Impact of pre-operative breast magnetic resonance imaging on contralateral synchronous and metachronous breast cancer detection—A case control comparison study with 1468 primary operable breast cancer patients with mean follow-up of 102 months

Background Women with unilateral breast cancer are at an increased risk for the development of contralateral breast cancers. We hypothesis that combined breast MRI would detect more contralateral synchronous breast cancer than conventional imaging alone, and resulted in less contralateral metachronous breast cancer during follow-up. Methods We retrospectively collected two groups of breast cancer patients diagnosed from 2009 to 2013 for evaluating the effectiveness and value of adding pre-operative breast MRI to conventional breast images (mammography and sonography) for detection of contralateral synchronous breast cancer. The new metachronous contralateral breast cancer diagnosed during follow-up was prospectively evaluated and compared. Results Group A (n = 733) comprised patients who underwent conventional preoperative imaging and group B (n = 735) combined with MRI were enrolled and compared. Seventy (9.5%) of the group B patients were found to have contralateral lesions detected by breast MRI, and 65.7% of these lesions only visible with MRI. The positive predictive value of breast MRI detected contralateral lesions was 48.8%. With the addition of breast MRI to conventional imaging studies, more surgical excisions were performed in contralateral breasts (6% (44/735) versus 1.4% (10/733), P< 0.01), more synchronous contralateral breast cancer detected (2.9% (21/735) versus 1.1% (8/733), P = 0.02), and resulted in numerical less (2.2% (16/714) versus 3% (22/725), p = 0.3) metachronous contralateral breast cancer during a mean follow-up of 102 months. Conclusions Our study provides useful estimates of the pre-operative breast MRI for the increased detection of contralateral synchronous breast cancer and less subsequent contralateral metachronous breast cancer.

A CASE OF SYNCHRONOUS BILATERAL BREAST CANCER WITH DISCORDANT ESTROGEN RECEPTOR STATUS

Synchronous bilateral breast cancer is dened as two tumours diagnosed within 6 month interval and those above 6 months termed as metachronous breast cancer though there is difference in time interval specied by various clinicians. SBBC is a rare entity with incidence of 0.3 – 1.2% though it is recently increasing due to improved life expectancy after treatment and routine use of contralateral mammography. It is considered that synchronous breast tumours are independent tumours than to be secondary to metastatic spread from primary. Presence of indraductal component, different histology and different degree of differentiation implies that 2 they are independent tumors. Mostly women with BSBC are treated with aggressive measures as they are thought to be aggressive. Recently overall consensus is that bilateral breast cancer is amenable to breast conservation surgeries 1 without compromising surviva

Impact of Pre-Operative Breast Magnetic Resonance Imaging (MRI) on Contralateral Synchronous and Metachronous Breast Cancer Detection- A Case Control Comparison Study With Mean Follow-Up of 102 Months.

Background: Women with unilateral breast cancer are at an increased risk for the development of contralateral breast cancers. We hypothesis that combined breast MRI would detect more contralateral synchronous breast cancer than conventional imaging alone, and resulted in less contralateral metachronous breast cancer during follow-up. Methods: In this case control analysis, we retrospectively collected two groups of patients for evaluating the effectiveness and value of adding pre-operative breast MRI to conventional breast images (mammography and sonography) for detection of contralateral synchronous breast cancer. The new metachronous contralateral breast cancer diagnosed during follow-up was prospectively evaluated and compared. Results: Group A (n=733) comprised patients who underwent conventional preoperative imaging and group B (n=735) combined with MRI were enrolled and compared. Seventy (9.5%) of the group B patients were found to have contralateral lesions detected by breast MRI, and 65.7% of these lesions only visible with MRI. The positive predictive value of breast MRI detected contralateral lesions was 48.8%. With the addition of breast MRI to conventional imaging studies, more surgical excisions were performed in contralateral breasts (6% (44/735) versus 1.4% (10/733), P< 0.01), more synchronous contralateral breast cancer detected (2.9% (21/735) versus 1.1% (8/733), P=0.02), and resulted in numerical less (2.2% (16/714) versus 3% (22/725), p=0.3) metachronous contralateral breast cancer during a mean follow-up of 102 months. Conclusions: Combining pre-operative breast MRI evaluation resulted in an increase of contralateral synchronous breast cancer detection, and a numerical less subsequent contralateral metachronous breast cancer occurrence compared to conventional imaging alone.

Morphometric Characteristics and Features of Metachronous Breast Cancer

An important morphological criterion for the development of the degree of malignancy of breast cancer is the change in the structure of cell nuclei. At the same time, both the morphometric parameters of metachronous breast cancer and their connection with the molecular biological characteristics of these tumors are currently unknown. The objective of the research was to identify metachronous malignant disease in the patients with breast cancer. Materials and methods. The study is based on a retrospective analysis of tumors in 63 patients with breast cancer, who developed uterine cancer or ovarian cancer within 5 years after diagnosis of breast cancer. All the patients received treatment at the Ivano-Frankivsk Regional Clinical Oncology Center. The criterion for selecting patients in the study was the presence of gynecologic cancer after the treatment of breast cancer. The age of patients with breast cancer involved in the study ranged from 24 to 83 years, averaging 56.8±1.5 years. Results and discussion. The maximum values ​​of the perimeter, radius, and area of ​​cell nuclei (19.21±0.7, 3.05±0.4 and 36.3±0.9, respectively) were observed in tumors of the patients with metachronous breast cancer. The improvement of the perimeter, radius, and area of ​​tumor cell nuclei in the patients with metachronous breast cancer was associated with an increase in the size of the tumors and the presence of metastases in regional lymph nodes. Conclusions. The morphometric sign of the high risk of developing metachronous breast cancer is the increase in the perimeter, radius, and cell nucleus area on the background of increased proliferative activity of low-grade cancer in the presence of large tumors and metastases in regional lymph nodes.

A Rare Case of Triple Positive Metachronous Breast Cancer

Metachronous contralateral breast cancer (MCBC) is defined as contralateral breast cancer (BC) diagnosed more than 1 year after previous BC diagnosis. More BC survivors are at risk of MCBC given improved life expectancy with the availability of advanced cancer care. Estrogen receptor/progesterone receptor negative and HER-2-positive status of first BC are independent risk factors for the development of MCBC. We present a rare case of triple positive (estrogen receptor, progesterone receptor, HER-2 positive) MCBC patient who eventually developed brain metastasis within 15 months despite a near complete pathologic response of primary tumor. This case highlights that even in this era of antiestrogen and anti-HER-2 therapies, triple positive MCBC can have an aggressive clinical course, especially with brain metastasis as the first sign of metastasis.