Breast cancer recurrence after ROLL lumpectomy

Published Date: 19th July 2016

Publication Authors: Jois RHS, Carini S, Harris O, Thind R, Desmond S, Ray A, Chagla LS, Bulgasim N,

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Background

Very few literatures are available on the long term outcomes after Radioguided Occult Lesion Localisation (ROLL) guided lumpectomy for non palpable invasive breast cancer. We previously published a recurrence of 1.9% with median follow up of 33 months. This is the first observation reporting after a Ten year experience with ROLL.

Materials and Methods

A continuous prospective series of patients undergoing ROLL for non palpable invasive breast cancers is followed with 6 monthly clinical exam and an annual mammography for five years. All patients' clinical records and investigation are checked for diagnosis of recurrence (local/systemic). All patients who had clinical or radiological suspicion of local recurrence underwent clinical or image guided core biopsy or fine needle cytology to prove the recurrence. Similarly, when there is clinical suspicion of systemic recurrence, patients underwent relevant imaging to rule out or to confirm systemic recurrence. Statistical analysis is carried out by using SPSS 14. 

Aim

What is the long term outcomes after ROLL for non-palpable invasive breast cancers?

Results

460 ROLL lumpectomies were performed for invasive breast cancers during Nov 2002-Dec 2012. Median tumour size was 12 mm. Median follow up time is 60 months. Neo-adjuvant therapy was given to 41 pts (8.9%). Presence of tumour (<1 mm) at margins (including superficial and deep margin) was +ve in 113 (24.4%). However, when superficial and deep margins were excluded as it did not affect clinical decision, margin +ve for tumour are 69 (15.4%). Median number of cavity shavings; 2 (0-7). Cavity shavings containing tumour were observed in 38 pts (8.2%). 10 pts (2.2%) developed local recurrence more frequently among patients with tumours having Lympho Vascular Inavasion (P <0.003), ER negative and HER 2 negative (P<0.001) and among those with Cavity shaving involved with tumor (P<0.063). Tumour grade & margin status failed to associate with local recurrence (p = 0.985). Biological variables associated with systemic recurrences [23 (4.9%)] were; Lymph node metastases (p < 0.022), +ve Cavity

shave (p < 0.001), +ve LVI (P<0.019) and grade 3 tumours (p < 0.044), those needing neo-adjuvant therapy (p < 0.004). Margin status, Invasive tumour size, failed to achieve statistical significance.

Conclusions 

The local recurrence observed is very low (2.2%) and is affected by biological status of the tumour more than the margin status. Similarly systemic recurrence (4.9%) after ROLL is once again affected by the biological behaviours of the tumour.

Jois, R; Kalia, A; Carini, S; Harris, O; Thind, R; Desmond, S; Ray, A; Chagla, LS; Bulgasim, N; Audisio, RA. (2013).  Breast cancer recurrence after ROLL lumpectomy - Ten year experience . European Journal of Cancer. 49 (Suppl 2), S456

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