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Fitzpatrick SE, Lam TC. Occult Breast Carcinoma Is More Common in Women Undergoing Breast Reduction after Contralateral Cancer: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 146:117e-126e. [PMID: 32740565 DOI: 10.1097/prs.0000000000006965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens. METHODS The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer. RESULTS Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001). CONCLUSIONS Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.
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Affiliation(s)
| | - Thomas C Lam
- From the Plastic and Reconstructive Surgery Department, Westmead Private Hospital
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Sears ED, Lu YT, Chung TT, Momoh AO, Chung KC. Pathology Evaluation of Reduction Mammaplasty Specimens and Subsequent Diagnosis of Malignant Breast Disease: A Claims-Based Analysis. World J Surg 2019; 43:1546-1553. [PMID: 30719555 DOI: 10.1007/s00268-019-04931-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to measure the use of pathology evaluation of breast specimens among patients undergoing reduction mammaplasty and assess rates of new diagnoses of breast disease and associated cost. METHODS We analyzed the Truven MarketScan Databases from 2009 to 2015 to identify adult female patients undergoing reduction mammaplasty for macromastia. We recorded patient age, rates of obtaining pathology evaluation, new diagnoses of benign or malignant breast disease after pathology evaluation, and total cost for the surgery encounter. RESULTS Among 17,738 macromastia patients undergoing reduction mammaplasty, 91.3% (n = 16,193) received pathology evaluation. Pathology evaluation rates were clinically similar across age groups <70 years (90.8-92.1%) and slightly lower for patients ≥70 (85.0%). Among 6987 patients less than 40 years who received pathology evaluation, 0.06% (n = 4) were subsequently diagnosed with malignant breast disease within 3 months, compared to 0.23% in the entire cohort (n = 37/16,193). Pathology claims resulted in an added $307 (SD 251) on average for the breast reduction surgery encounters. CONCLUSIONS Breast tissue after reduction mammaplasty is routinely submitted for pathology evaluation, without consideration of age-based risk for breast cancer. Routine pathology evaluation of breast tissue in patients in lower risk age groups (less than 40 years) required an additional $536,000 on average to detect a single occult breast cancer compared to an added $85,600 to detect a new malignancy in patients 40 years and older. Clinicians and policy makers should consider whether routine pathology evaluation of breast tissue should be individualized based on risk factors for breast cancer.
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Affiliation(s)
- Erika D Sears
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA. .,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Yu-Ting Lu
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA
| | - Ting-Ting Chung
- Center for Big Data Analytics and Statistics and Division of Rheumatology, Allergy and Immunology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Adeyiza O Momoh
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Taubman Center 2130, SPC 5340, 1500 E, Medical Center Drive, Ann Arbor, MI, 48109-5340, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Huysmans M, Bronckaers M, Schillebeeckx C, Servaes D. Incidental breast carcinoma in reduction mammoplasty. Acta Chir Belg 2017; 117:308-311. [PMID: 28610472 DOI: 10.1080/00015458.2017.1328767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed. METHODS We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented. RESULTS A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2-73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%). CONCLUSIONS Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.
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Affiliation(s)
| | - Marc Bronckaers
- Department of General Surgery, AZ Turnhout, Turnhout, Belgium
| | | | - Dirk Servaes
- Department of General Surgery, AZ Turnhout, Turnhout, Belgium
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Goodwin JT, Decroff C, Dauway E, Sybenga A, Mahabir RC. The management of incidental findings of reduction mammoplasty specimens. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255031302100414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jessica T Goodwin
- Division of Plastic Surgery, Department of Surgery; Scott and White Healthcare and Texas A&M Health Sciences Center College of Medicine, Texas, USA
| | - Chantelle Decroff
- Division of Plastic Surgery, Department of Surgery; Scott and White Healthcare and Texas A&M Health Sciences Center College of Medicine, Texas, USA
| | - Emilia Dauway
- Division of Plastic Surgery, Department of Surgery; Scott and White Healthcare and Texas A&M Health Sciences Center College of Medicine, Texas, USA
| | - Amelia Sybenga
- Division of Plastic Surgery, Department of Surgery; Scott and White Healthcare and Texas A&M Health Sciences Center College of Medicine, Texas, USA
| | - Raman C Mahabir
- Division of Plastic Surgery, Department of Surgery; Scott and White Healthcare and Texas A&M Health Sciences Center College of Medicine, Texas, USA
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Desouki MM, Li Z, Hameed O, Fadare O, Zhao C. Incidental atypical proliferative lesions in reduction mammoplasty specimens: analysis of 2498 cases from 2 tertiary women's health centers. Hum Pathol 2013; 44:1877-81. [PMID: 23656973 DOI: 10.1016/j.humpath.2013.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 02/25/2013] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
Atypical proliferative lesions (APLs) are occasionally found in breast reduction specimens. The aim of the study was to investigate the prevalence of APL in reduction mammoplasty specimens from patients who were treated mainly for macromastia. A retrospective medical record review of pathology records on patients who underwent reduction mammoplasty from 2006 to 2012 generated 2498 cases. The sole exclusion criterion was a history of invasive and/or ductal carcinoma in situ (DCIS). Laterality, specimen weight, number of blocks submitted, and presence of APL were recorded and analyzed. We defined APL as invasive carcinoma, DCIS or lobular carcinoma in situ, atypical ductal (ADH) or lobular hyperplasia, and flat epithelial atypia (FEA). The presence of papillomas, radial scars, and fibroadenomas was also recorded. At least 1 APL was identified in 107 (4.3%) of 2498 reduction mammoplasty specimens including invasive duct carcinoma (n = 2), DCIS (n = 4), ADH/FEA (n = 47), and lobular carcinoma in situ/atypical lobular hyperplasia (n = 54). One hundred four (97%) of the 107 patients underwent bilateral, and 3 (3%) underwent unilateral reductions. In conclusion, the frequency of detection of APLs in patients with no history of breast cancer is low (4.3%). Detection of invasive and DCIS lesions is extraordinarily low at 0.2%. The most common APL is lobular neoplasia (2.2%), whereas ADH and FEA are seen in 1.9%. Our findings provide data on the distribution of these lesions in this setting, as well as some insight into their prevalence in the general population. A protocol for submitting tissues from these specimens is also proposed.
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Affiliation(s)
- Mohamed M Desouki
- Department of Pathology, Vanderbilt University, Nashville, TN 37232-2561, USA.
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