The Breast : official journal of the European Society of Mastology
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Randomized Controlled Trial
Adjuvant treatment of premenopausal women with endocrine-responsive early breast cancer: design of the TEXT and SOFT trials.
In 2003 the International Breast Cancer Study Group (IBCSG) initiated the TEXT and SOFT randomized phase III trials to answer two questions concerning adjuvant treatment for premenopausal women with endocrine-responsive early breast cancer: 1-What is the role of aromatase inhibitors (AI) for women treated with ovarian function suppression (OFS)? 2-What is the role of OFS for women who remain premenopausal and are treated with tamoxifen? ⋯ We present the original designs of TEXT and SOFT and adaptations to ensure timely answers to two questions concerning optimal adjuvant endocrine treatment for premenopausal women with endocrine-responsive breast cancer. Trial Registration TEXT: Clinicaltrials.govNCT00066703 SOFT: Clinicaltrials.govNCT00066690.
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Ductal carcinoma in situ (DCIS) is a heterogeneous, pre-malignant disease accounting for 10-20% of all new breast tumours. Evidence shows a statistically significant local control benefit for adjuvant radiotherapy (RT) following breast conserving surgery (BCS) for all patients. ⋯ Ongoing studies are attempting to define subgroups of patients who are at sufficiently low risk of recurrence that RT may be safely omitted; investigating RT techniques and dose fractionation schedules; and defining the role of endocrine therapy. Future directions in the management of patients with DCIS will include investigation of prognostic and predictive biomarkers to inform individualised therapy tailored to the risk of recurrence.
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Comparative Study Clinical Trial
Sentinel node biopsy versus low axillary sampling in women with clinically node negative operable breast cancer.
Sentinel node biopsy (SNB) was initially conceived as excision of the first station axillary lymph node(s) (LN) identified by radioactive and/or blue dye uptake. The definition was subsequently enlarged to also include palpable lymph nodes in the vicinity of sentinel node(s) (SN). We reasoned that the excision of this combination of nodes might be best achieved by sampling the lower axilla. ⋯ NCT00128362.
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Sentinel node and occult lesion localization (SNOLL) is an alternative to wire-guided localization (WGL) for guiding surgical excision of non-palpable breast cancer and the performance of concurrent sentinel lymph node biopsy (SLNB). This review provides an overview of the available evidence on the accuracy of SNOLL in patients undergoing breast-conserving surgery. ⋯ Available scientific evidence suggests that SNOLL is a safe and accurate technique for the localization of non-palpable breast cancers.
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Primary axillary clearance (ANC) is currently performed based on cytology from abnormal appearing node(s) without considering extent of involvement. We assessed correlation between nodal burden and nodal appearance. 439 invasive breast cancer cases underwent axillary ultrasound (AUSS) with nodal scoring [UN2-normal (n = 293), UN3-indeterminate (n = 84), UN4-suspicious (n = 29), and UN5-replaced (n = 34)]. ⋯ Most UN3 nodes are either not involved or have low metastatic burden which may be better served by SLNB alone. Redefining our FNAC nodal threshold could potentially avoid additional ANC morbidity and reduce pre-operative workload.