Prophylactic Lymphovenous Bypass at the Time of Axillary Lymph Node Dissection Decreases Rates of Lymphedema.

Background: Breast cancer-related lymphedema impacts 30% to 47% of women who undergo axillary lymph node dissection (ALND). Studies evaluating the effectiveness of prophylactic lymphovenous bypass (LVB) at the time of ALND have had small patient populations and/or short follow-up. The aim of this study is to quantitatively and qualitatively evaluate prophylactic LVB in patients with breast cancer. Methods: A retrospective review of patients who underwent ALND from 2018 to 2022 was performed. Patients were divided into cohorts based on whether they underwent prophylactic LVB at the time of ALND. Primary outcomes included 30-day complications and lymphedema. Lymphedema was quantitatively evaluated by bioimpedance analysis, with L-dex scores >7.1 indicating lymphedema. Results: One-hundred five patients were identified. Sixty-four patients (61.0%) underwent ALND and 41 patients (39.0%) underwent ALND+LVB. Postoperative complications were similar between the cohorts. At a median follow-up of 13.3 months, lymphedema occurred significantly higher in the ALND only group compared with ALND+LVB group (50.0% vs 12.2%; P < 0.001). ALND without LVB was an independent risk factor for lymphedema development (odds ratio, 4.82; P = 0.003). Conclusions: Prophylactic LVB decreases lymphedema and is not associated with increased postoperative complications. A multidisciplinary team approach is imperative to decrease lymphedema development in this patient population.

Prognostic Predictors of Mortality in Male Breast Cancer: Outcomes in an Urban Population.

INTRODUCTION: Male breast cancer (MBC) accounts for 0.5% to 1% of all breast cancers diagnosed annually. The purpose of this study is to evaluate prognostic factors in MBC. METHODS: We performed a retrospective chart review of patients with MBC between 2010 and 2021. Demographics, comorbidities, cancer characteristics, recurrence, and mortality were collected. Cox proportional hazards regression model was used to determine prognostic factors. A Kaplan-Meier curve was used to plot survival probabilities. RESULTS: A total of 47 male patients were identified. The mean age at presentation was 64.1 y. Twenty eight (59.6%) patients were African American and 14 patients (29.8%) were Caucasian. Most patients had invasive ductal carcinoma (89.4%) and presented with T1 or T2 tumors (40.4% and 38.3%, respectively). Three patients (6.4%) had a recurrence and eight patients (17%) died. Using mortality as an end point, age (≥ 76.1 y) indicated a hazard ratio (HR) of 1.13 (P = 0.004), diabetes mellitus (HR = 5.45, P = 0.023), atrial fibrillation (HR = 8.0, P = 0.009), end-stage renal disease (HR 6.47, P = 0.023), Eastern Cooperative Oncology Group performance status of 3 (HR = 7.92, P = 0.024), poorly differentiated grade (HR = 7.21, P = 0.033), and metastatic disease (HR = 30.94, P = 0.015) had an increased risk of mortality. Overall survival at 3 y was 79.2%. CONCLUSIONS: Advanced age, diabetes mellitus, atrial fibrillation, end-stage renal disease, Eastern Cooperative Oncology Group score of 3, poorly differentiated tumors, and metastatic disease are unfavorable prognostic factors in MBC. Compared to female breast cancer, MBC showed poorer overall survival.

Stage IV Breast Implant-associated Anaplastic Large-cell Lymphoma with Complete Pathologic Response to Neoadjuvant Chemotherapy.

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare lymphoma that has been associated with textured breast implants. Most cases present as a delayed (>1 year) seroma, which can be aspirated for diagnosis. Fewer patients present with masses or skin signs. Surgical resection is the cornerstone of treatment for this form of lymphoma. For advanced disease, treatment is multidisciplinary and incorporates adjuvant chemotherapy, radiation therapy, and potentially, the immunotherapeutic agent brentuximab vedotin, an anti-CD30 antibody-drug conjugate. However, relapse rates are high among patients with peripheral ALCL. We present the case of a 39-year-old woman who developed BIA-ALCL 13 years after augmentation with silicone, textured implants and had a complete pathologic response to neoadjuvant cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine (Oncovin), etoposide, prednisolone (CHOEP) at time of bilateral removal of implants and capsules. CHOEP is a long-standing regimen for treatment of peripheral ALCL and is a suggested regimen for treatment of BIA-ALCL. This case report is the first to demonstrate the use of neoadjuvant chemotherapy in the treatment of BIA-ALCL and suggests a role for its use in advanced disease.

21-gene recurrence assay in patients receiving intraoperative radiotherapy: are "favorable" characteristics a surrogate for low recurrence?

BACKGROUND: Intraoperative radiotherapy (IORT) has gained momentum for early stage and favorable breast cancers (BC). The 21-gene recurrence assay guides treatment of hormone positive and node-negative BC. METHODS: Analysis of 82 invasive BC treated with breast conservation surgery (BCS) and IORT 2013-2015. Data collection included patient demographics, tumor characteristics, nodal status, recurrence test (RS) and adjuvant therapy. RESULTS: The mean age was 68 years. Tumors were stage Ia (86.6%), 3.6% Ib and 9.8% IIa. Of 50 patients (61.0%) with RS testing, 72% (n=36) were low risk (RS 0-17), with 28% (n=14) at intermediate risk (RS 18-30). The 39% (n=32) of patients without RS testing, were more likely to have smaller tumors (1.3 vs. 0.9 cm) and age >70 (P<0.05). CONCLUSIONS: Most patients selected for IORT based on clinical features were indeed low risk based on RS. Given the limited long-term clinical outcome and safety data of this technique, additional investigation is needed.

DCIS treated with excision alone using the National Comprehensive Cancer Network (NCCN) guidelines.

BACKGROUND: In 2008, the NCCN published guidelines allowing low-risk DCIS patients to be treated by excision alone. The goal of this study was to determine local and distant recurrence and breast-cancer specific survival in patients with DCIS that meet NCCN criteria and are treated with excision alone. METHODS: A prospective, single institution database was analyzed for patients with the following: pure ductal carcinoma in situ (no microinvasion), tumor extent 20 mm or less, age ≥50 years, margin width ≥2 mm, and nuclear grade 1 or 2 (non-high grade). Patients were treated with excision alone. Kaplan-Meier analysis was used to determine recurrence and survival rates. RESULTS: A total of 205 patients were treated with excision alone. The median age was 59 years. The median time of follow-up was 51 months. The median extent of disease was 8 mm. There were a total of nine local recurrences. The 6-year probability of local recurrence was 6.6 %. The 12-year probability of local recurrence was 7.8 %. The 12-year breast cancer-specific survival probability was 100 %. CONCLUSIONS: The 12-year local recurrence rate for DCIS patients in NSABP Protocol B-17 treated with excision alone was 32 %, and for excision plus radiation therapy, it was 16 %. In this study, retrospectively applying the NCCN Guidelines to our patients, the 12-year local recurrence rate for excision alone was 7.8 %. Patients with a low risk of local recurrence, if treated by excision alone, can be safely selected using the NCCN Guidelines.