Answer
Relative contraindications to lumpectomy include small breast size, large tumor size (>5 cm), and collagen vascular disease. Absolute contraindications include the following:
-
Multifocal disease
-
History of previous radiation therapy to the area of treatment
-
Inability to undergo radiation therapy for invasive disease
-
First or second trimester of pregnancy
-
Persistent positive margins following attempts at conservation
Factors that are often considered but should not be deterrents include axillary node involvement and tumor location. Consideration of cosmesis, while important, should never outweigh the clinical priority of obtaining negative surgical margins. For instance, lesions involving Paget disease of the nipple may be treated with excision of the nipple-areolar complex and reconstruction. Larger lesions in patients with concerns regarding cosmesis may be better served by standard modified radical mastectomy and concurrent reconstruction.
-
This mammogram shows a spiculated mass to be transfixed by the guidewire
-
Grid technique of localization.
-
This orthogonal (mediolateral) projection confirms the position of the needle to be placed beyond the cluster of microcalcification.
-
This specimen radiograph shows the wire and the localized speculated mass in situ, with a good excision margin.
-
Radical mastectomy defect.
-
Inflammatory breast cancer.
-
Advanced breast cancer.
-
Metastatic breast cancer to the back.
-
Nipple retraction due to breast cancer.
-
Breast cancer. Lobular carcinoma in situ. Enlargement and expansion of lobule with monotonous population of neoplastic cells.
-
Breast cancer. Lobular carcinoma in situ. Enlargement and expansion of lobule with monotonous population of neoplastic cells.
-
Breast cancer. Infiltrating ductal carcinoma. Low-grade carcinoma with well-developed glands invading the fibrous stroma.
-
Breast cancer. Intraductal carcinoma, comedo type. Distended duct with intact basement membrane and central tumor necrosis.
-
Breast cancer. Intraductal carcinoma, noncomedo type. Distended duct with intact basement membrane, micropapillary, and early cribriform growth pattern.
-
Breast cancer. Papillary carcinoma. Solid papillary growth pattern with early cribriform and well-developed thin papillary fronds.
-
Breast cancer. Inflammatory carcinoma. Nests of tumor cells plugging dermal lymphatics.
-
Breast cancer. Colloid (mucinous) carcinoma. Nests of tumor cells in pool of extracellular mucin.
-
Breast cancer. Estrogen receptor, immunostain. Positive staining of tumor cell nuclei with monoclonal antibody to estrogen receptor.
-
Breast cancer. Her-2/neu overexpression. Infiltrating carcinoma with strong membrane immunoreactivity representing Her-2/neu overexpression.