Breast-conserving Surgery For Breast Cancer Research Articles

Does Breast Surgery Type Alter Incidental Axillary Irradiation? A Dosimetric Analysis of the "Sentinel Envahi et Randomisation du Curage" SERC Trial.

An incidental axillary dose of adjuvant radiotherapy using tangential beams is usually given after breast-conserving surgery for breast cancer. The goal of this sub-study was to evaluate this incidental dose in the setting of post-mastectomy radiotherapy (PMRT) according to two different radiotherapy techniques. Patients participating in a randomized SERC trial who received PMRT in a single center were included. We collected the incidental axillary dose delivered to the Berg level 1 using different dosimetric parameters and compared two techniques using Student's t-test: three-dimensional conformal radiotherapy (3D-CRT) and volumetric arc therapy (VMAT). We analyzed radiotherapy plans from 52 patients who received PMRT from 2012 to 2021. The mean dose delivered to the Berg level 1 was 37.2 Gy. It was significantly higher with VMAT than with 3D-CRT-43.6 Gy (SD = 3.1 Gy) versus 34.8 Gy (SD = 8.6 Gy) p < 0.001. Eighty-four percent of the Berg level 1 was covered by 40 Gy isodose in the VMAT group versus 55.5% in the 3D-CRT group p < 0.001. On the Berg level 1, PMRT gives a dose at least equivalent to the one given by post-breast-conserving surgery radiotherapy, making it possible to limit completion axillary lymph node dissections in select pN1a patients treated with a mastectomy. Modern radiotherapy techniques like VMAT tend to increase this incidental dose.

Breast-Conserving Surgery for Breast Cancer

Breast-Conserving Surgery for Breast Cancer

The top 100 most cited manuscripts in breast-conserving surgery for breast cancer: a bibliometric analysis

The top 100 most cited manuscripts in breast-conserving surgery for breast cancer: a bibliometric analysis

ASO Visual Abstract: Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

ASO Visual Abstract: Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

The purpose of this study was to evaluate the delay in initiating adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer who underwent oncoplastic reduction mammoplasty (ORM) following BCS compared with a matched cohort of patients who did not undergo ORM between BCS and RT. Medical records of 112 women (56 ORMs and 56 matched non-ORMs) with carcinoma in situ or early-stage breast cancer treated with BCS were reviewed. ORM was performed in a delayed manner following BCS, allowing confirmation of negative surgical margins. Time to RT was defined as time from last oncologic surgery to start of RT. The median follow-up time was 6.8 years for the ORM cohort and 6.7 years for the control non-ORM cohort. Patients who underwent ORM following BCS experienced a significant delay in initiating RT (>8 weeks) than matched patients not undergoing ORM (66% vs. 34%; p<0.001). Wound complications occurred in 44.6% (n=25) of patients in the ORM cohort, which were mostly minor, including delayed wound healing and/or infection (39%). There was no significant difference in local recurrence between patients in the non-ORM and ORM cohorts (p=0.32). This study demonstrates that ORM following BCS has the potential to delay RT >8 weeks, largely as a result of increased risk of wound complications; however, this delay did not impact local control. ORM can be safely considered for appropriately selected patients with breast cancer.

Radiotherapy refusal in breast cancer with breast-conserving surgery

BackgroundAlthough 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.MethodsTo 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.ResultsThe 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.ConclusionsPostoperative 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.

¿Cuál es el fraccionamiento estándar en la irradiación del cáncer de mama?

Radiotherapy (RT) after breast-conserving surgery for breast cancer (BC) has been shown to reduce local recurrence rates and mortality. The conventional treatment of postoperative radiotherapy was 50 to 50.4 Gy, administered in 25 to 28 fractions over a period of 5 to 6 weeks. In the last 20 years, there is clinical evidence to consider hypofractionated treatment regimens safe and effective. Moderate hypofractionation, administered over 3 weeks, can be considered the standard of care after conservative surgery or mastectomy, as well as in irradiation of lymph node areas, with similar results regarding local control and survival and with effects on acute and chronic normal tissue. , similar or smaller. Ultrahypofractionated treatment, administered in 5 sessions, for 1 or 5 weeks, is a safe and effective treatment after conservative surgery and mastectomy without reconstruction. Early results have been reported that ultrahypofractionated treatment in 1 week is safe when lymph node areas are irradiated.

Intraoperative evaluation of the resection margin with the usage of digital two-point sectorography (Faxitron PathVision)

Background. Surgery is fundamental in complex and combined approach in the treatment of the early breast cancer. It is a common fact, that absence of tumor cells in the resection margin is the main indicator of oncological safety of the breast-conserving surgery (BCS). The presence of tumor cells in examined margin is the predictor of local recurrence after BCS for breast cancer. Currently the clinical need for precise and fast method of intraoperative assessment of the resection margin status is kept. Intraoperative evaluation of the resection margin with the usage of digital two-point sectorography (Faxitron PathVision) appeared as the alternative to intraoperative histological examination, providing the optimum size of the information about adequacy of the carried out surgical treatment.Aim. To evaluate diagnostic features of the digital two-point sectorography Faxitron PathVision in the intraoperative assessment of the resection margin status after the surgical treatment in comparison with planned histologic examination.Materials and methods. 368 conducted conservative surgeries were analyzed; patients were divided in two groups depending on neoadjuvant chemotherapy. The first group of patients included 236 patients, who didn't receive neoadjuvant chemotherapy before surgery; second group included 132 patients, who received neoadjuvant chemotherapy. Subset analysis of detection rate of the positive resection margin (R1) was carried out with the usage of the intraoperative assessment of the resection margin on the X-ray device Faxitron PathVision or without this method. After each BCS resection margin status was assessed on planned histologic examination for the presence of the tumor cells, with subsequent analysis of the frequency of reoperations when R1 was found.Results. In 368 tested surgical specimens after BCS R1 was found in 25 cases, which is 6.8 %. From 236 patients in the first group after BCS R1 was found in 20 cases, which is 8.5 %; from 132 conducted operations in the second group in 5 (3.8 %) cases the presence of R1 is found. Reoperations were performed in 13 cases and tumor cells were found in 3 cases in the sub-group which didn't receive intraoperative assessment with X-ray device Faxitron PathVision.Conclusions. Assessing the results of our study we can make a conclusion about the positive experience of performing BCS and intraoperative evaluation of the resection margin with the usage of the digital two-point sectorography (Faxitron PathVision) and low frequency of R1 (3.8 %) in comparison with absence of this method (8.5 %).

Simple recommendation for cases requiring re-excision on breast surgery

Breast cancer is an important health problem that especially affects women. In breast cancer where surgical procedures are the primary treatment modality, breast-conserving surgery with radiotherapy is becoming more popular than mastectomy. Re-excision may be necessary in cases of recurrence or positive surgical margins. Damage to the cavity formed due to scar formation in the old operation lodge may make dissection difficult. Failure to see the dissection plan clearly may result in incomplete surgery or removal of excess tissue. We present how we macroscopically removed the lesion with clear margins with a simple technique we performed during surgery in a patient who underwent breast-conserving surgery for breast cancer and presented with suspicion of recurrence.

Ultrasound-assisted carbon nanoparticle labeling of neoadjuvant chemotherapy for breast-conserving surgery in breast cancer.

Neoadjuvant chemotherapy has gradually become an important means of breast cancer treatment; however, tumor regression following chemotherapy remains a concern. This study was conducted to investigate the effect of ultrasound-assisted carbon nanoparticle labeling in neoadjuvant chemotherapy for breast-conserving surgery in breast cancer. This was a prospective clinical trial study (clinical registration number: ChiCTR-OOC-15006844). Sixty-eight breast cancer patients confirmed by biopsy between July 2015 and January 2017 were randomly selected from the clinical data. Of these, 32 patients were screened for neoadjuvant chemotherapy, forming a consecutive, random series. An ultrasound-guided carbon nanotube was used to mark the original tumor, and sentinel lymph node biopsies were performed. After 4-6 cycles of standard neoadjuvant chemotherapy, 26 patients were selected for breast-conserving surgery. The feasibility and validity of carbon nanoparticle labeling were analyzed through the negative rate of incision margin, the volume of resected tumors, the detection rate of black-stained sentinel lymph nodes, the recurrence rate of ipsilateral breast, and postoperative survival. In all, 32 patients underwent sentinel lymph node biopsy, 29 cases were detected (90.6%), the false-negative rate was 3.8% (1/26), and 0-4 sentinel lymph nodes (mean 1.8±1.1) were detected. A total of 26 patients underwent breast-conserving surgery, 5 underwent secondary excision, and 1 underwent subcutaneous adenectomy due to a positive margin. The minimum margin between the resected site and the infiltrated part was 1.0-2.1 cm (1.3±0.3 cm). The diameter of resected tumors ranged from 2.2 to 4.5 cm (3.1±0.6 cm). No recurrence or distant metastasis of ipsilateral breast tumors was observed during follow-up (the median follow-up time was 9 months). Ultrasound-assisted carbon nanoparticle labeling is effective for sentinel lymph node tracing before neoadjuvant chemotherapy and has a high detection rate for metastatic lymph nodes. During breast-conserving surgery, it can determine the extent of tumor resection to achieve precision surgical treatment.

Abstract P1-09-03: Impact of BRCA1/2 pathogenic variants on ipsilateral breast tumor recurrence and prognosis following breast-conserving surgery

Abstract Background The risk of ipsilateral breast tumor recurrence (IBTR) and the prognostic outcome of breast-conserving surgery (BCS) for germline BRCA1/2 pathogenic variant (BRCA1/2+) carriers remain controversial. We examined differences in IBTR and prognosis between BRCA1/2+ carriers and non-carriers following BCS for breast cancer. Methods Clinical and pathological data were collected by retrospectively reviewing charts of consecutive patients with stage 0-III breast cancer who underwent genetic testing for germline BRCA1/2 and BCS between 1996 and 2020. Patients with variants of breast cancer-associated genes other than BRCA1/2 were excluded. We compared the incidence of IBTR and prognosis, including overall survival (OS), breast cancer-specific survival (BCSS), and distant recurrence-free survival (DRFS), between BRCA1/2+ carriers and non-carriers. Results We analyzed 551 patients (587 breasts with cancer), including 30 BRCA1+ carriers (32 breasts) and 31 BRCA2+ carriers (32 breasts). The median follow-up was 5.8 years (7.2 and 5.3 years for carriers and non-carriers, respectively). The median age at breast cancer diagnosis was 43 and 46 years for carriers and non-carriers, respectively, indicating younger onset of cancer in carriers (age ≤ 40 years; 46.9% for carriers vs. 27.5% for non-carriers, p = 0.001). In carriers, breast cancer more frequently expressed estrogen receptor-negative (56.2% for BRCA1+ carriers and 15.6% for BRCA2+ carriers vs. 22.0% for non-carriers, p = 0.013), progesterone receptor-negative (62.5% for BRCA1+ carriers and 31.3% for BRCA2+ carriers vs. 29.5%, p = 0.005), nuclear grade III (45.3% for carriers vs. 29.5% for non-carriers, p = 0.010), or a higher Ki-67 index (Ki-67 index &amp;gt; 20) (89.5% vs. 61.8%, p = 0.001) than non-carriers. Moreover, carriers underwent chemotherapy more frequently than non-carriers (62.5% vs. 42.4%, p = 0.002). Cancer stage, tumor size, HER2 status, presence of lymphovascular invasion, and the rate of positive or close surgical margins did not statistically differ between the examined groups. No statistical differences were detected in the number of patients who underwent whole-breast radiotherapy following BCS: 59 breasts in carriers and 503 in non-carriers (92.2% vs. 96.4%). During follow-up, we noted that 9 breasts of BRCA1/2+ carriers (5 [15.6%] for BRCA1+ and 4 [12.5%] for BRCA2+) and 35 breasts (6.7%) of non-carriers developed IBTR (p = 0.035). In an analysis excluding patients who did not undergo radiotherapy, the rate of IBTR remained significantly higher in BRCA1/2+ carriers (p = 0.034) than that in non-carriers. The median time to IBTR was 10.2 years in carriers (10.2 years for BRCA1+ and 8.5 years for BRCA2+) and 3.5 years in non-carriers. Carriers were more likely than non-carriers to exhibit distinct subtypes of recurrent tumors in the ipsilateral breast (66.7% for carriers vs. 19.4% for non-carriers, p = 0.006), occurring in a different quadrant from the primary tumor (50.0% vs. 27.3%, p = 0.215). No significant differences in OS (p = 0.068), BCSS (p = 0.109), or DRFS (p = 0.359) were noted between carriers and non-carriers. Conclusion BRCA1/2+ carriers exhibited a higher risk of IBTR after BCS and a longer time to IBTR than non-carriers. One limitation of the present study is a longer follow-up period for carriers than for non-carriers, as carriers typically underwent long-term observation at our institution; hence, further data accumulation is warranted for validating these findings. Subtypes and quadrants of IBTR were frequently distinct in carriers, indicating the increased incidence of new primary breast cancer. Although the prognosis did not differ between carriers and non-carriers, our results suggest the necessity for long-term intensive breast surveillance of BRCA1/2+ carriers after BCS. Citation Format: Sakiko Kondo, Kumiko Kida, Misato Suzuki, Chika Fukano, Atsushi Yoshida, Naoki Hayashi, Junko Takei, Michiko Yamanaka, Hideko Yamauchi. Impact of BRCA1/2 pathogenic variants on ipsilateral breast tumor recurrence and prognosis following breast-conserving surgery [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-03.

Application of near-infrared fluorescence imaging in the accurate assessment of surgical margins during breast-conserving surgery

ObjectiveTo evaluate the feasibility and accuracy of near-infrared fluorescence imaging technology for assessing margins during breast-conserving surgery for breast cancer.MethodsForty-three breast cancer patients who received surgical treatment at Yijishan Hospital of Wannan Medical College were selected. Before the operation, the patients were administered with an indocyanine green injection of 0.5 mg/kg intravenously 2 h before operation. During and after the operation, all patients underwent surgical margin monitoring with the near-infrared fluorescence imaging system for fluorescence imaging and acquisition of images and quantitative fluorescence intensity. During the operation, the patients’ tissue specimens were collected on the upper, lower, inner, outer, apical, and basal sides of the fluorescence boundary of the isolated lesions for pathological examination.ResultsFluorescence was detected in the primary tumor in all patients. The average fluorescence intensities of tumor tissue, peritumoral tissue, and normal tissue were 219.41 ± 32.81, 143.35 ± 17.37, and 105.77 ± 17.79 arbitrary units, respectively (P < 0.05, t test). The signal-to-background ratio of tumor to peritumor tissue and normal tissue was 1.54 ± 0.20 and 2.14 ± 0.60, respectively (P < 0.05, t test). Abnormal indocyanine green fluorescence was detected in 11.6% patients (5/43), including 3 patients with residual infiltrating carcinoma and 2 patients with adenosis with ductal dilatation.ConclusionThis study confirms the high sensitivity and specificity of near-infrared fluorescence imaging technology for breast-conserving surgery margin assessment. Near-infrared fluorescence imaging technology can be used as an intraoperative diagnosis and treatment tool to accurately determine the surgical margin and is of important guiding value in breast-conserving surgery for breast cancer.

Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs

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 (€ 3757.01 on average per patient) and € 47,042.55 in mastectomies (€ 6720.36 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.

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.