Standardized method for quantification of developing lymphedema in patients treated for breast cancer.

PURPOSE: To develop a simple and practical formula for quantifying breast cancer-related lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal changes. METHODS AND MATERIALS: We analyzed bilateral perometer measurements of the upper extremity in a series of 677 women who prospectively underwent lymphedema screening during treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and November 2008. Four sources of variation were analyzed: between repeated measurements on the same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery, age, weight, and body mass index were also analyzed. RESULTS: The statistical distribution of variation of measurements suggests that the ratio of volume ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we present the formula for relative volume change (RVC): RVC = (A(2)U(1))/(U(2)A(1)) - 1, where A(1), A(2) are arm volumes on the side of the treated breast at two different time points, and U(1), U(2) are volumes on the contralateral side. Relative volume change is not significantly associated with hand dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC; however, baseline body mass index or weight changes over time do not. CONCLUSIONS: We propose the use of the RVC formula to assess the presence and course of breast cancer-related lymphedema in clinical practice and research.

Outcome of multiple-wire localization for larger breast cancers: do multiple wires translate into additional imaging, biopsies, and recurrences?

BACKGROUND: Breast conservation is possible in breast cancer patients whose mammographic lesions are large enough to require multiple localizing wires for excision. METHODS: A retrospective review of 112 patients who underwent multiple-wire and 160 controls who underwent single-wire lumpectomy for breast cancer. Rates of in-breast recurrence, metastasis, and additional imaging and biopsy procedures were calculated. RESULTS: The median follow-up was 24 months. One multiple-wire and 2 single-wire patients developed in-breast recurrences (P = .84). No distant metastases developed among the multiple-wire patients. Additional follow-up imaging was obtained in 29% of multiple-wire and 22% of single-wire cases (P = .1). Seven (6%) of the multiple-wire and 11 (6%) of the single-wire cases underwent biopsy (P = .94). CONCLUSIONS: We found no increased risk of early local recurrence, metastasis, or additional imaging or biopsies in patients requiring multiple-wire localization for lumpectomy. Breast conservation should be considered a safe option even for patients with mammographically extensive lesions.

Tubular carcinoma of the breast: results of a large contemporary series.

BACKGROUND: Tubular carcinoma (TC) of the breast is an uncommon subtype associated with a favorable prognosis. This study aimed to assess recent trends and prognostic features in the treatment of TC. METHODS: We performed a retrospective review of cases of TC of the breast treated between 1997 and 2004. RESULTS: We identified 111 cases of TC of the breast. The median patient age at diagnosis was 55 years, and the median follow-up period was 72 months. Breast-conservation surgery was performed in 75% (83 of 111) of patients. Axillary staging was performed in 80% (89 of 111). Nine (8.1%) were found to be node-positive. Node positivity was associated with larger tumor size (P = .003). All node-positive tumors were greater than 1 cm. One patient developed an in-breast recurrence. No patient developed distant metastases or died from breast cancer. CONCLUSIONS: In this series of TC, the locoregional recurrence rate was low and no patient developed distant metastases. Surgical staging of the axilla may not be necessary in lesions measuring 1 cm or less.

The American Cancer Society guidelines for breast screening with magnetic resonance imaging: an argument for genetic testing.

BACKGROUND: The American Cancer Society (ACS) guidelines for screening with breast magnetic resonance imaging (MRI) recommend MRI for women who have a lifetime risk > or = 20% of developing breast cancer. Genetic testing for breast cancer gene (BRCA) mutations is offered to women who have a risk > or = 10% of carrying a mutation. The objectives of the current study were 1) to identify the number of women in a breast cancer screening population who had > or = 20% lifetime breast cancer risk and, thus, were candidates for screening MRI; and 2) to determine the number of women who had > or = 10% risk of BRCA mutation yet had <20% lifetime risk of breast cancer and, thus, may not have been identified as candidates for MRI screening. METHODS: From 2003 to 2005, women who underwent screening mammography completed a self-administered questionnaire regarding breast cancer risk factors. For each patient, the lifetime breast cancer risk and the risk of BRCA mutation was determined by using the computerized BRCAPRO breast cancer risk-assessment model. RESULTS: Of 18,190 women, 78 (0.43%) had > or = 20% lifetime risk of breast cancer, all of whom had > or = 10% risk of carrying a BRCA mutation. An additional 374 women (2.06%) had <20% lifetime breast cancer risk but > or = 10% risk of mutation. Overall, there were 183 (1%) predicted mutation carriers, 27 women (0.15%) who had > or = 20% lifetime risk of breast cancer, and 62 women (0.34%) who had > or = 10% risk of mutation but <20% lifetime breast cancer risk. CONCLUSIONS: The ACS guidelines for breast MRI screening may systematically exclude MRI screening for many women who have a substantial risk for BRCA mutation. The current results demonstrated a need for greater awareness of breast cancer risk factors in the screening mammography population, so that high-risk women can be identified and given access to genetic testing and counseling regarding all risk-reducing interventions.

Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion?

BACKGROUND: Because the implications of micrometastases found on sentinel node biopsy (SNB) for ductal carcinoma in situ (DCIS) or ductal carcinoma in situ with microinvasion (DCISM) are largely unknown, we wished to determine if SNB pathology predicted recurrence risk in DCIS/DCISM. METHODS: Retrospective chart review identified patients with DCIS/DCISM who underwent SNB. SNB findings and all local and distant recurrences were determined. RESULTS: A total of 322 patients underwent SNB for DCIS/DCISM. There were 13 local recurrences (4.0%) and 1 (.03%) distant recurrence at a median follow-up of 47.9 months (range 0 to 110.6), 12 in patients with negative SNBs; 1 patient had a positive SNB. There were 4 recurrences after mastectomy and 9 after lumpectomy. In 29 patients with positive SNBs, there was only 1 recurrence (3.4%). CONCLUSIONS: Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of local or distant recurrence. Other features of DCIS and DCISM may be important in predicting recurrence risk.