Abstract P1-20-26: Management of breast fibromatosis: Is further surgical resection treatment necessary after ultrasound-guided vacuum-assisted biopsy?

Abstract

Abstract Purpose: Recently, some studies confirmed that the surgical margin in patients with breast fibromatosis was not associated with recurrence. Wide tumor-free resection surgery, which used to be the first-line treatment, might not be necessary for all fibromatosis patients. Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a minimally invasive technique which has been used for complete excision of benign breast tumors. The purpose of this study is to compare the risk of relapse between patients with breast fibromatosis received UGVAB alone to local surgical resection (SR) in our hospital. Material and methods: The pathology database was searched over the period of 2007 to 2017 for cases in which patients diagnosed as breast fibromatosis/desmoid-typed tumors. All patients were accepted breast ultrasound examination and then treated by UGVAB alone or SR at our breast tumor center. Postoperative follow-up was carried out with ultrasound examination at intervals of 3 to 6 months. X2 test was used to compare clinicopathologic features, Kaplan-Meier method with a log-rank test was used as a univariate analysis to compare the relapse-free survival (RFS) rates, Cox regression analysis was used for multivariate analysis. Results: A total of 40 patients were enrolled in this study. Of these 40 patients, 13 (32.5%) were classified as UGVAB group and 27 (67.5%) as local SR group. The age at the time of initial diagnosis ranged between 21-65 years, with a median age of 35.5 years. Sixteen (16/40, 40.0%) patients had a past history of breast surgery. Tumors were palpable in most patients (33, 82.5%), which was significantly different in two groups [8 (61.5%) in UGVAB group, 25 (92.66%) in SR group, p = 0.027]. Meanwhile, there was a trend towards smaller tumors in UGVAB group (median size 1.1cm) than SR group (median size 1.9cm, p = 0.172). (Table 1) During the follow-up, 25% (10/40) patients developed a tumor recurrence, the median RFS was 36 months (range, 5-110 months). RFS was 69.2% in the UGVAB group and 77.8% in the SR group, the RFS has no difference between these two groups (p = 0.082, log-rank test). Multivariate analysis also identified that treatment strategy (UGVAB vs. SR) was not associated with an increased risk of relapse events (hazard ratio [HR] 0.309, 95% confidence interval [CI] 0.063-1.515; p = 0.148) (Table 2). Conclusion: Patients who were diagnosed with breast fibromatosis and received UGVAB treatment did not have a significantly compromised RFS than those who underwent SR. UGVAB could be an alternative and relatively conservative therapy for local control of breast fibromatosis. TABLE 1 Clinicopathologic features of patients included in the studyTotal N=40UGVAB Group n=13(32.5%)Local SR Group n=27(67.5%)pAge(y)≤3520(50.0)6(46.2)14(51.9)0.736>3520(50.0)7(53.8)13(48.1)Previous breast surgeryYes16(40)3(23.1)13(48.1)0.130No24(60)10(76.9)14(51.9)PalpableYes33(82.5)8(61.5)25(92.6)0.027*No7(17.5)5(38.5)2(7.4)Initial tumor size(cm)≤230(80.0)12(92.3)18(66.7)0.172#>210(20.0)1(7.7)9(33.3)LateralityRight13(32.5)4(30.8)9(33.3)0.586*Left24(60.0)9(69.2)15(55.6)Bilateral3(7.5)0(0)3(11.1)USG BI-RADS category38(20.0)5(38.5)3(11.1)0.126*4A12(30.0)4(30.8)8(29.6)4B-4C/520(50.0)4(30.8)16(59.3)UGVAB ultrasound-guided vacuum-assisted biopsy, SR surgical resection, USG ultrasonography, BI-RADS Breast Imaging-Reporting and Data System* Fisher’s exact test # Continuity correction Table 2. Multivariate analysis of prognostic factors for RFS.UnivariateMultivariateHazard ratio (95% CI)p-valueHazard ratio (95% CI)p-valueAge (≤35 vs. >35)0.640 [0.161-2.551]0.5270.519[0.083-3.245]0.483History of breast surgery (yes vs. no)0.679[0.134-3.448]0.6400.922[0.119-7.113]0.938Treatment (UGVSB vs. SR)0.288[0.064-1.293]0.1040.309[0.063-1.515]0.148Tumor size (≤2cm vs. >2cm)0.259 [0.032-2.079]0.2030.316[0.038-2.648]0.288RFS relapse free survival, UGVAB ultrasound-guided vacuum-assisted biopsy, SR surgical resection Citation Format: Jingsi Mei, Yue Hu, Chang Gong. Management of breast fibromatosis: Is further surgical resection treatment necessary after ultrasound-guided vacuum-assisted biopsy? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-26.