S E Singletary

....

..These articles are extraordinary not only for breaking new ground in their respective technical areas, but also for the keen insights shown by the authors into what would become important in the future...

..This new frontier of surgery without scalpels will require surgeons to develop radiologic expertise and to acquire a basic understanding of molecular biology...

..Revisions of the previous staging system are related to the number of affected axillary lymph nodes and to the classification of level III axillary lymph nodes and lymph nodes outside of the axilla...

..By increasing the number of prognostic markers that can give independent information about patient outcome, physicians will be better able to determine optimal treatment approaches for individual patients...

..The addition of chest x-rays as part of routine follow-up should be considered as a cost-effective approach for early assessment of metastases to the lung or sternum that may be appropriate for surgical excision...

..Successful ablation will be determined by core and fine needle biopsies, and long-term outcomes will be assessed using imaging studies and quality of life measurement scales for 5 years following treatment...

..This article will discuss such techniques in three evolving areas: 1) management of the axilla after neoadjuvant chemotherapy; 2) sentinel node dissection; and 3) radiofrequency ablation of primary tumors of the breast...

..This review examines published reports about standard and innovative approaches to assessing surgical margins, the clinical significance of margin size, and risk factors for positive margins...

..Surrogate end point biomarkers (SEBs) that can be measured in ductal carcinoma in situ or early-stage invasive cancer are needed to improve the efficiency and reduce the cost of chemoprevention trials...

..To revise the American Joint Committee on Cancer staging system for breast carcinoma...

..To examine treatment trends in invasive lobular carcinoma (ILC) over the last 15 years and, in particular, to compare rates of recurrence and disease-free survival associated with breast conservation therapy compared with mastectomy...

..To update and summarize evidence of risk factors for breast cancer...

..However, there are no medical contraindications to breast reconstruction after mastectomy, although most clinicians prefer to wait until after the completion of radiotherapy before attempting this additional surgery...

..Effective mentoring is especially critical in the training of surgeons. The practice of surgery in the 21st century is changing rapidly at every level, requiring a more complex approach to mentoring young surgeons...

..Accurate diagnosis is critically important, as multimodal therapy can significantly improve outcomes if instituted early enough...

..These deficits may be filled by future developments in functional imaging (e.g., positron emission tomography) and nanobiotechnology...

..It will be important for surgeons to stay aware of all developments that may improve the care of their patients and to be true surgical oncologists rather than merely surgical technicians...

..We conducted a prospective randomized trial to compare standard-dose chemotherapy with the same therapy followed by high-dose chemotherapy. PATIENTS and..

..0001). CONCLUSIONS: Occult primary carcinoma with axillary metastases can be treated with preservation of the breast without a negative impact on local control or survival...

..To determine the impact of tamoxifen and chemotherapy on local control for breast cancer patients treated with breast-conservation therapy...

..To determine local-regional failure rates in breast cancer patients treated with surgery and high-dose chemotherapy with stem cell transplant and to relate local-regional failure to the use and timing of radiation treatment...

..These new, less invasive approaches require the close cooperation of a team of physicians,including surgeons, pathologists, radiologists, and medical and radiation oncologists...

..To compare prospectively the antitumor activity of single-agent paclitaxel to the three-drug combination of fluorouracil, doxorubicin, and cyclophosphamide (FAC) as neoadjuvant therapy in patients with operable breast cancer...

....

..This treatment should be considered as the standard of care for elderly patients without severe comorbid disease...

....

..CONCLUSION: Physical examination, ultrasonography, and mammography were only moderately useful for predicting residual pathologic tumor size after neoadjuvant chemotherapy...

..These factors predict for high LRR rates regardless of the number of involved axillary nodes...

..The reported literature in this area, including a discussion of the value of genetic counseling and genetic testing, is reviewed...

....

..For most patients with clinical T1 or T2 disease and one to three positive lymph nodes, the 5-year risk for LRR was low, and the routine inclusion of postmastectomy radiotherapy does not appear to be justified...

..Patients with 20% or greater involved nodes and those with less than 20% nodes and tumors of 5.0 cm or greater are at significant risk of LRR and should be considered for postoperative irradiation...

....

..Nonetheless, BCS can be performed safely if negative margins are achieved and if appropriate adjuvant radiotherapy or systemic therapy is administered...

..543 and P = 0.540, respectively). CONCLUSIONS: Although the finding of SLN micrometastases by IHC may change management in > 12% of patients, preliminary results suggested that such micrometastases do not affect outcomes significantly...

..A scoring system incorporating these factors may help determine which patients would benefit from additional axillary surgery...

..Breast ductal fluid can be obtained from women by simple nipple aspiration and may be useful for analyzing the microenvironment of the breast...

..The current findings have implications for current trials evaluating aromatase inhibitors and other chemopreventive agents for this disease...

..Because of technical difficulties and variations in the measurement of many of these factors, tumor size and tumor grade remain the only markers that currently have broad clinical usefulness for this patient group...

..An ongoing study is investigating the use of radiofrequency ablation for the treatment of breast tumors 2 cm or less in diameter...

....

..This technique effectively addresses the problem of preoperative localization of the tumor bed in complete or nearly complete response of breast cancer to neoadjuvant chemotherapy...

..Lymphatic mapping with blue dye should be performed in a setting where personnel are trained to recognize and treat anaphylaxis...

..Prospective studies are needed to examine whether decreasing the RVs in this patient population leads to an increased LRR rate...

..Improved breast imaging methods after chemotherapy are necessary to improve accuracy in predicting the feasibility of BCT, especially in patients presenting with diffuse calcifications or multicentricity...

..Disease-specific survival among patients with LRR was similar to that among patients with no recurrence. CONCLUSIONS: Multidisciplinary treatment strategies should be used to accomplish durable locoregional control after BCT...

..Advanced nodal involvement at diagnosis, residual tumor larger than 2 cm, multifocal residual disease, and lymphovascular space invasion predict higher rates of LRR and IBTR...

..The current low incidence of IBTR with multidisciplinary management of breast carcinoma may result in more patients choosing BCT over mastectomy...

..We conclude that the use of skin-sparing technique for early breast cancer patients does not significantly increase the risk of tumor recurrence after mastectomy...

..Because of the significant frequency of false-negative results in SLNB, which will depend upon the surgeon's experience, caution is urged in determining when ALND can be safely eliminated in patients with a negative SLNB...

..Patient survey revealed a satisfaction rate of 86%. CONCLUSION: Bilateral reduction mammoplasty is a reasonable and safe option for breast cancer patients with macromastia who desire breast conservation therapy...

..Identification of malignant intraMLNs by lymphatic mapping may help to identify high-risk patients for whom further evaluation of the axillary lymph nodes is warranted despite otherwise clinically negative findings in the axilla...

..Determinants of prognosis after IBTR should be taken into account when evaluating the need for further systemic therapy and designing risk-stratified clinical trials...

..Agreement of residual tumor size in mammography and sonography with pathologic residual tumor size was moderate...

..Concurrent ADH, ALH, or LCIS with DCIS is not a contraindication to BCT...

..TIC seems to be an acceptable substitute for frozen section as a nomogram variable. The nomogram may help predict an individual's risk of non-SLN metastases and assist in patient decision making regarding the benefit of CLND...

..Longterm followup of patients with lymphoscintigraphic evidence of extraaxillary drainage is needed to determine whether regional and systemic recurrence patterns differ in these patients...

..Collaboration with a plastic surgery team may be beneficial in the surgical management of these patients...

..Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. An appreciation of associated pathology with IPC may be critical in surgical decision-making...

..We investigated whether intraoperative margin assessment aids in obtaining negative margins, and to evaluate the local control thus achieved...

..The aim of this study was to examine ER expression in LCIS to determine the relationship of ERalpha to ERbeta and, thereby, to determine whether it is of clinical value to measure ERbeta along with ERalpha...

..Resection of the tumor bed remains necessary in women deemed to have a complete clinical response to ensure low rates of recurrence...

..To determine whether estrogen replacement therapy (ERT) alters the development of new or recurrent breast cancer in women previously treated for localized breast cancer...

..These trials will answer some of the many questions that remain regarding optimal hormonal therapy for hormone-dependent breast cancer...

..No significant clinicopathologic criteria were found to impact sensitivity of ultrasonography; however, excisional biopsy for diagnosis may be a confounding variable in subsequent axillary ultrasonography...

..Risks and benefits of SLNB should be discussed with patients who are younger, are diagnosed by core-needle biopsy, or have large or high-grade DCIS...

..This is because patients with new carcinomas had significantly lower rates of metastasis than those with local disease recurrence, but were more likely to develop contralateral breast carcinomas...

..These patients have favorable rates of long-term local control and survival. Mastectomy is not mandatory for all patients with breast cancer who present with skin involvement...

..Breast-conservation surgery and radiotherapy is associated with grade 2 or greater complications in only 9.9% of patients. Nearly half of these complications are attributable to axillary dissection...

..In patients with pathologic discharge with normal findings on physical examination and other imaging studies, ductography might be the only means of localizing and resecting breast lesions associated with nipple discharge...

..The delay between injection and surgery did not appear to promote significant passage of sulfur colloid to second-echelon nodes...

..Antibiotic prophylaxis is controversial in patients undergoing axillary lymph node dissection (ALND). We determined whether preoperative antibiotics decreased incidence or treatment cost of infectious complications following ALND...

..The purpose of this study was to determine long-term outcome in patients achieving pCR of cytologically proven axillary lymph node (ALN) metastases...

....

..0001). CONCLUSIONS: Patients with CWR are a heterogeneous population. Patients with initial node-negative disease who develop CWR after 24 months have an optimistic prognosis, especially if they are treated with radiation...

..CONCLUSIONS: Paget's disease of the breast is almost always associated with an underlying breast cancer. Breast-conserving approaches result in local control and survival rates similar to those achieved with mastectomy...

..In this prospective randomized trial, the role of paclitaxel was evaluated in an adjuvant setting to determine its impact on reducing the risk of recurrence in patients with operable breast cancer...

..To compare the pathologic factors associated with postmastectomy locoregional recurrence (LRR) in breast cancer patients not receiving radiation who were treated with neoadjuvant chemotherapy (NEO) vs. adjuvant chemotherapy (ADJ)...

....

..To the authors' knowledge there are few data that correlate the expression of the epidermal growth factor receptor (EGFR) with the outcome of patients who have breast carcinoma and are treated with anthracycline chemotherapy...

..Above all, the patient with breast cancer diagnosed during pregnancy is best served by early and continued involvement of a multidisciplinary cancer treatment team...

..The purpose of the current study was to determine long-term outcome in patients achieving a pCR of cytologically proven inflammatory breast carcinoma ALN metastases after primary chemotherapy...

..Alternative therapeutic strategies such as novel systemic agents, use of planned myocutaneous repair for closure, or radiation combined with radiosensitizing agents, should be considered in this class of patients...

..The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies...

..Cytologic-histologic correlations of NAF were performed in only a few studies...

..To define clinical and pathologic predictors of local-regional recurrence (LRR) for patients treated with neoadjuvant chemotherapy and mastectomy without radiation...

..To determine the characteristics of popular breast cancer related websites and whether more popular sites are of higher quality...

....

..These data support the continued use of immediate breast reconstruction without fear of concealing a recurrence or influencing the oncologic outcome...

....

..05). CONCLUSIONS: Among patients treated with BCT for larger breast tumors, patients treated with preoperative chemotherapy have less extensive resection, with no change in rates of re-excision...

..The best result is obtained when similar methods and tissues are used on both sides...

....

..Larger studies are needed to confirm our findings...

..The subset of patients who would most benefit from surgery remains unclear. This study evaluates the pathological attributes and optimum timing for surgery in patients who present with stage IV breast cancer and an intact primary...

..Ongoing clinical and translational research in breast cancer seeks to improve the efficacy of systemic agents for use in the conventional postoperative (adjuvant) setting...

..CONCLUSION: Using daily menstrual bleeding records, it is demonstrated that age, the specific chemotherapy regimen received, and tamoxifen use impact ovarian function...