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Background: Breast cancer liver metastases (BCLM) is considered a systemic disease with poorly defined selection criteria for surgery and little evidence for the appropriate timing of surgery. Methods: Postoperative outcomes of patients operated for BCLM were retrospectively reviewed and compared based on the timing of surgery, with the early surgery (ES) group treated ≤12 months after BCLM diagnosis, and late surgery (LS) group operated >12 months after diagnosis. Results: Seventy-two patients with BCLM underwent liver surgery, including 37 and 35 in the ES and LS groups, respectively. Demographic and preoperative characteristics were similar between the groups, except that multifocal liver disease was more frequent in the LS group (p = 0.008). The LS group had a morbidity rate of 38%, compared to 11% in the ES group (p = 0.015). No postoperative deaths occurred. In the whole cohort, median progression-free (PFS) and overall survival (OS) were 19 and 50 months, respectively, and 1-, 3- and 5-year PFS and OS were 63%, 41%, 24% and 93%, 66%, 43%, respectively, with no significant difference observed between the ES and LS groups. Multivariate analysis revealed that breast cancer progesterone receptor negativity (HR = 3.34, p = 0.03) and a size of LM > 40 mm (HR = 3.11, p = 0.01) were significant negative prognostic factors for PFS. Only a size of LM > 40 mm (HR = 2.79, p = 0.008) was significantly associated with shorter OS. Conclusion: A prolonged preoperative observational period does not improve long-term outcomes after liver surgery in patients with resectable BCLM, suggesting that early management can safely be proposed to those patients, with good oncological outcomes., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Surgery for breast cancer liver metastases (BCLM) remains controversial. Recently, histological growth pattern (HGP), defined as replacement (rHGP) or desmoplastic (dHGP), has been demonstrated of prognostic value in patients operated for colorectal liver metastases. In BCLM, the types of HGP and their prognostic values have not been determined. We aimed to characterize HGPs in a series of patients undergoing liver resection for BCLM and correlate these patterns with postoperative outcomes. Methods A series of 74 patients operated for BCLM was reviewed. Clinicopathologic variables, overall and disease-free survivals (OS and DFS) were analyzed. HGP could not be evaluated in 37 cases, due to exclusive radiofrequency treatment (N = 22), complete pathological response (N = 9) or unavailability of tissue sections (N = 6). HGP was assessed in archival H&E stained tissue sections, according to international consensus guidelines in 37 patients. The proportions of rHGP and dHGP were determined in each metastasis. Patients were categorized as pure (100% rHGP or dHGP) or dominant phenotype (>50% rHGP or dHGP, on the entire tumor/normal liver interface). In case of multiple metastases, mean HGP was calculated. All these factors were correlated with OS and DFS. Results After a mean postoperative follow-up of 81 months, 5-years OS and DFS in global population were 49.7% and 22.7%, respectively. No clinicopathologic preoperative factor was found to be predictive for OS or DFS. Among the 37 patients analyzed for HGP, 17 were pure rHGP (46%), 10 dominant rHGP (27%), 9 dominant dHGP (24.3%) and 1 pure dHGP. Five-years OS and DFS were significantly reduced in patients with pure rHGP, respectively of 20.3 and 0% (all patients recurring within 2 years) as compared with patients with any dHGP component, respectively of 63 and 45% (p = 0.03 and Conclusions In this series of patients undergoing surgical resection for BCLM, the large majority of metastases displayed pure or dominant rHGP. Pure rHGP appears as a strong negative prognostic factor for postoperative outcome in these patients. Legal entity responsible for the study Vincent Donckier. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background The use of sentinel lymph node biopsy (SLNB) during breast surgery for ductal carcinoma in situ (DCIS) is controversial. It is accepted in high risk lesions (high histological grade, palpable, large >25 mm, and multifocal lesions) since it avoids a second operation if the definitive diagnosis reveals infiltrating ductal carcinoma (IDC) and its recommended due to some technical obligations in patients with planned total mastectomy or with tumor localization to the upper outer quadrant.. We aimed to evaluate the use of SLNB in patients with preoperative diagnosis of high risk DCIS lesions. Methods A monocentric retrospective study was conducted on 467 patients with primary diagnosed DCIS operated for partial or total mastectomy with or without SLNB. The frequency of each risk factor, and the incidence of IDC were calculated in the overall series. The predictive value of each risk factor is calculated by comparing these factors in the groups depending to the definitive pathology (IDC vs DCIS) using the chi square test. A value of p Results Breast surgery was done within a median of 42 ± 23 days of DCIS diagnosis. Median age was 57± 10 years. High risk DCIS lesions accounted for 73.1% of all cases (342/468). Grade III lesion, multifocal, palpable and larger than 25 mm lesions were present in 263 (56.3%), 61 (13.1%), 86 (18.4%) and 99 (21.2%) respectively. IDC was diagnosed in 95/468 patients (20.3%) in the global series and in 75patients/342 (22%) in the patients with high risk lesions. A palpable lesions and a tumor diameter >25 mm were associated with higher risk of invasive carcinoma (p = 0.007 and p = 0.017 respectively).Overall SLNB was done in 383 patients (82%), of which 318 patients (83%) had high risk lesions. A Positive SLN was detected in overall 5 patients (1.3%), all of which had high risk lesions (5/318: 1.6%). Conclusions In our study, the preoperative classification of high risk lesion showed a 79% sensitivity (75/95) and a 22% specificity (75/342) of detecting IDC. A positive SLN was found in only 1.6% of patients with high risk CDIS lesions operated for SLNB. The use of SLNB in patients with high risk DCIS avoids reoperation in 22% of cases. Nevertheless the low risk of positive SLN finding in this setting cannot justify its routine use. Legal entity responsible for the study Jean Marie Nogaret. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.