ABSTRACT
As more women put off pregnancy until their 30s and beyond, the possibility of pregnancy-associated breast cancer (PABC) will rise. Treatment options for patients with PABC need to consider possible harm to the fetus. The goal of this study is to review our institution's experience with sentinel lymph node (SLN) biopsies in patients with PABC. A prospectively accrued breast Institutional Review Board (IRB) approved data base was searched under separate IRB approval for cases of SLN biopsy in patients with PABC. Ten patients were identified between 1994 and 2006 out of 5,563 patients. A chart review was performed on all 10 patients. Ten patients with PABC and an average gestation age of 15.8 weeks underwent SLN biopsy. All patients successfully mapped. Positive SLN were identified in 5/10 patients (50%) while there was no evidence of metastases in 5/10 patients (50%). 9/10 (90%) of patients went on to deliver healthy children without any reported problems. One patient (10%) decided to terminate her pregnancy in the first trimester following surgery prior to the start of chemotherapy. SLN biopsy can safely be performed in patients with PABC with minimal risk to the fetus. By performing a SLN biopsy, a large proportion of patients with PABC may be spared the risk of a complete axillary lymph node dissection.
Subject(s)
Breast Neoplasms/pathology , Lymph Nodes/pathology , Pregnancy Complications, Neoplastic/pathology , Prenatal Exposure Delayed Effects , Sentinel Lymph Node Biopsy , Adult , Female , Humans , Lymphatic Metastasis , Maternal Exposure , Neoplasm Staging , Pregnancy , Pregnancy Outcome , Retrospective StudiesABSTRACT
Patients with neurofibromatosis type I and breast cancer represent a subset of people who may be considered at high risk for secondary cancers after conventional whole breast radiation therapy and breast conservation surgery. A case of a 49-year-old woman with neurofibromatosis type I is presented. She was diagnosed with a 1.1-cm right breast infiltrating ductal carcinoma. Clinical, diagnostic imaging, and pathologic features are discussed. Her initial treatment plan of breast conserving therapy was thwarted when her sentinel node biopsy was positive for micrometastatic disease in 1/14 lymph nodes. She elected to have a bilateral simple mastectomy. This case addresses the rare dilemma of offering breast conservation therapy as a viable option for patients with neurofibromatosis type I. Current data on radiation-induced secondary cancers such as sarcoma after treatment for breast and other cancers are reviewed.
Subject(s)
Breast Neoplasms/complications , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/therapy , Neoplasms, Second Primary , Neurofibromatosis 1/complications , Biopsy, Needle , Breast Neoplasms/diagnosis , Carcinoma, Ductal, Breast/diagnosis , Female , Genetic Predisposition to Disease , Humans , Mammography , Mastectomy , Mastectomy, Segmental , Middle Aged , Neoplasms, Radiation-Induced/etiology , Radiotherapy, Adjuvant/adverse effects , Sentinel Lymph Node BiopsyABSTRACT
BACKGROUND: Locoregional chest wall recurrences involving ribs and/or sternum after primary surgical treatment predict a poor outcome in patients with breast cancer. The precise natural history and surgical outcome of these chest wall recurrences are not fully understood. The objective of this study is to clarify the clinicopathological features of chest wall recurrence of breast cancer and evaluate prognostic factors predicting survival after chest wall resection and reconstruction (CWRR). METHODS: A total of 28 patients who underwent CWRR at the H. Lee Moffitt Cancer Center between December 1999 and September 2007 were retrospectively analyzed. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables was evaluated by log-rank and Cox regression analyses. RESULTS: The postoperative morbidity and mortality was 21% and 0%, respectively. Overall 5-year survival for the entire cohort was 18%. Disease-free interval <24 months (P = 0.03) and triple-negative phenotype (P = 0.002) were the only independent predictors of survival. Overall 1-, 2-, and 5-year survival rates for the triple-negative phenotype were 38%, 23%, and 0%, respectively. In contrast, overall 1-, 2-, and 5-year survival rates for the non-triple-negative phenotype were 100%, 70%, and 39%, respectively. CONCLUSIONS: Radical chest wall resection can be done without mortality and acceptable morbidity to accomplish long-term palliation. The strongest predictor of overall survival was the triple-negative phenotype. Because the triple-negative phenotype is not amenable to any form of therapy, palliative resection may be warranted. Development of appropriate targeted therapies to this population of patients is critical.
