1
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Seto Y, Ishitobi M, Shien T, Oshiro C, Inoue H, Shima H, Kuba S, Watanabe N, Iwatani T, Nakayama T. Patient Preference for Surgical Methods for Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 2024:10.1245/s10434-024-15282-0. [PMID: 38594578 DOI: 10.1245/s10434-024-15282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Mastectomy has been the standard surgical treatment for ipsilateral breast tumor recurrence (IBTR). Recently, there has been growing interest in repeat breast-conserving surgery (rBCS) for IBTR among breast surgeons; however, there is currently little information regarding patient preferences for surgical procedure for IBTR. The purpose of this study was to evaluate preference for surgical procedure (mastectomy vs. rBCS) among breast cancer patients who had undergone salvage surgery for IBTR. METHODS Overall, 100 breast cancer patients who had undergone salvage surgery for IBTR were asked about their preferred surgical methods for IBTR and the reason. The association of patient preference and the reasons related to various clinical and pathological factors were assessed. RESULTS Of the 100 respondents, only 11 patients (11%) preferred rBCS. Patients who had undergone rBCS and radiotherapy for IBTR were significantly more likely to prefer to undergo rBCS than other groups (p = 0.030). The most frequent reason for choosing rBCS was the patient's desire to minimize breast deformity and surgical wounds. CONCLUSIONS Our study revealed that there is a low rate of patients who opt to undergo rBCS among patients who had undergone salvage surgery for IBTR. Discrepancies in perceptions regarding the surgical procedure for IBTR between patients and their surgeons may exist.
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Affiliation(s)
- Yukiko Seto
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Ishitobi
- Department of Breast Surgery, Mie University School of Medicine, Tsu, Japan.
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Chiya Oshiro
- Department of Breast Surgery, Kaizuka City Hospital, Kaizuka, Japan
| | - Hiroaki Inoue
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Medical Sciences, Tokushima, Japan
| | - Hiroaki Shima
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Osaka, Japan
| | - Sayaka Kuba
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriyuki Watanabe
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tsuguo Iwatani
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
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2
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Berger L, Grimm A, Sütterlin M, Spaich S, Sperk E, Tuschy B, Berlit S. Major complications after intraoperative radiotherapy with low-energy x-rays in early breast cancer. Strahlenther Onkol 2024; 200:276-286. [PMID: 37591980 DOI: 10.1007/s00066-023-02128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To describe and analyze major local complications after intraoperative radiotherapy (IORT) with low-energy x‑rays during breast-conserving surgery (BCS) in early breast cancer. METHODS Ten women out of 408 who were treated with IORT between 2002 and 2017 and subsequently developed a severe local complication requiring surgical intervention were retrospectively identified and analyzed. Demographic, clinical, and surgical parameters as well as complication characteristics and treatment methods were evaluated. RESULTS At initial presentation, eight patients (80%) showed redness, six (60%) seroma, six (60%) wound infection, six (60%) suture dehiscence, and four (40%) induration of the former surgical area. Hematoma and necrosis were observed in one case (10%) each. Time interval until appearance of the first symptoms ranged from directly postoperative until 15 years postoperatively (median 3.1 months). Initial treatment modalities comprised antibiotic therapy (n = 8/80%) and transcutaneous aspiration of seroma (n = 3/30%). In the majority of patients, smaller surgical interventions (excision of a necrotic area/fistula [n = 6/60%] or secondary suture [n = 5/50%]) were sufficient to overcome the complication, yet larger interventions such as complex flap surgery and mastectomy were necessary in one patient each. CONCLUSION IORT is an efficient and safe treatment method as < 2.5% of all IORT patients experienced major local complications. However, it seems to pose the risk of causing severe local complications that may require lengthy and burdensome treatment. Thorough preoperative counseling, implementation of recommended intraoperative precautions, and high vigilance for first symptoms of complications during follow-up appointments are necessary measures.
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Affiliation(s)
- Laura Berger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Anja Grimm
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
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3
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Krug D, Vladimirova V, Untch M, Kühn T, Schneeweiss A, Denkert C, Ataseven B, Solbach C, Gerber B, Tesch H, Golatta M, Seiler S, Heil J, Nekljudova V, Holtschmidt J, Loibl S. Breast-conserving surgery is not associated with increased local recurrence in patients with early-stage node-negative triple-negative breast cancer treated with neoadjuvant chemotherapy. Breast 2024; 74:103701. [PMID: 38422624 PMCID: PMC10910157 DOI: 10.1016/j.breast.2024.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/10/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) is routinely used for patients with triple-negative breast cancer (TNBC). Upfront breast-conserving therapy (BCT) consisting of breast-conserving surgery (BCS) and adjuvant radiotherapy (RT) has been shown to be associated with improved outcome in patients with early TNBC as compared to mastectomy. METHODS We identified 2632 patients with early TNBC from the German Breast Group meta-database. Patients with cT1-2 cN0 and ypN0, available surgery and follow-up data were enrolled. Data of 1074 patients from 8 prospective NACT trials were available. Endpoints of interest were locoregional recurrence as first site of relapse (LRR), disease-free survival (DFS) and overall survival (OS). We performed univariate and multivariate Fine-Gray analysis and Cox regression models. RESULTS After a median follow-up of 64 months, there were 94 (8.8%) locoregional events as first site of relapse. Absence of pathologic complete response (pCR) was associated with increased LRR upon uni- and multivariate analysis (hazard ratio [HR] = 2.28; p < 0.001 and HR = 2.22; p = 0.001). Type of surgery was not associated with LRR. Patients in the BCS-group had better DFS and OS (DFS: HR = 0.47; p < 0.001 and OS: HR = 0.40; p < 0.001). BCS was associated with improved DFS and OS upon multivariate analysis (DFS: HR = 0.51; p < 0.001; and OS HR = 0.43; p < 0.001), whereas absence of pCR was associated with worse DFS and OS (DFS: HR = 2.43; p < 0.001; and OS: HR = 3.15; p < 0.001). CONCLUSIONS In this retrospective analysis of patients with early stage node-negative TNBC treated with NACT, BCS was not associated with an increased risk of LRR but with superior DFS and OS.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | | | | | - Thorsten Kühn
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany; Department of Gynecology and Obstectrics, Die Filderklinik, Filderstadt, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - Beyhan Ataseven
- Department of Gynecology, Gynecologic Oncology and Obstetrics, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, Germany
| | - Christine Solbach
- Goethe University Frankfurt, Department of Gynecology and Obstetrics, University Hospital, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Hans Tesch
- Center for Hematology and Oncology Bethanien, Frankfurt, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany; Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121 Heidelberg, Germany
| | | | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany; Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121 Heidelberg, Germany
| | | | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany; Center for Hematology and Oncology Bethanien, Frankfurt, Germany
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4
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Wickberg Å, Prag C, Valachis A, Karlsson L, Johansson B. Intraoperative Radiation Therapy Delivered by Brachytherapy in Breast Cancer: An Interim Analysis of a Phase 2 Trial. Clin Breast Cancer 2024; 24:243-252. [PMID: 38185607 DOI: 10.1016/j.clbc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Intraoperative breast cancer radiotherapy (IORT) offers an alternative to external beam radiotherapy (EBRT) after breast-conserving surgery (BCS). The Intraoperative brachytherapy (IOBT) trial applies high dose rate (HDR) brachytherapy with a new applicator prototype as IORT after BCS. In this interim analysis of the IOBT trial, we present the oncological safety and toxicity of the method METHODS: Eligible patients were women, ≥ 50 years old with an unifocal nonlobular, estrogen-receptor-positive, HER2-negative breast cancer, cN0, ≤ 3 cm, treated with BCS and sentinel node biopsy (SNB). Toxicity was registered according to the LENT-SOMA scale. Cumulative incidence of local (LR) and regional recurrence (RR) were calculated through cumulative incidence function whereas overall survival (OS) was illustrated through Kaplan-Meier curve. RESULTS Until February 2023, 155 women (median age 68 years) were included in the trial. Twenty-nine women (18.7%) received supplemental EBRT, mostly due to positive SNB. Three-year cumulative incidence of LR and RR were 1.0% (CI 95 % 0.1%-2.3%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five- year cumulative incidence of LR and RR were 3.9% (CI 95% 1.8%-6.4%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five-year OS was 96.3% (CI 95% 93.6%-98.4%). Side effects were limited, low grade, and transient. CONCLUSION Acknowledging the short median follow-up time at interim analysis, our initial results indicate that delivering IORT through HDR brachytherapy in carefully selected breast cancer patients is feasible and oncological safe so far. A long-term follow-up is essential to confirm the initial results.
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Affiliation(s)
- Åsa Wickberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden.
| | - Clara Prag
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden
| | - Leif Karlsson
- Department of medical Physics, Örebro University Hospital, Örebro, Sweden
| | - Bengt Johansson
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden
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5
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Hannoun-Lévi JM, Savignoni A, Féron JG, Malhaire C, Ezzili C, Brédart A, Loap P, Kirova Y. Management of second ipsilateral breast tumor event: An advocacy for a randomized trial. Cancer Radiother 2024; 28:188-194. [PMID: 38216433 DOI: 10.1016/j.canrad.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/14/2024]
Abstract
For a second ipsilateral breast tumor event, salvage mastectomy is the standard of care while second conservative treatment is a possible option. However, level 1 proofs are missing, leading to perform salvage mastectomy for patients who could receive second conservative treatment and consequently avoid psychological/quality of life salvage mastectomy deleterious impacts. A phase 3 randomized trial comparing salvage mastectomy to second conservative treatment is needed. Here we discuss what would be to us the optimal design of such trial to confirm the non-inferiority between the two salvage options, with a focus on methodological aspects in terms of patient characteristics and statistical issues.
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Affiliation(s)
- J-M Hannoun-Lévi
- Department of Radiation Oncology, centre Antoine-Lacassagne, université Côte d'Azur, Nice, France.
| | - A Savignoni
- Department of Biostatistics, institut Curie, Paris, France
| | - J-G Féron
- Department of Breast Surgery, institut Curie, Paris, France
| | - C Malhaire
- Department of Medical Imaging, institut Curie, Paris, France
| | - C Ezzili
- Department of Clinical Research, institut Curie, Paris, France
| | - A Brédart
- Psycho-Oncology Unit, institut Curie, Paris, France
| | - P Loap
- Department of Radiation Oncology, institut Curie, Paris, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France
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6
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Jung JJ, Cheun JH, Kim HK, Lee HB, Moon HG, Hwang KT, Han W. Comparison of long-term oncologic outcomes of central lumpectomy and conventional breast-conserving surgery for invasive breast cancer: propensity score matching analysis. Breast Cancer Res Treat 2024:10.1007/s10549-024-07297-8. [PMID: 38526688 DOI: 10.1007/s10549-024-07297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Central lumpectomy (CL) is a breast-conserving surgical (BCS) technique that involves excision of the nipple-areolar complex with breast tumor in centrally located breast cancers. We aimed to investigate the long-term clinical outcomes of CL in comparison with conventional BCS (cBCS). METHODS Patient records who underwent BCS with clear resection margins for invasive breast cancer between 2004 and 2018 were retrospectively reviewed. Of the total 6,533 patients, 106 (1.6%) underwent CL. Median follow-up duration was 73.4 months. 1:3 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimize selection bias. RESULTS The CL group showed a significantly higher ipsilateral breast tumor recurrence (IBTR) rate than the cBCS group (10-year IBTR rate: 5.8% vs. 3.1%, p = 0.004), even after adjusting for other variables (hazard ratio (HR), 2.65; 95% confidence interval (CI), 1.07-6.60, p = 0.048). However, there were no significant differences observed in regional recurrence, distant metastasis, or overall survival rates between the two groups. Both PSM and IPTW analyses showed significantly higher IBTR in the CL group (PSM HR, 3.27; 95% CI, 0.94-11.36; p = 0.048 and IPTW HR, 4.66; 95%CI, 1.85-11.77; p < 0.001). Lastly, when analyzing 2,213 patients whose tumors were located within 3 cm of the nipple, the CL group showed a significantly higher IBTR than the cBCS group before and after PSM. CONCLUSION CL was associated with a higher rate of IBTR compared to cBCS, while other survival outcomes were comparable. For centrally located tumors, CL may be considered for patients preferring breast preservation. However, higher risk for IBTR should be informed and careful surveillance may be necessary during the early post-operative follow-up periods.
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Affiliation(s)
- Ji-Jung Jung
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jong-Ho Cheun
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
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7
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Chauhan H, Jiwa N, Nagarajan VR, Thiruchelvam P, Hogben K, Al-Mufti R, Hadjiminas D, Shousha S, Cutress R, Ashrafian H, Takats Z, Leff DR. Clinicopathological Predictors of Positive Resection Margins in Breast-Conserving Surgery. Ann Surg Oncol 2024:10.1245/s10434-024-15153-8. [PMID: 38520579 DOI: 10.1245/s10434-024-15153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is associated with risk of positive resection margins following breast-conserving surgery (BCS) and subsequent reoperation. Prior reports grossly underestimate the risk of margin positivity with IBC containing a DCIS component (IBC + DCIS) due to patient-level rather than margin-level analysis. OBJECTIVE The aim of this study was to delineate the relative risk of IBC + DCIS compared with pure IBC (without a DCIS component) on margin positivity through detailed margin-level interrogation. METHODS A single institution, retrospective, observational cohort study was conducted in which pathology databases were evaluated to identify patients who underwent BCS over 5 years (2014-2019). Margin-level interrogation included granular detail into the extent, pathological subtype and grade of disease at each resection margin. Predictors of a positive margin were computed using multivariate regression analysis. RESULTS Clinicopathological details were examined from 5454 margins from 909 women. The relative risk of a positive margin with IBC + DCIS versus pure IBC was 8.76 (95% confidence interval [CI] 6.64-11.56) applying UK Association of Breast Surgery guidelines, and 8.44 (95% CI 6.57-10.84) applying the Society of Surgical Oncology/American Society for Radiation Oncology guidelines. Independent predictors of margin positivity included younger patient age (0.033, 95% CI 0.006-0.060), lower specimen weight (0.045, 95% CI 0.020-0.069), multifocality (0.256, 95% CI 0.137-0.376), lymphovascular invasion (0.138, 95% CI 0.068-0.208) and comedonecrosis (0.113, 95% CI 0.040-0.185). CONCLUSIONS Compared with pure IBC, the relative risk of a positive margin with IBC + DCIS is approximately ninefold, significantly higher than prior estimates. This margin-level methodology is believed to represent the impact of DCIS more accurately on margin positivity in IBC.
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Affiliation(s)
- Hemali Chauhan
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Natasha Jiwa
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Paul Thiruchelvam
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Katy Hogben
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Ragheed Al-Mufti
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Dimitri Hadjiminas
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Sami Shousha
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
- North West London Pathology, Imperial College NHS Trust, London, UK
| | - Ramsey Cutress
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zoltan Takats
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
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8
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Jacobs LM, Helder LS, Albers KI, Kranendonk J, Keijzer C, Joosten LA, Strobbe LJ, Warlé MC. The role of surgical tissue injury and intraoperative sympathetic activation in postoperative immunosuppression after breast-conserving surgery versus mastectomy: a prospective observational study. Breast Cancer Res 2024; 26:42. [PMID: 38468349 PMCID: PMC10926636 DOI: 10.1186/s13058-024-01801-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Breast cancer is the second most common cause of death from cancer in women worldwide. Counterintuitively, large population-based retrospective trials report better survival after breast-conserving surgery (BCS) compared to mastectomy, corrected for tumour- and patient variables. More extensive surgical tissue injury and activation of the sympathetic nervous system by nociceptive stimuli are associated with immune suppression. We hypothesized that mastectomy causes a higher expression of plasma damage associated molecular patterns (DAMPs) and more intraoperative sympathetic activation which induce postoperative immune dysregulation. Immune suppression can lead to postoperative complications and affect tumour-free survival. METHODS In this prospective observational study, plasma DAMPs (HMGB1, HSP70, S100A8/A9 and S100A12), intraoperative sympathetic activation (Nociception Level (NOL) index from 0 to 100), and postoperative immune function (plasma cytokine concentrations and ex vivo cytokine production capacity) were compared in patients undergoing elective BCS (n = 20) versus mastectomy (n = 20). RESULTS Ex vivo cytokine production capacity of TNF, IL-6 and IL-1β was nearly absent in both groups one hour after surgery. Levels appeared recovered on postoperative day 3 (POD3), with significantly higher ex vivo production capacity of IL-1β after BCS (p = .041) compared to mastectomy. Plasma concentration of IL-6 was higher one hour after mastectomy (p = .045). Concentrations of plasma alarmins S100A8/A9 and S100A12 were significantly higher on POD3 after mastectomy (p = .003 and p = .041, respectively). Regression analysis showed a significantly lower percentage of NOL measurements ≤ 8 (absence of nociception) during mastectomy when corrected for norepinephrine equivalents (36% versus 45% respectively, p = .038). Percentage of NOL measurements ≤ 8 of all patients correlated with ex vivo cytokine production capacity of IL-1β and TNF on POD3 (r = .408; p = .011 and r = .500; p = .001, respectively). CONCLUSIONS This pilot study revealed substantial early postoperative immune suppression after BCS and mastectomy that appears to recover in the following days. Differences between BCS and mastectomy in release of DAMPs and intraoperative sympathetic activation could affect postoperative immune homeostasis and thereby contribute to the better survival reported after BCS in previous large population-based retrospective trials. These results endorse further exploration of (1) S100 alarmins as potential therapeutic targets in breast cancer surgery and (2) suppression of intraoperative sympathetic activation to substantiate the observed association with postoperative immune dysregulation.
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Affiliation(s)
- Lotte Mc Jacobs
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Leonie S Helder
- Department of Anaesthesiology, Radboudumc, Nijmegen, The Netherlands
| | - Kim I Albers
- Department of Anaesthesiology, Radboudumc, Nijmegen, The Netherlands
| | - Josephine Kranendonk
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands
| | | | - Leo Ab Joosten
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania
| | - Luc Ja Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands.
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9
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Korayem IM, Ramadan R, Fayed H. Feasibility and early cosmetic outcome of modified lateral intercostal artery perforator flap after breast conservative surgery. BMC Surg 2024; 24:75. [PMID: 38431543 PMCID: PMC10908061 DOI: 10.1186/s12893-024-02367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lateral intercostal artery perforator (LICAP) flap aims at replacing the excised breast lump with axillary tissue rich blood supply. The purpose of this study is to report the initial results of a modification LICAP flap technique in terms of intraoperative technical feasibility and short-term cosmetic outcomes in the early postoperative period. METHODS Modified LICAP flap technique was performed on 36 female patients with pathologically proven BC located in the outer half of the breast in the period from June 1, 2021, to April 30, 2022. RESULTS The LICAP flap modification enabled performing the procedure with the patient in supine position without repositioning. The majority of the patients (90%) had satisfactory early cosmetic results as reported by the patients and oncoplastic independent surgeon. CONCLUSION Modified LICAP flap reconstruction is feasible to be performed with the patient in supine position without repositioning and it has satisfactory early cosmetic outcomes.
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Affiliation(s)
- Islam M Korayem
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rabie Ramadan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Haytham Fayed
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Talapatra K, Chitkara G, Murali-Nanavati S, Gupte A, Bardeskar NS, Behal S, Shaikh M, Atluri P. Practice of Tumor Bed Boost in Patients after Oncoplastic Breast-Conserving Surgery. Indian J Surg Oncol 2024; 15:63-70. [PMID: 38511033 PMCID: PMC10948658 DOI: 10.1007/s13193-023-01824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 03/22/2024] Open
Abstract
The practice of boost to the tumor bed after treatment with oncoplastic breast-conserving surgery (BCS) remains variable. Using a survey, the present study evaluated the current practice of tumor bed boost administered in women after oncoplastic BCS. Actively practicing radiation oncologists across India were sent a questionnaire on the practice of adjuvant whole-breast radiotherapy and tumor bed boost after oncoplastic BCS via email and encouraged to participate. Of the 54 radiation oncologists who participated, most (98.1%) used a linear accelerator for radiotherapy. Hypofractionation was preferred by 59.26%, standard fractionation by 7.41%, and the remaining selected the fractionation strategy based on various patient factors. In addition, 83.33% participants reported that they always planned tumor boost, 51.85% preferred photons for the boost, and 75.93% administered sequential boost. The most common dose for the boost was 12.5 Gy in five fractions (40.74%). Most participants (77.78%) revealed that they used a combination of methods for identifying the tumor bed. With respect to clip placement, most surgeons (96%) at the participants' centers placed ≥ 4 clips at the tumor site, with both the base and margins being preferred by surgeons (81.48%) for placement. Finally, 12.96% participants revealed that the surgeons always involved them during surgical planning, whereas 7.4% participants reported that they always included the surgeons during radiotherapy planning, suggesting that radiation oncologists and oncoplastic surgeons do not involve each other during surgical and radiotherapy planning, possibly leading to suboptimal treatment. This may be attributed to the absence of guidelines regarding boost practices after oncoplastic BCS.
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Affiliation(s)
- Kaustav Talapatra
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Garvit Chitkara
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Sridevi Murali-Nanavati
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Ajinkya Gupte
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Nikhil S. Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Shruti Behal
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Muzammil Shaikh
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Pooja Atluri
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
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11
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Almasarweh S, Sudah M, Okuma H, Joukainen S, Vanninen R, Masarwah A. Specimen tomosynthesis provides no additional value to specimen ultrasound in ultrasound-visible malignant breast lesions. Scand J Surg 2024:14574969241233435. [PMID: 38414158 DOI: 10.1177/14574969241233435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy and added value of specimen tomosynthesis (ST) to specimen ultrasound (SUS) in margin assessment of excised breast specimens in breast-conserving therapy for non-palpable US-visible breast lesions. MATERIALS Between January 2018 and August 2019, all consecutive patients diagnosed with non-palpable breast cancer visible by ultrasound (US), treated with breast-conserving surgery (BCS) and requiring radiological intraoperative breast specimen assessment, were included in this study. Excised breast specimens were examined with SUS by radiologists blinded to the ST results, and margins smaller than 10 mm were recorded. STs were evaluated retrospectively by experienced radiologists. RESULTS A total of 120 specimens were included. SUS showed a statistically significant correlation with pathological margin measurements, while ST did not and provided no additional information. The odds ratios (ORs) for SUS to predict a positive margin was 3.429 (confidence interval (CI) = 0.548-21.432) using a 10-mm cut-off point and 14.182 (CI = 2.134-94.254) using a 5-mm cut-off point, while the OR for ST were 2.528 (CI = 0.400-15.994) and 3.188 (CI = 0.318-31.998), respectively. CONCLUSIONS SUS was superior in evaluating intraoperative resection margins of US-visible breast resection specimens when compared to ST. Therefore, ST could be considered redundant in applicable situations.
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Affiliation(s)
- Sa'ed Almasarweh
- Department of Obstetrics and Gynaecology
- Essen University Hospital Hufelandstraße 55 45147 Essen Germany
- Diagnostic Imaging Center and Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
- Cancer Center of Eastern Finland University of Eastern Finland Kuopio Finland
| | - Mazen Sudah
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Hidemi Okuma
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Sarianna Joukainen
- Division of Surgery, Department of Plastic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Amro Masarwah
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
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12
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Krug D, Banys-Paluchowski M, Brucker SY, Denkert C, Ditsch N, Fasching PA, Haidinger R, Harbeck N, Heil J, Huober J, Jackisch C, Janni W, Kolberg HC, Loibl S, Lüftner D, van Mackelenbergh M, Radosa JC, Reimer T, Welslau M, Würstlein R, Untch M, Budach W. Radiotherapy statements of the 18th St. Gallen International Breast Cancer Consensus Conference-a German expert perspective. Strahlenther Onkol 2024:10.1007/s00066-024-02209-7. [PMID: 38393398 DOI: 10.1007/s00066-024-02209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To summarize the radiotherapy-relevant statements of the 18th St. Gallen Breast Cancer Consensus Conference and interpret the findings in light of German guideline recommendations. METHODS Statements and voting results from the 18th St. Gallen International Breast Cancer Consensus Conference were collected and analyzed according to their relevance for the radiation oncology community. The voting results were discussed in two hybrid meetings among the authors of this manuscript on March 18 and 19, 2023, in light of the German S3 guideline and the 2023 version of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) guidelines. RESULTS AND CONCLUSION There was a high level of agreement between the radiotherapy-related statements of the 18th St. Gallen International Breast Cancer Consensus Conference and the German S3 and AGO guidelines. Discrepancies include the impact of number of lymph node metastases for the indication for postmastectomy radiotherapy.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany.
| | - Maggie Banys-Paluchowski
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Peter A Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Nadia Harbeck
- Brustzentrum, Frauenklinik, LMU Klinikum München, Munich, Germany
| | - Jörg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
- Medizinische Fakultät, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach GmbH, Offenbach, Germany
| | | | | | - Sibylle Loibl
- German Breast Group (GBG), Neu-Isenburg, Germany
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz, Buckow, Germany
- Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf/Berlin, Germany
| | - Marion van Mackelenbergh
- Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Julia C Radosa
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik, Klinikum Südstadt Rostock, Rostock, Germany
| | - Manfred Welslau
- Onkologie Aschaffenburg, Hämato-Onkologische Schwerpunktpraxis, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Rachel Würstlein
- Brustzentrum, Frauenklinik, LMU Klinikum München, Munich, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Kim Y, Ganduglia-Cazaban C, Tamirisa N, Lucci A, Krause TM. Contemporary Analysis of Reexcision and Conversion to Mastectomy Rates and Associated Healthcare Costs for Women Undergoing Breast-Conserving Surgery. Ann Surg Oncol 2024:10.1245/s10434-024-14902-z. [PMID: 38319511 DOI: 10.1245/s10434-024-14902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study was designed to provide a comprehensive and up-to-date understanding of population-level reoperation rates and incremental healthcare costs associated with reoperation for patients who underwent breast-conserving surgery (BCS). METHODS This is a retrospective cohort study using Merative™ MarketScan® commercial insurance data and Medicare 5% fee-for-service claims data. The study included females aged 18-64 years in the commercial cohort and females aged 18 years and older in the Medicare cohort, who underwent initial BCS for breast cancer in 2017-2019. Reoperation rates within a year of the initial BCS and overall 1-year healthcare costs stratified by reoperation status were measured. RESULTS The commercial cohort included 17,129 women with a median age of 55 (interquartile range [IQR] 49-59) years, and the Medicare cohort included 6977 women with a median age of 73 (IQR 69-78) years. Overall reoperation rates were 21.1% (95% confidence interval [CI] 20.5-21.8%) for the commercial cohort and 14.9% (95% CI 14.1-15.7%) for the Medicare cohort. In both cohorts, reoperation rates decreased as age increased, and conversion to mastectomy was more prevalent among younger women in the commercial cohort. The mean healthcare costs during 1 year of follow-up from the initial BCS were $95,165 for the commercial cohort and $36,313 for the Medicare cohort. Reoperations were associated with 24% higher costs in both the commercial and Medicare cohorts, which translated into $21,607 and $8559 incremental costs, respectively. CONCLUSIONS The rates of reoperation after BCS have remained high and have contributed to increased healthcare costs. Continuing efforts to reduce reoperation need more attention.
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Affiliation(s)
- Youngran Kim
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
| | - Cecilia Ganduglia-Cazaban
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Trudy Millard Krause
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Skjerven HK, Myklebust EM, Korvald C, Stubberud K, Hovda T, Porojnicu AC, Kaaresen R, Hofvind S, Schlicting E, Sahlberg KK. Long-term follow-up of complex oncoplastic breast-conserving surgery, standard breast conservation and skin-sparing mastectomy in DCIS - a register-based study. Eur J Surg Oncol 2024; 50:107938. [PMID: 38199004 DOI: 10.1016/j.ejso.2023.107938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/10/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Few studies evaluate oncological safety in complex oncoplastic breast-conserving surgery(C-OBCS) for DCIS. It still needs to be defined whether it is equivalent to standard breast conservation(S-BCS) or an alternative to skin-sparing mastectomy(SSM). This study compares local recurrence rates(LR), disease-free survival(DFS) and overall survival (OS) between the three surgical techniques. METHODS We conducted a retrospective register-based study on LR, DFS and OS of patients operated with S-BCS(n=1388), C-OBCS (n=106) or skin-sparing mastectomy (n=218) for DCIS diagnosed 2007-2020. Data was extracted from the Norwegian Breast Cancer Registry. RESULTS In the S-BCS, C-OBCS and SSM groups, median age was 60, 58 and 51 years (p<0.001), median size 15, 25, and 40 mm (p<0.001) and median follow-up 55, 48 and 76 months. At ten years, the overall LR was 12.7%, 14.3% for S-BCS, 11.2% for C-OBCS and 6.8% for SSM. Overall DFS at ten years was 82.3%, 80.5% for S-BCS, 82.4% for C-OBCS and 90.4% for SSM. At ten years, the OS was 93.8%, 93.0% in S-BCS, 93.3% in C-OBCS and 96.6% in the SSM group. Weighted Kaplan Meier plots showed that SSM had a significantly higher DFS than S-BCS (p=0.003) and C-OBCS (p=0.029). DFS in C-OBCS versus S-BCS and the difference in OS was not significant (p=0.264). CONCLUSION SSM had a significantly higher DFS than S-BCS and C-OBCS. The difference in DFS between S-BCS and C-OBCS, and OS between the three groups was not statistically significant. Our study suggests that C-OBCS is a safe alternative to S-BCS and SSM.
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Affiliation(s)
- Helle Kristine Skjerven
- Section for Breast and Endocrine Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Even Moa Myklebust
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research and Innovation, Vestre Viken Hospital Trust, Drammen, Norway
| | - Christian Korvald
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjetil Stubberud
- Section for Breast and Endocrine Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Tone Hovda
- Section for Breast and Endocrine Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Rolf Kaaresen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solveig Hofvind
- Department of Health and Care Sciences, The Artic University, UiT, Tromsø, Norway; Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Ellen Schlicting
- Section for Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Kristine Kleivi Sahlberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research and Innovation, Vestre Viken Hospital Trust, Drammen, Norway
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Binici S, Güven M, Özdemir A, İlik ZA, Demirhan B, Uygur S, İliklerden ÜH. Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management. Histochem Cell Biol 2024:10.1007/s00418-024-02267-z. [PMID: 38282055 DOI: 10.1007/s00418-024-02267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.
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Affiliation(s)
- Serhat Binici
- General Surgery Department, Şırnak State Hospital, Şırnak, Turkey.
| | - Mustafa Güven
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Abdulselam Özdemir
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| | - Zehra Akman İlik
- Department of Pathology, Van Education and Research Hospital, Van, Turkey
| | - Birhan Demirhan
- Faculty of Medicine, Department of Radiation Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Serhat Uygur
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Ümit Haluk İliklerden
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
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16
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Noguchi M, Morioka E, Yokoi-Noguchi M, Haba Y, Inokuchi M, Hisano M. Oncoplastic breast surgery to prevent "Bird's beak" deformity in the breast: a comparative retrospective study. Surg Today 2024; 54:14-22. [PMID: 37157037 DOI: 10.1007/s00595-023-02690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
PURPOSES Breast deformity occurring in the lower pole after breast conserving surgery (BCS) is known as bird's beak (BB) deformity. This retrospective study evaluated the outcomes in breasts reconstructed with a conventional closing procedure (CCP) and a downward-moving procedure (DMP), respectively, after BCS. METHODS In CCP, the inferomedial and inferolateral portions of breast tissues were reapproximated toward the midline after wide excision to repair the breast defect. In DMP, the retro-areolar breast tissue was detached from the nipple-areolar complex after wide excision, and the upper pole breast tissue was moved downward to refill the breast defect. RESULTS CCP was performed in 20 patients (Group A), and DMP was performed in 28 patients (Group B). Although retraction of the lower part of the breast was postoperatively observed in 13 (72%) of 18 patients from Group A, it was observed in 7 (28%) of 25 patients in Group B (p < 0.05). The downward pointing of the nipple was observed in 8 (44%) of 18 patients from Group A and in 4 (16%) of 25 patients in Group B (p < 0.05). CONCLUSIONS DMP is more useful for preventing BB deformity than CCP.
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Affiliation(s)
- Masakuni Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan.
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan.
| | - Emi Morioka
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Miki Yokoi-Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Yusuke Haba
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Machiko Hisano
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
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Lee TH, Ahn SH, Chung K, Park W, Cho WK, Kim N, Kim TG, Kim H. Quantitative assessment of breast volume changes after whole-breast irradiation for breast cancer using breast auto-segmentation. Breast Cancer Res Treat 2024; 203:205-214. [PMID: 37833452 DOI: 10.1007/s10549-023-07146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE This study aimed to quantitatively estimate the changes in breast volume associated with radiotherapy in patients undergoing breast-conserving surgery and whole-breast irradiation (WBI). METHODS Pre-WBI simulation computed tomography (CT) scans and post-WBI follow-up chest CT scans from a total of 1,151 breast cancer patients were analyzed using a deep-learning-driven auto-segmentation approach. The CT-based asymmetry index (CTAI) was calculated by dividing the volume of the irradiated breast by the volume of the contralateral breast. Significant breast shrinkage was defined as a CTAI < 0.85. To quantify changes in CTAI over the follow-up period, the CTAI ratio was determined as the post-WBI CTAI divided by the pre-WBI CTAI. A multivariate logistic regression analysis was conducted to identify potential variables associated with post-WBI significant breast shrinkage. RESULTS The median CTAI values for pre- and post-WBI CT scans were 0.973 (interquartile range: 0.887-1.069) and 0.866 (interquartile range: 0.773-0.967), respectively. The difference between them was statistically significant (p < 0.001). Following WBI, there was an increase in the rate of significant breast shrinkage from 16.3 to 44.8%. The CTAI ratio showed a negative association with the time interval (p < 0.001, Pearson r = - 0.310). In the multivariate logistic regression analysis, lower pre-WBI CTAI, younger age, and longer interval between CT scans were found to be significantly associated with a higher occurrence of post-WBI significant breast shrinkage. CONCLUSION Breast volume decreases following WBI, and this decrease is correlated with an increased duration after WBI. These findings highlight the long-term consequences of WBI on breast asymmetry.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang Hee Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kwangzoo Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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18
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D'Angelo A, Scardina L, Palma S, Cicero SL, Maresca A, Caprini F, Biondi E, Franco A, Terribile D, Franceschini G, Belli P, Manfredi R. Magnetic seed versus skin tattoo localization of non-palpable breast lesions: a single institution cohort study. Eur Radiol 2024; 34:149-154. [PMID: 37526666 DOI: 10.1007/s00330-023-10008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE The objective of this retrospective study was to investigate the accuracy and feasibility of magnetic seed compared to skin tattoo in preoperative localization of impalpable breast lesions in terms of accuracy of placement, re-excision and positive margins rates, and breast/surgical specimen volume ratio. METHODS We retrospectively analyzed 77 patients who underwent breast conservative surgery in our center from November 2020 to November 2021, with previous localization with skin tattoo or magnetic seed. RESULTS Thirty-seven magnetic seeds were placed in 36 patients (48.6%) and 40 skin tattoos were performed in the remaining cases (51.4%). The seeds were placed correctly at the two-view mammogram acquired after the insertion in 97.6% (36/37) of cases. With both methods, 100% of the index lesions were completely removed and found in the surgical specimen. The reported re-excision rate was 0% for both groups. A significant difference was observed in the volume of breast parenchyma removed between the two groups, inferior in the seed group (p = 0.046), especially in case of voluminous breasts (p = 0.003) and small lesions (dimension < 8 mm, p = 0.019). CONCLUSIONS Magnetic seed is a non-radioactive localization technique, feasible to place, recommended in case of non-palpable breast lesions, saving the breast parenchyma removed compared with skin tattoo, without reducing the accuracy. CLINICAL RELEVANCE STATEMENT Our findings contribute to the current evidence on preoperative localization techniques for non-palpable breast lesions, highlighting the efficacy of magnetic seed localization for deep and small lesions. KEY POINTS • Magnetic seed is a non-radioactive technique for the preoperative localization of non-palpable breast lesions studied in comparison with skin tattoo. • Magnetic seed is feasible to place in terms of post-placement migration and distance from the target lesion. • Magnetic seed is recommended in case of non-palpable breast lesions, saving the breast parenchyma removed without reducing the accuracy.
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Affiliation(s)
- Anna D'Angelo
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy.
| | - Lorenzo Scardina
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Simone Palma
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Stefano Lo Cicero
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Alessandro Maresca
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Flavia Caprini
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Ersilia Biondi
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Franco
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniela Terribile
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Paolo Belli
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
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Vohra LM, Farooqi N, Jiwani U, Ali D. Outcomes of oncoplastic breast surgery compared to breast-conserving surgery in breast cancer patients in a developing country: a retrospective cohort study. Pak J Med Sci 2024; 40:8-13. [PMID: 38196478 PMCID: PMC10772441 DOI: 10.12669/pjms.40.1.7360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/07/2023] [Accepted: 09/26/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Objective Breast-conserving surgery (BCS) with adjuvant radiotherapy remains the standard of care for early breast cancers in Pakistan. We sought to compare the outcomes of BCS with oncoplastic surgery (OPS), a relatively infrequent approach to breast cancer treatment in the country. Methods This retrospective cohort study was conducted at Aga Khan University Hospital and Ziauddin Hospital in Karachi. Patients who had biopsy-proven Stage-I to III breast cancer and underwent either OPS or BCS between August 1, 2016, and December 31, 2021, were identified and followed for 30 days. Data were collected by reviewing patient files and electronic records. Results A total of 481 patients were included in the study, where 204 (42.4%) underwent BCS and 277 (57.6%) underwent OPS. Mean tumor volume (146.8 vs. 90.4 cm3), and postoperative complications (2.2 % vs. 0%) were higher in OPS while the frequency of positive margins was greater in the BCS group (15.7 % vs. 2.2 %). There were no significant differences in the histologic type of tumor between the two groups. Conclusion OPS is a valid alternative approach to breast cancer treatment that can be offered to women with early stage, locally advanced, multifocal or tumors at complex locations owing to the reduced occurrence of positive margins and thus lowered re-excision rates.
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Affiliation(s)
- Lubna M. Vohra
- Lubna M. Vohra, FCPS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Nifasat Farooqi
- Nifasat Farooqi, FCPS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Uswa Jiwani
- Uswa Jiwani, MBBS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Danish Ali
- Danish Ali, MBBS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
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Costeira B, da Silva FB, Fonseca F, Oom R, Costa C, Moniz JV, Abecasis N, Santos CR. Long-term locoregional recurrence in patients treated for breast cancer. Breast Cancer Res Treat 2023; 202:551-561. [PMID: 37707638 DOI: 10.1007/s10549-023-07089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND/PURPOSE Locoregional control in breast cancer is a fundamental part of treatment and determinant for survival outcomes. It has been reported that most locoregional recurrence (LRR) events occur in the first 5 years after treatment. However, LRR continue to occur after this timeline, with unclear risk factors and unknown survival impact. METHODS Retrospective singe-centered cohort of patients treated for primary breast cancer, between January 2002 and December 2004. Primary outcome was LRR; secondary outcomes were overall survival (OS), disease-free survival (DFS), and predictive factors for LRR. RESULTS This analysis included 1001 patients, of which 959 (95%) had invasive carcinoma. A mastectomy was performed in 501 (50%) and 500 (50%) had breast conservative surgery (BCS). Median follow-up time was 197 [Inter-quartile range (IQR) 96-211] months. Global LRR rate was 7.6%, with median time to recurrence of 45 [IQR 21-91] months. There was no difference in LRR rate after mastectomy vs BCS, adjusted to tumor stage (p > 0.05). The 10-year OS and DFS rates were 68.4 and 77.8%, respectively. Factors associated with LRR were metastatic axillary lymph nodes and high histologic grade (p < 0.05). Estrogen-negative (ER) tumors had higher LRR rates than ER-positive tumors in the first 5 years (p < 0.05); but no difference was observed with longer follow-up (p > 0.05). LRR was associated with OS (p < 0.05). DISCUSSION AND CONCLUSIONS Global LRR in this cohort was 7.6% (with over 16 years of follow-up). LRR associates with decreased OS. Time to LRR varies significantly with tumor biology, supporting differentiation of follow-up regimens.
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Affiliation(s)
- Beatriz Costeira
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal.
- Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Serviço de Cirurgia, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal.
| | - Francisca Brito da Silva
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
| | - Filipa Fonseca
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
| | - Rodrigo Oom
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
| | - Cristina Costa
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
| | - João Vargas Moniz
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
| | - Nuno Abecasis
- Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Serviço de Cirurgia, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
| | - Catarina Rodrigues Santos
- Breast Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Clínica da Mama, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
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Xiao J, Wang T, Yi J, Huang M, Yan C, Ling R. Neoadjuvant Chemotherapy of Taxanes With or Without Anthracyclines in Different Molecular Subtypes of Breast Cancer: A Propensity Score Matching Study. Clin Breast Cancer 2023; 23:882-893. [PMID: 37833133 DOI: 10.1016/j.clbc.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/21/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To compare the efficacy of taxane (T) based neoadjuvant chemotherapy (NAC) with T and anthracycline (A) based NAC in different molecular types of breast cancer (BC). METHODS We retrospectively analyzed the date of NAC for BC from 20 hospitals in China from January 2010 to December 2020, 7870 cases were enrolled. The propensity score matching was used to equalize the baseline characteristics. Pathological complete response (pCR) rate, clinical response rate and breast-conserving rate were analyzed. RESULTS The efficacy of 2 regimens were similar in luminal A subtype. The breast-conserving rate was higher in T-based NAC in luminal B subtype (17.9% vs. 10.2%, P = .043).The pCR (T0/isN0M0) and tpCR (T0N0M0) rates in T-based NAC were higher than those in TA-based NAC for triple-negative subtype (pCR: 34.5% vs. 25.8%, P = .041, tpCR: 26.9% vs. 17.1%, P = .008). For HER2+(HR-) subtype, the pCR, and tpCR rates were higher in T-based NAC in insufficient anti-HER2 therapy (P < .05), and those were higher in TA-based NAC in dual-target anti-HER2 therapy (pCR: 69.2% vs. 53.8%, P = .254, tpCR: 61.5% vs. 42.3%, P = .165). For HER2+(HR+) breast cancer, both pCR and tpCR rates were higher in TA group, regardless of the adequacy of anti-HER2 treatment. CONCLUSIONS T-based NAC could replace TA-based NAC for luminal A, luminal B, and triple-negative early-stage BC, but anthracyclines cannot be abandoned in HER2+ breast cancer. The development of anthracyclines with lower adverse reactions is one of the directions for the treatment of HER2+ breast cancer.
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Affiliation(s)
- Jingjing Xiao
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ting Wang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jun Yi
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Meiling Huang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changjiao Yan
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
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Oei SL, Thronicke A, Grieb G, Schad F, Groß J. Evaluation of quality of life in breast cancer patients who underwent breast-conserving surgery or mastectomy using real-world data. Breast Cancer 2023; 30:1008-1017. [PMID: 37587322 DOI: 10.1007/s12282-023-01494-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Due to advances in the fight against breast cancer, aesthetic aspects and the prevention of breast deformities are playing an important role in surgical procedures. Currently the main form of breast cancer surgery is breast-conserving surgery (BCS), and even if mastectomy (MAS) is required, oncoplastic surgery and reconstruction options can improve outcomes, including health-related quality of life (QoL) of cancer patients. The purpose of this study was to assess whether surgery options induce different outcomes in self-reported QoL in guide-line treated breast cancer patients of the Network Oncology (NO). METHODS This prospective Real-World-Data (RWD) study was conducted using data from the NO-clinical registry. QoL was assessed by evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Association factors between type of surgery options, without or with immediate breast reconstructions the EORTC QLQ-C30-scales at baseline after surgery, 6, 12, and 24 months later were analyzed with adjusted multivariate regression analysis, considering age, cancer stage, and treatment regimens, using software R. RESULTS A total of 623 primary breast cancer patients (all tumor stages, median age 58 (ICR: 50-68) diagnosed and guide-line treated between 2013 and 2021), 524 BCS and 99 MAS, 24 of whom received immediate breast reconstruction (MBR), were eligible for analyses. Compared with BCS patients, MBR patients self-reported considerably lower global health, physical and social functioning, and higher burden of pain and financial difficulties at baseline. In later follow-up surveys, functional scales increased and symptoms decreased in all patients, and the differences between MAS and BCS equalized. Longitudinal analyses after 24 months were obtained from 258 patients and revealed that compared to 224 BCS, the 34 MAS patients reported increased social functioning (p = 0.04). CONCLUSIONS At 24 months after MAS, breast cancer patients' QoL improved compared with BCS, although impairments in QoL were reported immediately after MAS. A growing expertise in surgical procedures as well as supportive care is critical to optimizing patients' well-being. These findings may be considered when counseling breast cancer patients pre- and post-surgery. TRIAL REGISTRATION NUMBER DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Friedemann Schad
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
- Interdisciplinary Oncology and Supportive Cancer Medicine, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
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Pak LM, Matar-Ujvary R, Verdial FC, Haglich KA, Sevilimedu V, Nelson JA, Gemignani ML. Long-Term Patient-Reported Outcomes Comparing Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery: A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:7091-7098. [PMID: 37556008 PMCID: PMC10996134 DOI: 10.1245/s10434-023-13962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/03/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Oncoplastic breast surgery (OBS) combines plastic surgery techniques with conventional breast-conserving surgery (BCS) and expands BCS eligibility. Limited data are available on patient-reported outcomes (PROs) after OBS. Here we compare long-term PROs after OBS and BCS utilizing the BREAST-Q. PATIENTS AND METHODS Women undergoing OBS or BCS between 2006 and 2019 who completed ≥ 1 long-term BREAST-Q survey 3-5 years postoperatively were identified. Baseline characteristics were compared between women who underwent OBS/BCS. Women who underwent OBS were paired with those who underwent BCS using 1:2 propensity matching [by age, body mass index (BMI), race, T stage, and multifocality]. BREAST-Q scores were compared preoperatively and 3-5 years postoperatively. RESULTS A total of 297 patients were included for analysis (99 OBS/198 BCS). Women who underwent OBS were younger (p < 0.001) and had higher BMI (p = 0.005) and multifocal disease incidence (p = 0.004). There was no difference between groups in nodal stage, re-excision rates, axillary surgery, chemotherapy, endocrine therapy, or radiotherapy. After propensity matching preoperatively, women who underwent OBS reported lower psychosocial well-being (63 versus 100, p = 0.039) but similar breast satisfaction and sexual well-being compared with women who underwent BCS; however, only three patients who underwent BCS had preoperative BREAST-Q scores available for review. In long-term follow-up, women who underwent OBS reported lower psychosocial scores (74 versus 93, p = 0.011) 4 years postoperatively, but not at 5 years (76 versus 77, p = 0.83). There was no difference in long-term breast satisfaction or sexual well-being. CONCLUSIONS Women who undergo OBS present with a larger disease burden and may represent a group of non-traditional BCS candidates; they reported similar long-term breast satisfaction and sexual well-being compared with women who undergo BCS. While women who underwent OBS reported lower psychosocial well-being scores preoperatively and during a portion of the follow-up period, this difference was no longer seen at 5 years postoperatively.
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Affiliation(s)
- Linda M Pak
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Regina Matar-Ujvary
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Francys C Verdial
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kathryn A Haglich
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
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Ren JH, Wang Y, Zhang X, Cheng Q, Wang K, Liu Q, Tang R, Yang L, Gong J, Xu J, Li H. A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study. Aesthetic Plast Surg 2023:10.1007/s00266-023-03631-5. [PMID: 37821554 DOI: 10.1007/s00266-023-03631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Approximately 25-30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate. METHODS A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire. RESULTS The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6-69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13). CONCLUSION Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- J H Ren
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiang Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qiao Cheng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kang Wang
- Department of Oncology-Pathology, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Qiang Liu
- The People's Hospital of Dazu, Chongqing, China
| | - Renxi Tang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ling Yang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junge Gong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jiawei Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongyuan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Zaher HAE, Fathy H, Abozeid M, Faisal M. Neoadjuvant chemotherapy for stage II-III breast cancer: a single-center experience. World J Surg Oncol 2023; 21:314. [PMID: 37805553 PMCID: PMC10559473 DOI: 10.1186/s12957-023-03199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/19/2023] [Indexed: 10/09/2023] Open
Abstract
INTRODUCTION We conducted this study to reflect a single-center experience with the use of neoadjuvant systemic chemotherapy (NAC) for the management of women with operable breast cancer. METHODS We conducted a retrospective chart review on all women presenting with operable, stage II-III, breast cancer and were scheduled for NAC at Suez Canal University Hospital. The primary outcome of this study was to estimate the proportion of patients with breast cancer who become eligible for breast-conserving surgery (BCS) after (NAC). RESULTS A total of 147 patients were included. Before the initiation of chemotherapy, only 66 (44.9%) patients were indicated for (BCS). A total of 40 (49.4%) new patients, out of the 81 patients who were ineligible before chemotherapy, became eligible for BCS after NAC (95% CI 39.3-61.9%). On the other hand, 8 (12.1%) patients became ineligible for BCS after NAC, out of 66 patients who were initially eligible. Out of the 98 eligible patients for BCS after chemotherapy, 72 (73.5%) patients underwent the surgery, and the remaining 26 (26.5%) patients chose modified radical mastectomy (MRM). A total of 55 out of 72 (76.4%) patients achieved pathological complete response (pCR). One woman (0.1%) experienced relapse in the 3rd year of follow-up and three women (2%) experienced relapse in the 5th year of follow-up. We found a statistically significant relationship between patients who became eligible for breast-conserving surgery and both age and estrogen receptor negativity (p = 0.001 and 0.007, respectively). CONCLUSION NAC can play a crucial role in increasing the rate of eligibility for BCS among women with operable, stage II-III, breast cancer.
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Affiliation(s)
- Haidi Abd El Zaher
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt
| | - Hamada Fathy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt
| | - Mohamed Abozeid
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohammed Faisal
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt.
- Department of General Surgery, Torsby Hospital, Region Värmland County Council, Värmland, Sweden.
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Yuan YW, Liu PC, Li FF, Yang YH, Yang W, Fan L, Mou DW, Yang HW, Chen MS. Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study. BMC Surg 2023; 23:298. [PMID: 37789365 PMCID: PMC10548734 DOI: 10.1186/s12893-023-02181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The evidence of breast-conserving therapy (BCT) applied in centrally located breast cancer (CLBC) is absent. This study aims to investigate the long-term survival of breast-conserving therapy (BCT) in centrally located breast cancer (CLBC) compared with mastectomy in CLBC and BCT in non-CLBC. METHODS Two hundred ten thousand four hundred nine women with unilateral T1-2 breast cancer undergoing BCT or mastectomy were identified from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier survival curves were assessed via log-rank test. Propensity score matching (PSM) was used to balance baseline features, and the multivariable Cox model was used to estimate the adjusted hazard ratio [HR] and its 95% confidence interval [CI] for breast cancer-specific survival (BCSS) and overall survival (OS). RESULTS With a median follow-up of 91 months, the BCSS and OS rates in patients who received BCT were greater than those patients treated with mastectomy in the entire CLBC set. Multivariable Cox analyses showed that CLBC patients who received BCT had better BCSS (HR = 0.67, 95%CI: 0.55-0.80, p < 0.001) and OS (HR = 0.78, 95%CI: 0.68-0.90, p = 0.001) than patients who received a mastectomy, but there were no significant differences of BCSS (HR = 0.65, 95%CI: 0.47-0.90, p = 0.009) and OS (HR = 0.82, 95%CI: 0.65-1.04, p = 0.110) after PSM. In patients treated with BCT, CLBC patients had a similar BCSS (HR = 0.99, 95%CI: 0.87-1.12, p = 0.850) but a worse OS (HR = 1.09, 95%CI: 1.01-1.18, p = 0.040) compared to that of the non-CLBC patient, but there was no significant difference both BCSS (HR = 1.05, 95%CI: 0.88-1.24, p = 0.614) and OS (HR = 1.08, 95%CI: 0.97-1.20, p = 0.168) after PSM. CONCLUSION Our findings revealed that BCT should be an acceptable and preferable alternative to mastectomy for well-selected patients with CLBC.
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Affiliation(s)
- Ye-Wei Yuan
- Department of Breast and Thyroid Surgery, Sichuan Provincial Hospital for Women and Children (Affiliated Women and Children’s Hospital of Chengdu Medical College), Chengdu, 610041 People’s Republic of China
| | - Peng-Cheng Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041 People’s Republic of China
| | - Fang-Fang Li
- Department of Operating Room, Suining Central Hospital, 127 Desheng Road West, Suining, 629000 People’s Republic of China
| | - Ya-Han Yang
- Medical Imaging, North Sichuan Medical College, Nanchong, 637000 People’s Republic of China
| | - Wei Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041 People’s Republic of China
| | - Li Fan
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
| | - De-Wu Mou
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
| | - Hong-Wei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
| | - Mao-Shan Chen
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
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Harbin Z, Sohutskay D, Vanderlaan E, Fontaine M, Mendenhall C, Fisher C, Voytik-Harbin S, Tepole AB. Computational mechanobiology model evaluating healing of postoperative cavities following breast-conserving surgery. Comput Biol Med 2023; 165:107342. [PMID: 37647782 PMCID: PMC10581740 DOI: 10.1016/j.compbiomed.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through Gaussian process surrogates. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.
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Affiliation(s)
- Zachary Harbin
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - David Sohutskay
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Vanderlaan
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muira Fontaine
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
| | - Carly Mendenhall
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - Carla Fisher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sherry Voytik-Harbin
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Department of Basic Medical Sciences Purdue University, West Lafayette, IN, USA
| | - Adrian Buganza Tepole
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA; Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA.
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Pop CF, Nziki LD, El Helou E, Moreau M, Radermecker M, Larsimont D, Veys I, De Neubourg F. Axillary Surgical Attitude Changing with Retrospective Application of ACOSOG Z0011 Eligible Criteria: An Institutional Evaluation. Eur J Breast Health 2023; 19:318-324. [PMID: 37795004 PMCID: PMC10546802 DOI: 10.4274/ejbh.galenos.2023.2023-6-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
Objective Sentinel lymph node biopsy (SLNB) represents the gold standard for axillary surgical staging. The aim of this study was to assess the proportion of axillary lymph node dissection (ALND) that could be avoided after retrospective application of the ACOSOG Z0011 criteria and to evaluate the shortterm complications associated with axillary surgery. Materials and Methods We reviewed breast cancer (BC) patients treated by primary breast-conserving surgery from 2012 to 2015. The percentage of SLNB vs ALND performed before and after the application of the ACOSOG Z0011 criteria was calculated. Complications were analyzed using crosstabs, with p<0.05 considered significant. Results Two hundred fifty one patients with a median age of 59.3 years were included. BC tumors had a median size of 13 mm and were mostly unifocal (83.9%). There were 30.3% with 1-2 metastatic lymph nodes (MLN). ALND was performed in 44.2%. The patients with 1-2 MLN, had only SLNB in 14.5% of cases. By applying the ACOSOG Z0011 criteria, ALND would have been avoided in 40.2% of patients. At least one postoperative complication was reported after SLNB or ALND for 45.7% and 74.7% of patients respectively. Seroma was the most frequent complication, and occurred in 29.3% of cases after SLNB and in 59.5% after ALND. Conclusion SNLB is the most commonly used axillary surgical staging procedure in this series (55.8%). With a retrospective application of the ACOSOG Z0011 criteria in our population, ALND could have been avoided for 40.2% patients. Post-operative complications rate was higher after ALND, with a seroma rate at 59.5%.
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Affiliation(s)
- C. Florin Pop
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lea Datin Nziki
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Etienne El Helou
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michel Moreau
- Data Centre and Statistics, Institut Jules Bordet, ULB, Brussels, Belgium
| | | | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, ULB, Brussels, Belgium
| | - Isabelle Veys
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Filip De Neubourg
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Zhao R, Zhang J, Gao J. Blood flow on ultrasound imaging is a predictor of lump margin status in breast-conserving patients: a retrospective matching study. Eur J Med Res 2023; 28:357. [PMID: 37730626 PMCID: PMC10510181 DOI: 10.1186/s40001-023-01356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE This study investigated the relationship between breast ultrasound features and lump margin status in breast-conserving patients. METHODS A single-institution database and medical records system were searched to identify patients who had undergone breast-conserving surgery between 2015 and 2022. Patients were divided into case and control groups based on their postoperative margin status, and different matching methods [case-control matching (CCM) and propensity score matching (PSM)] were used to match the cases and controls at a ratio of 1:1. RESULTS Before matching, patients with positive margins were more likely to have a tumor with increased blood flow (OR = 2.90, 95% CI 1.83-4.61, p < 0.001) and microcalcifications (OR = 2.22, 95% CI 1.44-3.42, p < 0.001). Among the 83 pairs of CCM subjects, patients with positive margins were prone to increased blood flow (p = 0.007) and crab sign (p = 0.040). In addition, there was a significant difference in blood flow (p = 0.030) among PSM subjects. After adjusting for the unbalanced factors, the same results were obtained. CONCLUSIONS Ultrasound blood flow significantly predicts the status of breast-conserving margins, but further studies are required to verify our findings.
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Affiliation(s)
- Rong Zhao
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Jianyong Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jinnan Gao
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
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Gilmore R, Chen J, Dembinski R, Reissis Y, Milek D, Cadena L, Habibi M. Cost minimization in breast conserving surgery: a comparative study of radiofrequency spectroscopy and full cavity shave margins. Cost Eff Resour Alloc 2023; 21:66. [PMID: 37716980 PMCID: PMC10504787 DOI: 10.1186/s12962-023-00477-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND In an effort to minimize positive margins and subsequent re-excision after breast conserving surgery (BCS), many providers and facilities have implemented either a Full Cavity Shave (FCS) approach or adding the MarginProbe Radiofrequency Spectroscopy System. OBJECTIVE We sought to create a functioning Pro-Forma for use by facilities and payers to evaluate and compare the cost savings of implementing FCS or MarginProbe based on personalized variable inputs. METHODS A decision tree demonstrating three possible surgical pathways, BCS, BCS + FCS, and BCS + MarginProbe was developed with clinical inputs for re-excision rate, mastectomy as 2nd surgery, rate of reconstruction, and rate of 3rd surgery derived by a literature review. A surgical pathway cost formula was created using the decision tree and financial inputs derived by utilizing the nation's largest database of privately billed health insurance claims and Medicare claims data (fairhealth.org). Using the surgical pathway formula and financial inputs, a customizable Pro-Forma was created for immediate cost savings analysis of BCS + FCS and BCS + Marginprobe using variable inputs. Costs are from the perspective of third-party payers. RESULTS Utilizing MarginProbe to reduce re-excisions for positive margins can be associated with better cost-savings than FCS due to the increased pathology processing costs by using an FCS approach. The reduction in re-excision provided by both FCS and MarginProbe offset their increased expense to various degrees with cost savings of each method improving as baseline re-excisions rates increase, until ultimately each may become cost-neutral or cost-prohibitive when compared to BCS alone. Our data suggest that in the privately insured population, MarginProbe provides a cost-savings over BCS alone when baseline re-excision rates are over 20% and that FCS becomes cost-saving when baseline re-excision rates are over 29%. For Medicare patients, MarginProbe provides a cost-savings when baseline re-excision rates exceed 34%, and FCS becomes cost-saving for re-excision rates over 52%. Our Pro-Forma allows an individual provider or institution to evaluate the cost savings of the FCS approach and/or utilization of the MarginProbe device such that the additional cost or cost-savings of utilizing one or both of these methods can be quickly calculated based on their facility's volume and baseline re-excision rate. CONCLUSIONS Our data suggest that utilizing either an FCS approach or the MarginProbe radiofrequency spectroscopy system may be a cost-saving solution to reducing the rate of re-excisions depending on a facility or practice's surgical volume and baseline re-excision rate. The degree to which each of these interventions provides an added cost or cost-savings to healthcare payers can be evaluated by utilizing the Pro-Forma outlined herein with customizable variable inputs.
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Affiliation(s)
- Richard Gilmore
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA
| | - Jennifer Chen
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA
| | - Robert Dembinski
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA
| | - Yannis Reissis
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA
| | - David Milek
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA
| | - Lisa Cadena
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA
| | - Mehran Habibi
- Director, Breast Program at Staten Island University Hospital, Chief of Breast Surgery, Western Region, Northwell Health, 256 Mason Ave., Building B, 2nd Fl., Staten Island, NY, 10305, USA.
- Department of Surgery, Northwell Health, Zucker School of Medicine, New York, United States.
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An YY, Hwang H, Suh YJ. What Should We Know in Postoperative Surveillance Imaging After Oncoplastic Breast-Conserving Surgery with Pellet-Type Acellular Dermal Matrix? Acad Radiol 2023; 30 Suppl 2:S16-S24. [PMID: 37263859 DOI: 10.1016/j.acra.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to evaluate the usual postoperative imaging findings among patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) and to assess the clinical utility of mammography (MG) and ultrasonography (US) in follow-ups. MATERIALS AND METHODS This retrospective review of our prospectively collected database of patients who underwent oncoplastic BCS with ADM was conducted with IRB approval and in HIPPA compliance. A total of 105 patients whose follow-up MG and US studies over 2years after surgery were available were included in this study. Postoperative imaging findings were analyzed based on sequential MG and US follow-ups. The clinical outcomes and pathological data were also reviewed. The diagnostic performance of MG and US for postoperative surveillance was assessed. RESULTS On MG, ADM presented as an oval (99/105, 94.3%), circumscribed/obscured (65/105, 61.9%), and high-density (56/105, 53.3%) mass with calcifications (54/105, 51.4%). On US, the ADM-filled cavity presented as an oval (93/105, 88.6%), circumscribed (70/105, 66.7%), heterogenous echoic (65/105, 61.9%) mass with marginal/posterior acoustic shadowing (95/105, 90.5%) on US. During the follow-up period (mean, 46.1months; range, 26-58 months), four tumor recurrences were diagnosed (4/105, 3.8%). One tumor recurrence detected on MG presented as microcalcifications (1/4, 25%), which were differentiated from benign postoperative calcifications due to their suspicious morphology and location. Two additional recurrences (2/4, 50%), which were MG-negative small masses or intraductal lesions, were detected on US. One tumor recurrence was missed on both MG+US and was detected by magnetic resonance imaging performed at clinician's request. The sensitivity and specificity of MG, US, and MG+US for postoperative surveillance were 25%, 50% and 75% and 100%, 98% and 98%, respectively. CONCLUSION Recognition and adequate interpretation of the usual findings after oncoplastic BCS with ADM insertion are important in postoperative imaging surveillance. The sole use of MG is not sufficient for the detection of mass-type tumor recurrence due to the density of inserted ADM fillers. Therefore, the combined use of MG+US could serve as a useful postoperative surveillance tool with increased sensitivity in this population.
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Affiliation(s)
- Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Republic of Korea (Y.Y.A., H.H.)
| | - Hyejung Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Republic of Korea (Y.Y.A., H.H.)
| | - Young Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Republic of Korea (Y.J.S.).
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. Eur Radiol 2023; 33:6213-6225. [PMID: 37138190 PMCID: PMC10415233 DOI: 10.1007/s00330-023-09600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- BioMaps (UMR1281), INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.r.l, La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy
- CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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Matar-Ujvary R, Haglich K, Flanagan MR, Fuzesi S, Sevilimedu V, Nelson JA, Gemignani ML. The Impact of Breast-Conserving Surgery Re-excision on Patient-Reported Outcomes Using the BREAST-Q. Ann Surg Oncol 2023; 30:5341-5349. [PMID: 37306849 PMCID: PMC10782578 DOI: 10.1245/s10434-023-13592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Approximately 14% of women undergoing breast-conserving surgery (BCS) require re-excision to achieve negative margins following the Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) margin guidelines, which may influence patient-reported outcomes (PROs). Few studies have assessed the impact of re-excision on PROs following BCS. PATIENTS AND METHODS Women with stage 0-III breast cancer undergoing BCS who completed a BREAST-Q PRO measure from 2010 to 2016 were identified from a prospective database. Baseline characteristics were compared between women who underwent one BCS and those who underwent ≥ 1 re-excision surgery for positive margins (R-BCS). Linear mixed models were used to analyze associations between number of excisions and BREAST-Q scores over time. RESULTS Of 2543 eligible women, 1979 (78%) had one BCS and 564 (22%) had R-BCS. Younger age, lower BMI, surgery pre-SSO Invasive Guidelines issuance, ductal carcinoma in situ (DCIS), multifocal disease, radiation therapy receipt, and endocrine therapy omission were more common in the R-BCS group. Breast satisfaction and sexual well-being were lower in the R-BCS group 2 years postoperatively. There were no differences in psychosocial well-being between groups over 5 years. On multivariable analysis, re-excision was associated with lower breast satisfaction and sexual well-being (p= 0.007 and p= 0.049, respectively), but there was no difference in psychosocial well-being (p= 0.250). CONCLUSIONS Women with R-BCS had lower breast satisfaction and sexual well-being 2 years postoperatively, but this difference did not remain long term. Psychosocial well-being in women who underwent one BCS were largely comparable over time to the R-BCS group. These findings may help in counseling women who are concerned about satisfaction and quality-of-life outcomes with BCS if re-excision is necessary.
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Affiliation(s)
- Regina Matar-Ujvary
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Haglich
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Sarah Fuzesi
- Breast Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Liu J, Zhu Z, Hua Z, Lin W, Weng Y, Lin J, Mao H, Lin L, Chen X, Guo J. Radiotherapy refusal in breast cancer with breast-conserving surgery. Radiat Oncol 2023; 18:130. [PMID: 37543579 PMCID: PMC10403910 DOI: 10.1186/s13014-023-02297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/14/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Although radiotherapy after breast-conserving surgery has been the standard treatment for breast cancer, some people still refuse to undergo radiotherapy. The aim of this study is to identify risk factors for refusal of radiotherapy after breast-conserving surgery. METHODS To investigate the trend of refusing radiotherapy after breast-conserving surgery in patients with breast cancer using the Surveillance, Epidemiology, and End Results database. The patients were divided into radiotherapy group and radiotherapy refusal group. Survival results were compared using a multivariate Cox risk model adjusted for clinicopathological variables. Multivariate logistic regression was used to analyze the influencing factors of patients refusing radiotherapy after breast-conserving surgery and a nomogram model was established. RESULTS The study included 87,100 women who underwent breast-conserving surgery for breast cancer between 2010 and 2015. There were 84,948 patients (97.5%) in the radiotherapy group and 2152 patients (2.5%) in the radiotherapy refusal group. The proportion of patients who refused radiotherapy after breast-conserving surgery increased from 2.1% in 2010 to 3.1% in 2015. The Kaplan-Meier survival curve showed that radiotherapy can improve overall survival (p < 0.001) and breast cancer specific survival (p < 0.001) in the patients with breast-conserving surgery. The results of multivariate logistic regression showed that age, income, marital status, race, grade, stage, subtype and chemotherapy were independent factors associated with the refusal of radiotherapy. CONCLUSIONS Postoperative radiotherapy can improve the benefits of breast-conserving surgery. Patients with old age, low income, divorce, white race, advanced stage, and no chemotherapy were more likely to refuse radiotherapy.
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Affiliation(s)
- Jiameng Liu
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Zhanlin Zhu
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Zhipeng Hua
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Weijie Lin
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Yiyin Weng
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Juli Lin
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Hehui Mao
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Lifen Lin
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Xuming Chen
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China.
| | - Jujiang Guo
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China.
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Araki M, Matsui K, Takagi K, Kanaya E, Sekine S, Nagasawa S, Watanabe T, Miwa T, Hirano K, Igarashi T, Tanaka H, Shibuya K, Hashimoto I, Hojo S, Yoshioka I, Okumura T, Hirabayashi K, Fujii T. A case of squamous cell carcinoma of the breast achieved a pathological complete response after dose-dense AC + dose-dense PTX. Surg Case Rep 2023; 9:137. [PMID: 37530896 PMCID: PMC10397160 DOI: 10.1186/s40792-023-01719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of the breast is a rare form of breast cancer, accounting for approximately 0.1% of all breast cancers. It is known for its rapid tumor growth and poor prognosis with no established treatment. CASE PRESENTATION A 56-year-old woman was diagnosed with breast SCC with axillary, supraclavicular and internal thoracic lymph node metastases. She received neoadjuvant chemotherapy (NAC) with dose-dense doxorubicin and cyclophosphamide (AC) followed by dose-dense paclitaxel (PTX). This treatment resulted in a pathological complete response (pCR) after breast-conserving surgery. The patient was then treated with radiotherapy. She remained free of recurrence for three years postoperatively. CONCLUSIONS We report a rare case of breast SCC treated with preoperative dose-dense chemotherapy, resulting in pCR and allowing breast-conserving surgery.
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Affiliation(s)
- Misato Araki
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Koshi Matsui
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Kohji Takagi
- Department of Diagnostic Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Emi Kanaya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Shinichi Sekine
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Shiho Nagasawa
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Toru Watanabe
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Takeshi Miwa
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Katsuhisa Hirano
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Takamichi Igarashi
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Haruyoshi Tanaka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Isaya Hashimoto
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Shozo Hojo
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Isaku Yoshioka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Tomoyuki Okumura
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Kenichi Hirabayashi
- Department of Diagnostic Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan.
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Afshar-Bakshloo M, Albers S, Richter C, Berninger O, Blohmer JU, Roehle R, Speiser D, Karsten MM. How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes. BMC Cancer 2023; 23:705. [PMID: 37507687 PMCID: PMC10375629 DOI: 10.1186/s12885-023-11172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. METHODS EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. RESULTS BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). CONCLUSIONS Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
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Affiliation(s)
- Melissa Afshar-Bakshloo
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Albers
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Chiara Richter
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ottilia Berninger
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dorothee Speiser
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Liu P, Zhao Y, Rong DD, Li KF, Wang YJ, Zhao J, Kang H. Diagnostic value of preoperative examination for evaluating margin status in breast cancer. World J Clin Cases 2023; 11:4852-4864. [PMID: 37583993 PMCID: PMC10424046 DOI: 10.12998/wjcc.v11.i20.4852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery (BCS). Preoperative imaging examinations are frequently employed to assess the surgical margin. AIM To investigate the role and value of preoperative imaging examinations [magnetic resonance imaging (MRI), molybdenum target, and ultrasound] in evaluating margins for BCS. METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021. The study gathered preoperative imaging data (MRI, ultrasound, and molybdenum target examination) and intraoperative and postoperative pathological information. Based on their BCS outcomes, patients were categorized into positive and negative margin groups. Subsequently, the patients were randomly split into a training set (226 patients, approximately 70%) and a validation set (97 patients, approximately 30%). The imaging and pathological information was analyzed and summarized using R software. Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS. A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis. This study aims to identify the risk factors associated with failure in BCS. RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS. These factors comprise non-mass enhancement (NME) on dynamic contrast-enhanced MRI, multiple focal vascular signs around the lesion on MRI, tumor size exceeding 2 cm, type III time-signal intensity curve, indistinct margins on molybdenum target examination, unclear margins on ultrasound examination, and estrogen receptor (ER) positivity in immunohistochemistry. LASSO regression was additionally employed in this study to identify four predictive factors for the model: ER, molybdenum target tumor type (MT Xmd Shape), maximum intensity projection imaging feature, and lesion type on MRI. The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set. Particularly, the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS. CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer. The model utilizes preoperative ultrasound, molybdenum target, MRI, and core needle biopsy pathology evaluation results, all of which align with the real-world scenario. Hence, our model can offer dependable guidance for clinical decision-making concerning BCS.
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Affiliation(s)
- Peng Liu
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of General Surgery, Beijing Fengtai Hospital, Beijing 100071, China
| | - Ye Zhao
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Dong-Dong Rong
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Kai-Fu Li
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ya-Jun Wang
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing Zhao
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hua Kang
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Liu P, Zhao Y, Rong DD, Li KF, Wang YJ, Zhao J, Kang H. Diagnostic value of preoperative examination for evaluating margin status in breast cancer. World J Clin Cases 2023; 11:4848-4860. [DOI: 10.12998/wjcc.v11.i20.4848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery (BCS). Preoperative imaging examinations are frequently employed to assess the surgical margin.
AIM To investigate the role and value of preoperative imaging examinations [magnetic resonance imaging (MRI), molybdenum target, and ultrasound] in evaluating margins for BCS.
METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021. The study gathered preoperative imaging data (MRI, ultrasound, and molybdenum target examination) and intraoperative and postoperative pathological information. Based on their BCS outcomes, patients were categorized into positive and negative margin groups. Subsequently, the patients were randomly split into a training set (226 patients, approximately 70%) and a validation set (97 patients, approximately 30%). The imaging and pathological information was analyzed and summarized using R software. Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS. A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis. This study aims to identify the risk factors associated with failure in BCS.
RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS. These factors comprise non-mass enhancement (NME) on dynamic contrast-enhanced MRI, multiple focal vascular signs around the lesion on MRI, tumor size exceeding 2 cm, type III time-signal intensity curve, indistinct margins on molybdenum target examination, unclear margins on ultrasound examination, and estrogen receptor (ER) positivity in immunohistochemistry. LASSO regression was additionally employed in this study to identify four predictive factors for the model: ER, molybdenum target tumor type (MT Xmd Shape), maximum intensity projection imaging feature, and lesion type on MRI. The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set. Particularly, the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS.
CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer. The model utilizes preoperative ultrasound, molybdenum target, MRI, and core needle biopsy pathology evaluation results, all of which align with the real-world scenario. Hence, our model can offer dependable guidance for clinical decision-making concerning BCS.
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Affiliation(s)
- Peng Liu
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of General Surgery, Beijing Fengtai Hospital, Beijing 100071, China
| | - Ye Zhao
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Dong-Dong Rong
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Kai-Fu Li
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ya-Jun Wang
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing Zhao
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hua Kang
- Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Kim H, Hieken TJ, Abraha F, Jakub JW, Corbin KS, Furutani KM, Boughey JC, Stish BJ, Deufel CL, Degnim AC, Shumway DA, Ahmed SK, Piltin MA, Sandhu NP, Conners AL, Ruddy KJ, Mutter RW, Park SS. Long-term outcomes of intraoperatively-placed applicator brachytherapy for rapid completion of breast conserving treatment: An analysis of a prospective registry data. Clin Transl Radiat Oncol 2023; 41:100639. [PMID: 37251618 PMCID: PMC10212787 DOI: 10.1016/j.ctro.2023.100639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/09/2023] [Accepted: 05/07/2023] [Indexed: 05/31/2023] Open
Abstract
Background and purpose To evaluate the long-term outcome of accelerated partial breast irradiation utilizing intraoperatively placed applicator-based brachytherapy (ABB) in early-stage breast cancer. Materials and methods From our prospective registry, 223 patients with pTis-T2, pN0/pN1mic breast cancer were treated with ABB. The median treatment duration including surgery and ABB was 7 days. The prescribed doses were 32 Gy/8 fx BID (n = 25), 34 Gy/10 fx BID (n = 99), and 21 Gy/3 fx QD (n = 99). Endocrine therapy (ET) adherence was defined as completion of planned ET or ≥ 80% of the follow-up (FU) period. Cumulative incidence of ipsilateral breast tumor recurrence (IBTR) was estimated and influencing factors for IBTR-free survival rate (IBTRFS) were analyzed. Results 218/223 patients had hormone receptor-positive tumors, including 38 (17.0%) with Tis and 185 (83.0%) with invasive cancer. After a median FU of 63 months, 19 (8.5%) patients had recurrence [17 (7.6%) with an IBTR]. Rates of 5-year IBTRFS and DFS were 92.2% and 91.1%, respectively. The 5-year IBTRFS rates were significantly higher for post-menopausal women (93.6% vs. 66.4%, p = 0.04), BMI < 30 kg/m2 (97.4% vs. 88.1%, p = 0.02), and ET-adherence (97.5% vs. 88.6%, p = 0.02). IBTRFS did not differ with dose regimens. Conclusions Postmenopausal status, BMI < 30 kg/m2, and ET- adherence predicted favorable IBTRFS. Our results highlight the importance of careful patient selection for ABB and encouragement of ET compliance.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | | | - Feven Abraha
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James W. Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Amy C. Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dean A. Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Mara A. Piltin
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole P. Sandhu
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amy L. Conners
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Duymus ME, Gumus S. Aesthetic outcomes of breast-conserving surgery and oncoplastic surgery with the new scale named Quality of Life Questionnaire Breast Reconstruction Module-23. Ann Surg Treat Res 2023; 104:249-257. [PMID: 37179696 PMCID: PMC10172031 DOI: 10.4174/astr.2023.104.5.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose Oncoplastic surgery (OPS) has been developed with the aim of improving breast-conserving surgery (BCS) to provide better aesthetic and functional outcomes for breast cancer patients. We aimed to compare overall quality of life (QoL) and satisfaction with breast reconstruction in patients undergoing BCS and OPS using the Quality of Life Questionnaire Core 30 (QLQ-C30) and recently validated QLQ-Breast Reconstruction module (QLQ-BRECON23). Methods A total of 87 patients were included in this single-center study between January 1, 2018 and December 31, 2021; 43 underwent OPS (49.4%) and 44 underwent BCS (50.6%). The data on patient, tumor, and treatment characteristics were obtained from the prospectively collected database at the hospital. QLQ-C30 and QLQ-BRECON23 were used to evaluate psychosocial well-being, fatigue symptoms, overall QoL, sexual well-being, sensation of the operative area, and satisfaction with the reconstruction. Results According to QLQ-C30 evaluation there were significantly better outcomes for patients treated with OPS than BCS in terms of psychosocial well-being, fatigue symptoms, and overall QoL (P = 0.005, P = 0.016, and P = 0.004; respectively), according to QLQ-BRECON23 evaluation there were also significantly better outcomes in terms of sexual well-being, sensation of the operative area, and satisfaction of the reconstruction (P < 0.001, P = 0.002, and P < 0.001; respectively). Conclusion We found that the overall QoL and satisfaction with breast reconstruction in patients undergoing OPS are better than those undergoing BCS. Our study is critical because it is the first study comparing OPS and BCS using the QLQ-BRECON23, which was recently validated.
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Affiliation(s)
- Mehmet Esat Duymus
- Division of Surgical Oncology, Department of General Surgery, Hatay Training and Researcher Hospital, Hatay, Turkey
| | - Serdar Gumus
- Division of Surgical Oncology, Department of General Surgery, Hatay Training and Researcher Hospital, Hatay, Turkey
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van Hemert AKE, van Olmen JP, Boersma LJ, Maduro JH, Russell NS, Tol J, Engelhardt EG, Rutgers EJT, Vrancken Peeters MJTFD, van Duijnhoven FH. De-ESCAlating RadioTherapy in breast cancer patients with pathologic complete response to neoadjuvant systemic therapy: DESCARTES study. Breast Cancer Res Treat 2023; 199:81-89. [PMID: 36892723 DOI: 10.1007/s10549-023-06899-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Neoadjuvant systemic therapy (NST) is increasingly used in breast cancer patients and depending on subtype, 10-89% of patients will attain pathologic complete response (pCR). In patients with pCR, risk of local recurrence (LR) after breast conserving therapy is low. Although adjuvant radiotherapy after breast conserving surgery (BCS) reduces LR further in these patients, it may not contribute to overall survival. However, radiotherapy may cause early and late toxicity. The aim of this study is to show that omission of adjuvant radiotherapy in patients with a pCR after NST will result in acceptable low LR rates and good quality of life. METHODS The DESCARTES study is a prospective, multicenter, single arm study. Radiotherapy will be omitted in cT1-2N0 patients (all subtypes) who achieve a pCR of the breast and lymph nodes after NST followed by BCS plus sentinel node procedure. A pCR is defined as ypT0N0 (i.e. no residual tumor cells detected). Primary endpoint is the 5-year LR rate, which is expected to be 4% and deemed acceptable if less than 6%. In total, 595 patients are needed to achieve a power of 80% (one-side alpha of 0.05). Secondary outcomes include quality of life, Cancer Worry Scale, disease specific and overall survival. Projected accrual is five years. CONCLUSION This study bridges the knowledge gap regarding LR rates when adjuvant radiotherapy is omitted in cT1-2N0 patients achieving pCR after NST. If the results are positive, radiotherapy may be safely omitted in selected breast cancer patients with a pCR after NST. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov on June 13th 2022 (NCT05416164). Protocol version 5.1 (15-03-2022).
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Affiliation(s)
- Annemiek K E van Hemert
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Josefien P van Olmen
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre+ - GROW School for Oncology and Reproduction, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Nicola S Russell
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 'S-Hertogenbosch, The Netherlands
| | - Ellen G Engelhardt
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Emiel J Th Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Karam R, Elmokadem AH, El-Rakhawy MM, Soliman N, Elnahas W, Abdel-Khalek AM. Clinical utility of abbreviated breast MRI based on diffusion tensor imaging in patients underwent breast conservative therapy. Radiol Med 2023; 128:289-298. [PMID: 36763315 DOI: 10.1007/s11547-023-01600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate the added value of the diffusion tensor imaging (DTI) parameters to abbreviated breast MRI protocol in differentiating recurrent breast cancer from post-operative changes in cases of breast conservative surgery (BCS). METHODS This prospective study was approved by our institutional review board. Written informed consent was obtained in all patients. 47 female patients (mean age, 49 years; range, 32-66 years) that previously underwent breast conservative surgery with a palpable mass were included in this study (62 breast lesions). Two abbreviated MRI protocols were compared using 1.5 Tesla MRI, AB-MRI 1 (axial T1, T2, pre-contrast T1, 1st post-contrast and subtracted images) and AB-MRI 2 (same sequences plus adding DTI). In both protocols, the wash-in rate was calculated. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity, and diagnostic accuracy for each protocol. RESULTS The mean total acquisition time was of 6 min for AB-MRI 1 and 10 min for AB-MRI 2 protocols while the mean interpretation time was of 57.5 and 75 s, respectively. Among analyzed DTI parameters, MD (mean diffusivity) showed the highest sensitivity (96.43%) and specificity (91.18%) (P value = < 0.001). FA (fractional anisotropy), AD (axial diffusivity) and RD (radial diffusivity) showed sensitivity = (78.57%, 82.14% and 85.71%), specificity = (88.24, 85.29% and 79.41%), respectively, P value (< 0.001). CONCLUSION DTI may be included in abbreviated MRI protocols without a significant increase in acquisition time and with the advantage of increasing specificity and clinical utility in the characterization of post-conservative breast lesions.
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Affiliation(s)
- Rasha Karam
- Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt.
| | | | - Nermin Soliman
- Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt
| | - Waleed Elnahas
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
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Li Z, Liu Y, Zhang J, Li Y, Du K, Zhang S, Han H, Zhang J. A large single-center prospective study to investigate the factors influencing the choice of breast-conserving surgery versus mastectomy in Chinese women with early breast cancer. World J Surg Oncol 2023; 21:43. [PMID: 36765355 PMCID: PMC9921411 DOI: 10.1186/s12957-023-02924-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Compared to mastectomy, breast-conserving surgery (BCS) provides the same survival rate and a higher quality of life for patients with early breast cancer (EBC). However, Chinese women with EBC are known to have a low BCS rate. A large prospective cohort study was conducted to investigate the factors influencing the choice of BCS in this population. METHODS In 2017, all women with unilateral EBC and eligible for BCS at our institution were enrolled. Before surgery, the patient's trust in the surgeon and her perceived strength of the surgeon's recommendation of BCS were measured through an in-person interview and validated ad hoc questionnaire. Multivariate logistic regressions on BCS procedure vs. mastectomy were used to estimate the odds ratio (OR). RESULTS One thousand one hundred thirty-six patients enrolled at analysis had an average age of 51.8 and tumor size of 2.4 cm. 19.9% of patients had BCS. The "strong" level of trust in the surgeon was significantly associated with BCS with an OR of 2.944 (p<0.001) when compared to the "average or under" trust. The "strong" and "moderate" strengths in surgeon recommendation for BCS were also found to be significantly associated with the BCS procedure with ORs of 12.376 (p <0.001) and 1.757 (p =0.040), respectively, compared to the "neutral or dissuaded" strength. CONCLUSIONS Stronger trust in surgeons and BCS recommendation by surgeons are associated with a higher rate of BCS in Chinese women with EBC. Interventional trials are needed to confirm this finding.
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Affiliation(s)
- Zhensheng Li
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035, China.
| | - Yunjiang Liu
- Department of Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035, China.
| | - Jing Zhang
- grid.452582.cDepartment of Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Yue Li
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Kaiye Du
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Shuo Zhang
- grid.452582.cDepartment of Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Huina Han
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Jun Zhang
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
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Marinovich ML, Saunders CM, Pereira G, Houssami N. Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. Breast 2023:S0960-9776(23)00013-9. [PMID: 36759253 DOI: 10.1016/j.breast.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). METHODS In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009-2013) and post-guideline (2014-2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. RESULTS The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference -4.0% [95% CI -5.9, -2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference -1.8% [95% CI -3.4, -0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference -2.2% [95% CI -3.4, -1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of -0.8% (95% CI -1.2, -0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was -0.5% (95% CI -4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. CONCLUSIONS Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline.
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Affiliation(s)
- M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia; Curtin School of Population Health, Curtin University, Kent Street, WA, Australia.
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, WA, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Vic, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Kent Street, WA, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Huang S, Yang Q, Zheng X, Chow KM, Wu J, Zhu J. Predictors of surgery choices in women with early-stage breast cancer in China: a retrospective study. BMC Cancer 2023; 23:23. [PMID: 36609281 PMCID: PMC9825016 DOI: 10.1186/s12885-023-10510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer. METHODS This retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice. RESULTS A total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer. CONCLUSIONS In China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.
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Affiliation(s)
- Sijia Huang
- grid.12955.3a0000 0001 2264 7233Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Qingmo Yang
- grid.12955.3a0000 0001 2264 7233Department of Breast Surgery, First Affiliated Hospital, Xiamen University, Xiamen, P.R. China
| | - Xujuan Zheng
- grid.263488.30000 0001 0472 9649School of Nursing, Health Science Centre, Shenzhen University, Shenzhen, Guangdong Province P.R. China
| | - Ka Ming Chow
- grid.10784.3a0000 0004 1937 0482The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Junhua Wu
- grid.12955.3a0000 0001 2264 7233Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Jiemin Zhu
- grid.12955.3a0000 0001 2264 7233Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China
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Hasan MT, Hamouda M, Khashab MKE, Elsnhory AB, Elghamry AM, Hassan OA, Fayoud AM, Hafez AH, Al-Kafarna M, Hagrass AI, Rabea RK, Gbreel MI. Oncoplastic versus conventional breast-conserving surgery in breast cancer: a pooled analysis of 6941 female patients. Breast Cancer 2023; 30:200-214. [PMID: 36622565 PMCID: PMC9950210 DOI: 10.1007/s12282-022-01430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Breast cancer is the most prevalent cancer in women. In the past few years, surgical interventions for breast cancer have experienced massive changes from radical excision to conserving approaches. In this study, we aim to compare the two breast surgery interventions, including conventional breast-conserving surgery (CBCS) versus oncoplastic breast-conserving surgery (OPBCS). METHODS We searched on PubMed, Web of Science (WOS), Scopus, Embase, and Cochrane till 2 October 2021. All relevant randomized controlled trials (RCTs) and observational studies were included. The data were extracted and pooled using Review Manager software (RevMan 5.4). RESULTS The pooled meta-analysis of the included studies showed that OPBCS was significantly superior to CBCS in most of the outcomes. Re-excision significantly favoured CBCS (RR = 0.49, 95% CI [0.37, 0.63], P < 0.00001). However, local recurrence (RR = 0.55, 95% CI [0.27, 1.09], P = 0.09), close surgical margins (RR = 0.37, 95% CI [0.14, 1.00], P = 0.05) and end up to the risk of mastectomy (RR = 0.73, 95% CI [0.54, 97], P = 0.06) showed no significant difference between both techniques. Notably, while performing a sensitivity analysis, other outcomes as local recurrence, significantly showed favourable results towards OPBCS. In terms of safety outcomes, there was no significant difference between OPBCS and CBCS. CONCLUSION We recommend the oncoplastic approach rather than the conventional one in females with breast cancer. Re-excision rates showed better results following OPBCS.
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Affiliation(s)
- Mohammed Tarek Hasan
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohamed Hamouda
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohammad K El Khashab
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Ahmed Bostamy Elsnhory
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdullah Mohamed Elghamry
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Obada Atef Hassan
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Aya Mamdouh Fayoud
- Faculty of Pharmacy, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdelrahman H Hafez
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohammed Al-Kafarna
- Faculty of Pharmacy, Al-Azhar University-Gaza, Gaza Strip, Palestine
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdulrahman Ibrahim Hagrass
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Randa Kamal Rabea
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohamed Ibrahim Gbreel
- Faculty of Medicine, October 6 University, Cairo Governorate, Giza, 11571, Egypt.
- International Medical Research Association (IMedRA), Cairo, Egypt.
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Kimoto M, Ishitobi M, Imai N, Nakamura K, Kojima R, Hatakawa E, Ogawa T. Long-term course of the changes in the nipple position after breast-conserving surgery. Surg Today 2023; 53:52-61. [PMID: 35701689 DOI: 10.1007/s00595-022-02531-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/24/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Even if favorable cosmetic outcomes are obtained shortly after breast-conserving surgery (BCS), cosmetic changes may occur up to several years after BCS. In the present study, we evaluated cosmetic changes while focusing on changes in the nipple position after BCS. METHODS We examined the long-term course of changes in the nipple position over time after BCS using the proportion of the distance between the sternal notch and nipple (PDSN) in 196 patients. We also evaluated risk factors for long-term nipple position changes. RESULTS The median follow-up period was 9.9 years. Nipple position changes occurred within eight years after BCS and seemed to plateau beyond that point. The body mass index (BMI), breast size, proportion of excision volume and axillary treatment were significantly associated with the nipple position changes within one to five years after BCS. The BMI, breast size, axillary treatment, chemotherapy and hormonal therapy were significantly associated with the nipple position changes within five to eight years after BCS. CONCLUSIONS After BCS, the nipple position changes occur within about eight years. Obesity, large breast size, large excision volume, axillary treatment, chemotherapy and hormone therapy were factors that affected the treated breast shrinkage and increase in the left-right difference after BCS.
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Lu T, Jorns JM, Ye DH, Patton M, Gilat-Schmidt T, Yen T, Yu B. Analysis of Deep Ultraviolet Fluorescence Images for Intraoperative Breast Tumor Margin Assessment. Proc SPIE Int Soc Opt Eng 2023; 12368:1236806. [PMID: 37292087 PMCID: PMC10249647 DOI: 10.1117/12.2649552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Positive margin status after breast-conserving surgery (BCS) is a predictor of higher rates of local recurrence. Intraoperative margin assessment aims to achieve negative surgical margin status at the first operation, thus reducing the re-excision rates that are usually associated with potential surgical complications, increased medical costs, and mental pressure on patients. Microscopy with ultraviolet surface excitation (MUSE) can rapidly image tissue surfaces with subcellular resolution and sharp contrasts by utilizing the nature of the thin optical sectioning thickness of deep ultraviolet light. We have previously imaged 66 fresh human breast specimens that were topically stained with propidium iodide and eosin Y using a customized MUSE system. To achieve objective and automated assessment of MUSE images, a machine learning model is developed for binary (tumor vs. normal) classification of obtained MUSE images. Features extracted by texture analysis and pre-trained convolutional neural networks (CNN) have been investigated for sample descriptions. A sensitivity, specificity, and accuracy better than 90% have been achieved for detecting tumorous specimens. The result suggests the potential of MUSE with machine learning being utilized for intraoperative margin assessment during BCS.
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Affiliation(s)
- Tongtong Lu
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53233 & 53226, USA
| | - Julie M. Jorns
- Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dong Hye Ye
- Department of Computer Science, Georgia State University, Atlanta, GA 30302, USA
| | - Mollie Patton
- Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Taly Gilat-Schmidt
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53233 & 53226, USA
| | - Tina Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Bing Yu
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53233 & 53226, USA
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Algara M, Rodríguez E, Martínez-Arcelus FJ, Salinas J, Sanz X, Beato I, Manso A, Soler A, Rodríguez JR, Frías A, Calín A, Juan G, Meireles P, Flaquer A. OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized clinical trial. Radiother Oncol 2022; 176:76-82. [PMID: 36210628 DOI: 10.1016/j.radonc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In breast cancer (BC) patients, the involvement of four or more lymph nodes (LN) is an indication of regional irradiation. The optimal treatment strategy remains unclear when fewer nodes are involved and lymphadenectomy is not performed. We designed a clinical trial to show the non-inferiority of Incidental (INC) compared to intentional (INT) irradiation of axillary nodes in patients with early-stage BC and low burden LN involvement. MATERIALS AND METHODS BC patients, cN0 (n = 487) undergoing breast conservation surgery and sentinel node biopsy, with total tumor load assessed by OSNA (One-Step Nucleic Acid Amplification) of 250-15,000 copies mRNA CK19/µL in sentinel LN were randomized to receive INC or INT nodal irradiation. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints were locoregional recurrence (LRR), distant recurrence (DR), and acute and chronic toxicity (CT). RESULTS Five-years DFS were 93.7% (INC) and 93.8% (INT) (difference 0.1% [one-sided 95% CI < 5.7%]; non-inferiority p = 0.075). Cumulative Incidences of LRR were 3.5% (INC) and 3.4% (INT) (difference of 0.1% [<4.8%]; p = 0.021), and 5% (INC) and 3.5% (INT) (difference 1.4% [<6.0%]; non-inferiority p = 0.101) for DR. CT was more Incident with INT (26.9%) than with INC (19.2%), though the difference was not statistically significant (HR 1.39 [95% CI: 0.92, 2.10]; p = 0.11). CONCLUSION Intentional does not outperform incidental irradiation by more than 5.7% in terms of 5-year DFS, 4.8% for LRR, and 6% for DR. REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02335957.
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Affiliation(s)
- Manuel Algara
- Radiation Oncology Department, Del Mar Hospital, Passeig Maritim 25, 08003 Barcelona, Spain.
| | - Elvira Rodríguez
- Radiation Oncology Department, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain.
| | - Francisco José Martínez-Arcelus
- Radiation Oncology Department, La Fe Polytechnic University Hospital, Av. Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Juan Salinas
- Radiation Oncology Department, Santa Lucia General University Hospital, C. Minarete, s/n, 30202 Cartagena, Spain.
| | - Xavier Sanz
- Radiation Oncology Department, Del Mar Hospital, Passeig Maritim 25, 08003 Barcelona, Spain.
| | - Inmaculada Beato
- Radiation Oncology Department, Castellón Provincial Hospital, Av. del Dr. Clarà, 19, 12002 Castellón de La Plana, Spain.
| | - Aurea Manso
- Radiation Oncology Department, La Paz University Hospital, P.° de la Castellana, 261, 28046 Madrid, Spain.
| | - Ana Soler
- Radiation Oncology Department, De La Ribera Hospital, km 1, Ctra. Corbera, 46600 Alzira, Spain.
| | - José Reyes Rodríguez
- Radiation Oncology Department, University Hospital of Leon, C. Altos de Nava, s/n, 24071 León, Spain.
| | - Andere Frías
- Radiation Oncology Department, de Cruces University Hospital, Plaza de Cruces, 48903 Barakaldo, Spain.
| | - Ana Calín
- Radiation Oncology Department, Gregorio Marañón University General Hospital, C. Dr. Esquerdo, 46, 28007 Madrid, Spain.
| | - Germán Juan
- Radiation Oncology Department, Cabueñes University Hospital, Los Prados, 395, 33394 Gijón, Spain.
| | - Pedro Meireles
- Radiation Oncology Department, São João Universitary Hospital Center, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Amanda Flaquer
- Radiation Oncology Department, Araba Txagorritxu University Hospital, Jose Atxotegi Kalea, s/n, 01009 Gasteiz, Spain.
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Lin CW, Chiang MH, Tam KW. Treatment of Mammary Paget Disease: A systematic review and meta-analysis of real-world data. Int J Surg 2022; 107:106964. [PMID: 36309195 DOI: 10.1016/j.ijsu.2022.106964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because the lesions of mammary Paget disease (MPD) are often limited to the nipple-areolar complex, the extension of optimal tumor excision is inconclusive. Moreover, the risk of potential tumor upstaging is unknown; therefore, the application of sentinel lymph node biopsy (SLNB) is required for analysis. We systematically reviewed the real-world data to evaluate the optimal treatment and potential predictors of poorer prognosis for MPD. METHODS The PubMed, Embase, and Cochrane Library databases were searched for relevant studies. Clinical studies were included if they evaluated the outcome of positive rates of SLNB, prognostic risk factors of MPD, and survival outcomes of treatments of interest for MPD, including mastectomy, breast-conserving surgery (BCS) with radiotherapy, and BCS alone. RESULTS A total of 38 studies with 24,062 patients were retrieved. Compared with BCS alone (21.2%), mastectomy (5.9%; P < 0.001) and BCS with radiotherapy (8; P = 0.001) had significantly lower local recurrence rates. Patients with palpable tumors (30.2%) had significantly worse prognoses than those with impalpable (3.4%) tumors in metastasis (P < 0.001), and significantly higher local recurrence rates were observed in patients with underlying invasive carcinoma (6.7%) than those with noninvasive carcinoma (4.5%; P = 0.032). The positive rate of SLNB was 17% (95% CI: 0.115-0.226). CONCLUSION Except for MPD alone, BCS alone is not recommended for treating MPD with invasive ductal carcinoma and MPD with ductal carcinoma in situ. Moreover, a palpable mass, underlying invasive carcinoma, and positive lymph node status may lead to a poorer prognosis, which may be taken into consideration for the application of SLNB.
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Affiliation(s)
- Cheng-Wei Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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