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Abstract
Breast cancer is the most common cancer among women contributing 30% of all female cancer. It affects 1 in 14 women during her lifetime, almost one of every three affected will die of the disease. It is most common in USA and least common in Japan. Breast cancer constitutes 33% of all cancer at National Cancer Institute of Cairo, the female to male is 44:1. Mammography is the most useful technique for detection of early breast cancer. Mammography and physical examination is very effective in diagnosing impalpable breast lesions with survival advantages resulting from early detection. The clinical staging of the regional lymphatic in patients with breast cancer is currently receiving attention in the medical literature. The presence of absence of regional LN metastasis has been are of the most important determining factors in recommending adjuvant chemotherapy for patients with breast cancer, so comes the importance to determine the potentiality involved group of ALNs in patients with breast cancer, and total number of positive lymph nodes. Hence, the specimen, whatever the type of the operation should contain at least 10 LNs and serial sectioning should be done meticulously for accurate detection of total number of positive axillary LNs. Objectives: The aim of this study is to evaluate mammography for diagnosis and staging of cancer breast in correlation to clinical staging, as well as the value of radical axillary dissection as a staging procedure. The incidence of early and late complications after axillary dissection, and the risk of local recurrence treated with radical axillary dissection without subsequent axillary irradiation will be recorded.Patients and methods: In this work, 50 patients with early breast cancer were admitted to the Department of Surgery in the Zagazig University Hospitals from November 2001 to December 2003. Clinical staging of the patients was stage I and II metastatic workup to exclude metastasis, mean patients’ age was 48.6 years, with highest frequency of 40% between 40-49% premenopausal more 62% and multipara (80%), with family history positive in 10%. Results: Left breast more affected (58%), upper outer quadrant as the most affected site in 48%. Clinical staging was 10% stage I, 40% stage IIa and 52% stage IIb; the main complaint of patients was painless breast mass in 80%. Mammographic studies with adjunct U/S were done for all patients for restaging of patients while clinical examination of the primary breast tumor was correct in 86%,the mammography and U/S were correct in 92%. Also, mammography could detect multicentric tumors in 4% and multiple breast masses in 8% of cases. About involved axillary lymph nodes, clinical examination was accurate in 75% while mammography LUS detected 93.7% as positive cases. Other benefits of mammography was down-estimate of the tumor size and thus T1 became 26% instead of 10%,T2a became 40% instead of 26% and T2b became 22% instead of 50%. Also, it could detect local recurrences during follow up. FNAC was done for all cases to both breast tumors and enlarged axillary lymph nodes. It was correct in 90% of cases, false negative in 4% and true negative in 6%. Invasive duct carcinoma was 82% of the pathological types of the tumor while invasive lobular carcinoma was 10%,tumor’s grade II was 80%; while G III 18% and grade I was 2%. Conclusion: For our study, we conclude that BCT is a safe and appropriate methods of primary therapy for the majority of women with early stage breast cancer and is preferable as it preserves the breast and provides survival equivalent that of mastectomy and axillary dissection. Surgical approach must be planned to achieve the best cosmetic results. It would conclude that complete axillary dissection is advisable in all patients with invasive breast cancer for proper staging and therapeutic purposes.