Breast-conserving Operations Research Articles

Future challenges in the surgical treatment of breast cancer – Oncoplastic, prophylactic procedures and reconstructive surgery

AbstractMedical knowledge is doubling faster and faster. Surgeons are highly specialized and must be trained not only in surgery, but also in imaging and oncology to meet the modern requirements of a breast center. This article describes what has changed in the surgical treatment of breast cancer over the past 20 years since the introduction of certified breast centers in Germany, and what could change in the future. Pre- and post-operative conferences have become a central component of the interdisciplinary exchange of information. Every breast-conserving operation must be precisely planned, marked and carried out in a controlled manner. Basic anatomical knowledge is not sufficient enough to perform a prophylactic mastectomy. Implant-based reconstructions change their shape and strength over time and usually lead to follow-up operations. Tissue engineering offers interesting approaches to replace the disadvantages of conventional implants in order to achieve the durability and quality similar to autologous tissue reconstructions.

Extreme Oncoplasty: Oncologically Safe When Compared with Mastectomy

BackgroundExtreme oncoplasty is a breast-conserving operation using oncoplastic techniques in a patient who does not meet the traditional criteria for breast conservation and in whom most physicians would suggest a mastectomy. These tumors are generally multicentric and/or multifocal, they span more than 50 mm, or they can be large recurrences in a previously irradiated breast.MethodsA prospective single institution database was queried from 2008 through mid 2023 for patients who met the criteria for extreme oncoplasty and were treated with excision plus whole-breast radiation therapy (WBRT) or mastectomy without WBRT. Patients with recurrent breast cancer were excluded. Endpoints were local, regional, and distant recurrence as well as overall and breast-cancer-specific survival.Results272 patients were treated with oncoplastic mammaplasty, using a standard or split reduction excision followed by postoperative WBRT. An additional 101 patients elected to be treated with mastectomy without postoperative radiation therapy. With a median follow-up of 7 years, there were no significant differences in local, regional, or distant recurrence, nor in breast-cancer-specific survival or overall survival.ConclusionsWe strongly support extreme oncoplasty plus WBRT as the default procedure of choice for patients with large multifocal/multicentric lesions amenable to reconstruction with volume displacement mammaplasty.

Extreme Oncoplastic Breast Surgery: A case series of three patients from a lower-middle income country.

Oncoplastic breast surgery has become a major player in modern breast surgery.It broadens the indications for breast-conserving surgery. More challenging cases are being treated more with what so-called "extreme oncoplastic breast surgery" which is defined as a breast-conserving operation, using oncoplastic techniques, in a patient who, in most physicians' opinions, requires a mastectomy. Replacement and/or displacement oncoplastic techniques with contralateral symmetrization to three female patients with breast cancer were done by an oncoplastic breast surgeon. The three patients had smooth recoveries with good aesthetic,oncologic and psychological outcomes. Oncoplastic breast surgery can be a better option than mastectomy with good oncologic, Psychological and aesthetic outcomes, even with extreme cases, yet long-term studies are needed.

Sub-Terahertz Waveguide Iris Probe for Ex-Vivo Breast Cancer Tumor Margin Assessment

In breast-conserving operations, terahertz imaging (THz) has become a popular method of assessing tumor margins intraoperatively. Typically, THz measurements are conducted with electro-optical setups that penetrate tissue just a few microns deep. The study demonstrates a robust, efficient, and cost-effective electronic sub-THz waveguide probe for detecting tumor margins intraoperatively during lumpectomies. The proposed iris waveguide probe is capable of detecting fat, fibrous, and tumorous tissue in breast tissue. The device can identify both positive and negative margins in the frequency range of 110-170 GHz. The scanning probe can be used to rapidly and effectively depict the excised tissue surface by placing it in contact with it. According to the imaging results, this probe has a lateral sensitivity of 0.2 mm and a detection depth of 1 mm. It is manufactured using CNC micromachining technology to ensure easy and cost-effective production. The probe was designed and tested in HFSS as well as fabricated and validated on an artificial excised breast mimicking phantom. In this research, sub-terahertz waves are used for tissue penetrating imaging of breast tumor margins, which is an application requiring high resolution and accurate techniques.

Oncologic Outcome of 1000 Postmastectomy Breast Reconstructions with Fat Transfer: A Single-Center, Matched Case-Control Study.

Autologous fat transfer has an important role in breast reconstructive surgery. Nevertheless, some concerns remain with regard to its oncologic safety. The authors present a single-center, case-matching study analyzing the impact of autologous fat transfer in the cumulative incidence of local recurrences. From a prospectively maintained database, the authors identified 902 patients who underwent 1025 breast reconstructions from 2005 to 2017. Data regarding demographics, tumor characteristics, surgery details, and follow-up were collected. Exclusion criteria were patients with distant metastases at diagnosis, recurrent tumor, or incomplete data regarding primary tumor; and patients who underwent prophylactic mastectomies and breast-conserving operations. Statistical analysis was conducted to evaluate the impact of the variables on the incidence of local recurrence. A value of p < 0.05 was considered statistically significant. After 1: n case-matching, we selected 919 breasts, of which 425 patients (46.2 percent) received at least one autologous fat transfer session versus 494 control cases (53.8 percent). Local recurrences had an overall rate of 6.8 percent, and we found local recurrences in 14 autologous fat transfer cases (3.0 percent) and 54 controls (9.6 percent). Statistical analysis showed that autologous fat transfer did not increase the risk of local recurrences (hazard ratio, 0.337; CI, 0.173 to 0.658; p = 0.00007). Multivariate analysis identified invasive ductal carcinoma subtype and lymph node metastases to have an increased risk of local recurrences (hazard ratio >1). Conversely, positive hormonal receptor status was associated with a reduced risk of events (hazard ratio <1). Autologous fat transfer was not associated with a higher probability of locoregional recurrence in patients undergoing breast reconstruction; therefore, it can be safely used for total breast reconstruction or aesthetic refinements. Risk, II.

Mammographically occult breast cancers detected with AI-based diagnosis supporting software: clinical and histopathologic characteristics

BackgroundTo demonstrate the value of an artificial intelligence (AI) software in the detection of mammographically occult breast cancers and to determine the clinicopathologic patterns of the cancers additionally detected using the AI software.MethodsBy retrospectively reviewing our institutional database (January 2017–September 2019), we identified women with mammographically occult breast cancers and analyzed their mammography with an AI software that provided a malignancy score (range 0–100; > 10 considered as positive). The hot spots in the AI report were compared with the US and MRI findings to determine if the cancers were correctly marked by the AI software. The clinicopathologic characteristics of the AI-detected cancers were analyzed and compared with those of undetected cancers.ResultsAmong the 1890 breast cancers, 6.8% (128/1890) were mammographically occult, among which 38.3% (49/128) had positive results in the AI analysis. Of them, 81.6% (40/49) were correctly marked by the AI software and determined as “AI-detected cancers.” As such, 31.3% (40/128) of mammographically occult breast cancers could be identified by the AI software. Of the AI-detected cancers, 97.5% were found in heterogeneously or extremely dense breasts, 52.5% were asymptomatic, 86.5% were invasive, and 29.7% had axillary lymph node metastasis. Compared with undetected cancers, the AI-detected cancers were more likely to be found in younger patients (p < 0.001), undergo neoadjuvant chemotherapy as well as mastectomy rather than breast-conserving operation (both p < 0.001), and accompany axillary lymph node metastasis (p = 0.003).ConclusionsAI conferred an added value in the detection of mammographically occult breast cancers.

Serous borderline ovarian tumors: modern possibilities of ultrasound diagnostics in monitoring the course of the disease after organ-preserving operations

Relevance. Borderline ovarian tumors (BOT) occur mainly in women of reproductive age and account for 20% of all neoplasms of the female genital organs. Currently, there is an increase in the incidence of ВОТ. One of the reasons for the increase in morbidity is the improvement of knowledge and experience in relation to the morphological diagnosis of tumors of low malignancy potential. Nevertheless, the results of a preliminary instrumental assessment of the nature of the disease and the final diagnosis formed by histological examination are not always satisfactory, since borderline tumors are a thin layer that occupies an intermediate position between benign and malignant tumors. And, in spite of the fact that ВОТ is an independent nosological form in the histological classification, nevertheless, they have signs of both benign and malignant neoplasms. In this regard, the complexity of both instrumental and morphological diagnostics of ВOT becomes understandable, and, therefore, difficulties arise in determining the tactics of treatment, choosing the optimal operation, and the need for drug therapy. All these issues are directly related to the patients quality of life, and, most importantly, to survival. Because an incorrectly established diagnosis entails incorrect treatment and unsatisfactory results. Thus, the study of the peculiarities of ВOT diagnostics is extremely important. The ultrasound computed tomography method is simple, relatively cheap and affordable. Considering that almost all patients with ovarian neoplasms undergo this type of examination, it is extremely important and interesting to assess the role of the ultrasound method in the diagnosis of ВОТ. Moreover, at present more and more gynecological oncologists are resorting to organ-preserving surgical interventions for ВOТ. Therefore, it is especially important to study the possibility of ultrasound diagnostics in monitoring the course of the disease after breast-conserving operations, identifying recurrences of the disease in the ovary, differentiating recurrence and cystic formations of the ovaries.&#x0D; Aim. To determine the effectiveness of computer-assisted ultrasound diagnostics in monitoring the course of BOT after breast-conserving operations.&#x0D; Materials and methods. At Blokhin National Medical Research Center of Oncology carried out a retrospective and prospective analysis of 405 patients with serous BOT for the period 19702013. The age of the patients varied in a wide range, the minimum was 15, the maximum was 78 years, the median corresponded to 38 years. Before the start of treatment, the patients underwent an ultrasound examination (ultrasound) of the abdominal organs, the pelvic organs and the retroperitoneal space. The studies were carried out on expert ultrasonic systems Siemens ACUSON S2000, Hitachi ARIETTA V70 and Philips EPIQ 5.&#x0D; Results. We studied the capabilities of the ultrasound method for diagnosing serous BOT based on the analysis of morpho-ultrasound comparisons in patients after conservative and ultra-conservative operations.&#x0D; Conclusion. It has been established that ultrasound diagnostics is of decisive importance both in the initial diagnosis and in the dynamic observation of patients with conservative and ultra-conservative surgery for serous BOT. Echography makes it possible to diagnose a tumor in the ovary in 83.3% of cases and to reject the diagnosis in 86.7% of cases.

Granulomatous mastitis − treatment options and our experience

Granulomatous mastitis (GM) is a rare benign inflammatory disease of the breast, first described by Kessler and Wolloch in 1972. Clinically, it can present as unilateral, sometimes painful, increasing breast resistance, or as a hard, irregular mass. Sonography is the most useful diagnostic method for GM evaluation. The only method for definitive diagnosis is the use of biopsy. In histological findings, GM is characterized by non-caseifying granulomas, often associated with microabscess and fistula formation. There is considerable heterogeneity in treatment options; this may explain the high recurrence rate which is close to 50%. Such a high recurrence rate is alarming and proves that current treatments are suboptimal. Two treatment options are discussed worldwide: conservative strategies involving drug therapy with corticosteroids versus a surgical approach involving partial or total mastectomy. All conservative treatment options are associated with a high risk of recurrence, and most patients require surgery in the end. Thorough excision of inflammatory tissue is crucial for successful treatment while negative surgical margins are associated with a low recurrence rate. The surgical approach to GM requires sufficient radicality and presumes knowledge in the field of reconstructive breast surgery, similarly to oncosurgical breast conservation operations. However, alternatives to GM treatment with oral steroids may be acceptable for patients concerned about surgery. This article presents six case reports of patients treated at our department.

Role of Metformin in Combination with Trastuzumab and Neoadjuvant Chemotherapy in Treatment of HER-2 Positive Breast Cancer

Backgound: HER2 overexpression is a good predictive marker of HER2 targeted therapy, which means that HER2 therapy will be very effective in reducing the size of HER2 positive breast cancers. Therefore, the size of HER2 positive breast cancer can easily be reduced in patients who wish to have a breast-conserving operation, and potentially improves the outcome of patients if pathologic complete response (PCR) can be achieved. Objective: To determine whether metformin use with trastuzumab was associated with improvement in PCR rate in patients with breast cancer receiving neoadjuvant chemotherapy. Patients and Methods: This prospective study was conducted at the Clinical Oncology Department, Aswan University and Upper Egypt Hospitals in the period between 1/7/2016 and 1/9/2019. This study included 30 patients divided into 2 groups, test group (metformin group) and standard group (non-metformin group). Histopathology was confirmed by tissue core biopsy. Results: All patients in the two groups in our study achieved either pathological complete response or partial response. No patients developed disease progression or were still stable disease. Among the patients in test group (metformin group), 12 patients (80%) achieved pathological complete response (PCR) while 3 (20%) patients did not achieve PCR. However, among the patients in standerd group (non-metformin group) 9 patients (60%) achieved pathological complete response (PCR) while 6 (40%) patients did not achieve PCR. There was statistically significant difference between the two groups regarding the response with better PCR in metformin group (p value is 0.089). Conclusion: The addition of metformin to tratuzumab in neoadjuvant chemotherapy has a significant impact on pathological complete response (PCR) in female patients with HER-2 positive breast cancer.

Role of Metformin in Combination with Trastuzumab and Neoadjuvant Chemotherapy in Treatment of HER-2 Positive Breast Cancer

HER2 overexpression is a good predictive marker of HER2 targeted therapy, which means that HER2 therapy will be very effective in reducing the size of HER2 positive breast cancers. Therefore, the size of HER2 positive breast cancer can easily be reduced in patients who wish to have a breast-conserving operation, and potentially improves the outcome of patients if pathologic complete response (PCR) can be achieved.

Differences in Re-excision Rates for Breast-Conserving Surgery Using Intraoperative 2D Versus 3D Tomosynthesis Specimen Radiograph

Intraoperative specimen radiographs performed during breast conservation surgery for cancer reduces the need for re-excision for positive margins. We studied 2D versus 3D image-guided cavity margin excision and compared it to final pathology and need for additional surgery. We conducted a retrospective review of 657 breast-conserving operations performed for cancer from 2013 to 2018. Procedures were performed by four surgeons at a single tertiary institution with access intraoperatively to 2D and 3D radiographs. Data collected included demographics, intraoperative margin assessment, final pathology, and re-excision rates. A total of 466 patients had 2D and 191 had 3D specimen imaging. The 2D group had a lower mean age and a higher body mass index and proportion of minority patients than the 3D group (P < 0.01). In the 3D group, there was a higher percentage of patients with mammographically denser breasts (P < 0.06); 58% of patients in the 3D group had additional imaging-directed cavity margins excised versus 32% of patients in the 2D group (P < 0.01). In the 2D group, 44 patients (9%) had positive final margins versus 8 patients (4%) in the 3D group (P = 0.02). No difference was found on total volume of excision (P = 0.56). The re-excision rate for the 2D group was 11% versus 5% for the 3D group (P = 0.02; adjusted odds ratio = 0.41, 95% confidence interval 0.19-0.86). Re-excision rates using both modalities are low. A lower re-excision rate is independently associated with 3D tomosynthesis. This allows surgeons to excise additional margins at the index operation, decreasing reoperations and anxiety/costs for patients.

Radiotherapy-Induced High Neutrophil-to-Lymphocyte Ratio is a Negative Prognostic Factor in Patients with Breast Cancer.

Radiotherapy (RT) is the standard of care following breast-conserving operation in breast cancer patients. The neutrophil-to-lymphocyte ratio (NLR) reflects the systemic change caused as a result of the radiotherapy. We aimed to evaluate the association between RT and the change in NLR following the receipt of RT, and to investigate the prognostic impact. We retrospectively reviewed NLR values of breast cancer patients taken before the administration of the first and the last session of RT. The cut-off point for the NLR was determined using the Youden index and receiver operating characteristic (ROC) curve within the training set. Recurrence-free survival (RFS), distant metastasis free survival, and overall survival were the main outcomes. Patients with an NLR higher than 3.49 after RT were classified to an RT-induced high NLR group and showed a significantly higher recurrence rate compared to those with low NLR (p < 0.001). In a multivariate Cox proportional hazards model, RT-induced high NLR remained a significant prognostic factor (HR 2.194, 95% CI 1.230–3.912, p = 0.008 for tumor recurrence. We demonstrated that an increase in NLR over the course of RT has a negative impact on survival, putting these patients with RT-susceptible host immunity at a higher risk of tumor recurrence.

A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the American Society of Breast Surgeons.

Several definitions of oncoplastic surgery have been reported in the literature. In an effort to facilitate communication regarding oncoplastic surgery to patients, trainees, and among colleagues, the American Society of Breast Surgeons (ASBrS) aimed to create a consensus definition and classification system for oncoplastic surgery. We performed a comprehensive literature search for oncoplastic surgery definitions using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following this, a consensus definition and classification system was created by the ASBrS. Overall, 30 articles defining oncoplastic surgery were identified, with several articles contradicting each other. The ASBrS definition for oncoplastic surgery defines this set of breast-conserving operations using volume displacement and volume replacement principles as: "Breast conservation surgery incorporating an oncologic partial mastectomy with ipsilateral defect repair using volume displacement or volume replacement techniques with contralateral symmetry surgery as appropriate". Volume displacement is defined as closing the lumpectomy defect and redistributing the resection volume over the preserved breast, and is divided into two levels: level 1 (< 20%) and level 2 (20-50%). Volume replacement includes those situations when volume is added using flaps or implants to correct the partial mastectomy defect. The ASBrS oncoplastic surgery definition and classification system provides language to facilitate discussion and teaching of oncoplastic surgery among breast surgeons, trainees, and patients.

Severe cognitive decline following chemotherapy of breast cancer

Chemotherapy for different types of cancer is often life-saving. On the other hand, the spectrum of side effects may involve the central nervous system (CNS) and lead to severe emotional and cognitive disturbances, a syndrome often referred to as “The Chemo Brain”. Here we report on a then 43-year-old female patient who first presented to our clinic in 2013 and in whom breast cancer of the right breast had been diagnosed four years earlier. At that time she became a patient of the Comprehensive Cancer Center of the University of Ulm (CCCU) and underwent breast-conserving therapy starting with systemic chemotherapy according to the rules of the GeparQuinto Study. This was followed by breast-conserving operation including axillary lymphonodectomy. Histological examination of the excised material revealed an invasive ductal mammary carcinoma the exact staging of which will be reported in detail. Convalescence of the patient was protracted, and she continued complaining of difficulties to concentrate and to remember what she had been told or read shortly before. In addition, she complained of frequent mood swings. Therefore, she was referred to our department. Exploring her case history, we learned that she had worked as a manager of a car rental company which she had no longer been able to do after her cancer treatment because of her cognitive deficits. Beside clinical and psychiatric examination, our diagnostic procedures included electroencephalography (EEG), magnetic resonance tomography (MRT) of the brain using gadolinium enhancement, and extensive neuropsychological testing. In detail, components of the Wechsler Adult Intelligence Scale (WAIS), the Ray Auditory Verbal Learning Test (RAVLT), the Multiple Choice Vocabulary (“Mehrfachwahl-Wortschatztest”), the “Regensburger Wortflussigkeitstest” (Regensburg Word Fluency Test, RWT), and the “Testbatterie zur Aufmerksamkeitsprufung” (Test Battery for the Assessment of Attention, TAP) were applied. Whereas the EEG was unremarkable, the MRT performed in 2013 showed brain atrophy with frontotemporal accentuation. As an accessory finding, an arachnoid cyst was detected at the left temporal pole. No metastases were found. Interestingly, we had the opportunity to compare these findings with those of an earlier MRT performed in 2011. In the latter one, the arachnoid cyst was also visible, but there was no pronounced brain atrophy. These observations raise the question if progressive brain atrophy might be associated with the syndrome of “Chemo Brain”. Neuropsychological examination revealed severe cognitive deficits in this patient – details of which will be reported – apparently due to the chemotherapy she had undergone. Possible mechanisms of action, treatment options, and ethical implications will be discussed.

Performance characteristics of specimen radiography for margin assessment for ductal carcinoma in situ: a systematic review.

Reducing positive margin rate (PMR) and reoperation rate in breast-conserving operations remains a challenge, mainly regarding ductal carcinoma in situ (DCIS). Intra-operative margin assessment tools have emerged to reduce PMR over the last decades, including specimen radiography (SR). No consensus has been reached on the reliability and efficacy of SR in DCIS. We performed a systematic literature review to assess the performance characteristics of SR for margin assessment of breast lesions with pure DCIS and invasive cancers with DCIS components. A literature search was conducted for diagnostic studies up to April 2017 concerning SR for intra-operative margin assessment of breast lesions with pure DCIS or with DCIS components. Studies reporting sensitivity and specificity calculated using final pathology report as reference test were included. Due to improved imaging technology, studies published more than 15years ago were excluded. Methodological quality was assessed using quality assessment of diagnostic accuracy studies-2 checklist. Due to clinical and methodological diversity, meta-analysis was considered not useful. Of 235 citations identified, 9 met predefined inclusion criteria and documented diagnostic efficacy data. Sensitivity ranged from 22 to 77% and specificity ranged from 51 to 100%. Positive predictive value and negative predictive value ranged from 53 to 100% and 32 to 95%, respectively. High or unclear risk of bias was found in reference standard in 5 of 9 studies. High concerns regarding applicability of index test were found in 6 of 9 studies. The present results do not support the routine use of intra-operative specimen radiography to reduce the rate of positive margins in patients undergoing breast-conserving surgery for pure DCIS or the DCIS component in invasive cancer. Future studies need to differentiate between initial and final specimen margin involvement. This could provide surgeons with a number needed to treat for a more applicable outcome.

Ageism and surgical treatment of breast cancer in Italian hospitals.

To determine if age is a factor influencing the type of breast cancer surgery (radical versus conservative) in Italy and to investigate the regional differences in breast cancer surgery clinical practice. Retrospective study is based on national hospital discharge records. The study draws on routinely collected data from hospital discharge records in Italy in 2010. The following exclusion criteria were applied: day hospital stays, patients younger than 17 years, males, patients without an ICD-9CM code indicating breast cancer and breast surgery, and repeated hospital admission of the same patient. Overall, 49,058 patient records were selected for the analysis. The proportion of conservative breast cancer operations was 70.9%. A greater number of women younger than 70 had undergone a breast-conserving operation compared to older women. There were regional variations ranging from a minimum in Basilicata to a maximum in Val d'Aosta. Multivariate analysis revealed that older patients with lower clinical severity were more likely to have undergone a radical operation than younger women. In addition, radical surgery was approximately twice as likely to occur in a private hospital that performed at least 50 breast cancer operations annually than in a public hospital that performed <50 breast surgeries. Notwithstanding increases in life expectancy and the lack of clinical evidence to support the use of age as a surrogate for co-morbid conditions and frailty, our data on breast cancer operations in Italy are consistent with the hypothesis suggesting the persistence of ageistic practice in the healthcare system.

Recurrent and Second Breast Cancer Detected on Follow-Up Mammography and Breast Ultrasound after Breast-Conserving Surgery: Imaging Findings and Clinicopathologic Factors

The breast-conserving operation is the established treatment modality for early breast cancer, with a long-term survival equal to radical surgery (1, 2). Early detection of an ipsilateral breast tumor recurrence (IBTR) and recurrence in regional lymph nodes has a beneficial impact on local disease control and survival of breast cancer patients when compared to late symptomatic detection (3). The risk factors associated with IBTR and regional recurrence include younger patient age (4-6), larger tumor size, multifocal multi-centric disease (7), close or positive margins (6, 8), an extensive intraductal component (4, 9), higher tumor grade (10), the presence of lymphovascular invasion (9), negative histology for estrogen receptor (ER) or progesterone receptor (PR) expression, and omission of radiation (11, 12). The current recommendations for postoperative follow-up for breast-conserving surgery following an invasive ductal carcinoma are to take the patient’s history, a clinical breast examination, and an annual mammogram of the breast tissues (13). Unlike recurrences after Recurrent and Second Breast Cancer Detected on Follow-Up Mammography and Breast Ultrasound after Breast-Conserving Surgery: Imaging Findings and Clinicopathologic Factors 유방보존수술 후 유방촬영술과 유방초음파에서 발견된 재발암 및 이차성 유방암: 영상소견과 임상병리적 요인

Teaching residents may affect the margin status of breast-conserving operations

The current study was performed to evaluate the effects of teaching surgical residents on the margin status after lumpectomy. A retrospective review of all patients from July 2006 to Nov 2009 was performed. The impact of the technical ability of surgical residents to perform lumpectomy was evaluated to determine if there was an effect on the margin status. A logistic regression analysis was performed to adjust for clinical variables known to affect the margin status. Of 106 patients, 19% had positive margins. Residents with unsatisfactory technical skills had a positive margin rate of 34% compared to 8% for residents with satisfactory skills (p = 0.004). In the multivariate logistic regression analysis, the operating surgeon remained significantly associated with a positive margin status. Operations performed by residents with satisfactory technical skills or by attending surgeons were less likely to have positive margins than those performed by residents with unsatisfactory technical skills (OR 0.26, 95% CI 0.08-0.86; p = 0.03). After a mean follow-up of 60 months, the breast cancer-specific survival rate was 94%, and there were no local recurrences as a first event. The technical ability of residents may affect the margin status after lumpectomy. The importance of teaching surgical residents needs to be considered in future quality of care evaluations.

Breast-conserving surgery versus modified radical mastectomy in treatment of early stage breast cancer: A retrospective study of 107 cases.

The aim of this retrospective study was to evaluate the clinical efficacy and prognosis of breast-conserving surgery versus modified radical mastectomy in the treatment of early stage breast cancer. Two hundred and nineteen cases of early stage breast cancer were reviewed and retrospectively included in this study form two hospitals (Quzhou hospital of Zhejiang university and Quzhou Traditional Chinese Hospital). The characteristics of operation procedure such as operation time, intraoperative blood loss and length of hospital stay were compared between the two groups. And the prognosis was recurrence rate was also compared to the two groups. For the included 219 early breast cancer cases, 107 subjects received the breast-conserving operation, and other 112 cases received the modified radical mastectomy. The operation time, intraoperative blood loss and length of hospital stay were (56.7 ± 14.6) min, (39.2 ± 10.1) ml, (12.1 ± 2.1) day in the breast-conserving group and (95.6 ± 1 3.5) min, (79.5 ± 13.6) ml, (14.8 ± 3.2) day in the modified radical mastectomy group respectively. The operation time, intraoperative blood loss and length of hospital stay were smaller in the breast-conserving group as compared with modified radical mastectomy group with statistical difference (P < 0.05). The overall survival was compared with Kaplan-Meier curve by using log-rank test for the hazard ratio (HR). And the HR was 0.75 with its 95% confidence interval of 0.38-1.48, which indicated that no statistical difference of overall survival was existed between the two groups (P > 0.05). The breast-conserving operation was superior to modified radical mastectomy in the aspects of operation time, intraoperative blood loss and length of hospital stay.

Body Image and Physical suffering during Radiotherapy in Breast Cancer Patients Following Breast Conserving Operations

유방암 치료가 과거에는 유방암의 병기와 상관없이 유방을 전부 절제하는 유방절제술을 시행하는 것이 보편적이었으나, 최근에는 유방보존술로 치료형태가 바뀌고 있다. 또한, 조기검진에 의한 암 의 발견으로 유방보존술이 증가하고 있으며, 수술 후 미세 병소 제 거 등 재발을 막기 위한 보조요법으로 항암화학요법, 방사선치료, 호르몬치료를 시행한다. 유방보존술은 4-5 cm 이하의 단일종양이고 심한 상피내암 성분 이 없는 경우 유방을 보존하는 수술로 유방보존술 후 방사선치료 는 3-4주가 경과한 후 항암화학요법과 동시에 하거나 항암화학요법 후 시행하게 되며, 환자의 상태에 따라 시기와 방법은 다르지만 방 사선요법을 표준치료로 시행하고 있다. 방사선치료 기간은 평균 6-7 유방보존술을 받은 유방암 환자의 방사선치료 시기에 따른 신체상과 신체적 불편감