Introduction
Neoadjuvant chemotherapy (NAC) was originally one of the standard
treatments for local advanced breast cancer. However, NAC is now
increasingly being used among patients with early-stage breast cancer,
because it can reduce the tumor size and convert patients who were
initially candidates for mastectomy to be candidates for breast
conserving surgery
(BCS)1,2Additionally, NAC can eliminate metastatic disease in reginal lymph
nodes which may change the surgical strategy of the axilla. It is
established that a negative margin
should be obtained when performing breast-conserving
therapy. Compared with negative
margins (>2mm), positive margins (defined as ink on ductal
carcinoma in situ or invasive carcinoma) lead to a twofold increase in
the risk of local recurrence3. To date, several
factors have been studied to be associated with the increased risk of
local recurrence after breast-conserving surgery, including
lymphovascular invasion, large tumor size, positive nodal status,
extensive intradutal component, close or involved margin status,
negative hormone receptor
status4.
Atypical hyperplasia (AH) of the
breast which can be categorized as atypical ductal hyperplasia (ADH) and
atypical lobular hyperplasia (ALH), is a premalignant lesion, refers to
abnormal epithelial proliferative breast lesions that are not
qualitatively or quantitatively abnormal enough to be classified as
carcinoma in situ5. It
has been established that patients with
AH on breast biopsy of benign lesions
have an approximate four-fold increased risk of later breast
cancer6,7.
However, whether AH can also lead to increased local recurrence in
patients underwent breast-conserving surgery remains unknown, especially
in patients who have received NAC.
Thus far, several studies have
explored the issue of whether AH at margins of breast conserving surgery
leads to increased local recurrence in the ipsilateral breast, and their
conclusions were
contradictory8-10.
Lennington et al. found that ADH is often located at the
periphery of ductal carcinoma in situ
(DCIS)11, thus ADH
identified at the margin of a BCS specimen may represent DCIS component
is already very close to the tumor margin. And close margin may be
related to higher local recurrence of the
breast4.
Therefore, it needs to be further
investigated whether AH at margins is associated with local recurrence
of breast cancer. To address this, our group previously reported a
series of 244 breast cancer patients without NAC treated with BCS
between 2009 and
201112.
We found that patients with AH at
the margins experienced the same local control as those without AH.
However, patients treated with NAC were excluded from our previous
study. So far, there is no study to investigate the impact of atypical
hyperplasia at margins on local recurrence and long-term survival
outcomes in the NAC population.
Therefore, the aim of the present
study was to evaluate the impact of atypical hyperplasia at the surgical
margins on the local recurrence and survival outcomes in breast cancer
patients treated with NAC and BCS.