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Breast Conservation After Neoadjuvant Chemotherapy

¹ The Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Israel
² Tel Aviv University, Sackler School of Medicine, Ramat Aviv, Tel Aviv, Israel
³ Department of Surgical Oncology ("C"), Chaim Sheba Medical Center, Tel Hashomer, Israel
⁴ Division of Oncology, Breast Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
⁵ Institute of Oncology, Breast Unit, Rabin Medical Center, Petach Tikva, Israel
⁶ Biostatistics Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

Correspondence: Address correspondence and reprint requests to: Siegal Sadetzki, MD, Cancer Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel; E-mail: siegals{at}gertner.health.gov.il.

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.

Key Words: Breast cancer • Breast conservation • Preoperative chemotherapy • Decision making