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 MajeedFatima Memorial Hospital College of Medicine and Dentistry

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

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

Estimation of Residual Tumor size• Physical Examintaion (PE)• Ultrasonography (US)• Mammography (M)• MRI• Contrast Enhanced CT• PET• Light and fluorescent probes (Nanobiotechnology)

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 “

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

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)

Pathological Tumor size

• Largest dimension of tumour bed

was measured on gross examination

• Largest Uni-dimentional strip section

• Selected sample :labelled and submitted in blocks

• Skip lesions /Scattered foci

Spearman AnalysisCorrelation 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

Correlation of tumor measurements Scatter plots

PHYSICAL SIZE ULTRASOUND SIZE

0 1 2 3 4 5 6 7 8 90

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2

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4

5

6

7

8

9

0 1 2 3 4 5 6 7 8 90

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2

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Pathological size

WEIGHTED KAPPA VALUES

MEASUREMENTS WEIGHTED KAPPA

Physical Examination vs Pathological measurements 0.457

Ultrasonography measurements vs Pathological measurements

0.384

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.

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)

References

• Accuracy of physical examintaion,ultrasonography and mamography to predict residual tumor size with correlation with pathrological size ,2006