Search

Background: Salvage mastectomy is traditionally recommended for patients who developed ipsilateral breast tumor recurrence (IBTR) in light of the previous breast irradiation. However, it remains controversial whether surgical axillary staging (SAS) is necessary for IBTR patients with negative nodes. This study aimed to evaluate the oncologic safety of omitting SAS for IBTR. Methods: We retrospectively identified patients who developed invasive IBTR with negative nodes after undergoing breast-conserving surgery (BCS). Patterns of care in nodal staging were analyzed based on prior axillary staging status. Clinicopathologic characteristics and adjuvant treatment of the initial tumor, as well as the IBTR, were compared between SAS and no SAS groups. Kaplan-Meier method and Cox regression model were utilized to compare the loco-regional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates after IBTR removal between the two groups. Results: A total of 154 IBTR patients were eligible for final analysis. Compared to no SAS group, SAS group was less likely to undergo ALND (15.1% vs 73.3%, p < 0.001) at initial BCS, had a longer recurrence interval (2.8 vs 2.1 years, p=0.03), and were more likely to have discordant molecular subtype with primary tumor (35.8% vs 12.9%, p=0.001). However, the extent of axillary staging did not affect systemic or radiation recommendations. In the subgroup of patients without previous ALND, the clinicopathologic characteristics were roughly comparable. Pathologic analysis revealed pathologically uninvolved nodal status in approximately 85% of patients receiving SAS at time of IBTR in the overall population and the subgroup (Table 1). No significant differences were observed in LRRFS, DMFS and OS between the two groups (Table 2). Conclusion: For node-negative IBTR patients, we observed selection bias on the basis of prior ALND, shorter recurrence interval, and concordant molecular subtype favoring no SAS, but comparable LRRFS, DMFS, and OS. These results support wider consideration of sparing SAS in the management of IBTR, especially in patients without previous ALND. Table 1. Pathologic axillary staging in patients receiving axillary surgery at time of IBTR. Table 2. Cox regression analysis of LRRFS, DMFS, and OS after IBTR. Citation Format: Feilin Qu, Caijin Lin, Jun-Jie Li, Zhi-Ming Shao. Omission of Axillary Surgery for Ipsilateral Breast Tumor Recurrence with Negative Nodes after Previous Breast-Conserving Surgery: Is It Oncologically Safe? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-07.

Background Vacuum-assisted breast biopsy (VABB) has been routinely recommended for stereotactic intervention in cases of isolate mammographically-detected calcifications. Herein we aimed to evaluate and compare the diagnostic consistency and accuracy of calcified and noncalcified specimens obtained from same sites of sampling on mammography-visible calcifications. In addition, we presented the biopsy procedure and retrospectively evaluated the usefulness of VABB as well as the complications of this technique over an eight-year experience in our centre. Methods This single-institution observational cohort study included 587 patients referred for stereotactic 11-gauge VABB of 594 mammographically-detected calcifications between January 2010 and December 2018. The rate of histopathological underestimation, the false negative, the diagnostic consistency and accuracy between calcified and noncalcified specimens of VABB were comprehensively evaluated based on the surveillance data and final histopathological result of the surgical specimens. Results In total, 594 biopsy procedures were performed in 587 patients (mean age 46 years, range, 21-80 years). The average number of biopsy specimens was 14.7 (range, 9-21) per lesion. VABB pathological results revealed 471 (79.3%) benign, 39 (6.6%) high-risk, and 84 (14.1%) malignant cases. The diagnostic inconsistency between calcified and noncalcified specimens was 14.6% (105/123) for high-risk and malignant lesions. Furthermore, calcified specimens exhibited higher diagnostic accuracy of malignant lesion as compared with the noncalcified specimens (97.7% versus 82.6%, respectively). Underestimation rate for high-risk lesions and in situ carcinoma was 5.1% and 54.1%, respectively, along with a false negative rate of 6.25%. In addition, mild complications were reported with high patient tolerance. Conclusions Stereotactic 11G-VABB might be preferred for the investigation of non-palpable mammographically-detected calcifications in terms of accuracy and safety profile. The high prevalence of diagnostic discordance between the specimens with and without calcifications revealed a higher value of calcified specimens in diagnosing high-risk and malignant calcifications.

Purpose Sentinel lymph node biopsy (SLNB) is currently the standard of care in clinically node-negative (cN0) breast cancer. The present study aimed to evaluate the negative predictive value (NPV) of 18F-FDG dedicated lymph node positron emission tomography (LymphPET) in cN0 patients. Methods This is a prospective phase II trial divided into two stages (NCT04072653). In the first stage, cN0 patients underwent axillary LymphPET, followed by SLNB. In the second stage, SLNB was omitted in patients with a negative preoperative axillary assessment after integrating LymphPET. Here, we report the results of the first stage; the primary outcome was the NPV of LymphPET to detect macrometastases of lymph nodes. Results 189 invasive breast cancer patients underwent LymphPET, followed by surgery, with definitive pathological reports. Forty patients had lymph node macrometastasis (LN-macro), and 16 patients had only lymph node micrometastasis (LN-micro). Of the 131 patients who had a negative LymphPET, 16 patients had LN-macro, the NPV was 87.8%. After combining axillary imaging evaluation with ultrasound and LymphPET, 100 patients were found to be both LymphPET and ultrasound negative, 9 patients had LN-macro, the NPV was 91%. Conclusions LymphPET can be used to screen potential patients to avoid SLNB with an NPV >90%. The second stage of the SOAPET trial is ongoing to confirm the safe omission of SLNB according to preoperational axillary evaluation when integrating LymphPET.

Objective The indication of adjuvant chemotherapy recommendation (ACR) in breast cancer patients with intermediate recurrence score (RS) is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients. Methods Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December 2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set (378 cases) and validated in an independent validation set (126 cases). A Youden-derived cut-off value was assigned to the nomogram for accuracy evaluation. Results The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node (LN) status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve (AUC) values were 0.905 [95% confidence interval (95% CI): 0.876-0.934] and 0.883 (95% CI: 0.824-0.942) in the training and validation sets, respectively. The accuracies of the nomogram for ACR were 84.4% in the training set and 82.1% in the validation set. Conclusions We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.

e12032 Background: The 21-gene Recurrence Score (RS) assay has been routinely used to guide systemic chemotherapy in patients (pts) with estrogen receptor positive, node-negative early breast cancer (EBC). However, there has been less clarity in recommendation of adjuvant chemotherapy (ACT) in pts with intermediate RS (IRS). According to the definitions of IRS in retrospective NSABP B14, B20 trials and prospective validation of TAILORx trial, we adopted the broaden cut-offs of 11-30 in our study. We sought to analyze the factors related to ACT decision in this subset of pts. Additionally, the role of Adjuvant!Online (AOL) was evaluated in ACT decision. Methods: A cohort of 564 pts with RS of 11-30 was retrospectively analyzed from January 2014 to October 2016 in Ruijin Hospital Shanghai Jiaotong University School of Medicine. The Oncotype DX RS, a RT-PCR 21-gene assay, was performed on RNA extracted from formalin-fixed paraffin-embedded tissue. The AOL was used to determine pts’ clinical risk. Predictive factors of chemotherapy usage in different clinical risk catogories were also assessed. Results: 267 (47.3%) pts received chemotherapy. Age, tumor grade, pathologic type, pT, pN, molecular subtype and RS were significantly correlated with ACT decision ( p