Peter Willsher

A retrospective study investigating the rate of HER2 discordance between primary breast carcinoma and locoregional or metastatic disease

BackgroundOverall survival of HER2 positive metastatic breast cancer patients has been significantly improved with inclusion of trastuzumab to chemotherapy. Several studies have demonstrated discordant HER2 status in the primary and metastatic tumour. However, rates of discordance vary considerably in published reports.MethodsInformation collected prospectively was analysed for all patients seen from 1999 to 2009 with primary breast cancer and who had biopsy of a local or distant recurrence. Patients were included if adequate tissue was available from both paired samples. Recurrent samples included fine needle aspirations, core and excisional biopsies. HER2 status in all paired samples was assessed by in-situ hybridisation by a single pathologist in a national reference laboratory. This was compared with HER2 immunohistochemistry results provided in the course of routine diagnosis at regional laboratories.ResultsIn total, 157 patients with recurrent (n = 137; 87.3%) or synchronous primary and metastatic (n = 20; 12.7%) breast cancer had biopsy of the metastatic site. The study population comprised of 116 patients with adequate tissue in both primary and metastasis. The concordance between HER2 status of the paired samples by local immunohistochemistry testing and central in-situ hybridization were 78% and 99%, respectively. Only one patient demonstrated HER2 discordance – primary lesion was positive whilst a metastatic site was negative.ConclusionsThis single institution study demonstrated a low rate of HER2 discordance between primary and recurrent breast cancer as assessed by in-situ hybridisation. This contrasts to results reported by others, which may be explained by differences in study methodology, definition of recurrent disease samples and generally small numbers of patients assessed. Despite the current findings, the decision to obtain metastatic tissue for evaluation is influenced by other factors. These include disease-free interval, which may raise the possibility of a new malignancy and the accuracy of initial HER2 assessment of the primary tumour.

LAPAROSCOPIC OOPHORECTOMY IN THE MANAGEMENT OF BREAST DISEASE

Background:  Oophorectomy is being increasingly carried out in the management of breast disease, as either adjuvant treatment for breast cancer or for prevention of ovarian and fallopian tube cancer in BRCA gene mutation carriers. The aims of this study were to determine the surgical outcome of laparoscopic oophorectomy when carried out by breast surgeons and whether laparoscopic oophorectomy can be safely carried out during the same anaesthesia as breast surgery.

Preoperative taxane-based chemotherapy in a standardized protocol for locally advanced breast cancer

Aims:  To assess the feasibility of a standardized multidisciplinary protocol for the management of locally advanced breast cancer (LABC). We also evaluated the accuracy of magnetic resonance imaging (MRI) and positron emission tomography (PET) in predicting the extent of residual disease.

Final results of XRP6976D: Preoperative TAC (docetaxel, doxorubicin, cyclophsophamide) in conjunction with the development of a standard protocol for the management of locally advanced breast cancer

628 Background: In Australia, there is no consistent management approach for locally advanced breast cancer (LABC). Our aim was to assess the feasibility of a standardized multidisciplinary protocol for the management of LABC. In addition, MRI and PET accuracy in predicting extent of residual disease following 6 cycles of TAC was evaluated. Methods: Patients with LABC, (T3/4, N2/3, M0); ECOG 0/1, received preoperative chemotherapy (docetaxel 75mg/m2, doxorubicin 50mg/m2, cyclophosphamide 500mg/m2 (TAC) q21 days for 6 cycles, unless progression or intolerable toxicity). Breast and regional nodes were monitored clinically and by ultrasound. MRI and PET performed at baseline and after cycle 6. Mastectomy or local excision with axillary clearance was done and post-surgery radiotherapy given according to the predetermined protocol. Adjuvant trastuzumab and endocrine therapy given as appropriate. Results: 50 patients were included from three institutions in Perth, Western Australia, April 2005 to October 2006. ...

Assessing wound morbidity after breast surgery using telephone interviews and postal questionnaires

The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) investigated the effect of postdischarge surveillanceon surgical site infection rates for selected surgical procedures.1 A significant number of surgical site infections would have been missed after breast surgery in the absence of postdischarge surveillance. The main reasons for this are the short stay in hospital after breast surgery and a low probability of readmission to hospital if an infection does occur. On the basis of this, SSHAIP recommended postdischarge surveillance for patients having breast surgery. It is difficult to obtain reliable information about surgical site infection rates after surgery at a reasonable cost. In most environments, the direct observations of wounds in the community would need to involve trained observers who were mobile. It is unlikely that patients would readily comply with requests to attend clinics just to have their wounds inspected. The aim of our study was to determine the accuracy of evaluations of wound infection conducted through a telephone interview, backed up by the use of a postal questionnaire for non-contactable patients, 3months after breast surgery. It was conducted in conjunction with a clinical trial evaluating the usefulness of antibiotic prophylaxis in patients undergoing primary, non-reconstructive breast surgery.2 In the clinical trial, patients were monitored for the first 42 days after surgery by a research nurse who reviewed their progress notes each day while they were in hospital; attended review clinics; communicated with outreach services and, when appropriate, made contact with local medical practitioners. Wound infection was defined as the discharge of pus or serous fluid containing pathogenic organisms. Of the 618 patients, 449 (73%) were contactable by telephone, 164 (26%) subsequently replied using the postal questionnaire and 5 (1%) were non-compliant with either approach (it is of interest that none of these patients had any form of wound morbidity detected by the research nurse). The results were the following: sensitivity = 83% (20/24), specificity = 99% (582/589), positive predictive value = 74% (20/27), negative predictive value = 99% (582/586) and overall accuracy = 98% (602/613). Our results support the use of telephone interviews backed up by a postal questionnaire to determine the incidence of site infection after non-reconstructive breast surgery in large groups of patients. Although it is too imprecise either to be used as a research tool or to draw conclusions about individual patients, it does provide a cost-efficient way of monitoring the rate of surgical site infections for a clinical service.