This document discusses in situ breast cancer and early breast cancer treatment options. It provides details on breast conservation surgery versus mastectomy, indications for each, and surgical techniques for breast conservation. It also discusses sentinel lymph node biopsy procedures and complications. Finally, it notes that adjuvant therapy after surgery may include tamoxifen for hormone positive tumors or trastuzumab for HER2-positive node positive cancers based on pathological factors.

1. In Situ Breast Cancer
Early Breast Cancer
Dr Mukhilesh R MS PG

5. VS

9. • Oncologically equivalent.
• Better aesthetic outcome.
• Psychological advantage with breast
preservation

11. Still require mastectomy….
• Extensive calcification on mammography
• Clear margins cannot be obtained.
• C/I to irradiation
• previous chest wall irradiation
• Pregnancy
• scleroderma / active lupus
Patient preference to mastectomy / desire to avoid irradiation

12. • Curvilinear incision – above
nipple.
• Radial incision – below nipple.
• If previous bx- scar to be
included.
• Adequate clearance.
• Specimen orientation.
• HPE–hormone status/HER-2neu

14. Treatment of axillary node do
not alter disease free / overall
survival.
Helps to stage the disease,
identify the prognosis and need
for adjuvant therapy.

16. Node negative by physical and
imaging studies.
Not recommended
T3/T4 tumour
inflammatory breast ca
pregnancy
DCIS without mastectomy
prior axillary surgery
after preop chemotherapy
Can be done
old age / obesity
male breast ca
prior excisonal bx
before preop chemo

18. In the operating room , 3-5 ml of isosulphan blue injected
parenchyma or subareolar

19. • Hand held gamma counter to identify the location.
• 3-4 cm curved transverse incision below hair line is made
and deepened, identify blue lymphatic channels.
• As sentinel lymph node is approached signal increases.
• Frozen section / touch imprint / permanent HPE.

20. • 10 sec in vivo and 10 sec ex vivo count to be obtained.
• All blue lymph nodes and those with >10% of 10 second
ex vivo count are to be removed.
• Entire surgical bed to be scanned.
• Should be <10% 0f 10 sec ex vivo count.

21. • Complications :
• Infection
• Seroma
• Hematoma
• Axillary paresthesia
• Dereased range of
motion
• Lymphedema of arm.
• Pathologic processing of the sentinel nodes – requires
standardisation.
• Intraoperative assessment of node varies in each
institution.

23. • Adverse prognostic factors
• Blood vessel or lymph vessel
invasion
• High nuclear grade
• High histologic grade
• HER – 2 /neu over expression
• Negative hormone receptors
• Tamoxifen – hormone positive >1cm
• Trastuzumab – HER-2/neu positive + node positive tumor.