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Zhu M, Mao J, Fang J, Chen D. Safety of Atypical Ductal Hyperplasia at the Nipple Margin in Nipple-Sparing Mastectomy. J Breast Cancer 2024; 27:260-269. [PMID: 39069781 PMCID: PMC11377941 DOI: 10.4048/jbc.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/16/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE Controversies persist regarding contraindications for nipple-sparing mastectomy (NSM). This study aimed to assess the accuracy of subareolar frozen section analysis and identify risk factors for nipple-areola complex (NAC) recurrence post NSM. METHODS Consecutive cases of primary invasive breast cancer undergoing NSM at our single center from January 2015 to December 2020 were retrospectively reviewed. RESULTS The nipples were retained in 126 patients (127 breasts), and the areola was retained with nipple excision for five breasts. Frozen section analysis demonstrated a sensitivity of 81.8% and specificity of 95.3%. The NAC recurrence rate was 4.3% over a median follow-up period of 48 (30-105) months. An atypical ductal hyperplasia (ADH) at the margin emerged as an independent factor for NAC recurrence in multivariate Cox regression analysis (hazard ratio, 25.464; 95% confidence interval, 1.841-352.145; p = 0.016). Kaplan-Meier survival analysis revealed no statistically significant reduction in overall survival rates (log-rank test, p = 0.660). CONCLUSION Frozen sections of subareolar tissue are reliable and re-excision may be necessary when ADH is detected at the nipple margin in NSM. The NAC recurrence rate was low, and the outcome was favorable following wide local excision.
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Affiliation(s)
- Meizhen Zhu
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
| | - Jiefei Mao
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Jun Fang
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Daobao Chen
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
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2
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Nashimoto M, Asano Y, Matsui H, Machida Y, Hoshi K, Kurosumi M, Fukuma E. Comparison of locoregional recurrence risk among nipple-sparing mastectomy, skin-sparing mastectomy, and simple mastectomy in patients with ductal carcinoma in situ: a single-center study. Breast Cancer 2024:10.1007/s12282-024-01613-2. [PMID: 39017823 DOI: 10.1007/s12282-024-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND In invasive breast cancer, there are no differences among the mid- and long-term oncological safety results of nipple-sparing mastectomy (NSM), skin-sparing mastectomy (SSM), and simple mastectomy (SM). There are several reports comparing NSM and SSM with SM in the context of ductal carcinoma in situ (DCIS); however, the eligibility criteria vary among institutions, and there are no reports that compare all three surgical methods simultaneously within the same institution. This study aimed to compare the local recurrence and survival rates of the three techniques (NSM, SSM, and SM) in Japanese patients undergoing mastectomy for DCIS. METHODS Patients undergoing NSM, SSM, or SM at our institution between 2006 and 2015 were identified, and their outcomes were analyzed. RESULTS The mean follow-up period was 80.4 months (standard deviation [SD]: 37.1 months). NSM was performed in 152 cases, SSM in 49, and SM in 44. Five of 245 patients developed local recurrences. Four of these patients had invasive cancer. The primary endpoints of 5-year cumulative local recurrence were 2.4% (95% confidence interval [CI]: 0.0-5.0) for NSM, 2.2% (95% CI: 0.0-6.3) for SSM, and 0% (95% CI: 0.0-0.0) for SM. There were no significant differences among the 5-year local recurrence rates. CONCLUSIONS In this single-center, retrospective study, the oncological safety of SSM and NSM for DCIS was comparable to that of conventional SM.
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Affiliation(s)
- Mika Nashimoto
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
| | - Yuko Asano
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Clinical Research Support Office, Kameda Medical Center, Chiba, Japan
| | - Youichi Machida
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
- Department of Radiology, Kameda Medical Center, Chiba, Japan
| | - Kazuei Hoshi
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Masafumi Kurosumi
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
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Delaloge S, Khan SA, Wesseling J, Whelan T. Ductal carcinoma in situ of the breast: finding the balance between overtreatment and undertreatment. Lancet 2024; 403:2734-2746. [PMID: 38735296 DOI: 10.1016/s0140-6736(24)00425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 05/14/2024]
Abstract
Ductal carcinoma in situ (DCIS) accounts for 15-25% of all breast cancer diagnoses. Its prognosis is excellent overall, the main risk being the occurrence of local breast events, as most cases of DCIS do not progress to invasive cancer. Systematic screening has greatly increased the incidence of this non-obligate precursor of invasion, lending urgency to the need to identify DCIS that is prone to invasive progression and distinguish it from non-invasion-prone DCIS, as the latter can be overdiagnosed and therefore overtreated. Treatment strategies, including surgery, radiotherapy, and optional endocrine therapy, decrease the risk of local events, but have no effect on survival outcomes. Active surveillance is being evaluated as a possible new option for low-risk DCIS. Considerable efforts to decipher the biology of DCIS have led to a better understanding of the factors that determine its variable natural history. Given this variability, shared decision making regarding optimal, personalised treatment strategies is the most appropriate course of action. Well designed, risk-based de-escalation studies remain a major need in this field.
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Affiliation(s)
- Suzette Delaloge
- Department of Cancer Medicine, Interception Programme, Gustave Roussy, Villejuif, France.
| | - Seema Ahsan Khan
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Jelle Wesseling
- Divisions of Molecular Pathology & Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Timothy Whelan
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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4
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Shaffer K, Harris L, Ng S, Tjoe JA. Nipple-Sparing Mastectomy and Adequate Margins for Patients With Ductal Carcinoma In Situ. Am Surg 2024:31348241246179. [PMID: 38605446 DOI: 10.1177/00031348241246179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND For patients with ductal carcinoma in situ (DCIS) undergoing breast conservation surgery (BCS), guidelines advise a margin width of at least 2 mm, with studies demonstrating decreased recurrence risk compared to narrower margins. However, limited data exist establishing if this margin is appropriate in mastectomies, and specifically for nipple-sparing mastectomy (NSM). Consequently, we evaluated the margins of DCIS patients undergoing NSM and resulting oncologic outcomes. METHODS A single-institution retrospective review was performed in patients with DCIS or DCIS with microinvasion (DCIS + MI) undergoing NSM from April 2010 to December 2021. Patient and tumor characteristics, margin status, treatment, and outcomes information were collected. The association between margins and local-regional (LRR) and distant recurrence (DR) were examined. RESULTS 161 patients were included, comprising 284 NSM (164 therapeutic, 120 prophylactic). 153 patients had DCIS and 8 had DCIS + MI. Most patients had hormone sensitive, 123 (76.4%), and nuclear grade 2, 72 (44.7%), disease. In total, 35 (21.7%) patients had positive or <2 mm margins. Of these, 21 (60%) involved the anterior margin. At a median follow-up of 45 months (range 0-151), 2.5% (n = 4) had a LRR and .6% (n = 1) had a DR. Of patients with a recurrence, only 2 had positive or <2 mm margins, 1 had received endocrine therapy, and none received adjuvant radiation. DISCUSSION No specific margin status was found to correlate with recurrence for patients with DCIS or DCIS + MI undergoing NSM, with an altogether low recurrence risk. Overall, this suggests that recommended DCIS margins in BCS doesn't necessarily apply in NSM, where margins of <2 mm may be acceptable.
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Affiliation(s)
- Kristina Shaffer
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Surgical Oncology, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Lilian Harris
- Department of Medical Oncology, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Stephanie Ng
- Program in Women's Oncology, Gynecologic Oncology, and Breast Surgery, Women and Infants Hospital, Providence, RI, USA
| | - Judy A Tjoe
- Division of Surgical Oncology, Green Bay Oncology, Green Bay, WI, USA
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5
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Youn S, Lee E, Peiris L, Olson D, Lesniak D, Rajaee N. Spare the Nipple: A Systematic Review of Tumor Nipple-Distance and Oncologic Outcomes in Nipple-Sparing Mastectomy. Ann Surg Oncol 2023; 30:8381-8388. [PMID: 37620525 DOI: 10.1245/s10434-023-14143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Preserving the nipple-areolar complex (NAC) in breast cancer surgery improves patient satisfaction and quality of life. The oncologic safety of NSM in tumors < 2 cm from the nipple remains in question. We conducted a systematic review to determine whether TND < 2 cm was associated with increased risk of LRR in patients undergoing NSM. METHODS We included studies of invasive or in situ breast cancer < 2 cm from NAC undergoing NSM which reported LRR rates. LRR rates were stratified by TND and culminated across studies. Cohort study quality was assessed using Newcastle-Ottawa Criteria. Meta-analysis was not possible due to heterogeneity in reporting survival outcomes. RESULTS We identified seven retrospective cohort studies with 2295 patients and 18 case series with 3507 patients. Direct tumor involvement of NAC was considered an absolute contraindication to NSM in all studies. In cohort studies, median follow-up was 31-112 (range 14-204) months. Cohorts with TND < 2 cm did not have a significantly higher rate of LRR. Amongst case series, 275 patients had TND < 2 cm. Combined LRR in case series was 2.6%, with median follow-up 10.4-71 (range 0-158) months. CONCLUSIONS Our systematic review did not identify TND < 2 cm as a significant risk factor for LRR. NSM appears oncologically safe in select patients with TND < 2 cm. Given the improved quality of life associated with NSM compared to skin-sparing mastectomy, we suggest NSM as the procedure of choice in appropriately selected patients.
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Affiliation(s)
- Susie Youn
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada.
| | - Esther Lee
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Lashan Peiris
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - David Olson
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - David Lesniak
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Nikoo Rajaee
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
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6
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ElSherif A, Freyvogel Ramirez M, Moore EC, Dietz JR, Tu C, Valente SA. Mastectomy margins for ductal carcinoma-in-situ (DCIS): 18 Years of follow-up. Am J Surg 2023; 226:646-651. [PMID: 37481406 DOI: 10.1016/j.amjsurg.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND In patients undergoing mastectomy for ductal carcinoma in situ (DCIS), the significance of a positive or close (<2 mm) margin and associated recurrence risk is unclear. The study sought to evaluate risk of recurrence in relation to the mastectomy surgical margin. METHODS A single institution retrospective review of patients with DCIS who underwent mastectomy between 2000 and 2010 was performed. Patient demographics, tumor biology, margin status and adjuvant therapy were recorded. The incidence of local recurrence (LR), distant metastasis were analyzed. RESULTS A total of 282 patients with DCIS were identified. Overall, 12.3% of patients had a pathological positive/close margin (n = 9 tumor on ink and n = 36 <2 mm). Adjuvant radiation was administered to 11 patients with a positive or close margin. At a median follow-up of 12 years, LR was 3.4% (n = 10). None of the patients with LR had a positive or close margin. Additionally, none of the patients who received radiation developed LR. CONCLUSION Risk of recurrence after mastectomy for DCIS is low and appears to be unrelated to margin status or the use of radiation therapy.
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MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy
- Follow-Up Studies
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Retrospective Studies
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/surgery
- Margins of Excision
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Affiliation(s)
- Ayat ElSherif
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Mary Freyvogel Ramirez
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Edwina C Moore
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, United States
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Stephanie A Valente
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
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Shinzaki W, Manabe H, Kubota M, Inui H, Hojo T, Ito T, Itani Y, Komoike Y. Breast cancer local recurrence after mastectomy with immediate latissimus dorsi myocutaneous flap reconstruction: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231177510. [PMID: 37325163 PMCID: PMC10265333 DOI: 10.1177/2050313x231177510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Even though most local recurrences after autologous breast reconstruction occur in superficial tissue, they also occur in deep tissue in the reconstructed breast. A 49-year-old woman presented with a bloody discharge from the right nipple. Ultrasonography revealed a hypoechoic area in her right breast, which was diagnosed as ductal carcinoma in situ on histopathology. We performed nipple-sparing mastectomy and immediate reconstruction of the breast with a latissimus dorsi myocutaneous flap. At 6 years postoperatively, the patient presented with a palpable mass. Ultrasonography revealed a solid mass lesion subcutaneously in the right breast. Computed tomography revealed multiple enhanced solid mass lesions in the subcutaneous and deep tissues of the reconstructed breast. The mass in the deep tissue of the reconstructed breast was diagnosed as an invasive micropapillary carcinoma by biopsy. For local recurrence, we performed wide excision of the reconstructed breast. The masses in the subcutaneous and deep tissues of the reconstructed breast were diagnosed as invasive micropapillary carcinoma. Superficial recurrence was first detected by physical examination, and deep recurrence was later detected with further imaging. We present a case of local recurrences that occurred in the deep tissue, in addition to superficial tissue of the reconstructed breast.
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Affiliation(s)
- Wataru Shinzaki
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Hironobu Manabe
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Michiyo Kubota
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Hiroki Inui
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Toshiya Hojo
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Toshikazu Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Yoshihito Itani
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Yoshifumi Komoike
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
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Modern Approaches to Implant-Based Breast Reconstruction. Clin Plast Surg 2023; 50:223-234. [PMID: 36813400 DOI: 10.1016/j.cps.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The modern approach to implant-based breast reconstruction encompasses an evolution in surgical techniques, patient selection, implant technology, and use of support materials. Successful outcomes are defined by teamwork throughout the ablative and reconstructive processes as well as appropriate and evidence-based utilization of modern material technologies. Patient education, focus on patient-reported outcomes, and informed and shared decision-making are the key to all steps of these procedures.
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Acea-Nebril B, García-Novoa A, Díaz MT, Alejandro AB, Carballada CD, Conde Iglesias C, Díaz Martínez I, Martínez Arribas C, Calvo Martínez L, Novoa SA, Santiago Freijanes P, Oses JM. Locoregional relapse after sparing mastectomies and immediate reconstruction in women with breast cancer. Cir Esp 2023; 101:97-106. [PMID: 36064171 DOI: 10.1016/j.cireng.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION In recent years, cultural changes in today's society and improved risk assessment have increased the indication for mastectomies in women with breast cancer. Various studies have confirmed the oncological safety of sparing mastectomies and immediate reconstruction. The objective of this study is to analyze the incidence of locoregional relapses of this procedure and its impact on reconstruction and overall survival. PATIENTS AND METHODS Prospective study of patients with breast carcinoma who underwent a sparing mastectomy and immediate reconstruction. Locoregional relapses and their treatment and their impact on survival were analyzed. RESULTS The study group is made up of 271 women with breast carcinoma treated with a skin-sparing mastectomy and immediate reconstruction. The mean follow-up was 7.98 years and during the same 18 locoregional relapses (6.6%) were diagnosed: 72.2% in the mastectomy flap and 27.8% lymph node. There were no significant differences in the pathological characteristics of the primary tumor between patients with and without locoregional relapse, although the percentage of women with hormone-sensitive tumors was higher in the group without relapse. Patients with lymph node relapse had larger tumors (80% T2-T3) and 60% had axillary metastases at diagnosis, compared to 7.7% of women with skin relapse (p = 0.047). All patients operated on for locoregional relapse preserved their reconstruction. The incidence of metastases and deaths was significantly higher in patients with a relapse, causing a non-significant decrease in overall survival. CONCLUSION Locoregional relapses are a rare event in women with a sparing mastectomy and immediate reconstruction. Most patients with locoregional relapse can preserve their initial reconstruction through local resection of the tumor and adjuvant and / or neoadjuvant therapies.
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Affiliation(s)
- Benigno Acea-Nebril
- Servicio de Cirugía General, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Alejandra García-Novoa
- Servicio de Cirugía General, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain.
| | - Mónica Torres Díaz
- Servicio de Cirugía General, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Alberto Bouzón Alejandro
- Servicio de Cirugía General, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Carlota Díaz Carballada
- Servicio de Ginecología, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Carmen Conde Iglesias
- Servicio de Ginecología, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Inmaculada Díaz Martínez
- Servicio de Oncología Radioterápica, Unidad de Mama, Centro Oncológico de Galicia, La Coruña, Spain
| | - Carme Martínez Arribas
- Servicio de Oncología Radioterápica, Unidad de Mama, Centro Oncológico de Galicia, La Coruña, Spain
| | - Lourdes Calvo Martínez
- Servicio de Oncología Médica, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Silvia Antolin Novoa
- Servicio de Oncología Médica, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Paz Santiago Freijanes
- Servicio de Anatomía Patológica, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Joaquín Mosquera Oses
- Servicio de Radiología, Unidad de Mama, Hospital Universitario de A Coruña, La Coruña, Spain
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10
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Cavalcante FP, Araújo MMP, Veras IM, Freitas-Junior R. Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1052-1058. [PMID: 36580950 PMCID: PMC9800068 DOI: 10.1055/s-0042-1751286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. METHODS This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. RESULTS Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. CONCLUSION In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.
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Affiliation(s)
- Francisco Pimentel Cavalcante
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil,Address for correspondence Francisco Pimentel Cavalcante, MD Rua Manuel Jacaré136/1401, Fortaleza 60175-110, CearáBrazil
| | | | | | - Ruffo Freitas-Junior
- Department of Obstetrics and Gynecology, Universidade Federal de Goiás, Goiânia, GO, Brazil
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11
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Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14:cancers14225624. [PMID: 36428718 PMCID: PMC9688088 DOI: 10.3390/cancers14225624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Oncoplastic level II breast-conserving surgery (OPS2) allows for wider excisions than standard breast-conserving surgery, but the literature on this technique in the treatment of DCIS is scarce. This study compares OPS2 to conservative mastectomy (CM) in patients undergoing surgery for large DCIS. The clinical, radiological, surgical, and post-operative data of 147 patients who underwent either CM or OPS2 for large DCIS between 2007 and 2021 were retrospectively reviewed. The surgical, oncological, and patient-reported outcomes (PRO) were analyzed and compared between the two groups. The surgical outcomes were similar, in terms of margin involvement (p = 0.211), complication rate (p = 0.827), and re-excision rate (p = 1). The rate of additional surgery for cosmetic optimization was significantly lower in the OPS2 group: only 1 (1.8%) patient required surgical adjustments versus 24 (26.4%) patients in the CM group (p < 0.001). The mean hospital stay was lower in the OPS2 group (p < 0.001). The oncological outcomes did not differ between the two groups (p = 0.662). The PRO analysis showed better outcomes in the OPS2 group, which achieved statistical significance in the sexual well-being module (p = 0.015). Skin sensitivity loss was also significantly lower in the OPS2 group (p < 0.001). When feasible, OPS2 should be considered in the treatment of large DCIS, as it is safe and shows high levels of patient satisfaction.
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12
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Akrida I, Mulita F. The clinical significance of HER2 expression in DCIS. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2022; 40:16. [PMID: 36352293 DOI: 10.1007/s12032-022-01876-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
HER2 is an established prognostic and predictive marker for patients with invasive breast cancer. The clinical and biological significance of HER2 overexpression in patients with ductal carcinoma in situ (DCIS) remains poorly defined. DCIS is a heterogeneous disease and some patients with DCIS will not progress to invasive breast cancer. However, clinically significant recurrence rates have been reported after breast-conserving surgery for DCIS and approximately half of these cases will be life-threatening invasive recurrences. Since the incidence of DCIS is rising due to the widespread use of screening mammography, there is robust interest in selecting high-risk DCIS patients that may benefit from adjuvant therapies. Molecular prognostic and predictive models in early invasive breast cancer help clinicians identify patients that will benefit from chemotherapy. Molecular subtyping and profiling could also be useful in treating DCIS patients. According to current practice guidelines, HER2 testing is not recommended in DCIS patients. Nevertheless, evidence suggests that HER2-positive DCIS cases may be associated with adverse clinicopathological parameters and increased recurrence rates. This review summarizes the existing body of evidence linking HER2 expression and ipsilateral breast cancer recurrence in DCIS. HER2, as well as its correlation with other clinicopathological markers might be a useful prognostic and predictive marker, helping clinical decision-making in DCIS patients.
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Affiliation(s)
- Ioanna Akrida
- Department of General Surgery, University General Hospital of Patras, Rion, Greece. .,Department of Anatomy-Histology-Embryology, University of Patras Medical School, 26504, Rion, Greece.
| | - Francesk Mulita
- Department of General Surgery, University General Hospital of Patras, Rion, Greece
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13
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Bargon CA, Young‐Afat DA, Ikinci M, Braakenburg A, Rakhorst HA, Mureau MA, Verkooijen HM, Doeksen A. Breast cancer recurrence after immediate and delayed postmastectomy breast reconstruction-A systematic review and meta-analysis. Cancer 2022; 128:3449-3469. [PMID: 35894936 PMCID: PMC9546326 DOI: 10.1002/cncr.34393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/11/2022] [Accepted: 05/28/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Oncological safety of different types and timings of PMBR after breast cancer remains controversial. Lack of stratified risk assessment in literature makes current clinical and shared decision-making complex. This is the first systematic review and meta-analysis to evaluate differences in oncological outcomes after immediate versus delayed postmastectomy breast reconstruction (PMBR) for autologous and implant-based PMBR separately. METHODS A systematic literature search was performed in MEDLINE, Cochrane Library, and Embase. The Cochrane Collaboration Handbook and Meta-analysis Of Observational Studies in Epidemiology checklist were followed for data abstraction. Variability in point estimates attributable to heterogeneity was assessed using I2 -statistic. (Loco)regional breast cancer recurrence rates, distant metastasis rates, and overall breast cancer recurrence rates were pooled in generalized linear mixed models using random effects. RESULTS Fifty-five studies, evaluating 14,217 patients, were included. When comparing immediate versus delayed autologous PMBR, weighted average proportions were: 0.03 (95% confidence interval [CI], 0.02-0.03) versus 0.02 (95% CI, 0.01-0.04), respectively, for local recurrences, 0.02 (95% CI, 0.01-0.03) versus 0.02 (95% CI, 0.01-0.03) for regional recurrences, and 0.04 (95% CI, 0.03-0.06) versus 0.01 (95% CI, 0.00-0.03) for locoregional recurrences. No statistically significant differences in weighted average proportions for local, regional and locoregional recurrence rates were observed between immediate and delayed autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrences after autologous PMBR, and of all outcome measures after implant-based PMBR. CONCLUSIONS Delayed autologous PMBR leads to similar (loco)regional breast cancer recurrence rates compared to immediate autologous PMBR. This study highlights the paucity of strong evidence on breast cancer recurrence after specific types and timings of PMBR. LAY SUMMERY Oncologic safety of different types and timings of postmastectomy breast reconstruction (PMBR) remains controversial. Lack of stratified risk assessment in literature makes clinical and shared decision-making complex. This meta-analysis showed that delayed autologous PMBR leads to similar (loco)regional recurrence rates as immediate autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrence after autologous PMBR, and of all outcome measures after implant-based PMBR. Based on current evidence, oncological concerns do not seem a valid reason to withhold patients from certain reconstructive timings or techniques, and patients should equally be offered all reconstructive options they technically qualify for.
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Affiliation(s)
- Claudia A. Bargon
- Division of Imaging and OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Department of SurgerySt. Antonius HospitalUtrechtThe Netherlands
- Department of Plastic, Reconstructive and Hand SurgerySt. Antonius HospitalUtrechtThe Netherlands
| | - Danny A. Young‐Afat
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam University Medical CentreAmsterdamThe Netherlands
| | - Mehmet Ikinci
- Department of SurgeryJeroen Bosch Hospitals‐HertogenboschThe Netherlands
| | - Assa Braakenburg
- Department of Plastic, Reconstructive and Hand SurgerySt. Antonius HospitalUtrechtThe Netherlands
| | - Hinne A. Rakhorst
- Department of PlasticReconstructive and Hand Surgery, Medisch Spectrum TwenteEnschedeThe Netherlands
| | - Marc A.M. Mureau
- Department of Plastic and Reconstructive SurgeryErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamThe Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Utrecht UniversityUtrechtThe Netherlands
| | - Annemiek Doeksen
- Department of SurgerySt. Antonius HospitalUtrechtThe Netherlands
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14
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Najmiddinov B, Park JKH, Yoon KH, Myung Y, Koh HW, Lee OH, Hoon JJ, Shin HC, Kim EK, Heo CY. Conventional versus modified nipple sparing mastectomy in immediate breast reconstruction: Complications, aesthetic, and patient-reported outcomes. Front Surg 2022; 9:1001019. [PMID: 36277278 PMCID: PMC9583667 DOI: 10.3389/fsurg.2022.1001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Nipple-sparing mastectomy (NSM) followed by immediate breast reconstruction (IBR) is the optimal surgical treatment for breast cancer. However, investigations are ongoing to improve the surgical technique to achieve better results. This study aimed to evaluate the outcomes of modified NSM (m-NSM), which preserves the anterior lamellar fat layer, in patients who underwent IBR. Methods All patients who underwent modified NSM (m-NSM) or conventional NSM (c-NSM) followed by IBR using autologous tissue or implants were retrospectively reviewed between January 2014 and January 2021. Two mastectomy types were compared in terms of postoperative complications and aesthetic outcomes using panel assessment scores by physicians and reported outcomes using Breast-Q. In addition, postoperative evaluations of the thickness of mastectomy flap was performed using CT scan images. Results A total of 516 patients (580 breasts) with NSM (143 breasts with c-NSM and 437 breasts with m-NSM) followed by IBR were reviewed. The mean ± SD flap thickness was 8.48 ± 1.81 mm in patients who underwent m-NSM, while it was 6.32 ± 1.15 mm in the c-NSM cohort (p = 0.02). The overall major complications rate was lower in the m-NSM group (3.0% vs. 9.0%, p < 0.013). Ischemic complications of the mastectomy flap and nipple-areolar complex (NAC) were more in c-NSM, although the difference was not statistically significant. The mean panel assessment scores were higher in the m-NSM group (3.14 (good) and 2.38 (fair) in the m-NSM and c-NSM groups, respectively; p < 0.001). Moreover, m-NSM was associated with greater improvements in psychosocial (p < 0.001) and sexual (p = 0.007) well-being. Conclusion Preserving the anterior lamellar fat in NSM was associated with thicker mastectomy flap, overall lower rates of complications, including ischemia of the mastectomy flap and nipple-areolar complex, and was associated with better aesthetic outcomes and improved quality of life.
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Affiliation(s)
- Bakhtiyor Najmiddinov
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joseph Kyu-hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hwak Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyoung Won Koh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ok Hee Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong Jae Hoon
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hee Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea,Correspondence: Eun-Kyu Kim Chan Yeong Heo
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea,Correspondence: Eun-Kyu Kim Chan Yeong Heo
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15
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Frasson AL, Falcone AB, Miranda I, Souza ABAD, Vollbrecht B, Barbosa F, Frasson MARM, Lichtenfels M. Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:376-384. [PMID: 35623619 PMCID: PMC9948099 DOI: 10.1055/s-0042-1742315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. METHODS We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. RESULTS Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60 months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. CONCLUSION Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.
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Affiliation(s)
- Antônio Luiz Frasson
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Beatriz Falcone
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Isabela Miranda
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Betina Vollbrecht
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Martina Lichtenfels
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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16
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Recaídas locorregionales tras mastectomías preservadoras y reconstrucción inmediata en mujeres con cáncer de mama. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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18
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Blanckaert M, Vranckx J. Oncological safety of therapeutic 'nipple-sparing mastectomy' followed by reconstruction: a systematic review. Acta Chir Belg 2021; 121:155-163. [PMID: 33929924 DOI: 10.1080/00015458.2021.1922829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Breast cancer (BC) treatment traditionally consisted of radical and often mutilating surgery. Advances in the field of BC have led to new remedies, enabling the paradigm shift from radical to conservative surgery. New treatments such as nipple-sparing mastectomy (NSM) are becoming more popular, aiming to improve both oncological and aesthetic outcomes. However, evidence confirming the oncological safety of NSM is currently lacking, hindering its application. This systematic review sought to analyze NSM's oncological safety as an alternative to conventional mastectomy (CM). PATIENTS AND METHODS A systematic review was performed, respecting the PRISMA guidelines. Pubmed, Embase, and Web of Science databases were consulted and searched for keywords: 'nipple-sparing mastectomy' and 'mammaplasty', or combinations of synonyms. Only original studies published between 2000 and 2020 reporting tumor recurrence and/or survival rates with a minimum of 5-year follow-up were included. RESULTS From the 1675 unique records found, 14 studies were included, amounting to 5980 female BC patients who underwent NSM plus reconstruction. Included studies described either only ductal carcinoma in situ (DCIS, n = 1), only invasive BC (n = 3) or DCIS and invasive BC (n = 10). The most recurrent oncological metrics were 5-year local recurrence (0-10%), locoregional recurrence (0-7.4%), distant recurrence (1.6-15.6%), and overall survival rate (93.1-100%). CONCLUSION Based on long-term low BC recurrences and high survival rates, NSM is perceived to be non-inferior to CM from an oncological perspective. This identifies NSM plus reconstruction to be a safe curative treatment. Further studies should aim to elicit clear and applicable selection criteria in order to maximize NSM's potential.
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Affiliation(s)
- Maxim Blanckaert
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
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19
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Oncologic Safety of Nipple-Sparing Mastectomy for Patients with Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-020-00399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Wu ZY, Kim HJ, Lee J, Chung IY, Kim J, Lee SB, Son BH, Han J, Han HH, Eom JS, Kim SB, Jung KH, Gong G, Kim HH, Ahn SH, Ko B. Oncologic Safety of Nipple-Sparing Mastectomy in Patients with Breast Cancer and Tumor-to-Nipple Distance ≤ 1 cm: A Matched Cohort Study. Ann Surg Oncol 2021; 28:4284-4291. [PMID: 33423119 DOI: 10.1245/s10434-020-09427-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND A short tumor-to-nipple distance (TND) is reported as a strong predictor of nipple-areola complex (NAC) involvement. Eligibility for nipple-sparing mastectomy (NSM) remains controversial, especially regarding TND. In this study, we compared long-term oncologic outcomes after NSM between patients with a TND ≤ 1 cm and those with a TND > 1 cm. METHODS Overall, 1369 patients with primary breast cancer who underwent NSM with immediate reconstruction from March 2003 to December 2015 were included for analysis. After propensity score matching, 495 patients with a TND ≤ 1 cm (group A) and 495 patients with a TND > 1 cm (group B) on imaging were selected to compare long-term oncologic outcomes. RESULTS After matching, the median follow-up periods for surviving patients were 109 months and 112 months for groups A and B, respectively. There were no significant differences between groups with respect to the 5-year cumulative local recurrence (8.1% vs. 6.3%; p = 0.268), NAC recurrence (5.1% vs. 2.8%; p = 0.072), regional recurrence (2.0% vs. 3.6%; p = 0.125), or distant recurrence (5.9% vs. 4.8%; p = 0.480) rates. Furthermore, no significant differences were observed between the groups with respect to the 10-year local recurrence-free survival (87.1% vs. 90.7%; p = 0.164) or disease-free survival (77.9% vs. 81.6%; p = 0.222) rates. CONCLUSIONS A preoperative TND ≤ 1 cm on imaging should not be contraindicated to NSM as long as there is no involvement of NAC clinically or on imaging and if retroareolar margins are confirmed to be negative for tumor cells.
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Affiliation(s)
- Zhen-Yu Wu
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongwon Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae-Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung-Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jing Han
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hyun Ho Han
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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21
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“Harms” Associated with Breast Cancer Screening and Reliability of Frozen Section in Older Women: In the Case of an 80 Year Old Woman. REPORTS 2020. [DOI: 10.3390/reports3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this paper is to present a rare case with negative final histologic examination despite abnormal findings of all previous exams indicating breast cancer in an 80 year old woman. Mammographic and magnetic resonance imaging findings were concordant with the frozen section biopsy result of DCIS. However, the final histologic diagnosis was radial scar (benign breast lesion that can radiologically mimic malignancy). As a conclusion, abnormal mammographic and magnetic resonance imaging findings with positive for DCIS frozen section reports are not always confirmed in the final histologic examination. Furthermore, considering that screening does not seem to be associated with a reduction in mortality due to breast cancer after the age of 75, breast cancer screening could be individualized in this age group.
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22
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Wu ZY, Ko B. ASO Author Reflections: Risk of Locoregional Recurrence After Nipple-Sparing Mastectomy and Immediate Breast Reconstruction for Pure Ductal Carcinoma In Situ. Ann Surg Oncol 2020; 27:1636-1637. [PMID: 32112216 DOI: 10.1245/s10434-020-08289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Zhen Yu Wu
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.,Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
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