early breast cancer management
TRANSCRIPT
Dr Mukhilesh R MS PG
In Situ Breast CancerEarly Breast Cancer
VS
• Oncologically equivalent.• Better aesthetic outcome.• Psychological advantage with
breast preservation
Still require mastectomy….
• Extensive calcification on mammography
• Clear margins cannot be obtained.
• C/I to irradiation
• previous chest wall irradiation
• Pregnancy
• scleroderma / active lupusPatient preference to mastectomy / desire to avoid
irradiation
• Curvilinear incision – above nipple.
• Radial incision – below nipple.
• If previous bx- scar to be included.
• Adequate clearance.• Specimen orientation.• HPE–hormone status/HER-
2neu
Treatment of axillary node do not alter disease free / overall survival.
Helps to stage the disease, identify the prognosis and need for adjuvant therapy.
Node negative by physical and imaging studies.Not recommended
T3/T4 tumourinflammatory breast capregnancyDCIS without
mastectomyprior axillary surgeryafter preop
chemotherapyCan be done
old age / obesitymale breast caprior excisonal bxbefore preop chemo
In the operating room , 3-5 ml of isosulphan blue injected parenchyma or subareolar
• Hand held gamma counter to identify the location.
• 3-4 cm curved transverse incision below hair line is made and deepened, identify blue lymphatic channels.
• As sentinel lymph node is approached signal increases.
• Frozen section / touch imprint / permanent HPE.
• 10 sec in vivo and 10 sec ex vivo count to be obtained.
• All blue lymph nodes and those with >10% of 10 second ex vivo count are to be removed.
• Entire surgical bed to be scanned.
• Should be <10% 0f 10 sec ex vivo count.
• Complications :• Infection • Seroma• Hematoma• Axillary paresthesia• Dereased range of
motion• Lymphedema of arm.
• Pathologic processing of the sentinel nodes – requires standardisation.
• Intraoperative assessment of node varies in each institution.
• Adverse prognostic factors • Blood vessel or lymph vessel
invasion• High nuclear grade• High histologic grade• HER – 2 /neu over
expression• Negative hormone receptors
• Tamoxifen – hormone positive >1cm
• Trastuzumab – HER-2/neu positive + node positive tumor.