PhD defence S. (Sara) van Bekkum

Brief summary of the doctoral thesis:

Breast cancer screening and improved imaging techniques resulted in an increase of detected non-palpable breast lesions and performed biopsies. Management of these lesions is based on characteristics determined on histologic biopsy. This thesis aimed to describe the role of breast biopsy in personalizing treatment based on data from daily clinical practice. In conclusion:

• Vacuum-assisted stereotactic biopsy for breast calcifications has a very high accuracy. A benign histopathologic result does not need follow-up. 
• MRI-guided breast biopsy in the diagnostic setting is an accurate procedure and a valuable tool in clinical decision-making.
• Pre-operative breast MRI cannot reliably predict the presence of invasive cancer in patients with biopsy proven DCIS. Therefore, it cannot be used in the selection of patients for a SLNB.  
• The prediction model of Meurs et al (2018) is a valid model and has the clinical utility in the selection for SLNB in patients with biopsy-proven DCIS.
• When surgical margins are pursued in the management of DICS, there is a very low ipsilateral breast cancer recurrence rate(8%). With a recurrence rate this low, there is no additional value of biomarkers to estimate the risk of recurrence.
• In the majority of patients, cALND did not lead to upstaging and consequently, it did not change adjuvant treatment.
• Patients were well-informed in their decision making and had individual motives to opt for or reject breast reconstruction. Differences in the rating of values seem to affect the decision since the same arguments were used as well to op for as to reject breast reconstruction.