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Webster AJ, Shanno JN, Santa Cruz HS, Kelly BN, Garstka M, Henriquez A, Specht MC, Gadd MA, Verdial FC, Nguyen A, Oseni TO, Coopey SB, Smith BL. Oncologic Safety of Nipple-Sparing Mastectomy for Breast Cancer in BRCA Gene Mutation Carriers: Outcomes at 70 Months Median Follow-Up. Ann Surg Oncol 2023; 30:3215-3222. [PMID: 36604360 DOI: 10.1245/s10434-022-13006-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Retention of the nipple-areola complex with nipple-sparing mastectomy (NSM) techniques provides a more natural cosmetic result than procedures that sacrifice the nipple. While the oncologic safety of NSM is established by several studies, there is little long-term data on outcomes in BRCA mutation carriers with breast cancer. PATIENTS AND METHODS BRCA1/2 mutation carriers who underwent NSM and immediate reconstruction from 2008 to 2019 were reviewed and patients with breast cancer on biopsy or final pathology were included. Patient demographics and tumor characteristics, as well as treatment, recurrence, and survival data were collected. RESULTS A total of 114 therapeutic NSM were performed in 105 BRCA mutation carriers (56 BRCA1, 47 BRCA2, and two women with both mutations). Median age was 45 years. Cancers were 18% stage 0, 52% stage I, 27% stage II, and 3% stage III. Mean invasive tumor size was 1.6 cm and 33 (35%) invasive tumors were triple negative. There were five (4.4%) positive nipple margins on final pathology; all underwent nipple excision. Most patients (80, 76%) received systemic therapy: 65 (62%) received chemotherapy and 48 (46%) received endocrine therapy. At 70 months median follow-up (range 15-150 months), no patient had developed a recurrence in the retained nipple-areola complex or at the site of a nipple excised for a positive margin. The rate of locoregional recurrence outside the nipple was 2.6%, and the rate of distant recurrence was 3.8%. Overall survival was 96%. CONCLUSIONS NSM is a safe option for BRCA1 and BRCA2 mutation carriers who undergo mastectomy for breast cancer.
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Affiliation(s)
- Alexandra J Webster
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Julia N Shanno
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi S Santa Cruz
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bridget N Kelly
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan Garstka
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Anthony Henriquez
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle C Specht
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michele A Gadd
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Francys C Verdial
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Anvy Nguyen
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Tawakalitu O Oseni
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne B Coopey
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara L Smith
- Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA.
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New classifications of axillary lymph nodes and their anatomical-clinical correlations in breast surgery. World J Surg Oncol 2021; 19:93. [PMID: 33781279 PMCID: PMC8008673 DOI: 10.1186/s12957-021-02209-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background In the last decade, two research groups, the French group by Clough et al. (Br J Surg. 97:1659–65, 2010) and the Chinese one by Li et al. (ISRN Oncol 2013:279013, 2013), proposed two types of classification of axillary lymph nodes in breast cancer, identifying novel anatomic landmarks for dividing the axillary space in lymph node dissection. Main body Knowledge of the exact location of the sentinel node helps to focus the surgical dissection and to reduce the morbidity of sentinel lymph node biopsy procedures, in particular the risk of arm lymphedema, without compromising sensitivity. Conclusion In this article, we aimed at focusing on the clinical impact that the most recent classifications of axillary lymph nodes have obtained in literature, highlighting the importance of defining new demarcations to preserve the axillary lymph nodes as much as possible in breast surgery.
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