1. POST NEOADJUVANT RESIDUAL BREAST
TUMOR SIZE;CLINICAL,RADIOLOGICAL
AND PATHOLOGICAL CORRELATION
Presented By:
Dr. Madiha Ehsan-Ul-Haq
Dr. Imrana Tanvir, Dr. Sabiha Riaz, Dr. Haseeb Khan and Dr. Huma Majeed
Fatima Memorial Hospital College of Medicine and Dentistry

2. Introduction
• Breast cancer:most common cancer diagnosed in
women worldwide
• Pakistan:90,000 every year
• Mastectomy replaced now by neoadjuvent
therapy followed by breast conservation surgery
or mastectomy

3. Neoadjuvant Therapy
• Neoadjuvant chemotherapy:part of treatment of
earlier stage operable cancer
• Increase Eligibility for Breast conservation surgery
• Efficacy of the systemic therapy can be assessed in
vivo
• One of the factor determining Post neoadjuvent
surgical procedure is residual size of tumor.
• Residual tumor size :major prognostic factor

4. Estimation of Residual Tumor size
•
•
•
•
•
•
•
Physical Examintaion (PE)
Ultrasonography (US)
Mammography (M)
MRI
Contrast Enhanced CT
PET
Light and fluorescent probes (Nanobiotechnology)

5. Aim and Objective
• Correlation between residual tumor size estimation
by these modalities with pathological measurements
is heterogenous
“To compare Post neoadjuvant residual breast
tumor size measured on clinical examination
and radiology with gold standard
histopathology “

6. Material and Method
• Retrospective study
• Conducted at Fatima memorial Hospital and Ittefaq
hospital
• The study was completed in 4 months
• Sample Population:25 cases of Invasive Ductal
Carcinoma

7. Data collection and Analysis
• Residual tumor size was measured by Clinical
examination (PE) and radiology (US) were
recorded from the file.
• Size correlation was done using Spearman rho
analysis
(to measure level of association )
• Weighted Kappa values were deducted
(reliability)

8. Pathological
Tumor size
• Largest dimension
of tumour bed
was measured on
gross examination

10. • Largest Unidimentional
strip section
• Selected
sample
:labelled and
submitted in
blocks
• Skip lesions
/Scattered foci

11. Spearman Analysis
Correlation of Postneoadjuvant
residual tumor size
Comparison
Postneoadjuvant
Chemotherapy
PE VS US
0.633
PE VS PATHOLOGY
0.722
US VS PATHOLOGY
0.394
<0=negative correlation , 0-0.5=weak positive correlation ,0.5-1=strong positive correlation

12. Correlation of tumor measurements
Scatter plots
PHYSICAL SIZE
9
8
8
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
ULTRASOUND SIZE
9
0
0
2
4
6
8
10
Pathological size
0
2
4
6
8
10

13. WEIGHTED KAPPA VALUES
MEASUREMENTS
WEIGHTED KAPPA
Physical Examination vs
Pathological measurements
0.457
Ultrasonography
measurements vs
Pathological measurements
0.384

14. Conclusion
• Post neoadjuvent tumor Size estimation of breast
tumor by Clinical examination and Radiological
modalities correlated on a moderate level with the
gold standard pathological tumor size
• Compared to radiological, Clinical tumor size
estimation correlate better with pathological tumor
size estimation.

15. Take home message
• SURGEONS:should try to get Wider Margins
to avoid positive margins
• PATHOLOGIST:More cautious when dealing
with post neoadjuvant residual tumor size (
gross,sampling and reporting)

17. References
• Accuracy of physical examintaion,ultrasonography
and mamography to predict residual tumor size with
correlation with pathrological size ,2006