A STUDY OF CLINICOPATHOLOGICAL SIGNIFICANCE AND SHORT TERM COMPLICATIONS OF LEVEL III AXILLARY LYMPH NODE DISSECTION IN EARLY BREAST CARCINOMA.

Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20-59 years. It accounts for 26% of all newly diagnosed cancers in females and is responsible for 15% of the cancer-related deaths in women. Presently, 75,000 new cases occur in Indian women every year. Locally advanced breast cancer (LABC) constitutes more than 50 to 70% of the patients presenting for treatment.

Evaluation of locoregional recurrence in patients with early breast carcinoma post-breast-conserving surgery with and without the use of preoperative chemotherapy

The effects of neoadjuvant chemotherapy in increasing the rate of conservative breast therapy and associated with reducing morbidity and better cosmetic has been fully acknowledged. Now, there are commonly used neoadjuvant chemotherapy for operable early breast carcinomas patients. Currently, neoadjuvant chemotherapy is used for locally advanced breast carcinoma, inflammatory breast cancer, and down staging of the large tumor to allow for breast conservative therapy. A prospective study performed in the department of surgery in Al-Sadder Medical City/Najaf city/Iraq, from the …….. of October 2015 to the 1st of October 2018, where 48 patients presented with a breast cancer diagnosis by clinical examination, Mammography, breast ultrasound, chest x-ray, bone scan, serum CEA, CA15_3 level, the initial diagnosis of breast cancer made by core needle biopsy. Breast saving surgery consisted of wide local excision with a safe margin with standard level I, II lymph node of axilla dissection. The resected specimen and lymph node was sent for histopathological examination; the size, width, length &height dimension were recorded and the resection margin was recorded positive if close to 2mm and negative if >2mm tumor-free margin. The 48 patients enrolled in this study with a mean age at diagnosis of 44.6 ± 8.4 years. 34 patients received neoadjuvant chemotherapy, Locoregional recurrence reported in 4 patients (28.6%) not received neoadjuvant chemotherapy (P. value < 0.001), the higher relapse rate was reported significantly in the cases aged more than 50 years compared to those aged 50 years or below (P. value = 0.05, significant). Neoadjuvant chemotherapy decreases the incidence of locoregional recurrence of early breast carcinoma after breast-conserving surgery.

Proportions and reasons for breast conservation surgery and modified radical mastectomy in early breast carcinoma

Background: Breast cancer is a common cancer among women in India and its incidence is increasing in an alarming rate. There is a paradigm shift in the management of early breast cancer with more emphasis given to breast conservation treatments. This study aimed to assess the proportion of patient underwent breast conservation surgery and reasons to choose breast conservation surgery or modified radical mastectomy in early breast cancer.Methods: Information of 41 patients with early breast carcinoma who attended the institute during the study period and who can choose either modified radical mastectomy or breast conservation surgery depending on their wish are included in the study group and the data thus obtained was entered in MS Excel data sheet and analysed using SPSS 16 software.Results: It was observed that the proportion of women selecting breast conserving therapy increased with improved literacy status. Similarly, menstrual status and location of tumor do have an influence in choosing breast conserving surgery with significant statistical correlation. However, unlike the previous studies we did not find any statistically significant association between age and surgical decision. Similarly, place of residence, and employment status of the patient does not influence the decision to undergo breast conservation surgery.Conclusions: We have to create awareness in the society about the safety of breast conservation treatment to popularize this modality of treatment there by more and more organs can be preserved.

Triple blinded prospective study assessing the impact of genomics: EndoPredict and artificial intelligence Watson for Oncology (WFO) on MDT’s decision of adjuvant systemic therapy for hormone receptor positive early breast carcinoma.

e18013 Background: : Decision on adjuvant systemic therapy in hormone positive early breast carcinoma is the only grey area in breast carcinoma management. This study was done to investigate the concordance between the results of genomic test, artificial intelligence and tumor board decision and implications of the same in clinical practice. Methods: This was a triple blinded, prospective study. Decision regarding the adjuvant systemic therapy was done by the multidisciplinary tumor board (MDT)after reviewing the pathology reports & the results correlated with Endopredict test reports & artificial intelligence(Watson for Oncology). Results: Total of 42 patients included. Mean age was 58.3 years, 71.4% were post-menopausal. Breast conservation was done in 47.6%. 64.2% were T1-2N0 stage. Infiltrating ducal carcinoma was major type (83.3%). Decision by MDT to give adjuvant chemotherapy was for 25 patients (59.5%) & hormonal therapy for rest. Recommendation by Watson for oncology was to give adjuvant chemotherapy in 50%. Endopredict score (EPclin) resulted in a low-risk group of 22 patients (52.3%), while 15(47.6%) had a high risk EPclin score. Discordance between the endopredict test, Watson & tumor board was for 11 patients (26.1%): 3 patients had high risk score, but the tumor board decision was to give hormonal therapy due to the age factor. 8 patients had low risk score, but tumor board decision was to give adjuvant chemotherapy. Extremes of age, premenopausal status, intermediate grade & high Ki 67% values were the factors associated with discordance. The treatment decision changed for 4 patients (4/11, 36%) after reviewing the endopredict test and Watson recommendation. Conclusions: Tumor board decision can be more scientific & evidence based with the help of genomics & a learnt colleague in the form of Watson for Oncology. Even though the clinical experience is the important determinant of adjuvant therapy, genomic test with artificial intelligence, which includes the scientific evidence, will guide in decision making. Long term follow up is needed for the validation in our clinical setting.

A Brief Review on Breast Carcinoma and Deliberation on Current Non Invasive Imaging Techniques for Detection

Background:Breast carcinoma is a life threatening disease that accounts for 25.1% of all carcinoma among women worldwide. Early detection of the disease enhances the chance for survival. </P><P> Discussion: This paper presents comprehensive report on breast carcinoma disease and its modalities available for detection and diagnosis, as it delves into the screening and detection modalities with special focus placed on the non-invasive techniques and its recent advancement work done, as well as a proposal on a novel method for the application of early breast carcinoma detection.Conclusion:This paper aims to serve as a foundation guidance for the reader to attain bird’s eye understanding on breast carcinoma disease and its current non-invasive modalities.