01) Regarding management of breast carcinoma [2022 March-Q.04] a) Core biopsy is mandatory before starting neoadjuvant chemotherapy b) Risk of recurrence is less in mastectomy than in breast conservative surgery c) Estrogen receptor positivity is a bad prognostic factor d) Sentinel LN biopsy reduces the risk of lymphedema than axillary clearance e) Surgery has no place in palliative care
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breast cancer AND sentinel lymph node biopsy
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NCI breast cancer treatment PDQ neoadjuvant chemotherapy core biopsy sentinel lymph node biopsy lymphedema breast conserving surgery mastectomy local recurrence
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Answers: a, b and d are true.
c and e are false.
c and e are false.
| Statement | True/False | Reason |
|---|---|---|
| a) Core biopsy is mandatory before starting neoadjuvant chemotherapy | True | Histological confirmation is required before systemic treatment. Core biopsy also establishes tumour grade and ER, PR, and HER2 receptor status, which guide neoadjuvant therapy. |
| b) Risk of recurrence is less in mastectomy than in breast-conservative surgery | True | In appropriately selected patients, breast-conserving surgery plus radiotherapy gives survival equivalent to mastectomy, but local recurrence is generally somewhat more frequent after breast-conserving treatment. A surgical text cites local recurrence of about 5%-22% after BCS plus RT versus 4%-14% after mastectomy. Mulholland and Greenfield's Surgery, p. 3944. |
| c) Estrogen receptor positivity is a bad prognostic factor | False | ER-positive cancers usually have a more favourable biology and are responsive to endocrine therapy. Low ER/PR expression is a higher-risk feature, not ER positivity itself. Current Surgical Therapy 14e, p. 1670. |
| d) Sentinel LN biopsy reduces the risk of lymphedema compared with axillary clearance | True | SLNB removes fewer nodes and has much less arm morbidity. Pooled lymphedema incidence is approximately 6.3% after SLNB versus 28% after axillary lymph-node dissection. Fischer's Mastery of Surgery, p. 1565. |
| e) Surgery has no place in palliative care | False | In metastatic breast cancer, surgery may be used selectively for palliation, such as to control ulceration, bleeding, infection, pain, or other local symptoms. Current Surgical Therapy 14e, p. 1679. |
The NCI breast-cancer treatment summary also supports pre-treatment tissue and nodal evaluation when planning neoadjuvant management.
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