Post neoadjuent breast cancer tumor size

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Post neoadjuent breast cancer tumor size

  1. 1. POST NEOADJUVANT RESIDUAL BREAST TUMOR SIZE;CLINICAL,RADIOLOGICAL AND PATHOLOGICAL CORRELATION Presented By: Dr. Madiha Ehsan-Ul-Haq Dr. Imrana Tanvir, Dr. Sabiha Riaz, Dr. Haseeb Khan and Dr. Huma Majeed Fatima Memorial Hospital College of Medicine and Dentistry
  2. 2. Introduction • Breast cancer:most common cancer diagnosed in women worldwide • Pakistan:90,000 every year • Mastectomy replaced now by neoadjuvent therapy followed by breast conservation surgery or mastectomy
  3. 3. Neoadjuvant Therapy • Neoadjuvant chemotherapy:part of treatment of earlier stage operable cancer • Increase Eligibility for Breast conservation surgery • Efficacy of the systemic therapy can be assessed in vivo • One of the factor determining Post neoadjuvent surgical procedure is residual size of tumor. • Residual tumor size :major prognostic factor
  4. 4. Estimation of Residual Tumor size • • • • • • • Physical Examintaion (PE) Ultrasonography (US) Mammography (M) MRI Contrast Enhanced CT PET Light and fluorescent probes (Nanobiotechnology)
  5. 5. Aim and Objective • Correlation between residual tumor size estimation by these modalities with pathological measurements is heterogenous “To compare Post neoadjuvant residual breast tumor size measured on clinical examination and radiology with gold standard histopathology “
  6. 6. Material and Method • Retrospective study • Conducted at Fatima memorial Hospital and Ittefaq hospital • The study was completed in 4 months • Sample Population:25 cases of Invasive Ductal Carcinoma
  7. 7. Data collection and Analysis • Residual tumor size was measured by Clinical examination (PE) and radiology (US) were recorded from the file. • Size correlation was done using Spearman rho analysis (to measure level of association ) • Weighted Kappa values were deducted (reliability)
  8. 8. Pathological Tumor size • Largest dimension of tumour bed was measured on gross examination
  9. 9. • Largest Unidimentional strip section • Selected sample :labelled and submitted in blocks • Skip lesions /Scattered foci
  10. 10. Spearman Analysis Correlation of Postneoadjuvant residual tumor size Comparison Postneoadjuvant Chemotherapy PE VS US 0.633 PE VS PATHOLOGY 0.722 US VS PATHOLOGY 0.394 <0=negative correlation , 0-0.5=weak positive correlation ,0.5-1=strong positive correlation
  11. 11. Correlation of tumor measurements Scatter plots PHYSICAL SIZE 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 0 ULTRASOUND SIZE 9 0 0 2 4 6 8 10 Pathological size 0 2 4 6 8 10
  12. 12. WEIGHTED KAPPA VALUES MEASUREMENTS WEIGHTED KAPPA Physical Examination vs Pathological measurements 0.457 Ultrasonography measurements vs Pathological measurements 0.384
  13. 13. Conclusion • Post neoadjuvent tumor Size estimation of breast tumor by Clinical examination and Radiological modalities correlated on a moderate level with the gold standard pathological tumor size • Compared to radiological, Clinical tumor size estimation correlate better with pathological tumor size estimation.
  14. 14. Take home message • SURGEONS:should try to get Wider Margins to avoid positive margins • PATHOLOGIST:More cautious when dealing with post neoadjuvant residual tumor size ( gross,sampling and reporting)
  15. 15. References • Accuracy of physical examintaion,ultrasonography and mamography to predict residual tumor size with correlation with pathrological size ,2006

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