BOOK
Changing Paradigms in Breast Cancer Diagnosis and Treatment, An Issue of Surgical Oncology Clinics of North America, E-Book
(2017)
Additional Information
Book Details
Abstract
This issue of Surgical Oncology Clinics of North America, guest edited by Dr. Kelly Hunt, is devoted to Changing Paradigms in Breast Cancer Diagnosis and Treatment. Dr. Hunt has assembled expert authors to review the following topics: Tomosynthesis in breast cancer imaging: how does it fit into preoperative evaluation and surveillance?; Lobular breast cancer: different disease, different algorithms?; Hypofractionated radiation therapy in breast conserving therapy; Oncoplastic breast reconstruction: should all patients be considered?; Neoadjuvant endocrine therapy: who benefits most?; Breast cancer disparities: how can we leverage genomics to improve outcomes?; Anatomy and breast cancer staging: is it still relevant?; When does atypical ductal hyperplasia require surgical intervention?; Surgical intervention for lymphedema; Are there alternative strategies in the local management of DCIS?; Genetic testing and genetic counseling: what is standard of care?; Molecular subtypes and local-regional control of breast cancer; Intraoperative margin assessment in breast cancer management; Triple negative breast cancer: who should receive neoadjuvant chemotherapy?; and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Changing Paradigms in Breast Cancer Diagnosis and Treatment\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Innovation in the Diagnosis and Management of Breast Cancer | vii | ||
| Preface: Integrating New Knowledge and Surgical Innovation into the Diagnosis and Management of Breast Cancer | vii | ||
| Considerations in Testing for Inherited Breast Cancer Predisposition in the Era of Personalized Medicine | vii | ||
| When Does Atypical Ductal Hyperplasia Require Surgical Excision? | vii | ||
| Tomosynthesis in Breast Cancer Imaging: How Does It Fit into Preoperative Evaluation and Surveillance? | vii | ||
| Anatomy and Breast Cancer Staging: Is It Still Relevant? | viii | ||
| Are There Alternative Strategies for the Local Management of Ductal Carcinoma in Situ? | viii | ||
| Lobular Breast Cancer: Different Disease, Different Algorithms? | viii | ||
| Molecular Subtypes and Local-Regional Control of Breast Cancer | viii | ||
| Neoadjuvant Endocrine Therapy: Who Benefits Most? | ix | ||
| Triple-Negative Breast Cancer: Who Should Receive Neoadjuvant Chemotherapy? | ix | ||
| Intraoperative Margin Assessment in Breast Cancer Management | ix | ||
| Oncoplastic Breast Reconstruction: Should All Patients be Considered? | ix | ||
| Alternatives to Standard Fractionation Radiation Therapy After Lumpectomy: Hypofractionated Whole-Breast Irradiation and Ac ... | x | ||
| Surgical Intervention for Lymphedema | x | ||
| Breast Cancer Disparities: How Can We Leverage Genomics to Improve Outcomes? | x | ||
| SURGICAL ONCOLOGY\rCLINICS OF NORTH AMERICA\r\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| April 2018 | xi | ||
| July 2018 | xi | ||
| October 2018 | xi | ||
| RECENT ISSUES | xi | ||
| October 2017 | xi | ||
| July 2017 | xi | ||
| April 2017 | xi | ||
| Foreword: Innovation in the Diagnosis and Management of Breast Cancer\r | xiii | ||
| Preface:\rIntegrating New Knowledge and Surgical Innovation into the Diagnosis and Management of Breast Cancer | xv | ||
| Considerations in Testing for Inherited Breast Cancer Predisposition in the Era of Personalized Medicine | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| IDENTIFICATION OF HIGH-RISK INDIVIDUALS | 2 | ||
| GENETIC COUNSELING | 5 | ||
| GENETIC TESTING | 5 | ||
| HIGHLY PENETRANT GENETIC SYNDROMES | 9 | ||
| BRCA1/BRCA2 | 9 | ||
| TP53/Li-Fraumeni Syndrome | 10 | ||
| PTEN/Cowden Syndrome | 13 | ||
| Other High-Penetrance Genes | 14 | ||
| PALB2 | 14 | ||
| CDH1 | 14 | ||
| MODERATE PENETRANCE GENES | 15 | ||
| ATM | 15 | ||
| CHEK2 | 15 | ||
| NEWER GENES WITHOUT A PROVEN ASSOCIATION WITH BREAST CANCER | 16 | ||
| SUMMARY | 16 | ||
| REFERENCES | 16 | ||
| When Does Atypical Ductal Hyperplasia Require Surgical Excision? | 23 | ||
| Key points | 23 | ||
| INTRODUCTION | 23 | ||
| SAMPLING ERROR WITH CORE NEEDLE BIOPSY | 24 | ||
| RADIOLOGIC-PATHOLOGIC CONCORDANCE | 24 | ||
| ATYPICAL DUCTAL HYPERPLASIA | 25 | ||
| CRITERIA FOR CONSERVATIVE MANAGEMENT | 25 | ||
| ADDITIONAL FACTORS TO CONSIDER | 26 | ||
| SUMMARY | 27 | ||
| REFERENCES | 27 | ||
| Tomosynthesis in Breast Cancer Imaging | 33 | ||
| Key points | 33 | ||
| INTRODUCTION | 33 | ||
| TECHNIQUE | 34 | ||
| Radiation Dose | 35 | ||
| Breast Density | 37 | ||
| Contraindications to Digital Breast Tomosynthesis | 37 | ||
| CLINICAL TRIALS | 37 | ||
| STORM Trial | 37 | ||
| TOMMY Trial | 38 | ||
| Clinical Performance Reader Trials | 38 | ||
| BENEFITS OF SCREENING WITH DIGITAL BREAST TOMOSYNTHESIS | 39 | ||
| Cancer Detection Rates | 39 | ||
| Callback Rates | 39 | ||
| CALCIFICATIONS | 41 | ||
| Detection | 41 | ||
| Extent of Ductal Carcinoma In Situ by Digital Breast Tomosynthesis | 41 | ||
| EXTENT OF DISEASE | 41 | ||
| Assessment | 41 | ||
| Clinical Example of Extent of Disease | 43 | ||
| INVASIVE LOBULAR CANCER | 44 | ||
| HIGH-RISK PATIENT EVALUATION | 44 | ||
| RADIAL SCAR AND SCLEROSING PAPILLARY LESIONS | 44 | ||
| DIGITAL BREAST TOMOSYNTHESIS AFTER MRI | 45 | ||
| SUMMARY | 46 | ||
| REFERENCES | 46 | ||
| Anatomy and Breast Cancer Staging | 51 | ||
| Key points | 51 | ||
| WHY CLINICIANS STAGE PATIENTS | 51 | ||
| HOW CLINICIANS STAGE PATIENTS | 52 | ||
| ANATOMIC STAGING, TUMOR GRADING, AND OUTCOMES | 56 | ||
| EVIDENCE TO SUPPORT INCORPORATION OF BIOMARKERS AND IMPLEMENTATION | 62 | ||
| SUMMARY | 65 | ||
| ACKNOWLEDGMENTS | 65 | ||
| REFERENCES | 65 | ||
| Are There Alternative Strategies for the Local Management of Ductal Carcinoma in Situ? | 69 | ||
| Key points | 69 | ||
| INTRODUCTION | 69 | ||
| SURGICAL MANAGEMENT | 70 | ||
| RADIATION THERAPY | 70 | ||
| ENDOCRINE THERAPY | 71 | ||
| NEOADJUVANT THERAPY | 72 | ||
| MEDICAL THERAPY ALONE | 72 | ||
| CONTROVERSIES FOR NONSURGICAL APPROACHES | 73 | ||
| PATIENT-REPORTED OUTCOME MEASURES | 76 | ||
| SUMMARY | 77 | ||
| REFERENCES | 77 | ||
| Lobular Breast Cancer | 81 | ||
| Key points | 81 | ||
| INTRODUCTION | 81 | ||
| EPIDEMIOLOGY | 81 | ||
| HISTOLOGY | 82 | ||
| MOLECULAR BIOLOGY | 83 | ||
| CLINICAL PRESENTATION AND DIAGNOSIS | 84 | ||
| MANAGEMENT | 85 | ||
| UPFRONT SURGERY | 85 | ||
| SURGERY FOLLOWING NEOADJUVANT THERAPY | 87 | ||
| RADIOTHERAPY | 88 | ||
| ADJUVANT SYSTEMIC TREATMENT | 89 | ||
| OUTCOMES | 90 | ||
| SUMMARY AND FUTURE DIRECTIONS | 90 | ||
| ACKNOWLEDGMENTS | 90 | ||
| REFERENCES | 90 | ||
| Molecular Subtypes and Local-Regional Control of Breast Cancer | 95 | ||
| Key points | 95 | ||
| INTRODUCTION | 95 | ||
| ESTROGEN RECEPTOR/PROGESTERONE RECEPTOR | 97 | ||
| ANDROGEN RECEPTOR | 98 | ||
| HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2 | 99 | ||
| KI67 | 100 | ||
| MOLECULAR SUBTYPES | 100 | ||
| Luminal A | 100 | ||
| Luminal B (Human Epidermal Growth Factor Receptor 2–Negative) | 101 | ||
| Human Epidermal Growth Factor Receptor 2 | 101 | ||
| Triple-Negative Breast Cancer | 101 | ||
| Gene Expression Testing | 102 | ||
| 70 Gene Signature | 102 | ||
| 21 Gene Recurrence Score Assay | 103 | ||
| Clinical Outcomes: Local-Regional Recurrence | 104 | ||
| RISK FACTORS FOR LOCAL-REGIONAL RECURRENCE | 104 | ||
| Breast-Conserving Therapy | 104 | ||
| Age | 104 | ||
| Margins | 104 | ||
| Extensive intraductal component | 104 | ||
| Mastectomy | 105 | ||
| Additional Risk Factors | 105 | ||
| Lymphovascular invasion | 105 | ||
| Receptor status | 105 | ||
| BRCA1 and 2 mutation carriers | 105 | ||
| INTRINSIC SUBTYPES, WHAT ROLE? | 106 | ||
| Luminal A | 106 | ||
| Luminal B | 106 | ||
| Luminal Tumor Considerations | 106 | ||
| HER2-Positive Disease | 106 | ||
| Triple-Negative Breast Cancer | 107 | ||
| LOCAL-REGIONAL RECURRENCE AND MOLECULAR SUBTYPES IN THE NEOADJUVANT SETTING | 107 | ||
| LOCAL-REGIONAL RECURRENCE AND AXILLARY DISEASE | 108 | ||
| ONGOING TRIALS AND FUTURE PERSPECTIVES | 109 | ||
| IDEA Study (Individualized Decisions for Endocrine Therapy Alone) | 109 | ||
| PRECISION Trial (Profiling Early Breast Cancer for Radiotherapy Omission) | 109 | ||
| LUMINA | 109 | ||
| SUPREMO Trial | 109 | ||
| SUMMARY | 109 | ||
| REFERENCES | 110 | ||
| Neoadjuvant Endocrine Therapy | 121 | ||
| Key points | 121 | ||
| OVERVIEW | 121 | ||
| NEOADJUVANT ENDOCRINE THERAPY VERSUS NEOADJUVANT CHEMOTHERAPY | 122 | ||
| TUMORS | 125 | ||
| Neoadjuvant Endocrine Therapy in Premenopausal Women | 125 | ||
| Neoadjuvant Endocrine Treatment in Estrogen Receptor–Positive, HER2-Positive Disease | 125 | ||
| THE MOST EFFICACIOUS ENDOCRINE AGENT | 127 | ||
| Tamoxifen Versus Aromatase Inhibitors | 127 | ||
| Comparison of Aromatase Inhibitors | 127 | ||
| Selective Estrogen Receptor Down-Regulators Versus Aromatase Inhibitors | 127 | ||
| DURATION OF TREATMENT | 129 | ||
| PREDICTORS OF RESPONSE AND SURROGATE ENDPOINTS | 131 | ||
| Pathologic Complete Response | 131 | ||
| Ki67 | 131 | ||
| Preoperative Endocrine Prognostic Index | 131 | ||
| Multigene Expression Tests | 132 | ||
| Prediction analysis of microarray 50 | 132 | ||
| Four-gene panel | 132 | ||
| Oncotype DX 21-gene recurrence score | 132 | ||
| WHO BENEFITS MOST? | 133 | ||
| RESIDUAL DISEASE CONSEQUENCES | 133 | ||
| FUTURE DIRECTIONS | 134 | ||
| Neoadjuvant Endocrine Therapy in Combination with Other Drugs | 134 | ||
| Current Ongoing Clinical Trials | 134 | ||
| SUMMARY | 137 | ||
| REFERENCES | 137 | ||
| Triple-Negative Breast Cancer | 141 | ||
| Key points | 141 | ||
| INTRODUCTION | 141 | ||
| INCIDENCE AND CLINICAL PRESENTATION | 142 | ||
| EPIDEMIOLOGY | 142 | ||
| ADJUVANT VERSUS NEOADJUVANT CHEMOTHERAPY | 143 | ||
| Benefits of Neoadjuvant Chemotherapy | 143 | ||
| Surgical Outcomes | 144 | ||
| Pathologic Response to Chemotherapy | 144 | ||
| Role of Platinum Agents in Triple-Negative Breast Cancer | 145 | ||
| Response-Guided Therapy | 146 | ||
| SMALL TUMORS | 146 | ||
| FUTURE DIRECTIONS | 147 | ||
| SUMMARY | 148 | ||
| REFERENCES | 148 | ||
| Intraoperative Margin Assessment in Breast Cancer Management | 155 | ||
| Key points | 155 | ||
| INTRODUCTION: NATURE OF THE PROBLEM | 155 | ||
| PREOPERATIVE LOCALIZATION | 156 | ||
| NEEDLE LOCALIZATION | 157 | ||
| Stereotactic-Guided Needle Localization | 157 | ||
| Ultrasound-Guided Needle Localization | 157 | ||
| Important Considerations for Needle Localization | 157 | ||
| INTRAOPERATIVE ULTRASOUND | 158 | ||
| RADIOGUIDED SURGERY | 158 | ||
| INTRAOPERATIVE ASSESSMENT TECHNIQUES | 159 | ||
| Gross Assessment | 159 | ||
| Specimen Radiograph | 160 | ||
| Frozen Section | 161 | ||
| Cavity Shave Margins | 161 | ||
| INVESTIGATIONAL DEVICES | 161 | ||
| SUMMARY | 161 | ||
| REFERENCES | 162 | ||
| Oncoplastic Breast Reconstruction | 167 | ||
| Key points | 167 | ||
| INTRODUCTION: NATURE OF THE PROBLEM | 167 | ||
| SURGICAL TECHNIQUE | 169 | ||
| Preoperative Planning | 169 | ||
| Anticipated Breast Deformities After Partial Mastectomy | 170 | ||
| Nipple Areolar Location | 171 | ||
| PREPPING AND PATIENT POSITIONING | 171 | ||
| SURGICAL APPROACH | 171 | ||
| SURGICAL PROCEDURE | 172 | ||
| Level II Volume Displacement Procedures | 172 | ||
| Level II Volume Displacement Techniques by Tumor Locations | 173 | ||
| Lower pole tumors | 173 | ||
| Upper pole tumors | 173 | ||
| Central tumors | 174 | ||
| OBESE PATIENTS | 175 | ||
| Level II Volume Replacement Techniques | 175 | ||
| POSTOPERATIVE CARE | 175 | ||
| RECOVERY AND REHABILITATION | 176 | ||
| POSTOPERATIVE SURGICAL COMPLICATIONS | 176 | ||
| DELAYED RECONSTRUCTION FOR PARTIAL MASTECTOMY DEFECTS | 176 | ||
| ONCOLOGICAL OUTCOMES | 177 | ||
| PARTIAL MASTECTOMY MARGIN STATUS | 177 | ||
| COSMETIC AND QUALITY OF LIFE OUTCOMES | 177 | ||
| SUMMARY | 178 | ||
| REFERENCES | 178 | ||
| Alternatives to Standard Fractionation Radiation Therapy After Lumpectomy | 181 | ||
| Key points | 181 | ||
| INTRODUCTION | 181 | ||
| HYPOFRACTIONATED WHOLE-BREAST IRRADIATION | 182 | ||
| EFFICACY OF HYPOFRACTIONATED WHOLE-BREAST IRRADIATION | 182 | ||
| Long-term Toxicity and Cosmesis of Hypofractionated Whole-Breast Irradiation | 184 | ||
| Consensus statement on hypofractionated whole-breast irradiation | 185 | ||
| Clinical considerations for hypofractionated whole-breast irradiation | 185 | ||
| Hypofractionated whole-breast irradiation and boost | 185 | ||
| Hypofractionated whole-breast irradiation and regional nodal irradiation | 185 | ||
| Hypofractionated whole-breast irradiation and chemotherapy | 186 | ||
| Hypofractionated whole-breast irradiation and ductal carcinoma in-situ | 186 | ||
| Utilization of hypofractionated whole-breast irradiation | 186 | ||
| Accelerated Partial Breast Irradiation | 187 | ||
| Multicatheter interstitial brachytherapy | 187 | ||
| Balloon catheter brachytherapy | 187 | ||
| Three-dimensional conformal radiation therapy | 188 | ||
| Intraoperative radiation therapy | 188 | ||
| Consensus statements on accelerated partial breast irradiation | 189 | ||
| Future Directions | 190 | ||
| SUMMARY | 191 | ||
| REFERENCES | 191 | ||
| Surgical Intervention for Lymphedema | 195 | ||
| Key points | 195 | ||
| INTRODUCTION | 195 | ||
| ANATOMY AND PATHOPHYSIOLOGY | 196 | ||
| CLINICAL PRESENTATION | 196 | ||
| CLINICAL MONITORING | 199 | ||
| DIAGNOSTIC IMAGING | 199 | ||
| NONSURGICAL MANAGEMENT OF LYMPHEDEMA | 200 | ||
| PREVENTATIVE SURGICAL TECHNIQUES | 200 | ||
| Sentinel Lymph Node Biopsy | 200 | ||
| Axillary Reverse Mapping | 201 | ||
| Lymphovascular Anastomosis Technique | 202 | ||
| SURGICAL TECHNIQUES | 202 | ||
| Lymphaticovenous Anastomosis | 202 | ||
| Indications | 202 | ||
| Lymphoscintigraphy | 203 | ||
| Technique | 204 | ||
| Results | 204 | ||
| Complications | 204 | ||
| Vascularized Lymph Node Transfer | 205 | ||
| Indications | 205 | ||
| Technique | 205 | ||
| Results | 206 | ||
| Complications | 206 | ||
| COMBINATION PROCEDURES | 207 | ||
| LIPECTOMY | 207 | ||
| SURGICAL EXCISION | 208 | ||
| SUMMARY | 209 | ||
| REFERENCES | 209 | ||
| Breast Cancer Disparities | 217 | ||
| Key points | 217 | ||
| BACKGROUND | 217 | ||
| GERMLINE GENOMICS | 220 | ||
| Hereditary Susceptibility Syndromes in African Ancestry Families | 220 | ||
| Ancestry Informative Markers | 223 | ||
| Genome-Wide Association Studies | 223 | ||
| Epigenetics | 224 | ||
| SOMATIC GENOMICS | 224 | ||
| SUMMARY | 228 | ||
| REFERENCES | 228 |