A 52-year-old woman has been diagnosed with breast cancer following a biopsy and imaging studies. She is being evaluated for breast-conserving therapy, which involves lumpectomy followed by radiation therapy. The medical team is considering various pathological findings to determine the best treatment approach for her condition.
Which of the following pathologic findings is the strongest contraindication to breast preservation (lumpectomy with breast radiation) as primary treatment for a newly diagnosed breast cancer?
A. Grade 3, poorly differentiated, infiltrating ductal carcinoma
B. Extensive intraductal cancer around the invasive lesion
C. Tumor size greater than 3 cm
D. Positive surgical margin for invasive cancer
Answer:
The Correct Answer is: D. Positive surgical margin for invasive cancer
Explanation:
Positive surgical margin for invasive cancer (D):
– A positive surgical margin indicates that cancer cells are present at the edge of the excised tissue, suggesting that not all cancerous tissue has been removed. This is a strong contraindication for breast-conserving therapy because it significantly increases the risk of local recurrence.
– Achieving clear margins (no cancer cells at the edge of the tissue) is crucial for the success of lumpectomy followed by radiation therapy. If the margins are positive, additional surgery, such as re-excision or mastectomy, is typically required to ensure complete removal of the cancer.
Explanation of Incorrect Options:
Grade 3, poorly differentiated, infiltrating ductal carcinoma (A):
– High-grade tumors are more aggressive and have a higher risk of recurrence, but they are not an absolute contraindication for breast-conserving therapy. With adequate surgical margins and appropriate adjuvant therapy (such as chemotherapy and radiation), breast preservation can still be considered.
Extensive intraductal cancer around the invasive lesion (B):
– Extensive ductal carcinoma in situ (DCIS) surrounding an invasive cancer can complicate breast-conserving therapy, but it is not an absolute contraindication. If the DCIS can be adequately excised with clear margins, lumpectomy followed by radiation may still be feasible.
Tumor size greater than 3 cm (C):
– Tumor size is an important factor in determining eligibility for breast-conserving therapy, but it is not an absolute contraindication. Tumors larger than 3 cm can sometimes be treated with lumpectomy if adequate margins can be achieved and if the patient has a favorable breast-to-tumor size ratio. Neoadjuvant therapy (chemotherapy before surgery) can also be used to shrink the tumor before surgery.
In conclusion, a positive surgical margin for invasive cancer is the strongest contraindication to breast preservation as primary treatment for a newly diagnosed breast cancer, making option D the correct answer.