It is recommended that patients with breast cancer who present with mammographically detected microcalcification should undergo postlumpectomy mammogram with magnification views to ensure adequate removal of all clinically demonstrable disease. The value of postlumpectomy mammogram has not been adequately examined in the literature. This report aims to quantify the value of such a study.Retrospective review identified 90 breast cancer patients referred to our department between 1992 and 1997 who met all of the following criteria: (1) patients were considered for breast conserving management; (2) patients had suspicious microcalcifications on diagnostic mammograms; (3) the mammographic lesions were thought to be removed entirely on postexcision specimen radiographs; (4) surgical excisions were thought to be adequate on the basis of a review of the histologic pathology reports; and (5) postlumpectomy mammograms with magnification views were obtained. Fifty patients had invasive adenocarcinoma and 40 patients had ductal carcinoma in situ. The margins of last resection were clear, close, or focally involved in 70, 13, and seven patients, respectively. Patient records were reviewed to determine whether postlumpectomy mammograms demonstrated residual microcalcifications.Sixteen patients (17%) were found to have residual microcalcifications on postlumpectomy mammograms. Twelve patients underwent either local re-excision (seven patients) or simple mastectomy (five patients). Re-excision was not performed in four patients. Residual malignant cells were found in eight patients (67% of the re-excision group and 9% of the whole group). Six of these patients had their tumors initially resected with clear margins and the remaining two patients had their tumors initially resected with close margins.Postlumpectomy mammograms with magnification views detected residual clinical disease in a significant proportion of patients. Our result supports the routine use of this test, even when satisfactory postexcision specimen radiographs and adequate lumpectomy resection margins are obtained. This finding is particularly true for patients with ductal carcinoma in situ.
Abstract Objective The goal was to compare the 5‐year DFS and 5‐year OS in patients with early‐stage human epidermal growth factor receptor 2 breast cancer (HER2+ BC) and triple‐negative breast cancer (TNBC) in relation to the amount of stromal tumor‐infiltrating lymphocytes (TILs) after locoregional management by either mastectomy without radiation or lumpectomy and whole‐breast radiotherapy (RT). Methods This was a retrospective review of HER2+ BC and TNBC patients’ charts and histopathology slides with clinical stage of T1‐T2 N0 who presented at our facility between January 2009 and December 2019. Locoregional treatment included either mastectomy without RT (M) or lumpectomy with RT (L+R). TILs were assessed by three pathologists using the guidelines of the 2014 TILs working group. A competing risk model and Kaplan–Meier analysis were used to analyze correlations between TILs levels and clinical outcome. Results We reviewed 211 patients’ charts. Of them, 190 proceeded to the final analysis. Patients were split into groups of "low TILs" and "high TILs" based on a 50% TILs cut‐off. Of them 26% had high TILs, 48% received RT, 97% received chemotherapy, all HER2+ BC patients received HER2‐directed therapy and all HER2+ BC that were also hormone receptor positive (HR+) received endocrine therapy (ET). In patient with low TILs, L+R did not improve outcomes compared to M. Moreover, patients with high TILs had a significant improvement of their DFS and OS with L+R when compared to M. Conclusion The results of our study reflect that a selected group of HER2+ BC and TNBC with elevated TILs, L+R is associated with improvement of 5‐year DFS and 5‐year OS.
Neutron beam radiotherapy (NRT) has been advocated for treatment of malignant salivary gland tumors and adenoid cystic carcinoma of the paranasal sinuses. The purpose of this study is to determine whether primary or adjuvant NRT results in a significantly increased rate of osteora-dionecrosis (ORN) of the maxillary-orbital complex (MOC).All patients who received primary or adjuvant NRT involving the MOC and/or maxillofacial prosthetic rehabilitation at Wayne State University from 1992 to 1997 were evaluated (n = 9).ORN did not develop in any of the 5 patients who received primary NRT. All 4 patients who received adjuvant NRT after surgical resection had ORN involving the MOC within the irradiated fields.The reported trend of ORN after definitive surgery and NRT shows a markedly increased complication rate.The use of adjuvant NRT after definitive surgical resection involving the MOC should be considered with great caution.
