Breast conservation after neoadjuvant chemotherapy.
BACKGROUND
Tumor downstaging by preoperative neoadjuvant chemotherapy in patients with locally advanced breast tumors allows breast conservation in women who were previously candidates for mastectomy. Nevertheless, lumpectomy success in such cases cannot be fully achieved. The aim of this study was to create a quantitative tool for preoperative evaluation of the success of breast conservation in such patients.


METHODS
The study population included 100 consecutive patients with stage II and III breast cancer who were designated for lumpectomy and 19 patients who were designated for mastectomy. All patients received neoadjuvant therapy. Breast-conserving surgery was offered in accordance with clinical and esthetic criteria. Demographic details and clinical, imaging, and pathologic information were collected from medical files. A decision protocol for classifying patients to lumpectomy or mastectomy was built by using the Classification and Regression Trees procedure based on preoperative characteristics.


RESULTS
Three factors were found to be the main predictors for successful breast conservation: absence of diffuse microcalcifications as seen in the pretreatment mammogram, a postchemotherapy tumor size of < 25 mm, and the existence of a circumscribed lesion on mammography.


CONCLUSIONS
The use of these criteria as a basis for decision on the type of surgery may decrease the performance of unnecessary procedures.
Sadetzki
Siegal
S
The Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. siegals@gertner.health.gov.il
Oberman
Bernice
B
Zipple
Douglas
D
Kaufman
Bella
B
Rizel
Shulamit
S
Novikov
Ilya
I
Papa
Moshe Z
MZ
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D002114:Calcinosis; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis