Breast Cancer

Key clinical point: Higher levels of leisure-time physical activity reduced the risk for premenopausal breast cancer (BC) significantly, with more prominent effects observed for human epidermal growth factor receptor 2 (HER2)-enriched BC.

Major finding: At a median follow-up of 11.5 years, higher vs lower levels (90^th vs 10^th percentile) of leisure-time physical activity were associated with a 10% reduced risk for overall BC (adjusted hazard ratio [aHR] 0.90; P < .001) and a substantial 45% reduction in the risk for HER2-enriched BC (aHR 0.55; 95% CI 0.37-0.82).

Study details: Findings are from a pooled analysis of the data from 19 prospective cohorts that included a total of 547,601 premenopausal women with 10,231 incident cases of in situ or invasive BC.

Disclosures: This study was supported by the Intramural Research Program of the US National Cancer Institute and US National Institutes of Health, and other sources. Some authors declared employment with; holding patents, stocks, and other ownership interests in; serving in consulting or advisory roles for; or receiving honoraria or research funding from various sources.

Source: Timmins IR et al. International pooled analysis of leisure-time physical activity and premenopausal breast cancer in women from 19 cohorts. J Clin Oncol. 2023 (Dec 11). doi: 10.1200/JCO.23.01101

Key clinical point: Higher levels of leisure-time physical activity reduced the risk for premenopausal breast cancer (BC) significantly, with more prominent effects observed for human epidermal growth factor receptor 2 (HER2)-enriched BC.

Major finding: At a median follow-up of 11.5 years, higher vs lower levels (90^th vs 10^th percentile) of leisure-time physical activity were associated with a 10% reduced risk for overall BC (adjusted hazard ratio [aHR] 0.90; P < .001) and a substantial 45% reduction in the risk for HER2-enriched BC (aHR 0.55; 95% CI 0.37-0.82).

Study details: Findings are from a pooled analysis of the data from 19 prospective cohorts that included a total of 547,601 premenopausal women with 10,231 incident cases of in situ or invasive BC.

Disclosures: This study was supported by the Intramural Research Program of the US National Cancer Institute and US National Institutes of Health, and other sources. Some authors declared employment with; holding patents, stocks, and other ownership interests in; serving in consulting or advisory roles for; or receiving honoraria or research funding from various sources.

Source: Timmins IR et al. International pooled analysis of leisure-time physical activity and premenopausal breast cancer in women from 19 cohorts. J Clin Oncol. 2023 (Dec 11). doi: 10.1200/JCO.23.01101

Key clinical point: Higher levels of leisure-time physical activity reduced the risk for premenopausal breast cancer (BC) significantly, with more prominent effects observed for human epidermal growth factor receptor 2 (HER2)-enriched BC.

Major finding: At a median follow-up of 11.5 years, higher vs lower levels (90^th vs 10^th percentile) of leisure-time physical activity were associated with a 10% reduced risk for overall BC (adjusted hazard ratio [aHR] 0.90; P < .001) and a substantial 45% reduction in the risk for HER2-enriched BC (aHR 0.55; 95% CI 0.37-0.82).

Study details: Findings are from a pooled analysis of the data from 19 prospective cohorts that included a total of 547,601 premenopausal women with 10,231 incident cases of in situ or invasive BC.

Disclosures: This study was supported by the Intramural Research Program of the US National Cancer Institute and US National Institutes of Health, and other sources. Some authors declared employment with; holding patents, stocks, and other ownership interests in; serving in consulting or advisory roles for; or receiving honoraria or research funding from various sources.

Source: Timmins IR et al. International pooled analysis of leisure-time physical activity and premenopausal breast cancer in women from 19 cohorts. J Clin Oncol. 2023 (Dec 11). doi: 10.1200/JCO.23.01101

Key clinical point: In patients with human epidermal growth factor receptor 2-negative (HER2−) inflammatory breast cancer (BC), the estrogen receptor-positive (ER+)/progesterone receptor-negative (PR−) vs ER+/PR+ phenotype was associated with significantly worse survival outcomes.

Major finding: Patients with ER+/PR‒ vs ER+/PR+ phenotype had significantly worse BC-specific survival (hazard ratio [HR] 1.764; P < .001) and overall survival (HR 1.675; P < .001) outcomes.

Study details: This retrospective study analyzed the data of 1553 women with ER+/HER2− inflammatory BC from the Surveillance, Epidemiology, and End Results (SEER) database, of whom 25.5% and 74.5% of patients presented with ER+/PR− and ER+/PR+ phenotypes, respectively.

Disclosures: This study was supported by grants from the North Sichuan Medical College Scientific Research and Development Project and Guigang Science and Technology Project. The authors declared no conflicts of interest.

Source: Luo Y et al. ER+/PR− phenotype exhibits more aggressive biological features and worse outcome compared with ER+/PR+ phenotype in HER2-negative inflammatory breast cancer. Sci Rep. 2024;14:197 (Jan 2). doi: 10.1038/s41598-023-50755-4

Key clinical point: In patients with human epidermal growth factor receptor 2-negative (HER2−) inflammatory breast cancer (BC), the estrogen receptor-positive (ER+)/progesterone receptor-negative (PR−) vs ER+/PR+ phenotype was associated with significantly worse survival outcomes.

Major finding: Patients with ER+/PR‒ vs ER+/PR+ phenotype had significantly worse BC-specific survival (hazard ratio [HR] 1.764; P < .001) and overall survival (HR 1.675; P < .001) outcomes.

Study details: This retrospective study analyzed the data of 1553 women with ER+/HER2− inflammatory BC from the Surveillance, Epidemiology, and End Results (SEER) database, of whom 25.5% and 74.5% of patients presented with ER+/PR− and ER+/PR+ phenotypes, respectively.

Disclosures: This study was supported by grants from the North Sichuan Medical College Scientific Research and Development Project and Guigang Science and Technology Project. The authors declared no conflicts of interest.

Source: Luo Y et al. ER+/PR− phenotype exhibits more aggressive biological features and worse outcome compared with ER+/PR+ phenotype in HER2-negative inflammatory breast cancer. Sci Rep. 2024;14:197 (Jan 2). doi: 10.1038/s41598-023-50755-4

Key clinical point: In patients with human epidermal growth factor receptor 2-negative (HER2−) inflammatory breast cancer (BC), the estrogen receptor-positive (ER+)/progesterone receptor-negative (PR−) vs ER+/PR+ phenotype was associated with significantly worse survival outcomes.

Major finding: Patients with ER+/PR‒ vs ER+/PR+ phenotype had significantly worse BC-specific survival (hazard ratio [HR] 1.764; P < .001) and overall survival (HR 1.675; P < .001) outcomes.

Study details: This retrospective study analyzed the data of 1553 women with ER+/HER2− inflammatory BC from the Surveillance, Epidemiology, and End Results (SEER) database, of whom 25.5% and 74.5% of patients presented with ER+/PR− and ER+/PR+ phenotypes, respectively.

Disclosures: This study was supported by grants from the North Sichuan Medical College Scientific Research and Development Project and Guigang Science and Technology Project. The authors declared no conflicts of interest.

Source: Luo Y et al. ER+/PR− phenotype exhibits more aggressive biological features and worse outcome compared with ER+/PR+ phenotype in HER2-negative inflammatory breast cancer. Sci Rep. 2024;14:197 (Jan 2). doi: 10.1038/s41598-023-50755-4

Key clinical point: Combining radiotherapy with pyrotinib and capecitabine led to improved intracranial survival outcomes and an acceptable radiation necrosis rate in patients with human epidermal growth factor receptor 2-positive (ERBB2+) breast cancer (BC) with brain metastases.

Major finding: The 1-year central nervous system (CNS) progression-free survival (PFS) rate was 74.9% (95% CI 61.9%-90.7%), and the median CNS PFS was 18.0 months (95% CI 15.5-not reached). Diarrhea (7.5%) was the most common grade ≥ 3 treatment-related adverse event. Asymptomatic radiation necrosis was identified in only 6% of the 67 lesions treated with fractionated stereotactic radiotherapy.

Study details: Findings are from a phase 2 trial that included 40 women with ERBB2+ BC and brain metastases who received fractionated stereotactic or whole-brain radiotherapy and initiated treatment with pyrotinib and capecitabine.

Disclosures: This study was supported by the National Natural Science Foundation of China (NSFC). Three authors declared receiving grants or personal fees from various sources, including the NSFC.

Source: Yang Z et al. Brain radiotherapy with pyrotinib and capecitabine in patients with ERBB2-positive advanced breast cancer and brain metastases: A nonrandomized phase 2 trial. JAMA Oncol. 2024 (Jan 4). doi: 10.1001/jamaoncol.2023.5791

Key clinical point: Combining radiotherapy with pyrotinib and capecitabine led to improved intracranial survival outcomes and an acceptable radiation necrosis rate in patients with human epidermal growth factor receptor 2-positive (ERBB2+) breast cancer (BC) with brain metastases.

Major finding: The 1-year central nervous system (CNS) progression-free survival (PFS) rate was 74.9% (95% CI 61.9%-90.7%), and the median CNS PFS was 18.0 months (95% CI 15.5-not reached). Diarrhea (7.5%) was the most common grade ≥ 3 treatment-related adverse event. Asymptomatic radiation necrosis was identified in only 6% of the 67 lesions treated with fractionated stereotactic radiotherapy.

Study details: Findings are from a phase 2 trial that included 40 women with ERBB2+ BC and brain metastases who received fractionated stereotactic or whole-brain radiotherapy and initiated treatment with pyrotinib and capecitabine.

Disclosures: This study was supported by the National Natural Science Foundation of China (NSFC). Three authors declared receiving grants or personal fees from various sources, including the NSFC.

Source: Yang Z et al. Brain radiotherapy with pyrotinib and capecitabine in patients with ERBB2-positive advanced breast cancer and brain metastases: A nonrandomized phase 2 trial. JAMA Oncol. 2024 (Jan 4). doi: 10.1001/jamaoncol.2023.5791

Key clinical point: Combining radiotherapy with pyrotinib and capecitabine led to improved intracranial survival outcomes and an acceptable radiation necrosis rate in patients with human epidermal growth factor receptor 2-positive (ERBB2+) breast cancer (BC) with brain metastases.

Major finding: The 1-year central nervous system (CNS) progression-free survival (PFS) rate was 74.9% (95% CI 61.9%-90.7%), and the median CNS PFS was 18.0 months (95% CI 15.5-not reached). Diarrhea (7.5%) was the most common grade ≥ 3 treatment-related adverse event. Asymptomatic radiation necrosis was identified in only 6% of the 67 lesions treated with fractionated stereotactic radiotherapy.

Study details: Findings are from a phase 2 trial that included 40 women with ERBB2+ BC and brain metastases who received fractionated stereotactic or whole-brain radiotherapy and initiated treatment with pyrotinib and capecitabine.

Disclosures: This study was supported by the National Natural Science Foundation of China (NSFC). Three authors declared receiving grants or personal fees from various sources, including the NSFC.

Source: Yang Z et al. Brain radiotherapy with pyrotinib and capecitabine in patients with ERBB2-positive advanced breast cancer and brain metastases: A nonrandomized phase 2 trial. JAMA Oncol. 2024 (Jan 4). doi: 10.1001/jamaoncol.2023.5791

Key clinical point: In patients with early breast cancer (BC) who were undergoing breast-conserving surgery and sentinel lymph node detection (SLND), a combination of paramagnetic seed + superparamagnetic iron oxide (SPIO) led to comparable rates of re-excision and resection ratios as the more standard approach with guidewire + SPIO.

Major finding: Paramagnetic seed + SPIO and guidewire + SPIO showed comparable re-excision rates (2.87% vs 2.84%; P = .99) and median resection ratios (2.01 vs 1.93; P = .70). The rate of failed breast lesion localizations was significantly more in the guidewire vs paramagnetic seed group (10.1% vs 1.9%; P < .001).

Study details: Findings are from the phase 3 MAGTOTAL trial that included 426 patients with early BC scheduled to undergo breast-conserving surgery and SLND who were randomly assigned to either lesion localization using paramagnetic seed + SPIO or guidewire + SPIO.

Disclosures: This study was supported partly by Uppsala University Hospital. Sweden, and institutional grants from Uppsala University and other sources. A Karakatsanis declared receiving grants and honoraria from various sources outside the study.

Source: Pantiora E et al. Magnetic seed vs guidewire breast cancer localization with magnetic lymph node detection: A randomized clinical trial. JAMA Surg. 2023 (Dec 27). doi: 10.1001/jamasurg.2023.6520

Key clinical point: In patients with early breast cancer (BC) who were undergoing breast-conserving surgery and sentinel lymph node detection (SLND), a combination of paramagnetic seed + superparamagnetic iron oxide (SPIO) led to comparable rates of re-excision and resection ratios as the more standard approach with guidewire + SPIO.

Major finding: Paramagnetic seed + SPIO and guidewire + SPIO showed comparable re-excision rates (2.87% vs 2.84%; P = .99) and median resection ratios (2.01 vs 1.93; P = .70). The rate of failed breast lesion localizations was significantly more in the guidewire vs paramagnetic seed group (10.1% vs 1.9%; P < .001).

Study details: Findings are from the phase 3 MAGTOTAL trial that included 426 patients with early BC scheduled to undergo breast-conserving surgery and SLND who were randomly assigned to either lesion localization using paramagnetic seed + SPIO or guidewire + SPIO.

Disclosures: This study was supported partly by Uppsala University Hospital. Sweden, and institutional grants from Uppsala University and other sources. A Karakatsanis declared receiving grants and honoraria from various sources outside the study.

Source: Pantiora E et al. Magnetic seed vs guidewire breast cancer localization with magnetic lymph node detection: A randomized clinical trial. JAMA Surg. 2023 (Dec 27). doi: 10.1001/jamasurg.2023.6520

Key clinical point: In patients with early breast cancer (BC) who were undergoing breast-conserving surgery and sentinel lymph node detection (SLND), a combination of paramagnetic seed + superparamagnetic iron oxide (SPIO) led to comparable rates of re-excision and resection ratios as the more standard approach with guidewire + SPIO.

Major finding: Paramagnetic seed + SPIO and guidewire + SPIO showed comparable re-excision rates (2.87% vs 2.84%; P = .99) and median resection ratios (2.01 vs 1.93; P = .70). The rate of failed breast lesion localizations was significantly more in the guidewire vs paramagnetic seed group (10.1% vs 1.9%; P < .001).

Study details: Findings are from the phase 3 MAGTOTAL trial that included 426 patients with early BC scheduled to undergo breast-conserving surgery and SLND who were randomly assigned to either lesion localization using paramagnetic seed + SPIO or guidewire + SPIO.

Disclosures: This study was supported partly by Uppsala University Hospital. Sweden, and institutional grants from Uppsala University and other sources. A Karakatsanis declared receiving grants and honoraria from various sources outside the study.

Source: Pantiora E et al. Magnetic seed vs guidewire breast cancer localization with magnetic lymph node detection: A randomized clinical trial. JAMA Surg. 2023 (Dec 27). doi: 10.1001/jamasurg.2023.6520

Key clinical point: Induction treatment with bevacizumab, etoposide, and cisplatin (BEEP) before whole-brain radiotherapy (WBRT) vs WBRT alone improved brain-specific progression-free survival (PFS) outcomes in patients with brain metastases from breast cancer (BMBC).

Major finding: Patients who received BEEP + WBRT vs WBRT alone had significantly longer median brain-specific PFS based on a predefined α level of ≤0.20 (8.1 vs 6.5 months; hazard ratio 0.71; P = .15) and higher 8-month brain-specific PFS rate (48.7% vs 26.3%; P = .03). Neutropenia, nausea, anemia, and leukopenia were the most common adverse events in the BEEP induction arm.

Study details: Findings are from the phase 2 A-PLUS trial that included 118 WBRT-naive patients with invasive breast cancer who had ≥1 metastatic brain tumors and were randomly assigned to receive BEEP induction followed by WBRT or only WBRT.

Disclosures: This study received investigational product support and grants funding from Roche Taiwan, Chugai Pharma Taiwan, and other sources. Four authors declared receiving personal fees, lecture fees, consulting or speakers’ bureau fees, travel support, or grants from Roche and other sources.

Source: Chen TW et al. Whole-brain radiotherapy alone vs preceded by bevacizumab, etoposide, and cisplatin for untreated brain metastases from breast cancer: A randomized clinical trial. JAMA Oncol. 2023 (Dec 21). doi: 10.1001/jamaoncol.2023.5456

Key clinical point: Induction treatment with bevacizumab, etoposide, and cisplatin (BEEP) before whole-brain radiotherapy (WBRT) vs WBRT alone improved brain-specific progression-free survival (PFS) outcomes in patients with brain metastases from breast cancer (BMBC).

Major finding: Patients who received BEEP + WBRT vs WBRT alone had significantly longer median brain-specific PFS based on a predefined α level of ≤0.20 (8.1 vs 6.5 months; hazard ratio 0.71; P = .15) and higher 8-month brain-specific PFS rate (48.7% vs 26.3%; P = .03). Neutropenia, nausea, anemia, and leukopenia were the most common adverse events in the BEEP induction arm.

Study details: Findings are from the phase 2 A-PLUS trial that included 118 WBRT-naive patients with invasive breast cancer who had ≥1 metastatic brain tumors and were randomly assigned to receive BEEP induction followed by WBRT or only WBRT.

Disclosures: This study received investigational product support and grants funding from Roche Taiwan, Chugai Pharma Taiwan, and other sources. Four authors declared receiving personal fees, lecture fees, consulting or speakers’ bureau fees, travel support, or grants from Roche and other sources.

Source: Chen TW et al. Whole-brain radiotherapy alone vs preceded by bevacizumab, etoposide, and cisplatin for untreated brain metastases from breast cancer: A randomized clinical trial. JAMA Oncol. 2023 (Dec 21). doi: 10.1001/jamaoncol.2023.5456

Key clinical point: Induction treatment with bevacizumab, etoposide, and cisplatin (BEEP) before whole-brain radiotherapy (WBRT) vs WBRT alone improved brain-specific progression-free survival (PFS) outcomes in patients with brain metastases from breast cancer (BMBC).

Major finding: Patients who received BEEP + WBRT vs WBRT alone had significantly longer median brain-specific PFS based on a predefined α level of ≤0.20 (8.1 vs 6.5 months; hazard ratio 0.71; P = .15) and higher 8-month brain-specific PFS rate (48.7% vs 26.3%; P = .03). Neutropenia, nausea, anemia, and leukopenia were the most common adverse events in the BEEP induction arm.

Study details: Findings are from the phase 2 A-PLUS trial that included 118 WBRT-naive patients with invasive breast cancer who had ≥1 metastatic brain tumors and were randomly assigned to receive BEEP induction followed by WBRT or only WBRT.

Disclosures: This study received investigational product support and grants funding from Roche Taiwan, Chugai Pharma Taiwan, and other sources. Four authors declared receiving personal fees, lecture fees, consulting or speakers’ bureau fees, travel support, or grants from Roche and other sources.

Source: Chen TW et al. Whole-brain radiotherapy alone vs preceded by bevacizumab, etoposide, and cisplatin for untreated brain metastases from breast cancer: A randomized clinical trial. JAMA Oncol. 2023 (Dec 21). doi: 10.1001/jamaoncol.2023.5456

Key clinical point: Adding atezolizumab to carboplatin improved overall survival (OS) outcomes in patients with metastatic triple-negative breast cancer (TNBC).

Major finding: Compared with carboplatin alone, carboplatin + atezolizumab demonstrated significant improvement in OS outcomes (hazard ratio [HR] 0.60; log-rank P = .03) even though the improvement in the primary endpoint of progression-free survival was not statistically significant (HR 0.66; log-rank P = .05). The prevalence of grade 3/4 serious adverse events was higher with carboplatin + atezolizumab vs carboplatin alone (41% vs 8%).

Study details: Findings are from the phase 2 TBCRC 043 trial that included 106 patients with metastatic TNBC who were randomly assigned to receive either carboplatin alone or in combination with atezolizumab.

Disclosures: This study was supported by a US National Cancer Institute grant, Susan G. Komen grants, and other sources. Some authors declared receiving grants or personal fees from or having other ties with various sources, including the funding agencies.

Source: Lehmann BD et al. Atezolizumab in combination with carboplatin and survival outcomes in patients with metastatic triple-negative breast cancer: The TBCRC 043 phase 2 randomized clinical trial. JAMA Oncol. 2023 (Dec 14). doi: 10.1001/jamaoncol.2023.5424

Key clinical point: Adding atezolizumab to carboplatin improved overall survival (OS) outcomes in patients with metastatic triple-negative breast cancer (TNBC).

Major finding: Compared with carboplatin alone, carboplatin + atezolizumab demonstrated significant improvement in OS outcomes (hazard ratio [HR] 0.60; log-rank P = .03) even though the improvement in the primary endpoint of progression-free survival was not statistically significant (HR 0.66; log-rank P = .05). The prevalence of grade 3/4 serious adverse events was higher with carboplatin + atezolizumab vs carboplatin alone (41% vs 8%).

Study details: Findings are from the phase 2 TBCRC 043 trial that included 106 patients with metastatic TNBC who were randomly assigned to receive either carboplatin alone or in combination with atezolizumab.

Disclosures: This study was supported by a US National Cancer Institute grant, Susan G. Komen grants, and other sources. Some authors declared receiving grants or personal fees from or having other ties with various sources, including the funding agencies.

Source: Lehmann BD et al. Atezolizumab in combination with carboplatin and survival outcomes in patients with metastatic triple-negative breast cancer: The TBCRC 043 phase 2 randomized clinical trial. JAMA Oncol. 2023 (Dec 14). doi: 10.1001/jamaoncol.2023.5424

Key clinical point: Adding atezolizumab to carboplatin improved overall survival (OS) outcomes in patients with metastatic triple-negative breast cancer (TNBC).

Major finding: Compared with carboplatin alone, carboplatin + atezolizumab demonstrated significant improvement in OS outcomes (hazard ratio [HR] 0.60; log-rank P = .03) even though the improvement in the primary endpoint of progression-free survival was not statistically significant (HR 0.66; log-rank P = .05). The prevalence of grade 3/4 serious adverse events was higher with carboplatin + atezolizumab vs carboplatin alone (41% vs 8%).

Study details: Findings are from the phase 2 TBCRC 043 trial that included 106 patients with metastatic TNBC who were randomly assigned to receive either carboplatin alone or in combination with atezolizumab.

Disclosures: This study was supported by a US National Cancer Institute grant, Susan G. Komen grants, and other sources. Some authors declared receiving grants or personal fees from or having other ties with various sources, including the funding agencies.

Source: Lehmann BD et al. Atezolizumab in combination with carboplatin and survival outcomes in patients with metastatic triple-negative breast cancer: The TBCRC 043 phase 2 randomized clinical trial. JAMA Oncol. 2023 (Dec 14). doi: 10.1001/jamaoncol.2023.5424

Key clinical point: Compared with the general population, the risk for overall breast cancer (BC) was nearly double in women with benign breast disease (BBD) diagnosed by percutaneous biopsies.

Major finding: Patients with BBD vs the general population were at a significantly higher risk for overall BC (standard incidence ratio [SIR] 1.95; 95% CI 1.76-2.17), including invasive BC (SIR 1.56; 95% CI 1.37-1.78) and ductal carcinoma in situ (SIR 3.10; 95% CI 2.54-3.77). The SIR for overall BC increased progressively with increasing BBD severity (nonproliferative 1.42; 95% CI 1.19-1.71; proliferative disease without atypia 2.19; 95% CI 1.88-2.54; atypical hyperplasia 3.91; 95% CI 2.97-5.14).

Study details: Findings are from a retrospective cohort study including 4819 female patients who underwent a BBD biopsy, of whom 338 patients had incident BC.

Disclosures: This study was supported by a grant from the US National Institutes of Health (NIH). Four authors declared receiving grants, research support, or personal fees from NIH and other sources.

Source: Sherman ME et al. Benign breast disease and breast cancer risk in the percutaneous biopsy era. JAMA Surg. 2023 (Dec 13). doi: 10.1001/jamasurg.2023.6382

Key clinical point: Compared with the general population, the risk for overall breast cancer (BC) was nearly double in women with benign breast disease (BBD) diagnosed by percutaneous biopsies.

Major finding: Patients with BBD vs the general population were at a significantly higher risk for overall BC (standard incidence ratio [SIR] 1.95; 95% CI 1.76-2.17), including invasive BC (SIR 1.56; 95% CI 1.37-1.78) and ductal carcinoma in situ (SIR 3.10; 95% CI 2.54-3.77). The SIR for overall BC increased progressively with increasing BBD severity (nonproliferative 1.42; 95% CI 1.19-1.71; proliferative disease without atypia 2.19; 95% CI 1.88-2.54; atypical hyperplasia 3.91; 95% CI 2.97-5.14).

Study details: Findings are from a retrospective cohort study including 4819 female patients who underwent a BBD biopsy, of whom 338 patients had incident BC.

Disclosures: This study was supported by a grant from the US National Institutes of Health (NIH). Four authors declared receiving grants, research support, or personal fees from NIH and other sources.

Source: Sherman ME et al. Benign breast disease and breast cancer risk in the percutaneous biopsy era. JAMA Surg. 2023 (Dec 13). doi: 10.1001/jamasurg.2023.6382

Key clinical point: Compared with the general population, the risk for overall breast cancer (BC) was nearly double in women with benign breast disease (BBD) diagnosed by percutaneous biopsies.

Major finding: Patients with BBD vs the general population were at a significantly higher risk for overall BC (standard incidence ratio [SIR] 1.95; 95% CI 1.76-2.17), including invasive BC (SIR 1.56; 95% CI 1.37-1.78) and ductal carcinoma in situ (SIR 3.10; 95% CI 2.54-3.77). The SIR for overall BC increased progressively with increasing BBD severity (nonproliferative 1.42; 95% CI 1.19-1.71; proliferative disease without atypia 2.19; 95% CI 1.88-2.54; atypical hyperplasia 3.91; 95% CI 2.97-5.14).

Study details: Findings are from a retrospective cohort study including 4819 female patients who underwent a BBD biopsy, of whom 338 patients had incident BC.

Disclosures: This study was supported by a grant from the US National Institutes of Health (NIH). Four authors declared receiving grants, research support, or personal fees from NIH and other sources.

Source: Sherman ME et al. Benign breast disease and breast cancer risk in the percutaneous biopsy era. JAMA Surg. 2023 (Dec 13). doi: 10.1001/jamasurg.2023.6382

SAN ANTONIO — Axillary lymph node dissection is the current standard of care in breast cancer when metastases are found in sentinel lymph nodes after neoadjuvant chemotherapy.

However, what to do when isolated tumor cells instead of outright metastases are found in sentinel nodes is an open question. Some surgeons opt for a full axillary dissection while others do not, and there is no standard of care, explained Giacomo Montagna, MD, a breast cancer surgeon at Memorial Sloan Kettering Cancer Center, New York City.

The study led and presented by Dr. Montagna at the San Antonio Breast Cancer Symposium brings some much-needed clarity to the issue.

The researchers found no difference in 5-year axillary or invasive recurrence rates whether women had axillary dissections or not. The findings argue strongly against “routine axillary lymph node dissection” — with its considerable morbidities — “in patients with residual isolated tumor cells after neoadjuvant chemotherapy,” Dr. Montagna said.

Study discussant Elizabeth Mittendorf, MD, PhD, a breast cancer surgeon at Brigham and Women’s Hospital, Boston, agreed.

“It appears that the presence of isolated tumor cells in the sentinel nodes does not negatively impact oncologic outcomes. These additional data allow us to debunk some of the surgical dogma we grew up with, specifically that lymph node dissection is required for either survival or local control,” Dr. Mittendorf said.

However, there was concern among audience members that the information gleaned from a full dissection might still be needed to guide follow-on adjuvant therapy decisions.

Dr. Mittendorf didn’t think so. Although additional positive lymph nodes were found in almost a third of women who had axillary dissections in the review, the majority of involved nodes simply had more isolated tumor cells; macrometastases were found in just 5% of cases.

So, for most patients, additional information from axillary dissections is “unlikely needed to inform adjuvant therapy, and in fact,” based on the 5% figure, “we are thinking we would have to do well over a hundred lymph node dissections in such patients to inform treatment recommendations for fewer than five. This comes at the cost of fair morbidity,” she said.

Study details

The retrospective study, dubbed OPBC05/EUBREAST-14R/ICARO, included 583 women with cT1-4 N0-3 breast cancer treated at 62 centers in 18 countries. The majority of subjects were from the United States and Europe.

Every patient was found to have isolated tumor cells (ITCs) in their sentinel lymph nodes after neoadjuvant chemotherapy (NAC), which generally included anthracycline and taxane-based regimens. The majority of patients did not have a pathologic complete response to NAC.

Overall, 182 patients (31%) had a subsequent axillary lymph node dissection; the rest did not.

Dissections were more common in the presence of lymphovascular invasion and N2/N3 disease as well as when fewer lymph nodes were removed and when ITCs were found during surgery on frozen section, which was the case in a quarter of patients.

Additional positive nodes were found in 30% of patients in the dissection group and consisted of more nodes with ITCs in 18%, micrometastases in 7%, and macrometastases in 5%. Receptor status and nodal status at presentation did not have an impact on the likelihood of finding macrometastases.

The main finding of the study was that there were no statistically significant differences in recurrence outcomes between the two groups.

The 5-year rate of isolated axillary recurrence was 1.7% with axillary lymph node dissection (ALND) versus 1.1% without it. The 5-year rate of any invasive recurrence was 16% in the ALND arm and 19% in the no-dissection group.

The median age in the study was 48 years. The majority of patients (57%) had clinical T2 tumors. Most were HR positive and either HER2 negative (41%) or HER2 positive (28%).

Regional nodal radiation was more common in the ALND group, 82% versus 75%. The dissection arm had a mean of 2.8 sentinel lymph nodes removed versus 3.5 in the no-dissection group.

“The likelihood of finding additional positive lymph nodes in patients with residual ITCs after NAC is lower than in patients with residual micro- and macrometastases. In the majority of cases, they contain ITCs. Nodal recurrence after omission of ALND is rare in this population,” the investigators concluded in their abstract.

The work was funded by EUBREAST. Dr. Montagna doesn’t have any disclosures. Dr. Mittendorf has several industry ties, including being an advisor for Roche, AstraZeneca, and Moderna and a speaker for Merck.

SAN ANTONIO — Axillary lymph node dissection is the current standard of care in breast cancer when metastases are found in sentinel lymph nodes after neoadjuvant chemotherapy.

However, what to do when isolated tumor cells instead of outright metastases are found in sentinel nodes is an open question. Some surgeons opt for a full axillary dissection while others do not, and there is no standard of care, explained Giacomo Montagna, MD, a breast cancer surgeon at Memorial Sloan Kettering Cancer Center, New York City.

The study led and presented by Dr. Montagna at the San Antonio Breast Cancer Symposium brings some much-needed clarity to the issue.

The researchers found no difference in 5-year axillary or invasive recurrence rates whether women had axillary dissections or not. The findings argue strongly against “routine axillary lymph node dissection” — with its considerable morbidities — “in patients with residual isolated tumor cells after neoadjuvant chemotherapy,” Dr. Montagna said.

Study discussant Elizabeth Mittendorf, MD, PhD, a breast cancer surgeon at Brigham and Women’s Hospital, Boston, agreed.

“It appears that the presence of isolated tumor cells in the sentinel nodes does not negatively impact oncologic outcomes. These additional data allow us to debunk some of the surgical dogma we grew up with, specifically that lymph node dissection is required for either survival or local control,” Dr. Mittendorf said.

However, there was concern among audience members that the information gleaned from a full dissection might still be needed to guide follow-on adjuvant therapy decisions.

Dr. Mittendorf didn’t think so. Although additional positive lymph nodes were found in almost a third of women who had axillary dissections in the review, the majority of involved nodes simply had more isolated tumor cells; macrometastases were found in just 5% of cases.

So, for most patients, additional information from axillary dissections is “unlikely needed to inform adjuvant therapy, and in fact,” based on the 5% figure, “we are thinking we would have to do well over a hundred lymph node dissections in such patients to inform treatment recommendations for fewer than five. This comes at the cost of fair morbidity,” she said.

Study details

The retrospective study, dubbed OPBC05/EUBREAST-14R/ICARO, included 583 women with cT1-4 N0-3 breast cancer treated at 62 centers in 18 countries. The majority of subjects were from the United States and Europe.

Every patient was found to have isolated tumor cells (ITCs) in their sentinel lymph nodes after neoadjuvant chemotherapy (NAC), which generally included anthracycline and taxane-based regimens. The majority of patients did not have a pathologic complete response to NAC.

Overall, 182 patients (31%) had a subsequent axillary lymph node dissection; the rest did not.

Dissections were more common in the presence of lymphovascular invasion and N2/N3 disease as well as when fewer lymph nodes were removed and when ITCs were found during surgery on frozen section, which was the case in a quarter of patients.

Additional positive nodes were found in 30% of patients in the dissection group and consisted of more nodes with ITCs in 18%, micrometastases in 7%, and macrometastases in 5%. Receptor status and nodal status at presentation did not have an impact on the likelihood of finding macrometastases.

The main finding of the study was that there were no statistically significant differences in recurrence outcomes between the two groups.

The 5-year rate of isolated axillary recurrence was 1.7% with axillary lymph node dissection (ALND) versus 1.1% without it. The 5-year rate of any invasive recurrence was 16% in the ALND arm and 19% in the no-dissection group.

The median age in the study was 48 years. The majority of patients (57%) had clinical T2 tumors. Most were HR positive and either HER2 negative (41%) or HER2 positive (28%).

Regional nodal radiation was more common in the ALND group, 82% versus 75%. The dissection arm had a mean of 2.8 sentinel lymph nodes removed versus 3.5 in the no-dissection group.

“The likelihood of finding additional positive lymph nodes in patients with residual ITCs after NAC is lower than in patients with residual micro- and macrometastases. In the majority of cases, they contain ITCs. Nodal recurrence after omission of ALND is rare in this population,” the investigators concluded in their abstract.

The work was funded by EUBREAST. Dr. Montagna doesn’t have any disclosures. Dr. Mittendorf has several industry ties, including being an advisor for Roche, AstraZeneca, and Moderna and a speaker for Merck.

SAN ANTONIO — Axillary lymph node dissection is the current standard of care in breast cancer when metastases are found in sentinel lymph nodes after neoadjuvant chemotherapy.

However, what to do when isolated tumor cells instead of outright metastases are found in sentinel nodes is an open question. Some surgeons opt for a full axillary dissection while others do not, and there is no standard of care, explained Giacomo Montagna, MD, a breast cancer surgeon at Memorial Sloan Kettering Cancer Center, New York City.

The study led and presented by Dr. Montagna at the San Antonio Breast Cancer Symposium brings some much-needed clarity to the issue.

The researchers found no difference in 5-year axillary or invasive recurrence rates whether women had axillary dissections or not. The findings argue strongly against “routine axillary lymph node dissection” — with its considerable morbidities — “in patients with residual isolated tumor cells after neoadjuvant chemotherapy,” Dr. Montagna said.

Study discussant Elizabeth Mittendorf, MD, PhD, a breast cancer surgeon at Brigham and Women’s Hospital, Boston, agreed.

“It appears that the presence of isolated tumor cells in the sentinel nodes does not negatively impact oncologic outcomes. These additional data allow us to debunk some of the surgical dogma we grew up with, specifically that lymph node dissection is required for either survival or local control,” Dr. Mittendorf said.

However, there was concern among audience members that the information gleaned from a full dissection might still be needed to guide follow-on adjuvant therapy decisions.

Dr. Mittendorf didn’t think so. Although additional positive lymph nodes were found in almost a third of women who had axillary dissections in the review, the majority of involved nodes simply had more isolated tumor cells; macrometastases were found in just 5% of cases.

So, for most patients, additional information from axillary dissections is “unlikely needed to inform adjuvant therapy, and in fact,” based on the 5% figure, “we are thinking we would have to do well over a hundred lymph node dissections in such patients to inform treatment recommendations for fewer than five. This comes at the cost of fair morbidity,” she said.

Study details

The retrospective study, dubbed OPBC05/EUBREAST-14R/ICARO, included 583 women with cT1-4 N0-3 breast cancer treated at 62 centers in 18 countries. The majority of subjects were from the United States and Europe.

Every patient was found to have isolated tumor cells (ITCs) in their sentinel lymph nodes after neoadjuvant chemotherapy (NAC), which generally included anthracycline and taxane-based regimens. The majority of patients did not have a pathologic complete response to NAC.

Overall, 182 patients (31%) had a subsequent axillary lymph node dissection; the rest did not.

Dissections were more common in the presence of lymphovascular invasion and N2/N3 disease as well as when fewer lymph nodes were removed and when ITCs were found during surgery on frozen section, which was the case in a quarter of patients.

Additional positive nodes were found in 30% of patients in the dissection group and consisted of more nodes with ITCs in 18%, micrometastases in 7%, and macrometastases in 5%. Receptor status and nodal status at presentation did not have an impact on the likelihood of finding macrometastases.

The main finding of the study was that there were no statistically significant differences in recurrence outcomes between the two groups.

The 5-year rate of isolated axillary recurrence was 1.7% with axillary lymph node dissection (ALND) versus 1.1% without it. The 5-year rate of any invasive recurrence was 16% in the ALND arm and 19% in the no-dissection group.

The median age in the study was 48 years. The majority of patients (57%) had clinical T2 tumors. Most were HR positive and either HER2 negative (41%) or HER2 positive (28%).

Regional nodal radiation was more common in the ALND group, 82% versus 75%. The dissection arm had a mean of 2.8 sentinel lymph nodes removed versus 3.5 in the no-dissection group.

“The likelihood of finding additional positive lymph nodes in patients with residual ITCs after NAC is lower than in patients with residual micro- and macrometastases. In the majority of cases, they contain ITCs. Nodal recurrence after omission of ALND is rare in this population,” the investigators concluded in their abstract.

The work was funded by EUBREAST. Dr. Montagna doesn’t have any disclosures. Dr. Mittendorf has several industry ties, including being an advisor for Roche, AstraZeneca, and Moderna and a speaker for Merck.

TOPLINE:

Routine clinical examination detects only 2.2% of second breast cancers during 10-year follow-up in women undergoing posttreatment surveillance after ductal carcinoma in situ (DCIS).

METHODOLOGY:

• National Comprehensive Cancer Network guidelines recommend DCIS surveillance with a physical exam every 6-12 months for 5 years and then annually with a mammogram every 12 months. Research, however, suggested clinical breast exams only detect 15% of second breast cancers.
• A retrospective cohort study of 1550 female members of Kaiser Permanente Northern California diagnosed with unilateral DCIS between January 1, 2008, and January 1, 2011, who were followed until 2021.
• Patients who developed a second breast cancer within 10 years of follow-up were identified from the electronic health records. The detection methods were categorized into three groups: Patient-detected, physician-detected, and imaging-detected.

TAKEAWAY:

• During follow-up, 11.5% of women developed a second breast cancer with a median time to diagnosis of 57 months. Among patients with second breast cancers, 43.0% were ipsilateral, 54.8% were contralateral, and 2.2% presented with distant metastases.
• Overall, patients had a median of five mammograms between years 1 and 6 of surveillance and a median of seven clinic visits with most providers completing a clinical examination during the visit.
• Second breast cancers were detected through imaging in 74.3% of cases compared with 20.1% detected by patients and only 2.2% detected by physicians during physical exams. The remaining 3.4% were detected incidentally from plastic surgery procedures unrelated to oncologic surveillance.
• Mammogram detected 99.2% of cases (132 of 133 cases) identified by imaging.

IN PRACTICE:

“Our findings highlight the importance of mammogram screening and patient education regarding self-detection and can inform future NCCN recommendations for DCIS survivorship care,” the authors concluded, adding that “decreasing the need for in-person breast examinations could allow for other effective methods of survivorship monitoring.”

SOURCE:

This study, led by Bethany T. Waites of Kaiser Permanente San Francisco Medical Center, San Francisco, California, was published online on December 28 in the Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

The retrospective design may have introduced selection bias or confounding. The study’s follow-up period until 2021, including the initial 18 months of the COVID-19 pandemic, may have affected surveillance patterns.

DISCLOSURES:

This study was supported by the Kaiser Permanente Northern California Graduate Medical Education program. The authors declared no relevant financial relationships.

A version of this article appeared on Medscape.com.

TOPLINE:

Routine clinical examination detects only 2.2% of second breast cancers during 10-year follow-up in women undergoing posttreatment surveillance after ductal carcinoma in situ (DCIS).

METHODOLOGY:

• National Comprehensive Cancer Network guidelines recommend DCIS surveillance with a physical exam every 6-12 months for 5 years and then annually with a mammogram every 12 months. Research, however, suggested clinical breast exams only detect 15% of second breast cancers.
• A retrospective cohort study of 1550 female members of Kaiser Permanente Northern California diagnosed with unilateral DCIS between January 1, 2008, and January 1, 2011, who were followed until 2021.
• Patients who developed a second breast cancer within 10 years of follow-up were identified from the electronic health records. The detection methods were categorized into three groups: Patient-detected, physician-detected, and imaging-detected.

TAKEAWAY:

• During follow-up, 11.5% of women developed a second breast cancer with a median time to diagnosis of 57 months. Among patients with second breast cancers, 43.0% were ipsilateral, 54.8% were contralateral, and 2.2% presented with distant metastases.
• Overall, patients had a median of five mammograms between years 1 and 6 of surveillance and a median of seven clinic visits with most providers completing a clinical examination during the visit.
• Second breast cancers were detected through imaging in 74.3% of cases compared with 20.1% detected by patients and only 2.2% detected by physicians during physical exams. The remaining 3.4% were detected incidentally from plastic surgery procedures unrelated to oncologic surveillance.
• Mammogram detected 99.2% of cases (132 of 133 cases) identified by imaging.

IN PRACTICE:

“Our findings highlight the importance of mammogram screening and patient education regarding self-detection and can inform future NCCN recommendations for DCIS survivorship care,” the authors concluded, adding that “decreasing the need for in-person breast examinations could allow for other effective methods of survivorship monitoring.”

SOURCE:

This study, led by Bethany T. Waites of Kaiser Permanente San Francisco Medical Center, San Francisco, California, was published online on December 28 in the Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

The retrospective design may have introduced selection bias or confounding. The study’s follow-up period until 2021, including the initial 18 months of the COVID-19 pandemic, may have affected surveillance patterns.

DISCLOSURES:

This study was supported by the Kaiser Permanente Northern California Graduate Medical Education program. The authors declared no relevant financial relationships.

A version of this article appeared on Medscape.com.

TOPLINE:

Routine clinical examination detects only 2.2% of second breast cancers during 10-year follow-up in women undergoing posttreatment surveillance after ductal carcinoma in situ (DCIS).

METHODOLOGY:

• National Comprehensive Cancer Network guidelines recommend DCIS surveillance with a physical exam every 6-12 months for 5 years and then annually with a mammogram every 12 months. Research, however, suggested clinical breast exams only detect 15% of second breast cancers.
• A retrospective cohort study of 1550 female members of Kaiser Permanente Northern California diagnosed with unilateral DCIS between January 1, 2008, and January 1, 2011, who were followed until 2021.
• Patients who developed a second breast cancer within 10 years of follow-up were identified from the electronic health records. The detection methods were categorized into three groups: Patient-detected, physician-detected, and imaging-detected.

TAKEAWAY:

• During follow-up, 11.5% of women developed a second breast cancer with a median time to diagnosis of 57 months. Among patients with second breast cancers, 43.0% were ipsilateral, 54.8% were contralateral, and 2.2% presented with distant metastases.
• Overall, patients had a median of five mammograms between years 1 and 6 of surveillance and a median of seven clinic visits with most providers completing a clinical examination during the visit.
• Second breast cancers were detected through imaging in 74.3% of cases compared with 20.1% detected by patients and only 2.2% detected by physicians during physical exams. The remaining 3.4% were detected incidentally from plastic surgery procedures unrelated to oncologic surveillance.
• Mammogram detected 99.2% of cases (132 of 133 cases) identified by imaging.

IN PRACTICE:

“Our findings highlight the importance of mammogram screening and patient education regarding self-detection and can inform future NCCN recommendations for DCIS survivorship care,” the authors concluded, adding that “decreasing the need for in-person breast examinations could allow for other effective methods of survivorship monitoring.”

SOURCE:

This study, led by Bethany T. Waites of Kaiser Permanente San Francisco Medical Center, San Francisco, California, was published online on December 28 in the Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

The retrospective design may have introduced selection bias or confounding. The study’s follow-up period until 2021, including the initial 18 months of the COVID-19 pandemic, may have affected surveillance patterns.

DISCLOSURES:

This study was supported by the Kaiser Permanente Northern California Graduate Medical Education program. The authors declared no relevant financial relationships.

A version of this article appeared on Medscape.com.

TOPLINE:

Paramagnetic seeds work just as well as standard guidewires for breast tumor localization and are easier for surgeons, radiologists, and operating room planners to use.

METHODOLOGY:

• Paramagnetic seeds have shown promise over standard guidewire localization, but the two methods of tagging breast lesions for surgical removal have never been compared head-to-head in a randomized trial.
• Paramagnetic seeds are magnetic markers smaller than a grain of rice that are injected into the lesion under ultrasound or x-ray guidance. While traditional guidewires are placed on the day of surgery, seeds can be placed up to 4 weeks ahead of time.
• In the current study, investigators at three hospitals in Sweden randomized 426 women undergoing breast-conserving surgery for early breast cancer to either paramagnetic seed (Magseed, Endomag, Cambridge, UK) or guidewire localization.
• Sentinel lymph nodes were also marked magnetically for removal by superparamagnetic iron oxide (Magtrace, Endomag, Cambridge, UK ) injected into the breast before surgery. This approach — an alternative to traditional radioisotopes and blue dye — can be done days before surgery.

TAKEAWAY:

• The investigators found no significant difference in re-excision rates (2.84% vs 2.87%), sentinel lymph node detection (98.1% vs 99.0%), or resection ratios — a metric of surgical precision — between the guidewire and seed approaches.
• The rate of failed localizations was significantly higher in the guidewire group (10.1% vs 1.9%; P < .001).
• Median operative time was significantly shorter in the seed localization group (69 min vs 75.5 min; P = .03).
• Surgery coordinators reported greater ease of planning with the seeds, radiologists reported easier preoperative localization, and surgeons reported easier detection of marked tumors during surgery.

IN PRACTICE:

Overall, the randomized trial found that “a paramagnetic marker was equivalent to the guidewire in re-excisions and excised specimen volumes, with advantages of shorter operative time, safer localization, and preferable logistics,” the authors concluded.

Another advantage of paramagnetic seeds: Surgical staff and patients were not confined to the same-day “restrictions posed by guidewire localization or radioisotope-based methods, making it an attractive alternative for numerous and diverse clinical settings,” the authors added.

SOURCE:

The work, led by Eirini Pantiora, MD, of Uppsala University, Sweden, was published in JAMA Surgery .

LIMITATIONS:

The investigators don’t yet know whether the benefits of implementing seed localization outweigh the costs.

DISCLOSURES:

The work was funded by Uppsala University, the Swedish Breast Cancer Association, and others. The senior investigator reported receiving grants from Endomag, the maker of the technology tested in the trial.

A version of this article appeared on Medscape.com.

TOPLINE:

Paramagnetic seeds work just as well as standard guidewires for breast tumor localization and are easier for surgeons, radiologists, and operating room planners to use.

METHODOLOGY:

• Paramagnetic seeds have shown promise over standard guidewire localization, but the two methods of tagging breast lesions for surgical removal have never been compared head-to-head in a randomized trial.
• Paramagnetic seeds are magnetic markers smaller than a grain of rice that are injected into the lesion under ultrasound or x-ray guidance. While traditional guidewires are placed on the day of surgery, seeds can be placed up to 4 weeks ahead of time.
• In the current study, investigators at three hospitals in Sweden randomized 426 women undergoing breast-conserving surgery for early breast cancer to either paramagnetic seed (Magseed, Endomag, Cambridge, UK) or guidewire localization.
• Sentinel lymph nodes were also marked magnetically for removal by superparamagnetic iron oxide (Magtrace, Endomag, Cambridge, UK ) injected into the breast before surgery. This approach — an alternative to traditional radioisotopes and blue dye — can be done days before surgery.

TAKEAWAY:

• The investigators found no significant difference in re-excision rates (2.84% vs 2.87%), sentinel lymph node detection (98.1% vs 99.0%), or resection ratios — a metric of surgical precision — between the guidewire and seed approaches.
• The rate of failed localizations was significantly higher in the guidewire group (10.1% vs 1.9%; P < .001).
• Median operative time was significantly shorter in the seed localization group (69 min vs 75.5 min; P = .03).
• Surgery coordinators reported greater ease of planning with the seeds, radiologists reported easier preoperative localization, and surgeons reported easier detection of marked tumors during surgery.

IN PRACTICE:

Overall, the randomized trial found that “a paramagnetic marker was equivalent to the guidewire in re-excisions and excised specimen volumes, with advantages of shorter operative time, safer localization, and preferable logistics,” the authors concluded.

Another advantage of paramagnetic seeds: Surgical staff and patients were not confined to the same-day “restrictions posed by guidewire localization or radioisotope-based methods, making it an attractive alternative for numerous and diverse clinical settings,” the authors added.

SOURCE:

The work, led by Eirini Pantiora, MD, of Uppsala University, Sweden, was published in JAMA Surgery .

LIMITATIONS:

The investigators don’t yet know whether the benefits of implementing seed localization outweigh the costs.

DISCLOSURES:

The work was funded by Uppsala University, the Swedish Breast Cancer Association, and others. The senior investigator reported receiving grants from Endomag, the maker of the technology tested in the trial.

A version of this article appeared on Medscape.com.

TOPLINE:

Paramagnetic seeds work just as well as standard guidewires for breast tumor localization and are easier for surgeons, radiologists, and operating room planners to use.

METHODOLOGY:

• Paramagnetic seeds have shown promise over standard guidewire localization, but the two methods of tagging breast lesions for surgical removal have never been compared head-to-head in a randomized trial.
• Paramagnetic seeds are magnetic markers smaller than a grain of rice that are injected into the lesion under ultrasound or x-ray guidance. While traditional guidewires are placed on the day of surgery, seeds can be placed up to 4 weeks ahead of time.
• In the current study, investigators at three hospitals in Sweden randomized 426 women undergoing breast-conserving surgery for early breast cancer to either paramagnetic seed (Magseed, Endomag, Cambridge, UK) or guidewire localization.
• Sentinel lymph nodes were also marked magnetically for removal by superparamagnetic iron oxide (Magtrace, Endomag, Cambridge, UK ) injected into the breast before surgery. This approach — an alternative to traditional radioisotopes and blue dye — can be done days before surgery.

TAKEAWAY:

• The investigators found no significant difference in re-excision rates (2.84% vs 2.87%), sentinel lymph node detection (98.1% vs 99.0%), or resection ratios — a metric of surgical precision — between the guidewire and seed approaches.
• The rate of failed localizations was significantly higher in the guidewire group (10.1% vs 1.9%; P < .001).
• Median operative time was significantly shorter in the seed localization group (69 min vs 75.5 min; P = .03).
• Surgery coordinators reported greater ease of planning with the seeds, radiologists reported easier preoperative localization, and surgeons reported easier detection of marked tumors during surgery.

IN PRACTICE:

Overall, the randomized trial found that “a paramagnetic marker was equivalent to the guidewire in re-excisions and excised specimen volumes, with advantages of shorter operative time, safer localization, and preferable logistics,” the authors concluded.

Another advantage of paramagnetic seeds: Surgical staff and patients were not confined to the same-day “restrictions posed by guidewire localization or radioisotope-based methods, making it an attractive alternative for numerous and diverse clinical settings,” the authors added.

SOURCE:

The work, led by Eirini Pantiora, MD, of Uppsala University, Sweden, was published in JAMA Surgery .

LIMITATIONS:

The investigators don’t yet know whether the benefits of implementing seed localization outweigh the costs.

DISCLOSURES:

The work was funded by Uppsala University, the Swedish Breast Cancer Association, and others. The senior investigator reported receiving grants from Endomag, the maker of the technology tested in the trial.

A version of this article appeared on Medscape.com.