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Preoperative Imaging Assessment and Utility of the Systemic Inflammatory Indices in the Management of Invasive Lobular Carcinoma of the Breast / ANITA HUWS

Swansea University Author: ANITA HUWS

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    Copyright: The author, Anita M. Huws, 2024. Licensed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 license. Third party content is excluded for use under the license terms.

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DOI (Published version): 10.23889/SUthesis.66392

Abstract

The last century has witnessed an evolution in the surgical and oncological management of breast cancer. However, the unique characteristics of lobular carcinoma continue to pose challenges in both the preoperative and adjuvant setting. In the first part of this study, the size of lobular cancer was...

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Published: Swansea, Wales, UK 2024
Institution: Swansea University
Degree level: Doctoral
Degree name: M.D
Supervisor: Morgan, Claire; Lewis, Paul
URI: https://cronfa.swan.ac.uk/Record/cronfa66392
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Abstract: The last century has witnessed an evolution in the surgical and oncological management of breast cancer. However, the unique characteristics of lobular carcinoma continue to pose challenges in both the preoperative and adjuvant setting. In the first part of this study, the size of lobular cancer was assessed on Digital Breast Tomosynthesis and compared with the standard imaging tool, Magnetic Resonance Imaging, using final pathology as the gold standard measurement. The correlation with sonography was calculated as a secondary analysis. The results found that lobular tumour size estimation on tomosynthesis and sonography has low to moderate correlation with final pathology. Although, there is some agreement with tumour sizes less than 2cm, the need for preoperative MRI remains. The introduction of contrast-enhanced spectral mammography may reduce the need for magnetic resonance imaging in the preoperative assessment of lobular breast cancer. Further investigation will be considered. The second analysis evaluated the potential of systemic peripheral blood ratios as prognostic indicators in the adjuvant setting of node negative early breast cancer, comparing two internationally validated tools, the Nottingham Prognostic Index and Oncotype DX® Recurrence Score, to assess whether the blood ratios may reduce the need for genomic testing in selected cases. The recurrence scores of 495 node negative patients with early breast cancer were compared with the Nottingham Prognostic Index and four systemic inflammatory indices calculated from the preoperative peripheral blood count. Statistical tests of correlation found that there was poor to no correlation with the Oncotype DX® Recurrence Score, the Nottingham Prognostic Index and the systemic inflammatory indices investigated, for both subtypes. The results of this study highlight the need for further work in this field. Lobular cancer has distinct morphomolecular and histomolecular properties that require studies specifically designed to address this.
Item Description: A selection of third party content is redacted or is partially redacted from this thesis due to copyright restrictions.
Keywords: Lobular carcinoma of the breast; Preoperative imaging; Adjuvant therapy; Systemic inflammatory indices;
College: Faculty of Medicine, Health and Life Sciences