Breast conservative surgery: is it appropriate for locally advanced breastcancer following downstaging by neoadjuvant chemotherapy? A pathological assessment
M. Moneer et al., Breast conservative surgery: is it appropriate for locally advanced breastcancer following downstaging by neoadjuvant chemotherapy? A pathological assessment, BREAST, 8(6), 1999, pp. 315-319
The application of breast conserving surgery to down-staged cases with loca
lly advanced breast cancer (LABC) after neoadjuvant chemotherapy (NACT) is
still a controversial issue with a variable incidence of locoregional failu
res. In this study, the response of LABC to NACT was assessed pathologicall
y and the elegible candidates for breast conserving surgery were identified
retrospectively. The efficacy of preoperative clinical examination and mam
mography in detecting these pathological changes were also evaluated.
The study included 41 LABC cases. They received NACT (FAC) and were then su
bjected to a mastectomy. The cases were examined clinically and by mammogra
phy before starting treatment and immediately before surgery. Residual rumo
urs in the mastectomy specimens were correlated with the pretreatment and p
reoperative clinical and mammographic findings inorder to assess the effica
cy of these tools for detection of NACT-induced changes.
After 3 cycles of NACT, 78% of women showed an objective response. However,
only 25% of them would have been eligible for breast conserving surgery. T
he remaining responders had an increased incidence of either multifocality
and or peritumoural in situ carcinoma. Both clinical examination and mammog
raphy were inadequate for detection of these chemotherapy-induced changes a
nd hence for selecting suitable candidates for breast conservation. This st
udy has shown that tumour regression by NACT is probably induced by a proce
ss of tumour segmentation and is associated with an increased incidence of
ductal in situ lesions in the original tumour bearing area. (C) 1999 Harcou
rt Publishers Ltd.