Background Invasive lobular carcinoma (ILC) is associated with high re-excision rates following breast-conserving surgery (BCS). The correlation between lesion size on different imaging modalities and final tumor size has not been well characterized. Methods A prospective database of patients with stage I-III breast cancer undergoing BCS between 2006 and 2016 was reviewed. Pearson correlation analysis was used to correlate tumor size on breast imaging to final pathology. Results Of these, 111 patients with ILC were identified. Mean lesion size was 1.93 cm for MMG, 1.61 cm for US, and 2.51 cm for MRI. Mean tumor size on surgical excision was 2.64 cm. The correlation coefficient between pathology and the different imaging modalities were as follows: MMG .17, US 0.37, and MRI .58. Actual tumor size was underestimated by 1 cm in 27.1% of MMGs, 50% of USs, and in 13.3% of MRIs. 38 patients (34.2%) underwent re-excision. No differences in re-excision rates were noted in patients with and without MRI, 30.3% vs 40.0%, respectively (P = .31). Conclusion While MRI provides a better estimate of tumor size than MMG and US, the size of the tumor on imaging only weakly correlated with pathology. The use of MRI does not decrease re-excision rates.

Introduction: Inadequate pain control frequently extends length of stay (LOS) and costs for patients undergoing mastectomy with implant-based reconstruction (IBR). We sought to examine the effects of Paravertebral blocks (PVB) and liposomal bupivacaine (LB) and compare LOS, pain scores and costs of hospitalization. Methods: Prospective database review of patients undergoing mastectomy with IBR was performed. Results: 541 patients were identified. 51/491 (9.4%) received PVB and 50 (9.2%) received LB. LOS in the PVB group was significantly less than that of the no block (NB) group (1 [1-2] days PVB vs 3 [2-4] days NB (p < 0.0001), but was not different from the LB group (1 [1-2] days LB, p = 0.23). PVB patients had lower PACU pain scores compared to NB patients (3.2 +/- 2.9 PVB vs 5.7 +/- 2.6 NB, p < 0.0001), but similar PACU pain scores to LB patients (4.1 +/- 2.3). Patients who received PVB had higher total costs compared to NB patients ($27148 +/-$7053 PVB vs $23113 +/- 6860 NB, p = 0.003) but similar to LB patients ($26183 +/- $3761). Conclusion: PVB and LB are associated with shorter LOS and lower pain scores compared to NB.

The assessment of axillary lymph node involvement in patients with early breast cancer is among the most essential prognostic factors and plays a significant role in the decision making for additional adjuvant therapy. Historically, the determination of lymph node metastases required an axillary lymph node dissection (ALND). ALND reliably identifies patients with regional metastases, provides regional control, and decreases the risk of axillary recurrence. However, ALND is associated with an increased risk of complications, such as lymphedema, nerve injury, and shoulder dysmotility [1–3].