Breast-conserving Surgery For Breast Cancer Research Articles

A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery.

Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change preintervention to postintervention between Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included 5 collaborative meetings in 2018 to 2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. In 2017, there were 3692 breast procedures in SCW and 1279 in nonparticipating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and nonparticipating hospitals (16.1% vs. 17.1%, P =0.47). Re-excision significantly decreased for SCW but not for nonparticipating hospitals (odds ratio=0.69, 95% confidence interval=0.52-0.91). Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for statewide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.

Comparing the outcomes of volume replacement oncoplastic breast surgery with standard breast-conserving surgery for breast cancer

Introduction: Oncoplastic breast surgery (OPS) allows breast conservation for women who would otherwise have a mastectomy or a suboptimal aesthetic result with standard breast-conserving surgery (s-BCS). Although OPS is gaining acceptance, evidence for safety and long-term outcomes is lacking - especially for volume-replacement (VR-OPS) techniques. We present the comparison of lateral chest-wall perforator VR-OPS with s-BCS with a 7-year follow-up.

Oncoplastic breast-conserving surgery versus conventional breast-conserving surgery for breast cancer: A systematic review and meta-analysis of 31 studies

Oncoplastic breast-conserving surgery versus conventional breast-conserving surgery for breast cancer: A systematic review and meta-analysis of 31 studies

Evaluation of Tumor Resection Effect of Color Doppler Ultrasound Positioning Guided Breast-Conserving Surgery Using Nano-Contrast Agent.

This study aimed to explore the clinical value of Fe3O4-based magnetic lipid nano-contrast agent in breast-conserving surgery for breast cancer using color doppler ultrasound positioning and to analyze the tumor resection effect of breast-conserving surgery. On account of Fe3O4 magnetic nanoparticles prepared by the chemical co-precipitation method, magnetic lipid ultrasonic microbubbles (MLU-MBs) were prepared by mechanical oscillation method after surface modification using polyethylene terephthalate (PET). Characterization and analysis of the prepared MLU-MBs were performed using scanning electron microscopy (SEM), energy spectrometer, transmission electron microscopy (TEM), and Fourier infrared spectroscopy (FIRS). A high-frequency alternating magnetic field was used to detect the heating of MLU-MBs and the color ultrasound machine was applied to observe the enhancement effect of the MLU-MBs on rabbit liver images. 92 patients undergoing breast-conserving surgery for breast cancer were taken as the research objects and were divided into a nano group (MLU-MB as contrast agent) and a control group (conventional contrast agent) according to the differences of intraoperative contrast agents, with 46 cases in each group. Before the surgery, both groups of patients were positioned and marked the tumor boundary under ultrasound. The differences in tumor volume (TV), amount of tissue removed, resection rate, and positive rate (PR) of resection margins were compared between the two groups. The results showed that the Fe3O4 magnetic nanoparticles were particles with an average particle size of about 15nm, and their iron and oxygen percentages were consistent with the content of Fe3O4. The MLU-MBs were spherical particles of about 1120nm, containing phosphorus (P), oxygen(O), and Ferrum (Fe). Under 30A and 220kHz of output current and frequency, the temperature rise of the MLU-MBs suspension with different concentrations was 10 ~ 60°C, and the temperature was constant after heating for 45 minutes. Compared with the rabbit liver parenchyma, the image was greatly enhanced. TV, the amount of tissue removed, the resection rate, and the PR of resection margins in the nano group were obviously lower than those in the control group (P<0.05). It showed that MLU-MBs with good image enhancement effect on account of Fe3O4 magnetic nanoparticles were successfully prepared and it could effectively reduce the PR of normal tissues and the positive margin of two-fold resection during breast-conserving surgery for breast cancer and showed good accuracy and stability.

Abstract P4-11-18: Arm lymphatic pulsing changes after mastectomy or breast-conserving surgery with axillary lymph node dissection, detected with near-infrared fluorescence lymphatic imaging

Abstract Introduction: Axillary lymph node dissection (ALND) that accompanies mastectomy or breast-conserving surgery is assumed to disrupt arm lymphatic fluid pumping that normally flows in a one-way, distal-to-proximal path to transit cellular waste, immune cells, and large molecules to the thorax. Any resulting stagnation of lymph is surmised to drive the development of lymphedema (LE), with potential lifelong, detrimental effects on quality of life for breast cancer survivors, yet the majority of breast cancer survivors receiving ALND never encounter LE. To date, no objective before-and-after-ALND lymphatic pumping data has been published. Methods: In a prospective, ongoing, longitudinal clinical study (NCT02949726) of breast cancer patients undergoing neoadjuvant chemotherapy, axillary lymph node dissection (ALND) with mastectomy or breast-conserving surgery, and radiation treatment (RT), we used near-infrared fluorescence lymphatic imaging (NIRF-LI) to observe changes in arm lymphatics anatomy and pulsing. NIRF-LI, using a custom-built imaging system, with indocyanine green (ICG) contrast, allows “see through the skin” visualization of arm lymph pumping through lymphatic vessels, and captured videos of 58 locally advanced breast cancer patients before and approximately four weeks after mastectomy or breast-conserving surgery with ALND. Lymphatic pumping frequencies (pulses per minute) were determined from fluorescence intensity fluctuations through regions of interest (ROIs) along lymphatic vessels, quantitated with ImageJ (NIH) free software. Ipsilateral and contralateral arm dorsal, ventral, and axillary-feeding (ventral upper arm) vessel pulsing was classified as 1) static or improved to normal range (improved), or 2) transitioning to abnormal ranges (worsened) after surgery. The number of vessels in each category were tallied and reported herein. Results: After ALND, arm lymphatic pulsing frequencies improved or worsened as shown in Table 1. Conclusions: NIRF-LI allowed objective quantitation of arm lymphatic pumping frequencies captured before and after ALND accompanying mastectomy or breast-conserving surgery for breast cancer. Pulsing frequencies in detectable vessels improved in more axilla-feeding vessels, surprisingly, but worsened or did not change in more ipsilateral and ventral vessels, on both ipsilateral and contralateral sides. While cancer surgery with ALND may be associated with increased risk of BCRL, other factors, such as neoadjuvant chemotherapy, cancer severity, and radiation treatment may contribute to LE etiology. Table 1.Anatomical position (arm)# of Vessels Improved# of Vessels WorsenedIpsilateral dorsal6499Ipsilateral ventral73107Ipsilateral axilla-feeding5626Contralateral dorsal97112Contralateral ventral8988Contralateral axilla-feeding10323 Citation Format: Melissa B Aldrich, Meghan E McWain, Wenyaw Chan, John C Rasmussen, Sarah DeSnyder, Eva M Sevick-Muraca, Simona F Shaitelman. Arm lymphatic pulsing changes after mastectomy or breast-conserving surgery with axillary lymph node dissection, detected with near-infrared fluorescence lymphatic imaging [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-18.

Abstract P4-09-02: The impact of breast conserving surgery re-excision on patient-reported outcomes using the BREAST-Q

Abstract Introduction: Although SSO/ASTRO consensus margin guidelines have led to decrease rate of re-excision, some women require additional surgery. Re-excision surgery may cause psychosocial stress and impact cosmetic outcomes and breast satisfaction. The purpose of this study was to assess patient-reported outcomes using the BREAST-Q breast satisfaction, psychosocial wellbeing, and sexual wellbeing subscales for women with breast cancer following index breast-conserving surgery (BCS). Methods: Women with stage 0 to 3 breast cancer undergoing BCS who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. The BREAST-Q breast conserving therapy module was used to assess outcomes between women with 1 BCS and those with ≥1 re-excision surgery (R-BCS). Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time. Results: Our study group was initially composed of 2570 women that was narrowed to 2549 women after excluding 21 who ultimately underwent mastectomy; 1982 (78%) had 1 BCS and 567 (22%) had ≥1 R-BCS. The median age of the cohort was 57 years (range 26-97). Women with 1 BCS were more likely to be older (p&amp;lt;0.001), have a higher BMI (p=0.01), present with invasive carcinoma (p=0.03), have unifocal disease (p&amp;lt;0.001), undergo surgery post-release of SSO Invasive Guidelines (p&amp;lt;0.001), receive endocrine therapy (p=0.006), and less likely to receive radiation therapy (p=0.02) compared to those with ≥1 R-BCS. At 2-years post-operative, women with ≥1 R-BCS compared to 1 BCS were noted to have lower average breast satisfaction and sexual well-being scores (76.0 vs. 71.8 [p=0.03] and 70.2 vs. 64.0 [p=0.01], respectively). No difference in psychosocial well-being scores existed for up to 5 years of post-operative follow-up. Multivariable linear regression confirmed that undergoing ≥1. R-BCS is a risk factor for decreased breast satisfaction and sexual well-being at 2 years postoperative. On multivariable analysis, re-excision was found to be associated with lower breast satisfaction and sexual well-being scores. (p=0.01 and p=0.02, respectively), while it was not associated with a change in psychosocial wellbeing score (p=0.07). Factors such as Race, BMI, and marital status were not associated with any difference across all subscales (all p&amp;gt;0.1). Chemotherapy and radiotherapy were associated with lower scores across all subscales (Table). Younger age was associated with lower psychosocial and sexual well-being scores (both p&amp;lt;0.001), and endocrine therapy was associated with a lower sexual well-being score (p=0.01). Conclusions: Psychosocial well-being in women with 1 BCS for breast cancer were largely comparable over time to those who underwent ≥1 R-BCS. At 2 years post-operative, women with 1-BCS had lower breast satisfaction and sexual well-being, but this difference did not remain at later time periods. These findings may help in counseling women who are concerned of satisfaction and quality of life outcomes with BCS if breast re-excision was necessary. Multivariable analysis of BREAST-Q Subscale scoresEstimateStandard Errorp valueBreast SatisfactionAge at surgery-0.0690.0480.147BMI-0.1380.0810.088Chemotherapy-2.5421.0260.015Adjuvant radiation-3.4371.5830.031Hormonal therapy-0.6511.1700.119≥1 R-BCS vs. 1 BCS-2.5420.8840.008Psychosocial well-beingAge at surgery0.1980.043&amp;lt;0.001BMI-0.079-0.0790.287 Chemotherapy-3.2090.9330.001Adjuvant radiation-4.5091.4600.004Hormonal therapy0.2081.0740.528≥1 R-BCS vs. 1 BCS-1.4450.7930.059Sexual well-beingAge at surgery0.2700.072&amp;lt;0.001BMI-0.1140.1180.337Chemotherapy-4.7131.428&amp;lt;0.001Adjuvant radiation-7.6292.493&amp;lt;0.001Hormonal therapy-1.1801.7080.008≥1 R-BCS vs. 1 BCS-2.9661.2190.015 Citation Format: Regina Matar, Meghan Flanagan, Sarah Fuzesi, Kathyrn Haglich, Shen Yin, Varadan Sevilimedu, Jonas Nelson, Mary L. Gemignani. The impact of breast conserving surgery re-excision on patient-reported outcomes using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-02.

Association of the Oncology Care Model With Value-Based Changes in Use of Radiation Therapy

Radiation utilization for breast cancer and metastatic bone disease varies in modality, fractionation, and cost, despite evidence demonstrating equal effectiveness and consensus recommendations such as Choosing Wisely that advocate for higher value care. We assessed whether the Oncology Care Model (OCM), an alternative payment model for practices providing chemotherapy to patients with cancer, affected the overall use and value of radiation therapy in terms of Choosing Wisely recommendations. We used Centers for Medicare & Medicaid Services administrative data to identify beneficiaries enrolled in traditional fee-for-service Medicare who initiated chemotherapy episodes at OCM and propensity-matched comparison practices. Difference-in-difference (DID) analyses evaluated the effect of OCM on overall use of postoperative radiation for breast cancer, use of intensity modulated radiation therapy and hypofractionation for breast cancer, and fractionation patterns for treatment of metastatic bone disease from breast or prostate cancer. We performed additional analyses stratified by the presence or absence of a radiation oncologist in the practice. Among 27,859 postoperative breast cancer episodes, OCM had no effect on overall use of radiation therapy after breast surgery (DID percentage point difference = 0.4%; 90% confidence interval [CI], -1.7%, 2.4%) or on use of intensity modulated radiation therapy in this setting (DID=-0.6; 90% CI, -3.1, 2.0). Among 19,366 metastatic bone disease episodes, OCM had no effect on fractionation patterns for palliation of bone metastases (DID for ≤10 fractions=-1.1%; 90% CI, -2.6%, 0.4% and DID for single fraction=-0.2%; 90% CI, -1.9%, 1.6%). Results were similar for practices with and without a radiation oncologist. We did not evaluate the effect of OCM on hypofractionated radiation after breast-conserving surgery owing to evidence of differential baseline trends. OCM had no effect on use of radiation therapy after breast-conserving surgery for breast cancer or on fractionation patterns for metastatic bone disease. Future payment models directly focused on radiation oncology providers may be better poised to improve the value of radiation oncology care.

Breast-conserving surgery as a viable alternative to radical mastectomy

Breast cancer represents a large proportion of cancers that affect women and it is a major public health concern. For many years radical mastectomy was considered to be the only surgical procedure with curative potential for breast cancer. Radical mastectomy has a major negative impact on the quality of life. In order to avoid the complete removal of the breast, breast-conserving surgical techniques have been developed. During breast-conserving surgical procedures only the tumor is removed along with the surrounding breast tissue within the oncologic safety margin. Based on specialty literature we will summarize the surgical technique and explain the indications and contraindications of breast-conserving surgery for breast cancer along with the risk factors for disease recurrence.

Oncological Safety of Lipofilling in Patients with Breast Cancer: A Metaanalysis

Abstract Background Lipofilling is an increasingly popular technique for breast reconstruction following both mastectomy and breast-conserving surgery (BCS). Autologous fat transfer (Lipofilling), is a technique which has been used for many years in the setting of aesthetic breast surgery. Although gaining popularity in this setting, there are still questions regarding its oncological safety when used in patients being treated for breast cancer. Objective To systematically evaluate the current literature regarding the oncological safety of lipofilling in patients who underwent surgical treatment for breast cancer by performing a metaanalysis to investigate the recurrence rates and the incidence of complications after lipofilling. Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materi als available in the Internet till 2019. Data Extraction All the studies which did not fulfill the inclusion criteria were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Through this analysis, no evidence that lipofilling significantly increases the risk of locoregional recurrence when used as part of a breast reconstruction procedure after either mastectomy or BCS for breast cancer was found. Therefore, it can be considered an oncologically safe procedure in suitable patients with careful oncological follow-up. In the future, more longterm, adequately powered, multicentre controlled studies are needed. Additionally, more research should be carried out on the incidence of complications following lipofilling so that efforts can be made to prevent them and optimise fat graft survival.

Ultrasound Image Features under Deep Learning in Breast Conservation Surgery for Breast Cancer.

This study was to analyze the effect of the combined application of deep learning technology and ultrasound imaging on the effect of breast-conserving surgery for breast cancer. A deep label distribution learning (LDL) model was designed, and the semiautomatic segmentation algorithm based on the region growing and active contour technology (RA) and the segmentation model based on optimized nearest neighbors (ON) were introduced for comparison. The designed algorithm was applied to the breast-conserving surgery of breast cancer patients. According to the difference in intraoperative guidance methods, 102 female patients with early breast cancer were divided into three groups: 34 cases in W1 group (ultrasound guidance based on deep learning segmentation model), 34 cases in W2 group (ultrasound guidance), and 34 cases in W3 group (palpation guidance). The results revealed that the tumor area segmented by the LDL algorithm constructed in this study was closer to the real tumor area; the segmentation accuracy (AC), Jaccard, and true-positive (TP) values of the LDL algorithm were obviously greater than those of the RA and ON algorithms, while the false-positive (FP) value was significantly lower in contrast to the RA and ON algorithms, showing statistically observable differences (P < 0.05); the actual resection volume of the patients in the W1 group was the closest to the ideal resection volume, which was much smaller in contrast to that of the patients in the W2 and W3 groups, showing statistical differences (P < 0.05); the positive margins of the patients in the W1 group were statistically lower than those in the W2 and W3 groups (P < 0.05). In addition, 1 patient in the W1 group was not satisfied with the cosmetic effect, 3 patients in the W2 group were not satisfied with the cosmetic effect, and 9 patients in the W3 group were not satisfied with the cosmetic effect. Finally, it was found that the ultrasound image based on the deep LDL model effectively improved the AC of tumor resection and negative margins, reduced the probability of normal tissue being removed, and improved the postoperative cosmetic effect of breast.

Tasa de afectación de los márgenes quirúrgicos tras la cirugía conservadora de mama y estimación de los costes directos

ObjectiveAssessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. Method146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. ResultsThe rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient). ConclusionsMargin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.

Value of intraoperative frozen section analysis in re-excision margin evaluation in breast-conserving surgery for cancer: a single institution experience

Previous studies have demonstrated that in women with breast cancer treated with breast-conserving surgery (BCS), intraoperative frozen section analysis of lumpectomy margins results in a decrease in reoperation rates for margin control. However, the value of intraoperative frozen margin evaluation (FME) in re-excision margin analysis was not fully understood. We conducted a retrospective review of patients who underwent attempted breast-conserving surgery for breast cancer with routine intraoperative frozen margin evaluation at our institution between January 1998 and May 2016. The number of frozen margin evaluation was analyzed. We additionally analyzed factors associated with positive re-excised margins to identify correlations with patient characteristics. A total of 760 patients who underwent attempted breast-conserving surgery were routinely conducted intraoperative frozen margin evaluation, frozen sections were obtained from the initial margin only in 82.5% (n = 627), the initial margin as well as a one-time re-excision analysis in 15.8% (n = 120), or the initial margin and two or more re-excision analyses in 1.7% (n-13). Based on the results of frozen margin evaluation, 727 (95.6%) of the patients underwent breast-conserving surgery, while the remaining 33 (4.4%) converted to mastectomy. Among the patients who underwent breast-conserving surgery, 112 (15.4%) had an initial positive margin on a frozen margin evaluation, underwent one-time margin re-excision and achieved a margin-free status, while 1.6% underwent a second margin resection due to a positive result on the first re-excised margin. In total, 72.7% of the conversions to mastectomy were due to a positive initial margin. Univariate and multivariate analyses showed that patients with the ductal carcinoma in situ (DCIS) histological type were more likely to have repeatedly positive re-excised margins during breast-conserving surgery. Routine intraoperative frozen margin evaluation of re-excised margins provided only limited value in patients who underwent attempted breast-conserving surgery; this method may be beneficial in the subgroup of patients with the ductal carcinoma in situ histological type.

Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment

Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment

Advanced Oncoplastic Breast Conserving Surgery: Single Institution Experience with 823 Patients.

Background: Oncoplastic breast conserving surgery (BCS) becomes the standard of care in multidisciplinary breast cancer treatment. From our perspective, the aim of oncoplastic BCS is the best oncological, aesthetic and functional surgical treatment results. The study's objective is to present our approaches to the selection of surgical techniques and determine operative and oncological outcomes of oncoplastic surgery. Methods: This retrospective study presents a single institution experience with patients who underwent oncoplastic BCS for breast cancer between 2007 and December 2020. Demographic and clinicopathologic characteristics as well as postoperative complications were analyzed. The analysis was performed by taking into account the types of procedures. Surgeries were categorized into two types: 1. volume displacement (level 1; advanced parenchyma displacements; therapeutic mammaplasties) and 2. volume replacement techniques (regional flaps with wide base, regional island perforant flaps). We consider as oncoplastic all the operations that are planned and performed taking into account an optimal aesthetic result regardless of the specific technique. Results: There were 833 surgeries performed for 823 cancer patients. In 153 cases, patients had symmetrized procedures. The average weight of specimens was 112,9 g (2-1034 g); the average size of tumors was 2,8 cm (0,2-15,8 cm). 106 patients (12,7%) had multifocal/multicentric tumors. In (3,8%) 32 cases involved margins were found and re-excision was required. 793 (96,4%) patients were on follow up. The median follow-up period was 48 months (6 164 months). Local recurrence was found in 10 (1,2%) patients, regional axillary recurrence in 2 (0,3%), systemic progression in 87 (11,0%) patients and 50 (6,2%) of them have died. Complications were observed in 190 (23,1%) patients, mostly seromas and ischemic disorders. Conclusions: We present our approaches to oncoplastic breast conserving surgery with focusing on the aesthetic results of the procedures. Oncological outcomes demonstrate the safety of advanced oncoplastic BCS in the framework of multidisciplinary teamwork.

Simple oncoplastic closure after breast-conserving cancer surgery improves cosmetic outcomes: A randomised controlled trial.

Background: Fair-to-poor cosmetic outcomes are still observed in up to 30% of patients after breast-conserving surgery (BCS), which can increase morbidity. Various factors are known to influence cosmetic outcomes. The aim of this study was to compare long-term cosmetic outcomes after BCS for breast cancer with vs. without simple oncoplastic defect closure.

Recurrence and survival after standard versus oncoplastic breast-conserving surgery for breast cancer.

BackgroundOncoplastic techniques in breast-conserving surgery (BCS) are used increasingly for larger tumours. This large cohort study aimed to assess oncological outcomes after oncoplastic BCS (OPS) versus standard BCS.MethodsData for all women who had BCS in three centres in Stockholm during 2010–2016 were extracted from the Swedish National Breast Cancer Register. All patients with T2–3 tumours, all those receiving neoadjuvant treatment, and an additional random sample of women with T1 tumours were selected. Medical charts were reviewed for local recurrences and surgical technique according to the Hoffman–Wallwiener classification. Date and cause of death were retrieved from the Swedish Cause of Death Register.ResultsThe final cohort of 4178 breast cancers in 4135 patients was categorized into three groups according to surgical technique: 3720 for standard BCS, 243 simple OPS, and 215 complex OPS. Median duration of follow up was 64 (range 24–110) months. Node-positive and large tumours were more common in OPS than in standard BCS (P < 0.001). There were 61 local recurrences: 57 (1.5 per cent), 1 (0.4 per cent) and 3 (1.4 per cent) in the standard BCS, simple OPS and complex OPS groups respectively (P = 0.368). Overall, 297 patients died, with an unadjusted 5-year overall survival rate of 94.7, 93.1 and 92.6 per cent respectively (P = 0.350). Some 102 deaths were from breast cancer, with unadjusted 5-year cancer-specific survival rates of 97.9, 98.3 and 95.0 per cent respectively (P = 0.056).DiscussionOncoplastic BCS is a safe surgical option, even for larger node-positive tumours, with low recurrence and excellent survival rates.

Comparison of Long-Term Oncological Outcomes in Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery for Breast Cancer: A Propensity Score-Matched Analysis.

PurposeThe oncoplastic breast-conserving surgery (OPS) technique, combined with the principles of oncological safety and plastic surgery, results in complete tumor resection while preserving the natural appearance of the breast. The purpose of this study was to evaluate the long-term oncological results after OPS compared with conventional breast-conserving surgery (BCS) for early breast cancer.MethodsThe medical records of patients who underwent breast cancer surgery and adjuvant radiation therapy at Seoul National University Hospital between 2011 and 2014 were reviewed. Ipsilateral breast tumor recurrence (IBTR)-free survival rate and recurrence-free survival (RFS) rates were compared between the OPS and BCS groups.ResultsOne-to-one propensity score matching was conducted, yielding 371 patients in each group. The mean tumor distance from the nipple was shorter, and the mean retrieved specimen size and pathologic tumor size, including ductal carcinoma in situ, were larger in the OPS group than in the conventional BCS group (p < 0.001). Surgical margin positivity was not significantly different between the two groups (p = 0.777). The surgical technique was not significantly associated with IBTR (OPS versus conventional BCS, 5-year survival rate, 96.9% vs. 98.6%; p = 0.355) and RFS (5-year survival rate, 92.9% vs. 94.5%; p = 0.357) on the log-rank test. Multivariate analysis revealed that OPS versus conventional BCS was not significantly associated with survival outcomes.ConclusionWe observed no significant differences in long-term IBTR and RFS between the OPS and conventional BCS groups in this retrospective analysis. OPS can be an oncologically and surgically safe alternative option for conventional BCS for early breast cancer.

Desmoid Breast Tumor after Breast-Conserving Surgery for Breast Cancer—A Case Report—

Desmoid Breast Tumor after Breast-Conserving Surgery for Breast Cancer—A Case Report—

Outpatient breast-conserving surgery for breast cancer: Use of local and intravenous anesthesia and/or sedation may reduce recurrence and improve survival

BackgroundThe use of general anesthesia (GA) with inhalational anesthetics for breast cancer surgery may be associated with breast cancer recurrence and increased mortality due to the immunosuppressive effects of these drugs. Less-immunosuppressive anesthetic techniques may reduce breast cancer recurrence. We evaluated the feasibility, safety, and efficacy of outpatient breast-conserving surgery (BCS) for breast cancer in a breast clinic in terms of the anesthetic technique used, complications occurring, recurrence, and survival. Methods: The sample comprised 456 consecutive patients with stage 0–III breast cancer who underwent BCS/axillary lymph node (ALN) management using local and intravenous anesthesia and/or sedation between May 2008 and January 2020. Most patients received adjuvant chemotherapy and/or endocrine therapy and radiotherapy after surgery. Patient outcomes were evaluated retrospectively. Results: All patients recovered and were discharged after resting for 3–4 h postoperatively. No procedure-related severe complication or death occurred. Sixty-four complications (14.0%) were observed: 14 wound infections, 17 hematomas, and 33 axillary lymphoceles. The median follow-up period was 2259 days (range, 9–4190 days), during which disease recurrence was observed in 25 (5.4%) patients. The overall survival and breast cancer–specific survival rates were 92.3% and 94.7%, respectively. Conclusions: Outpatient surgery for breast cancer involving BCS and ALN management under local and intravenous anesthesia and/or sedation can be performed safely, without serious complication or death. Less-immunosuppressive anesthetic techniques with spontaneous breathing may reduce the recurrence of breast cancer and improve survival relative to GA.

Absence of residual fluorescence in the surgical bed at near-infrared fluorescence imaging predicts negative margins at final pathology in patients treated with breast-conserving surgery for breast cancer

IntroductionPositive margins after breast-conserving surgery (BCS) for breast cancer (BC) remain a major concern. In this study we investigate the feasibility and accuracy of indocyanine green (ICG) fluorescence imaging (FI) for the in vivo assessment of surgical margins during BCS. Materials and methodsPatients with BC admitted for BCS from October 2015 to April 2016 were proposed to be included in the present study (NCT02027818). ICG (0.25 mg/kg) was intravenously injected at induction anesthesia and ICG-FI of the surgical beds was correlated with final pathology results. ResultsFifty patients consented to participate and thirty-five patients were retained for final analysis, 15 patients having been excluded for, respectively, incomplete video records data for signal to background ratio (SBR) calculation (11) and in situ tumors (4). The final pathological assessment of 35 breast specimens identified 5 (14.7%) positive margins. Intraoperative ICG-FI revealed hyperfluorescent signals in 15 (42.9%) patients and an absence of fluorescent signals in 20 (57.1%). Median SBR in patients with involved margins was 1.8 (SD 0.7) and was 1.25 (SD 0.6) in patients with clear margins (p = 0.05). The accuracy, specificity, positive and negative predictive value of ICG-FI for breast surgical margin assessment were 71%, 60%, 29% and 100%, respectively. ConclusionICG-FI of BC surgical beds has a high negative predictive value for surgical margin assessment during BCS. The absence of residual fluorescence in the surgical bed of patients with fluorescent tumors predicts negative margins at final pathology and allows the surgeon to avoid further intraoperative analysis.