Breast cancer

Reflector-guided localisation of non-palpable breast lesions: A prospective evaluation of the SAVI SCOUT system on 137 patients (2024)

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Type of publication:
Conference abstract

Author(s):
Taj S.; Han S.; *Lefroy R.; Hajiesmaeili H.; Alamgir C.F.; Rahman E.; Khosla M.; Bowen N.; Troman P.; Vidya R.; Verma R.; Mylvaganam S.; Clarke D.; Ingle H.; Sircar T.

Citation:
European Journal of Surgical Oncology. Conference: The Association of Breast Surgery Conference 2024. Bournemouth International Centre, Bournemouth United Kingdom. 50(Supplement 1) (no pagination), 2024. Article Number: 108190. Date of Publication: May 2024.

Abstract:
Introduction: Traditionally, wire-guided localisation has been the gold-standard for localising non-palpable breast lesions. However, this method has some limitations, including patient discomfort, wire migration and scheduling radiology appointments on the day of surgery, causing delay in start of theatre list. Various wire-less alternatives have been developed. Therefore, the aim of this study was to evaluate the safety and effectiveness of the SAVI SCOUT localisation technique. Method(s): This was a prospective study of 137 consecutive patients with SAVI SCOUT reflector, deployed between December 2020 and November 2023. We studied the rate of successful localisation and retrieval of SCOUT, imaging modality used for localisation, re-excision rate, pathology, median weight of specimen and SCOUT-related complications. Result(s): A total of 137 SAVI SCOUT reflectors were deployed in 137 consecutive patients undergoing breast conserving surgery for non-palpable lesions which included malignancy 97% (n=133), high risk lesions 2.18% (n=3) and benign lesion in 0.72% (n=1). The rate of radiological localisation and retrieval of the reflector at surgery was 97.8% (n=134) and 100% (n=137) respectively. The most common modality for localisation was ultrasound 97% (n=133). The median specimen weight was 21.5gm. The mean duration between deployment day and surgery was 2 days (range 0-30). The re-excision rate was 8% (n=11). There was no specific technique-related surgical complication. Conclusion(s): Our study demonstrates that the SAVI SCOUT localisation system is a safe, effective, and reliable localization modality for non-palpable breast lesions with low re-excision rate.

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA) (2022)

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Type of publication:Journal article

Author(s):Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, Cozzi A, de Andrade DA, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, *Ozcan Umit A, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Sacchetto D, Scaperrotta GP, Schiaffino S, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G.

Citation:European Radiology. 2022 Mar;32(3):1611-1623.

Abstract:Objectives: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods: This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). Conclusions: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. Key points: • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.

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Solving the preoperative breast MRI conundrum: design and protocol of the MIPA study (2020)

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Type of publication:Journal article

Author(s):Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Alvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Andrade DA, de Lima Docema MF, Depretto C, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, *Ozcan, Umit A., Pediconi F, Preibsch H, Raya-Povedano JL, Sacchetto D, Scaperrotta GP, Schlooz M, Szabo BK, Ulus OS, Taylor DB, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G.

Citation:European Radiology. 2020 Oct;30(10):5427-5436.

Abstract:Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.

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High BMI at breast cancer diagnosis associated with significantly more metastatic disease, and increased likelihood of death from breast cancer recurrence (2023)

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Type of publication:
Conference abstract

Author(s):
*Lake, Blossom; Damery, Sarah; *Wilson, Mandy; *Appleton, Donna; Jolly, Kate

Citation:
European Journal of Surgical Oncology, February 2023, Volume 49(2), pages E87-E88

Abstract:
Background: 50% of patients with breast cancer are overweight or obese, with the West Midlands having second highest rate of obesity in the UK. Elevated BMI has been associated with breast cancer recurrence. This study looked at recurrence in Shropshire breast cancer survivors.

Effectiveness of weight loss interventions in breast cancer survivors: a systematic review of reviews (2022)

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Type of publication:Systematic Review

Author(s):*Lake B; Damery S; Jolly K

Citation:BMJ Open, 2022 Oct 07; Vol. 12 (10), pp. e062288

Abstract:Background: Elevated body mass index (BMI) in breast cancer survivors (BCS) is associated with cancer recurrence and poorer treatment response. Guidelines recommend 5%-10% weight loss for overweight or obese BCS.Objectives: To assess effectiveness of lifestyle interventions for female BCS on weight loss, BMI, body composition, health-related quality of life (HRQoL), physical functioning, psychosocial measures, biomarkers.Design: Systematic review of reviews and meta-analyses.Setting: All clinical settings.Participants: Adult female BCS (active treatment or post-treatment).Methods: Medline, Embase, CINAHL, PsycINFO, Cochrane Library (including Database of Abstracts of Reviews of Effects) were searched for systematic reviews published in English between 1990 and 2022, with weight, BMI or body fat as primary outcome. Narrative reviews, editorials, letters, conference abstracts were excluded. Review quality was assessed using the Joanna Briggs Institute quality assessment tool.Results: 17 reviews were included. Twelve reported significant reductions in one or more anthropometric outcomes: weight -1.36 kg (95% CI:-2.51 to -0.21) to -3.8 kg (95% CI: -5.6 to -1.9); BMI -0.89 kg/m 2 (95% CI: -0.15 to -0.28) to -3.59 kg/m 2 (95% CI: -6.29 to 0.89) or body fat -1.6% (95% CI: -2.31 to -0.88) to -2.6% (95% CI not reported). Significant reductions in two or more anthropometric outcomes were reported in 7/12 reviews, with effective interventions comprising aerobic exercise/aerobic exercise plus resistance training (n=5), or diet and exercise with or without counselling (n=2). Significant improvements were also reported for HRQoL (8/11 reviews), mental health (4/7) and physical functioning (2/3). Group interventions comprising aerobic exercise or aerobic exercise plus resistance training were most likely to improve outcomes.Conclusions: Lifestyle interventions can significantly improve outcomes for BCS. Multimodal interventions are likely to have the greatest impact in reducing weight, BMI and body fat. Further research must define the optimal combination, intensity and duration of effective interventions.

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Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant (2022)

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Type of publication:
Journal article

Author(s):
*Parikh S; *Pettit L; *AbdelGadir H

Citation:
BMJ Case Reports, 2022 Mar 22; Vol. 15

Abstract:
Two postmenopausal women with breast cancer developed acute confusion and seizures, less than 24 hours after the first cycle of neoadjuvant chemotherapy with fluorouracil, epirubicin and low-dose cyclophosphamide. They were found to have severe, life-threatening hyponatraemia with sodium levels of 113 and 115 mEq/L, respectively. Both women made a full recovery within 24 hours of admission with slow correction of sodium levels. Following investigational workup, the most likely diagnosis was cyclophosphamide-associated syndrome of inappropriate antidiuretic hormone secretion (SIADH). Aprepitant – a commonly used antiemetic and moderate cytochromeP450 3A4 inhibitor was identified as the precipitating factor. Aprepitant was discontinued and both women were successfully re-challenged with full dose cyclophosphamide in an outpatient setting with no subsequent adverse events. This is a typical case of a rare cause of a common medical problem. A systematic approach to diagnosis and treatment of hyponatraemia in an oncology patient requires awareness of toxicities of systemic anticancer agents.

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Rare histological subtypes of breast cancer: A study of 10 years' experience at (SATH) UK District General Hospital (2022)

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Type of publication:Conference abstract

Author(s):*Mansour A.; *Pettit L.

Citation:European Journal of Surgical Oncology; Feb 2022; vol. 48 (no. 2)

Abstract:Background: Breast cancer is a heterogeneous disease with different histologic subtypes, molecular characteristics, oestrogen receptors (ER) and HER2 status. Common subtype include lobular and ductal cancers. The rare subtypes are a heterogeneous group with differing behaviour specific for each subtype. This study aims to determine the clinicopathological features, management pathway and survival outcome of rare subtypes of invasive breast cancer (IBC) at a single U.K. hospital.Material(s) and Method(s): Data was obtained from the department of Cellular Pathology at The Shrewsbury and Telford Hospital (SATH) NHS Trust. All patients diagnosed with a rare subtype of breast cancer from January 2005 to December 2014 were identified. The histology diagnosis of a rare subtype of breast cancer was reviewed. Biological behaviour, management, follow up and prognosis were obtained from surgical and oncology clinic letters. Also, survival data and cause of death when applicable is reviewed from Clinical Portal (our hospital digital documentation system). Patients with imaging, after the introduction of the digital format to the system in 2012, were also reviewed.
Result(s): Total number of patients diagnosed with IBC was 3049. 201 patients (6.59%) were identified to have a rare subtype of IBC. Patients were divided into subgroups according to their specific rare subtype and included mucinous, tubular, medullary, metaplastic, papillary, neuroendocrine, cribriform, apocrine, malignant phyllodes, angiosarcoma, lymphoma and metastatic from non-breast primary. Some cancers had good prognosis with 100% 5 years overall survival like tubular carcinoma and some have poor prognosis like metaplastic and angiosarcoma.Conclusion(s): Our experience with these heterogeneous groups of rare subtypes of breast cancer identified the clinical behaviour and prognosis of each type. This could be the basis to improve the management of these subtypes and for further studies to improve the outcome for patients with identified breast cancer known to have poorer prognosis.

Her-2 expression pattern evaluation in breast invasive lobular carcinoma and its association to the clinicopathomorphological characteristics and female sex hormones expression in 71 cases (2022)

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Type of publication:Conference abstract

Author(s):Barron M.; Asaad A.; Ali S.; Chicken W.; Elamass M.; Alkistawi F.; Abdalla Al-Zawi A.S.; *Khan K.A.; Idaewor P.; Osayi K.

Citation:European Journal of Surgical Oncology; Feb 2022; vol. 48 (no. 2)

Abstract:Background: HER2 status is considered as an important prognostic and predictive factor in breast cancer treatment The cellular E-cadherin protein (encoded by the CDH1 gene) is expressed in the breast epithelial cells. Its function is functions is epithelial-to epithelial cell adhesion and epithelial-to-mesenchymal transition. Invasive lobular carcinoma (ILC) is characterised by the absence of E-cadherin expression, usually its oestrogen /progesterone positive however lack Her-2 amplification. Approximately, about 20% of breast cancers are Her2 +ve. The evidence revealed that, HER2 amplification or overexpression is encountered predominantly in invasive ductal carcinomas (NST) of high nuclear grade and infrequently in pleomorphic lobular carcinomas. The aim is to analyse the Her-2 expression pattern in breast invasive lobular carcinoma.Material(s) and Method(s): The clinical records of 71 patients diagnosed in the period between 2014 -2019,with ILC has been analysed. The lobular phenotype was confirmed by the absence of E-cadherin expression. We have evaluated the following criteria: clinico-pathologic variables, female sex hormone receptor status as well as Her-2 expression status.Result(s): ILC cases has been identified in 71 cases, the age ranges between 39-85 yrs, with mean of 68.In 22.% of cases, the phenotype was mixed ILC& invasive ductal carcinoma. Her-2 overexpression detected in 13% cases, 89% of Her2+ve group are above 65 years of age. Her2 overexpression was more associated with ER+ve group (13%), where 60% were ER+ve,PR+ve and Her2-ve, also 23% noticed to have PR-ve status. Triple negative status was seen only in two cases(2.8%), one of them was pleomorphic lobular carcinoma, both cases age was > 80 yrs.Ki-67 was tested in 58 patients, it was low or moderate in 66%, 7% was Her2 +ve with high Ki-67.Her2+ve status was associated with tumour grade 2 in 7% of cases, grade 3(1.4%) and grade 1 (4%).Conclusion(s): ER expression is noticed to in HER2+ classical ILCs, in spite of the fact that the level of expression is significantly low, compared with the Her2ve- disease.

Effective implementation of an advanced clinical practitioner role in breast imaging (2021)

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Type of publication:
Conference abstract

Author(s):
*Deane L.; *Williams S.; *Cielecki L.; *Burley S.

Citation:
Breast Cancer Research 2021, 23(Suppl 1):P57

Abstract:
Background: Due to the immense pressure to provide capacity for women with breast symptoms, to be seen  within two weeks, a new innovative role has been created to provide increased capacity. Introduction: The breast services see many women with conditions that are benign and easily identified upon ultrasound. The majority of these conditions occur in women under the age of 40years. The role of an advanced clinical practitioner was created to answer a service need. This role requires a highly specialised cohort of skills combining breast image interpretation, breast ultrasound and breast biopsying alongside a range of clinical competences enabling autonomous practice within clear governance.
Method(s): A new clinic was created for under 40 aged women only requiring only a breast clinical specialist and an advanced clinical practitioner, using ultrasound for assessment. Unexpected findings suspicious upon ultrasound-would be redirected to the next consultant led clinic for full imaging assessment and biopsy.
Result(s): Increased capacity was achieved, without increased costs. Anxiety levels were reduced due to these patients seen within these clinics and more specialist skills could be directed to more complex cases in the traditional cancer clinics.
Conclusion(s): The use of this specialist role has proven to be innovative and specialised in answering capacity issues within the workforce. The ACP role is utilised as a support to all clinics working alongside consultant radiographers as well as in an autonomous role, thereby freeing up the consultants for cases requiring specialist skills. The stability of the breast service has been ensured

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Male breast ultrasound: 2019 audit results (2021)

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Type of publication:
Conference abstract

Author(s):
*Ozcan U.A.; *Williams S.; *Metelko M

Citation:
Breast Cancer Research 2021, 23(Suppl 1):O3.3

Abstract:
Background and Purpose: Male breast cancer is rare whereas gynaecomastia is very common. Only asymmetrical gynaecomastia require breast imaging and focal lumps are amenable to clinical core biopsy. So the use of ultrasound in the assessment of male breast should be limited. The aim of this study is to audit the referral indications and ultrasound outcomes in male breast US (MBUS) patients against local guidelines.
Method(s): In the last 5 years, 968 patients were referred for MBUS in our Trust. This audit includes the patients between 02/01/2019-04/12/2019. The duplicate patients and follow-ups were excluded from the study. In total, 197 patients were analysed (mean age: 58 (8-90) retrospectively. Referral diagnosis, age, US grading and clinical outcomes were noted.
Result(s): Of the 197 patients, 79% were gynecomastia (133), lipoma (21) or fat necrosis (2), and 15% (30) were normal. There was 1 chest wall lymphoma and 1 DCIS, and 9 (5%) patients had benign breast disease (fibroepithelial lesions, abscess, papilloma, sebaceous cysts, haematoma). In 122 patients (62%) clinical grade was not given, 66 had P2, 8 had P3, 1 had P5. 2 patients were scored as U4 and 4 patients as U3.
Conclusion(s): These results clearly show that 99% of the patients referred to MBUS were benign. And also 95% of the patients were clinically benign or not assessed. The excessive use of MBUS without a clinical indication leads to patient anxiety, increased waiting times and might delay the proper imaging to the patients who should have the priority in terms of clinical indication. Careful clinical assessment before ultrasound referral is mandatory for better care.

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