Clinical utility of radioactive seed localization in nonpalpable breast cancer: A retrospective single institutional cohort study.

BACKGROUND: With advances in mammographic screening techniques, it has become easier to detect nonpalpable breast lesions at an early stage. Pre-surgical localization of lesions by radioactive seed localization (RSL) has several benefits over conventional wire localization (WL) in guiding breast conserving surgery. In this study, we compared WL and RSL, focusing on the relationship between the techniques and in-breast recurrence or margin positivity. METHODS: This study included 1083 patients with nonpalpable breast lesions who underwent breast conserving surgery between 2010 and 2015. The patients were classified into WL and RSL groups. RESULTS: Margin positivity and in-breast recurrence rates did not differ significantly between the WL and RSL groups (P = 0.368 and P = 0.167, respectively). Multivariate analysis showed that tumor grade (OR: 5.016; 95% CI: 1.53-23.059) was significantly associated with margin positivity in patients undergoing RSL. Tumor size was significantly associated with in-breast recurrence in both the WL group (OR: 2.299; 95% CI: 1.561-3.411) and RSL group (OR: 2.998; 95% CI: 1.128-8.043). CONCLUSION: As the method of tumor localization did not influence margin positivity or in-breast recurrence, either WL or RSL appear to be appropriate for breast conserving surgery. Given the advantages of RSL, including the ability to perform this technique days to weeks before surgery, we propose that high-volume breast centers consider adopting this localization method.

Clinicopathological features of breast angiosarcoma: A 16-years single-institution experience.

BACKGROUND: Breast Angiosarcoma is a rare type of malignancy arising from endothelial cells lining blood vessels, accounting for 1% of all soft tissue breast tumors. This retrospective study describes the clinical pathological features and clinical management and outcomes of a series of 5 patients with primary and secondary Angiosarcoma of the breast present to King Faisal Specialty Hospital and Research Center during the last 16 years. METHODS: A retrospective review of our institution's pathology database was conducted and all patients who had a pathologically confirmed breast angiosarcoma were included in this study. The patient's data, including demographic characteristics, pathological features, clinical management history and clinical outcomes were collected. RESULTS: Five patients were diagnosed with Breast Angiosarcoma (one secondary and four primary cases). The median age of patients with primary angiosarcoma was 22 years (range 13-25 years). All primary cases were presented late as post-excisional biopsy at local hospitals. Median tumor size was 6cm (range 4.0-17.0cm). All primary angiosarcoma patients had total mastectomy. Three-year disease-free survival (DFS) of patients with primary angiosarcoma was 25%. 5-year surviving rate of primary angiosarcoma was 50%. Recurrence was observed in three of the patients with primary Angiosarcoma and in the case of post irradiation Angiosarcoma. CONCLUSIONS: Our study demonstrates that Breast Angiosarcoma exhibits high recurrence and mortality rates. Early detection, small tumor size, and clear surgical margins seem to be crucial factors for survival. Mastectomy with adequate tumor margin is recommended and close long-term follow-up is of utmost importance. Surgery for local recurrence may be potentially curative.

Impact of Surgery on Survival in Stage IV Breast Cancer.

We aimed to assess retrospectively the survival outcome in patients with stage IV breast cancer who underwent surgery. In a retrospective, nonrandomized study of stage IV breast cancer patients diagnosed in a single institution between 2000 and 2012, we assessed patient's survival in the context of baseline characteristics. A total 678 patients with metastatic breast cancer were included; 412 (60.77%) underwent surgery for the primary tumor (Surgery group), and 266 (39%) did not underwent surgery for the primary tumor (Nonsurgery group), with a median follow-up of 41 months. Patients in the Surgery group had longer survival (41 versus 27 months, p < 0.0029). The 5-year survival rate for Surgery group was 34% compared with 14% for the Nonsurgery group. A multivariate analysis revealed surgery (p = 0.0003), large tumor size (p = 0.0195), ER-positive (p < 0.0001), and metastasis at presentation (p = 0.0032) were prognostic variables. Loco-regional surgery does confer a survival advantage in stage IV breast cancer, however, selection bias cannot be excluded, a well-designed and powerful randomized, controlled trial would be valuable to answer whether surgery can improve survival.