Local Excision Of Breast Cancer Research Articles

Routine four-quadrant cavity shaving at the time of wide local excision for breast cancer reduces re-excision rate.

Breast conservation therapy (BCT) has been shown to have comparable long-term survival outcomes when compared with mastectomy. Clearance of excision margin is one of the mainstays of the surgical treatment, which if not achieved at the first operation of BCT results in the need for subsequent surgery. This study evaluated the impact of routinely taken cavity shavings on re-excision rates. This retrospective two-centre study describes the use of routine four-quadrant cavity shaving in 449 patients with consecutively treated with wide local excision for invasive cancer or ductal carcinoma in situ. The overall incomplete excision rate was 10.6%. Routine cavity shaving prevented the need for re-excision in 84 patients (18.7%) and identified the need for further re-excision in 33 patients (7.3%). Median time from surgery to radiotherapy was 50 days (range 13-209) for non-re-excised patients versus 78 days (range 47-260) for re-excised patients (p<0.001). Median time to chemotherapy (n=75) was 44 days (range 14-106) for non-re-excised patients versus 56 days (range 35-116) for re-excised patients (p=0.017). This study demonstrates that routine cavity shaving decreases re-excision rate in patients treated with wide local excision and prevents delays to adjuvant treatment due to incomplete excision.

199 Poster - Direct or delayed oncoplastic reconstruction after wide local excision for breast cancer in breast conserving therapy: A single centre cohort study of 252 cases

199 Poster - Direct or delayed oncoplastic reconstruction after wide local excision for breast cancer in breast conserving therapy: A single centre cohort study of 252 cases

Abstract P4-13-10: An evaluation of patient reported outcomes following oncoplastic breast conserving surgery with a crescent modification of the chest wall perforated flap utilizing Breast Q

Abstract Background: An increasing acceptance of chest wall perforator flaps has provided additional options for enhancing the cosmetic appearance of the conserved breast after breast cancer surgery. Traditional lateral intercostal anterior perforator (LICAP) flap involves a lateral chest wall scar. To enhance the cosmetic results of LICAP flap, we propose the crescent modification of the LICAP flap to conceal the scar in the inframammary crease. Aim: The aim of our study was to investigate patient satisfaction and cosmetic outcome by using the BREAST-Q after undergoing crescent-modification of LICAP flap partial breast reconstruction. Methods: All eighteen consecutive patients with who underwent crescent modification of LICAP flap reconstruction for partial breast reconstruction after wide local excision of breast cancer between June 2017 and July 2019 were invited to complete the BREAST-Q questionnaire. All patients were prospectively evaluated and their demographic, clinical and pathological details were recorded on a database. Results: The median psychological, physical and sexual well-being scores were 93 (IQR 63-100), 82 (IQR 69-95) and 70 (IQR 46-96) respectively. The median satisfaction score with breast was 88 (IQR 66-100) Conclusions: In a carefully selected group of women with breast cancer, our study demonstrates that the crescent-modification of the LICAP flap for partial breast reconstruction provides a safe and effective technique with preservation of satisfaction with breast, physical, psychological and sexual well-being. Citation Format: Amtul R Carmichael, Amtul Shafee Sami, Kefah Mokbel. An evaluation of patient reported outcomes following oncoplastic breast conserving surgery with a crescent modification of the chest wall perforated flap utilizing Breast Q [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-13-10.

Excessive Healthy Breast Tissue Removal during Wide Local Excision of Breast Cancer after Neo-Adjuvant Therapy

Excessive Healthy Breast Tissue Removal during Wide Local Excision of Breast Cancer after Neo-Adjuvant Therapy

Direct or Delayed Oncoplastic Reconstruction after Wide Local Excision for Breast Cancer in Breast Conserving Therapy: A Single Centre Cohort Study of 252 cases

Direct or Delayed Oncoplastic Reconstruction after Wide Local Excision for Breast Cancer in Breast Conserving Therapy: A Single Centre Cohort Study of 252 cases

P159. Margin re-excision rates following wide local excision with surgeon-operated intraoperative ultrasound

Introduction: Positive resection margins following wide local excision for breast cancer is a significant issue often requiring additional surgery and resources. NICE guidelines recommends consideration of re-excision if margin is less than 2mm. Recent meta-analysis (Koning et al, 2018) quotes 4-23% positive margin rate (PMR) for breast cancer requiring re-excision.

Abstract P3-13-06: Breast conserving surgery by periareolar mammoplasty – Surgical and oncological outcomes

Abstract Background Periareolar mammoplasty is a volume displacement oncoplastic technique for patients with small to medium sized breasts. This approach provides good access for a safe excision for both central and peripheral lesions, especially for those in the upper half of the breast. Cosmetically it allows good reshaping of the breast, and contralateral symmetrisation is rarely required. This technique has the potential to replace the standard wide local excision for breast cancer. There is scarcity of data about the results of this procedure in the literature. We present a single surgeon experience with this technique in terms of surgical and oncological outcomes. Methods Retrospective review of patients' records from October 2013 to December 2017 was performed. The patients' demographics, tumour characteristics and the early oncological outcomes were studied. The postoperative complications and rate of symmetrisation were also studied. Results -There were 110 patients in this study period. The median age was 60 years (range 36 – 82 years) and screen detected tumours accounted for 66% (72 patients) of cases. -Neoadjuvant therapy was given in 14 patients (endocrine therapy – 12, chemotherapy – 1, dual targeted therapy – 1). -Most patients had the lesion in the upper half of the breast (upper outer-71, upper inner-33). -The average size of the tumour was 18.9mm (range 1.8 – 70mm) and the average weight of the excised specimen was 47.2gm (range 11-190gms). Invasive carcinoma was seen in 94 patients (85%) of which 86 patients had invasive ductal carcinoma, 4 had invasive lobular carcinoma and 4 had special type. Pure DCIS was present in 16 patients (15%). Most patients had grade 2 cancers (45%). DCIS was present with invasive carcinoma in 55% of cases. -Thirteen patients had positive margins (&amp;lt;1mm) and DCIS coexisted with invasive carcinoma in 7 of 13 patients. Four patients with pure DCIS had positive margins. -Of the 13 patients with positive margins: 5 required margin re-excision, 6 had completion mastectomy and 2 received only radiotherapy. -The median follow-up was 25 months (range 3 – 53 months). Seven patients developed complications which included 3 hematomas (2 requiring evacuation) and 4 wound infection which were treated with antibiotics. Only two patients required contralateral symmetrisation and no local recurrences were encountered in this study period. Conclusion Periareolar mammoplasty is a robust, easily adaptable and reproducible oncoplastic technique allowing for safe wide local excision of breast cancer. The margin re-excision, postoperative complication and recurrence rates in this study are acceptable and low compared to standard wide local excision. This technique gives excellent access, and allows better breast reshaping resulting in pleasing aesthetic outcome. Contralateral symmetrisation is rarely required with this technique. Citation Format: Burrah R, Vinayagam R, James K. Breast conserving surgery by periareolar mammoplasty – Surgical and oncological outcomes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-06.

Routine four quadrant cavity shavings at the time of wide local excision for breast cancer may reduce positive margin rates

Routine four quadrant cavity shavings at the time of wide local excision for breast cancer may reduce positive margin rates

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

BackgroundBreast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation.MethodsTo date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study.ResultsWe applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site.ConclusionsIn our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

Abstract: Oncoplastic Volume Replacement Using Local Perforator Flaps

INTRODUCTION: Patients undergoing breast conserving surgery require tumour excision with replacement of the resected tissue to ensure good long-term cosmesis following radiotherapy. Adequate volume replacement can be challenging using local mobilization of glandular tissue alone in the smaller non-ptotic breast. This can be addressed by importing tissue and we describe our unit experience using local perforator flaps. METHODS: Patients undergoing partial mastectomy defect reconstruction with loco-regional perforator flaps were identified. In our unit the LICAP, LTAP and TDAP flaps were used. For the majority of the cases of BCS (29/30) a two-stage approach was adopted to ensure complete surgical excision and avoid flap compromise if subsequent axillary dissection was required. RESULTS: Between January 2014 and May 2016, thirty-six patients underwent unilateral breast reconstruction using 18 LICAP flaps (50%), 14 combined LICAP & LTA (39%), 2 LTA flaps (5.5%) and 2 TDAP flaps (5.5%). In 30 cases surgery was performed following wide local excision of breast cancer and the mean excision volume was 92g (27-149g). Six procedures were performed as revisional surgery for asymmetry correction. All flaps were transferred successfully and the donor sites were closed primarily. Nine patients (30%) had incomplete tumour excision necessitating further excision at second stage and one patient required a completion axillary node clearance. There were two patient who had post-operative complications; one patient had delayed wound healing (non primary cancer patient) and one patient had an infection seroma which responded quickly to percutaneous drainage and oral antibiotics. Adjuvant therapy was not delayed in any patient. The cosmetic outcomes were good and to date no patients have required further revisional surgery. CONCLUSIONS: Local perforator flaps are reliable and useful for the correction of breast deformity with minimal donor morbidity. Success depends on patient selection and coordinated planning. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products mentioned in this manuscript.

Microdosimetric characteristics of 50 kV X rays at different depths for breast intraoperative radiotherapy.

An intraoperative radiation therapy (IORT) device with 50 kV X rays was designed to deliver a single dose to the tumour bed after local excision of breast cancer. The quality of a radiation can be determined by the microscopic distribution of energy transfers along and across the charged particle tracks. The lineal energy, y, serves as an accurate measure of local energy concentration. The dose mean lineal energy, yD, is an indicator of radiation quality. For low linear energy transfer radiation, the ratio of its dose mean lineal energy to that of (60)Co gamma rays can serve as a good indicator of the relative biological effectiveness (RBE) at low doses. In this study, microdosimetric simulations are performed for soft tissue irradiated by 50 kV X rays generated from the IORT device, with a 4-cm breast applicator attached. All energy transfers are recorded with the location coordinates in the tissue. Microdosimetric single events in a sphere of 1 µm in diameter are scored as a function of radial distances from the applicator surface. Single-event spectra are then constructed. From those single-event spectra, dose mean lineal energy is calculated. Compared with dose mean lineal energy of (60)Co gamma rays, the estimated RBEs at low doses are given for the X rays at different depths in the tissue. The RBEs at clinically relevant doses, as a function of depth, are also presented.

Extent of Margin Involvement, Lymphovascular Invasion, and Extensive Intraductal Component Predict for Residual Disease After Wide Local Excision for Breast Cancer

BackgroundPositive margins after wide local excision (WLE) increase the probability of residual disease, and additional surgery is often recommended. However, residual tumor will be found in only two thirds of cases, suggesting that additional surgery can be avoided in many instances. In the present study, we sought to establish the frequency of residual tumor when the surgical margins are inadequate and to identify factors that predict for residual tumor. Materials and MethodsA retrospective review was performed of 720 consecutive patients who had undergone WLE for ductal carcinoma in situ and nonmetastatic breast cancer at a single unit from January 1, 2004 to December 31, 2010. ResultsAt least a single radial margin was affected (either involved or close, defined as tumor < 1 mm from the margin) in 244 patients who had undergone WLE, and either the anterior or posterior margin was affected in another 103 patients. Reoperation was performed in 215 patients with affected radial margins and 9 others with affected anterior or posterior margins. Residual disease was found in 98 of 224 patients (43.8%) and was more likely when tumor was present at the inked margin, when > 1 radial margin was affected, and when lymphovascular invasion (LVI) or an extensive intraductal component (EIC) was present. The association with tumor size was of borderline significance. No association was found with tumor histologic type or patient age. ConclusionAdditional evaluation is needed to determine whether additional surgery can be safely omitted in women with tumors without LVI or EIC when a single radial margin has been deemed to be close.

Wide local excision of breast cancer under local anaesthetic: A treatment option for elderly

Wide local excision of breast cancer under local anaesthetic: A treatment option for elderly

A Technique to Correct a Malpositioned Nipple Within the Confines of a Well-Placed Areola

We present a case where the nipple was malpositioned after a wide local excision for breast cancer. Despite the nipple malposition, the areola was symmetrical with the contralateral side. We were able to reproduce symmetry between both breasts by the use of a transposition flap to reposition the nipple and skin grafting.

Positive Tumor Margins in Wide Local Excision of Breast Cancer: A 10-Year Retrospective Study

Background. The safety of wide local excision as a standard surgical option for early stage breast cancer management in Ghana has not been evaluated. The aim of this study was to use retrospective histopathological descriptive study to evaluate the prevalence of positive tumor margins in wide local excision specimens and offer recommendations. Study design. We reviewed 147 breast lumps, following wide local excision, which were received in the Department of Pathology, for positive tumor margins. The data was analyzed using SPSS software (version 16). Results. A total of 2,751 female breast cancers were diagnosed during the study period, of which 147 (5.3%) were from wide local excisions (lumpectomies). Thirty-one (21.0%) had positive tumor margins. The mean age of women with positive margins was 53.4 (SD = 17.1) years. The mean size of primary tumor was 4.0 (SD = 2.1) cm, the majority (53.0%) of which were greater than 2.0 cm, but less than or equal to 5.0 cm (T2). A total of 26 (83.4%) of these tumors were invasive ductal carcinomas (NOS), 24 (92.3%) of the cases had combined Bloom-Richardson grading, and many, 10 (41.7%), were grade 1. Conclusion. Our study shows that 21.0% of all wide local excision biopsies had positive tumor margins, a figure that is comparable to those of other studies. Tumors with positive margins in this study were large, 4.0 cm (T2), and common in relatively young women. Treatment failure is therefore likely to occur in these patients.

Mammographic findings and rates of ultrasound and biopsy following wide local excision for breast cancer in patients treated with intraoperative radiotherapy (IORT) versus external beam whole breast radiotherapy (EBRT)

Introduction: As part of the TARGIT-A trial, breast cancer patients were prospectively randomised to either EBRT or a single dose of IORT, with comparable results in local recurrence and complication rates. Our aim was to compare follow-up mammographic findings and rates of adjunctive ultrasound and biopsy between the two groups.

76P Wide Local Excision of Breast Cancer Under Local Anaesthetic: A Treatment Option

IntroductionElderly and medically unfit patients make up a small but significant proportion of breast cancer patients. MethodsA prospective study of breast cancer wide local excisions (WLE) performed under local anaesthesia (LA) from Mar 2008 to Apr 2011. Results17 patients were included, with average age of 81 years (range 59 – 94 years). 10 patients had American Society of Anaesthesia (ASA) grade 3 and 7 patients had ASA grade 2. Mini mental state examination (MMSE) range was 8-10 (average 8.75). Preoperative Portsmouth Physiologic and Operative Severity Score for enumeration of Mortality and Morbidity (PPOSSUM), score predicted morbidity at 28.5 % (range 15 – 60%) and mortality at 1.8 % (range 0.1 – 6.1%). The observed morbidity was 5.8 % and mortality was 0%. Tumor size was 13-47mm (median 26mm). 10 patients were oestrogen receptor (ER) negative and 7 were positive. 100% disease free survival has been observed. The follow-up range was 8-54 months (median 39 months). ConclusionsWLE of breast cancer under LA is a useful option. All patients in this selected ‘unfit’ group were treated as day cases. All patients currently remain disease free. DisclosureAll authors have declared no conflicts of interest.

Wide local excision of breast cancer under local anaesthetic: A treatment option

Aims: Elderly and medically unfit patients make up a small but significant proportion of breast cancer patients. Treatment of such patients can be challenging. We studied breast cancer excision under local anaesthesia (LA).

576 Wide Local Excision of Breast Cancer Under Local Anaesthetic–a Treatment Option

576 Wide Local Excision of Breast Cancer Under Local Anaesthetic–a Treatment Option

Oestrogen receptor status predicts for local recurrence following wide local excision for breast tumours

Status of the surgical margins following wide local excision for breast cancer remains one of the strongest predictors of local recurrence. In our practice, a margin of 1 mm and more is considered adequate. In this study, we aim to determine whether clinicopathological factors other than surgical margins contribute to the risk of local recurrence.