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Metastatic breast cancer surgical management

Chuan Tan, Rebecca Caragata, Ian Bennett
The aim of this study was to review the outcomes of a series of breast cancer patients who underwent sentinel node biopsy inclusive of lymphoscintigraphy, and to assess the incidence of internal mammary node (IMN) metastatic positivity at exploration and whether these findings influenced treatment. Between April 2001 and December 2012, 581 breast cancer patients at Princess Alexandra Hospital underwent preoperative lymphoscintigraphy in the course of the performance of sentinel node biopsy. Analysis was performed of those patients who demonstrated radio-isotope uptake to the IMN chain, and who had sentinel node biopsy of the IMN's and were found to have metastatic involvement...
January 24, 2017: Breast Journal
P Anract, D Biau, P Boudou-Rouquette
The diagnosis of pathological fracture should be considered routinely in patients with long limb-bone fractures. Investigations must be performed to establish the diagnosis of pathological fracture then to determine that the bone lesion is a metastasis. In over 85% of cases, the clinical evaluation combined with a detailed analysis of the radiographs is sufficient to determine that the fracture occurred at a tumour site. Aetiological investigations establish that the tumour is a metastasis. In some patients, the diagnosis of metastatic cancer antedates the fracture...
January 11, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
Michal Jarzab, Monika Kowal, Wieslaw Bal, Malgorzata Oczko-Wojciechowska, Justyna Rembak-Szynkiewicz, Malgorzata Kowalska, Ewa Stobiecka, Ewa Chmielik, Tomasz Tyszkiewicz, Malgorzata Kaszuba, Elzbieta Nowicka, Barbara Lange, Agnieszka Czarniecka, Jolanta Krajewska, Alicja Dyla, Miroslaw Dobrut, Dariusz Lange, Barbara Jarzab, Barbara Bobek-Billewicz, Rafal Tarnawski
INTRODUCTION: Prediction of response to preoperative breast cancer chemotherapy may offer a substantial optimization of medical management of this disease. The most efficient prediction would be done a priori, before the start of chemotherapy and based on the biological features of patient and tumor. Numerous markers have been proposed but none of them has been applied as a routine. The role of MKI67 and HSP90 expression has been recently suggested to predict treatment sensitivity in HER2-positive breast cancer...
2016: Folia Histochemica et Cytobiologica
Brandyn A Castro, Ruby Kuang, Priscilla K Brastianos
Metastases to the brain are a common complication of various cancers and are associated with poor prognosis. Management of these patients requires a multidisciplinary approach including whole-brain radiation therapy, stereotactic radiosurgery, surgical resection, chemotherapy, and supportive treatment. Because of recent technological advancements in genomics, our understanding of the genetics of brain metastases is rapidly advancing. This has led to the discovery of many potential genetic therapeutic targets in metastatic brain lesions...
November 2016: Discovery Medicine
Michael Lallemand, Morgan Barron, Jason Bingham, Andrew Mosier, Mark Hardin, Vance Sohn
BACKGROUND: The optimal role of breast magnetic resonance imaging (MRI) in the management of ductal carcinoma in situ (DCIS) remains controversial. We sought to better define the impact of breast MRIs when utilized during the workup of DCIS. METHODS: Patients with biopsy-proven DCIS without any additional invasive disease were prospectively enrolled in the multidisciplinary breast cancer pathway and comprised the study group. Patients who met any additional criteria for MRI screening were excluded...
January 2017: American Journal of Surgery
John R Benson, Ismail Jatoi, Masakazu Toi
The heterogeneous nature of ductal carcinoma in situ has been emphasised by data for breast-cancer screening that show substantial increases in the detection of early-stage non-invasive breast cancer but no noteworthy change in the incidence of invasive and distant metastatic disease. Indolent non-progressive forms of ductal carcinoma in situ are managed according to similar surgical strategies as high-risk disease, with extent of resection dictated by radiological and pathological estimates of tumour dimensions...
October 2016: Lancet Oncology
Kyungmin Shin, Abigail S Caudle, Henry M Kuerer, Lumarie Santiago, Rosalind P Candelaria, Basak Dogan, Jessica Leung, Savitri Krishnamurthy, Wei Yang
OBJECTIVE: The purpose of this article is to describe the feasibility and safety of a multidisciplinary approach to imaging-guided axillary staging that facilitates personalized, less invasive surgical management of the axilla through targeted axillary dissection in patients with biopsy-proven nodal metastasis undergoing neoadjuvant chemotherapy. CONCLUSION: Axillary nodal status, critical in breast cancer staging, affects prognosis and treatment. As the paradigm shifts toward minimally invasive therapy, a clip marker is placed in the biopsied metastatic node for patients with N1-N2 disease undergoing neoadjuvant chemotherapy to facilitate targeted axillary dissection of the clipped node...
December 2016: AJR. American Journal of Roentgenology
Yihong Wang, Shaolei Lu, Theresa Graves, Madhu M Ouseph, Murray B Resnick, Evgeny Yakirevich
BACKGROUND: Papillary carcinoma (PC) of the breast represents ∼0.5% of all newly diagnosed cases of breast cancer and usually has an indolent course. The current data suggest lack of a consensus in the surgical management of this disease. Because patients can occasionally develop metastatic disease, sentinel lymph node (SLN) biopsy is often performed during surgery. MATERIALS AND METHODS: In the present study, we retrospectively evaluated the histologic characteristics of 99 cases of PC with or without associated frank invasive carcinoma, including 43 encapsulated or intracystic PCs, 24 solid PCs, and 32 intraductal PCs, and correlated these with the incidence of nodal metastasis...
September 8, 2016: Clinical Breast Cancer
Thomas M Churilla, Brian L Egleston, Colin T Murphy, Elin R Sigurdson, Shelly B Hayes, Lori J Goldstein, Richard J Bleicher
PURPOSE: Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient. METHODS: Patients diagnosed with non-metastatic invasive breast cancer from 1992-2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist...
November 2016: Breast Cancer Research and Treatment
M Ahmed, R Baker, I T Rubio
BACKGROUND: Sentinel node biopsy (SNB) in recurrent breast cancer offers targeted axillary staging compared with axillary lymph node dissection (ALND) or no treatment. The evidence for lymphatic mapping in recurrent breast cancer is reviewed, focusing on aberrant drainage and its implications for patient management. METHODS: A meta-analysis of studies evaluating lymphatic mapping in recurrent breast cancer was performed. Outcomes included sentinel node identification, aberrant lymphatic pathways and metastatic node rates in aberrant drainage and ipsilateral axilla...
November 2016: British Journal of Surgery
K Harano, X Lei, A M Gonzalez-Angulo, R K Murthy, V Valero, E A Mittendorf, N T Ueno, G N Hortobagyi, M Chavez-MacGregor
Trastuzumab-based treatment has dramatically improved the outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC) patients, with some patients achieving prolonged survival times. In this study, we aim to identify factors that are associated with long-term survival. Patients with HER2+ MBC treated with anti-HER2 target therapy were identified. Patients were grouped according to overall survival (OS) and categorized as long-term survivors (LTS, OS ≥ 5 years), or non-long-term survivors (non-LTS, OS < 5 years)...
September 2016: Breast Cancer Research and Treatment
C Rory Goodwin, Nancy Abu-Bonsrah, Laurence D Rhines, Jorrit-Jan Verlaan, Mark H Bilsky, Ilya Laufer, Stefano Boriani, Daniel M Sciubba, Chetan Bettegowda
STUDY TYPE: A review of the literature. OBJECTIVE: The aim of this study was to discuss the evolution of molecular signatures and the history and development of targeted therapeutics in metastatic tumor types affecting the spinal column. SUMMARY OF BACKGROUND DATA: Molecular characterization of metastatic spine tumors is expected to usher in a revolution in diagnostic and treatment paradigms. Molecular characterization will provide critical information that can be used for initial diagnosis, prognosticating the ideal treatment strategy, assessment of treatment efficacy, surveillance and monitoring recurrence, and predicting complications, clinical outcome, and overall survival in patients diagnosed with metastatic cancers to the spinal column...
October 15, 2016: Spine
Giovanni Paolino, Chiara Panetta, Dario Didona, Michele Donati, Pietro Donati
Dear Editor, Cutaneous metastases (CM) are detected in about 0.6-10.4% of patients with an internal malignancy (1-3). Excluding melanoma, breast and lung carcinomas are the main source of CM in women and men, respectively (1,4,5). CM can have different clinical features, and a diagnosis of CM is usually suspected before performing a biopsy. However, this can be a pitfall for clinicians when the clinical presentation is not the typical inflammatory nodule or mass. Herein we report 2 cases of cutaneous metastases of breast carcinoma, initially treated as a common skin infection...
June 2016: Acta Dermatovenerologica Croatica: ADC
Nathan T Zwagerman, Michael M McDowell, Ronald L Hamilton, Edward A Monaco, John C Flickinger, Peter C Gerszten
OBJECTIVE Increased survival time after diagnosis of neoplastic disease has resulted in a gradual increase in spine tumor incidence. Radiosurgery is frequently a viable alternative to operative management in a population with severe medical comorbidities. The authors sought to assess the histopathological consequences of radiosurgery in the subset of patients progressing to operative intervention. METHODS Eighteen patients who underwent radiosurgery for spine tumors between 2008 and 2014 subsequently progressed to surgical treatment...
August 2016: Neurosurgical Focus
H Portha, C Jankowski, M Cortet, I Desmoulins, E Martin, V Lorgis, L Arnould, C Coutant
Triple-negative breast cancer (TN), as defined by the triple negativity in immunohistochemistry: the absence of estrogen receptor, progesterone receptor and the absence of overexpression or amplification of HER2, corresponds to 15 % of invasive breast cancers. This is a very heterogeneous group of tumors both at the genomic and transcriptomic level and at morphological, clinical and prognostic level. Although there are some good prognosis forms, the majority of TN tumors is characterized by a poor prognosis with a greater frequency of visceral metastases and a maximum risk of relapse in the first two years after diagnosis...
September 2016: Gynécologie, Obstétrique & Fertilité
Emanuela Esposito, Viviana Sollazzo, Rosa Di Micco, Maria Cervotti, Gaetano Luglio, Giacomo Benassai, Pasquale Mozzillo, Stefano Perrotta, Vincenzo Desiato, Bruno Amato, Pietro Forestieri, Gennaro Limite
INTRODUCTION: Sentinel lymph node biopsy (SLNB) is a minimally invasive technique to stage the axillary lymph node status. The burden of nodal metastasis is of great concern, as the clinical relevance and therapeutic implications of pN1mi and pN0(i+) in the sentinel lymph node (SLN) remain a matter of debate. MATERIALS AND METHODS: We examined the pathological features of 901 patients above the age of 65 presenting with clinical T1-T2 N0M0 breast tumours (<3 cm), detecting tumours related to llary non-sentinel node (NSN) metastases when the SLN was minimally involved...
September 2016: International Journal of Surgery
Fiona Langlands, Eleanor Cornford, Emad Rakha, Barbara Dall, Eleanor Gutteridge, David Dodwell, Abeer M Shaaban, Nisha Sharma
OBJECTIVE: To review the clinical presentation, baseline imaging features, surgical management and final surgical pathology of metaplastic carcinoma of the breast. METHODS: A total of 71 cases were identified over a 10-year period from two major UK breast cancer institutions. Imaging at diagnosis including mammography, ultrasound, MRI and CT scans and histological diagnosis were reviewed. Follow-up data including local and systemic recurrence were retrieved. RESULTS: Of the 71 cases, 60 (84...
June 21, 2016: British Journal of Radiology
A Clavier, C Cornou, P Capmas, A-S Bats, C Bensaid, C Nos, F Lécuru, C Ngô
OBJECTIVES: Today, according to St-Gallen and ASCO clinical guidelines, axillary lymph node dissection (ALND) should be avoided in patients who meet the ACOSOG Z011 criteria. In French guidelines, ALND is still recommended in case of macrometastasis in sentinel lymph node (SLN) and in case of micrometastasis without systemic treatment. We performed a survey of the French practices in the management of the axilla. MATERIAL AND METHODS: A questionnaire was sent to 454 breast surgeons between June 2014 and January 2015...
May 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
A Jibia, O D N'Dri, D Sissoko, L Derou, E Broalet, G Varlet, V Ba Zeze
INTRODUCTION: Metastatic epiduritis is the most frequent extrinsic epidural cause of spinal cord compression. Although neurosurgery is essential to its management, the exact role of this discipline in the treatment of spinal cancer in sub-Saharan Africa has not yet been assessed. AIM: To analyze recent hospital data of patients with metastatic epiduritis managed in the Abidjan neurosurgery department. METHODOLOGY: We conducted a retrospective analysis of files of 56 patients admitted from January 2007 through December 2012...
January 2016: Médecine et Santé Tropicales
M Onorati, P Uboldi, C L Bianchi, M Nicola, G M Corradini, S Veronese, A I Fascì, F Di Nuovo
Thyroid gland is one of the most vascularized organs of the body, nevertheless clinical and surgical series report an incidence of secondary malignancies in this gland of only 3%. Colorectal carcinoma metastatic to the thyroid gland is not as uncommon as previously believed, infact the number of cases seems to be increased in recent years due to the more frequent use of fine-needle aspiration cytology (FNAC) guided by ultrasonography. Although kidney, breast and lung metastases to the thyroid are frequent, metastasis from colon cancer is clinically rare with 52 cases reported in the literature in the last 5 decades and three cases described as solitary thyroid metastasis from the colon cancer without any other visceral metastases...
September 2015: Pathologica
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