Response of locally advanced breast cancer to primary chemotherapy; is it eligible for breast conservation

Assess the eligibility of breast-conserving surgery for large tumours after response to primary chemotherapy [PCT]. 50 patients with locally advanced cancer breast presented to Alexandria Surgical Oncology Unit. All patients had complete breast examination, mammography, and US and core biopsies before started of PCT in the form of 4 cycles of either Adryamicine or Cyclophosphamide [AC] or 5-flurouracil, Epirubicin, and Cyclophosphamide [FEC]. All responders underwent modified radical mastectomy. Single histopathologist had reviewed all operative specimens. The questionable area which is the difference between pre and post PCT sizes were examined carefully for at least 4 different radial par-tumour areas, searching for any residual tumour tissue. 5 patients [10%] achieved complete clinical response [CR] and 38 patients [76%] partial clinical response [PR]. Total of 402 slides were examined from questionable areas with positive tumour tissue present in only 22 of them, which belong to 7 patients only out of 43 responders [16.3%]. Multivariate analysis showed that: smaller initial tumour size < 5cm, absence of ductal carcinoma insitue and absence of vascular invasions were the best predictors of absence of tumour tissue in questionable area slides. Those factors were good indicators of eligibility of breast conserving surgery in responders locally advanced breast tumours to PCT