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The Significance of Skin Oedema in Locally Advanced Breast Cancer and Its Response to Neoadjuvant Chemotherapy

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Abstract

The prognostic impact of skin oedema in the setting of locally advanced breast cancer, the extent to which this responds to neoadjuvant chemotherapy [NACT], and whether the persistence of oedema represents residual cancer are not known. A prospective study was conducted in the Department of General Surgery, PGIMER, Chandigarh, between 1 August 2017 and 31 July 2018. Locally advanced breast cancer patients who had skin oedema on clinical examination and who completed NACT were included. A punch biopsy was taken from the site of maximum oedema pre-NACT. The resolution of skin changes—oedema/ulceration post-NACT—and skin involvement by histopathology of the mastectomy specimen were analysed. All 29 patients had skin oedema to start with, and 4/29 (13.8%) had skin ulceration. Ten out of 29 (34.5%) patients had skin involvement demonstrable on histopathology pre-NACT. The skin oedema persisted in 26/29 (89.7%) post-NACT, and ulceration persisted in 3/4 (75%). On histopathology of the mastectomy specimen, skin involvement was demonstrable only in 4 patients (13.8%)—3 direct skin infiltration by tumour, 1 dermal lymphatic embolus. Skin oedema clinically persisted even in 4 patients who had a pathological complete response. While most patients have persistence of skin oedema post-NACT, this does not necessarily translate into an actual pathological skin involvement.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Agarwal G, Ramakant P (2008) Breast cancer care in India: the current scenario and the challenges for the future. Breast Care [Basel] 3(1):21–27. https://doi.org/10.1159/000115288

    Article  PubMed  Google Scholar 

  2. Haagensen CD (1974) Disease of the breast, 1st edn. W. B. Saunders Company Ltd

    Google Scholar 

  3. Güth U, Jane Huang D, Holzgreve W, Wight E, Singer G (2007) T4 breast cancer under closer inspection: a case for revision of the TNM classification. Breast 16(6):625–636. https://doi.org/10.1016/j.breast.2007.05

    Article  PubMed  Google Scholar 

  4. Silverman D, Ruth K, Sigurdson ER et al (2014) Skin involvement and breast cancer: are T4b lesions of all sizes created equal? J Am Coll Surg 219(3):534–544. https://doi.org/10.1016/j.jamcollsurg.2014.04.003

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shukla HS, Hughes LE, Gravelle IH, Satir A (1979) The significance of mammary skin edema in noninflammatory breast cancer. Ann Surg 189(1):53–57. https://doi.org/10.1097/00000658-197901000-00011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline [version 1.1]. Eur J Cancer 45(2):228–247. https://doi.org/10.1016/j.ejca.2008.10.026

    Article  CAS  PubMed  Google Scholar 

  7. Leith A (1909) Peau d’orange in acute mammary carcinoma. It’s cause and diagnostic value. Lancet 2:861

    Article  Google Scholar 

  8. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR et al (eds) (2017) AJCC cancer staging manual, 8th edn. Springer International Publishing: American Joint Commission on Cancer

    Google Scholar 

  9. Gallager HS, Martin JE (1969) The study of mammary carcinoma by mammography and whole organ sectioning. Early observations. Cancer 23(4):855–873. https://doi.org/10.1002/1097-0142[196904]23:4%3c855::aid-cncr2820230420%3e3.0.co;2-8

    Article  CAS  PubMed  Google Scholar 

  10. Dawood S, Merajver SD, Viens P et al (2011) International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol 22(3):515–523. https://doi.org/10.1093/annonc/mdq345

    Article  CAS  PubMed  Google Scholar 

  11. Amin MB, Greene FL, Edge SB et al (2017) The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67(2):93–99. https://doi.org/10.3322/caac.21388

    Article  PubMed  Google Scholar 

  12. Bonnier P, Charpin C, Lejeune C et al (1995) Inflammatory carcinomas of the breast: a clinical, pathological, or a clinical and pathological definition? Int J Cancer 62(4):382–385. https://doi.org/10.1002/ijc.2910620404

    Article  CAS  PubMed  Google Scholar 

  13. Charpin C, Bonnier P, Khouzami A et al (1992) Inflammatory breast carcinoma: an immunohistochemical study using monoclonal anti-pHER-2/neu, pS2, cathepsin, ER and PR. Anticancer Res 12(3):591–597

    CAS  PubMed  Google Scholar 

  14. Shen J, Valero V, Buchholz TA et al (2004) Effective local control and long-term survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy. Ann Surg Oncol 11(9):854–860. https://doi.org/10.1245/ASO.2004.02.003

    Article  PubMed  Google Scholar 

  15. Wiggett WS, Louw M, Karusseit VO (2012) The histology of peau d’orange in breast cancer - what are the implications for surgery? S Afr J Surg 50(3):75–78. https://doi.org/10.7196/sajs.1103

    Article  CAS  PubMed  Google Scholar 

  16. McIntosh SA, Ogston KN, Payne S et al (2003) Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy. Am J Surg 185(6):525–531. https://doi.org/10.1016/s0002-9610[03]00078-3

    Article  PubMed  Google Scholar 

  17. Wang M, Hou L, Chen M et al (2017) Neoadjuvant chemotherapy creates surgery opportunities for inoperable locally advanced breast cancer. Sci Rep 7:44673. https://doi.org/10.1038/srep44673

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Guth U, Wight E, Schotzau A, Langer I, Dieterich H, Rochlitz C et al (2006) A new approach in breast cancer with non-inflammatory skin involvement. Acta Oncol 45:576–583

    Article  PubMed  Google Scholar 

  19. Guth U, Huang DJ, Schotzau A, Dirnhofer S, Wight E, Singer G (2010) Breast cancer with non-inflammatory skin involvement: current data on an underreported entity and it’s problematic classification. Breast 19:59–64

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Ishita Laroiya, Santhosh Irrinki, Akhil Goud Pachimatla, Siddhant Khare, Gurpreet Singh & S. N. Satish

  2. Department of Pathology, PGIMER, Chandigarh, India

    Amanjit Bal

  3. Departement of Radiodaignosis, PGIMER, Chandigarh, India

    Tulika Singh

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  1. Ishita Laroiya
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  2. Santhosh Irrinki
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  3. Akhil Goud Pachimatla
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  4. Siddhant Khare
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  5. Gurpreet Singh
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  6. S. N. Satish
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  7. Amanjit Bal
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  8. Tulika Singh
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All authors have contributed equally to the manuscript.

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Correspondence to Ishita Laroiya.

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Laroiya, I., Irrinki, S., Pachimatla, A.G. et al. The Significance of Skin Oedema in Locally Advanced Breast Cancer and Its Response to Neoadjuvant Chemotherapy. Indian J Surg (2023). https://doi.org/10.1007/s12262-023-03856-3

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