurrence Handle1:STN:280:DyaK1MvgslKqsw%3D%3D Occurrence Handle10478253
G Hermann RJ Keller S Drossman et al. (1999) ArticleTitleMammographic pattern of microcalcifications in the preoperative diagnosis of comedo ductal carcinoma in situ: histopathologic correlation Can Assoc Radiol J 50 234–40
I Rosenfeld PI Tartter C Gajdos G Hermann I Bleiweiss (2001) ArticleTitleThe significance of malignancies incidental to microcalcifications in breast spot localization biopsy specimens Am J Surg 182 1–5 Occurrence Handle10.1016/S0002-9610(01)00666-3 Occurrence Handle1:STN:280:DC%2BD3MvovFOgtA%3D%3D Occurrence Handle11532405
EL Dupont NN Ku C McCann CE Cox (1999) ArticleTitleDuctal carcinoma in situ of the breast Cancer Control 6 264–71 Occurrence Handle10758556
NS Goldstein L Kestin F Vicini (2000) ArticleTitleIntraductal carcinoma of the breast: pathologic features associated with local recurrences in patients treated with breast-conserving therapy Am J Surg Pathol 24 1058–67 Occurrence Handle10.1097/00000478-200008000-00003 Occurrence Handle1:STN:280:DC%2BD3czpvFKqtQ%3D%3D Occurrence Handle10935646
M Ferno (1998) ArticleTitlePrognostic factors in breast cancer: a brief review Anticancer Res 18 2167–71 Occurrence Handle1:STN:280:DyaK1czmvFCjsA%3D%3D Occurrence Handle9703779
M Kaufmann (1996) ArticleTitleReview of known prognostic variables Recent Results Cancer Res 140 77–87 Occurrence Handle1:STN:280:BymB2sritFE%3D Occurrence Handle8787079
J Cangiarella J Gross WF Symmans et al. (2000) ArticleTitleThe incidence of positive margins with breast conserving therapy following mammotome biopsy for microcalcification J Surg Oncol 74 263–6 Occurrence Handle10.1002/1096-9098(200008)74:4<263::AID-JSO4>3.0.CO;2-1 Occurrence Handle1:STN:280:DC%2BD3cvlvFGnuw%3D%3D Occurrence Handle10962457
AC Neuschatz T DiPetrillo M Steinhoff et al. (2002) ArticleTitleThe value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast Cancer 94 1917–24 Occurrence Handle10.1002/cncr.10460 Occurrence Handle11932892
DM Lagios MJ Silverstein (1997) ArticleTitleDuctal carcinoma in situ. The success of breast conservation therapy: a shared experience of two institutional randomized prospective studies Surg Oncol Clin North Am 6 385–92 Occurrence Handle1:STN:280:ByiB1c7os1Q%3D
SE Singletary (2002) ArticleTitleSurgical margins in patients with early-stage breast cancer treated with breast conservation therapy Am J Surg 184 383–93 Occurrence Handle10.1016/S0002-9610(02)01012-7 Occurrence Handle12433599
DD Dershae (2002) ArticleTitleBreast imaging and the conservative treatment of breast cancer Radiol Clin North Am 40 501–16 Occurrence Handle10.1016/S0033-8389(01)00003-3 Occurrence Handle12117189
DR McCready GN Hortobagyi SW Kau TL Smith AU Buzdar CM Balch (1989) ArticleTitleThe prognostic significance of lymph node metastases after preoperative chemotherapy for locally advanced breast cancer Arch Surg 124 21–5 Occurrence Handle1:STN:280:BiaD1cjivVQ%3D Occurrence Handle2910244
DM Sataloff BA Mason AJ Prestipino UL Seinige CP Lieber Z Baloch (1995) ArticleTitlePathologic response to induction chemotherapy in locally advanced carcinoma of the breast: a determinant of outcome J Am Coll Surg 180 297–306 Occurrence Handle1:STN:280:ByqC2sbjsFc%3D Occurrence Handle7874340
SE Singletary MD McNeese GM Hortobagyi (1992) ArticleTitleFeasibility of breast conservation surgery after induction chemotherapy for locally advanced breast carcinoma Cancer 69 2849–52 Occurrence Handle1571916
LA Newman AU Buzdar SE Singletary et al. (2002) ArticleTitleA prospective trial of preoperative chemotherapy in resectable breast-conservation therapy feasibility Ann Surg Oncol 9 228–34 Occurrence Handle10.1245/aso.2002.9.3.228 Occurrence Handle11923128
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sadetzki, S., Oberman, B., Zipple, D. et al. Breast Conservation After Neoadjuvant Chemotherapy. Ann Surg Oncol 12, 480–487 (2005). https://doi.org/10.1245/ASO.2005.07.021
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2005.07.021