B. Shea1, W. Boyan1, K. Kamrani1, G. Lepis2, S. Chang1, M. Goldfarb1, D. Dupree1, M. Kohli1 2St. George’s University School Of Medicine,St. George’s, St. George’s, Grenada 1Monmouth Medical Center,Surgery,Long Branch, NJ, USA
Introduction:
Breast conservation therapy has become a preferred method of treating early stage breast cancer by many surgeons and patients. Multiple trials have shown similar survival rates with less invasive surgery to both the breast and axilla thanks in part to adjuvant therapies and a better understanding of breast cancer biology. As care continues to evolve, different sizes and types of lesions are allowed less invasive treatment options. A relatively simple explanation of early breast cancer care is detection, biopsy, surgery and adjuvant therapy. The authors in this article look to challenge that algorithm for a specific type of disease.
Methods:
A single institution retrospective review was performed to identify all patients over the last five years who have undergone breast biopsy for malignant or pre-malignant lesions. Of these, 115 met the requirements of being less than one centimeter at detection and undergoing the traditional treatment algorithm outlined above. These cases were analyzed for biopsy technique and outcome of final surgical excision to find when no residual disease was found upon final pathology because the entire lesion was removed by the initial biopsy.
Results:
The authors found that seventeen of 115 patients (14.8%) who underwent biopsy for sub cm breast cancer had no residual disease found on final surgical resection. Neither size of biopsy sample nor size of the lesion correlated with having no residual disease on surgical resection. Although size of needle also didn’t reach statistical significance, the smallest needle biopsies were never found to have no residual disease (ten patients) on final pathology while biopsies with the largest 7 gauge needle was found to have negative pathology in two out of three patients.
Conclusion:
This study looked at 115 patients that were diagnosed and treated for sub cm breast cancer in the standard: detection, biopsy, surgery pathway. The authors thought that sub cm lesions represents a unique subset of breast cancer that presents a plethora of questions. If the ever shrinking margins can be obtained with a biopsy needle, what benefit does a formal resection provide? Many lumpectomies result in comparatively large resections for a small lesion, causing cosmetic distress. Although 14.8% is not a large portion of the samples, this number was obtained when radiologists were merely trying to get a sample of tissue for diagnosis. If sub cm lesions could be treated with a larger needle and effort to resect the whole mass, the yield could be much higher. Prospective protocol based trials would be needed to truly see how much sub cm breast cancer is truly left after biopsy alone.