Upper-inner Quadrant Research Articles

Aesthetic and surgical outcomes of the modified matrix rotation technique for upper inner quadrant breast tumors: a case series.

In patients with breast cancer, oncoplastic breast-conserving surgery can achieve a good aesthetic outcome without compromising oncological outcomes. However, tumors located in the upper inner quadrant (UIQ) are challenging for surgeons because treatment gives rise to visible scars, glandular deformities, and deviation of the nipple-areolar complex. The present study was performed to analyze a modification of the matrix rotation technique for UIQ tumors and address the main drawback of this technique, which is a visible scar on the commonly exposed part of the breast. A prospective database of seven patients who presented with UIQ tumors and underwent the new modification technique was utilized for the analysis. All patients preferred the modified technique over the standard technique because of the absence of a scar in the UIQ (visible breast line). The postoperative patient-reported outcomes regarding breast shape, breast symmetry, and scar location were also satisfactory. No surgical complications were reported. This modified surgical technique results in a scarless UIQ and is an aesthetically acceptable procedure that can be considered for UIQ tumors.

A clinico-epidemiological study of breast eczema sparing nipple and areola from a tertiary care hospital in western Rajasthan

Nipple eczema can be a local manifestation of atopic dermatitis/eczema when it arises with classic age-related patterns of eczema on other body sites, or it can occur in isolation. In our study, breast eczema sparing nipple and areola, was observed in females of western Rajasthan. This study reports the demography, clinico-morphological patterns and factors causing it. After due informed consent, thirty consecutive female patients of breast eczema were undergone a detailed history, clinical examination and patch testing. Hamilton Anxiety Rating Scale was used for anxiety severity assessment. Most common site of breast eczema was the upper-outer quadrant (15/30) followed by upper-inner quadrant (9/30). The cell-phone was the most common object which was kept in close contact with the breast followed by purse (26/30) and money (11/30). Total 20 positive patch tests were seen in 17 patients. Fifteen patch tests were relevant to the current dermatitis. Mild anxiety cases were significantly more in acute type whereas moderate-severe type was more with chronic type (p value=0.021). Larger study is required to establish the exact cause of this type of breast eczema. Breast eczema seems to have diverse etiology, supplemented by various factors such as anxiety, perspiration in hot arid weather, traditional loosely-fit inner clothing of women in this region of western Rajasthan and friction produced by the objects (cell phones) that are kept in contact with breasts, work together to produce dermatitis.

Modifications of the LICAP/LTAP Flap Technique in Partial Breast Reconstruction for Difficult Tumor Locations.

The authors propose modifications of the lateral thoracic artery perforator/lateral intercostal artery perforator flap partial breast reconstruction that can help achieve improved aesthetic results, especially for centrally and medially located tumors. Lumpectomy is performed using the retromammary approach through lateral contour access without skin mobilization from parenchyma. This minimizes trauma and scarring of parenchyma and skin in the lateral part of the breast. In case of central or medial location of the tumor, the authors propose moving the flap into the tumor bed through a cut ("window") in the musculus pectoralis major. This helps stabilize the flap in an optimal position and redistribute the tissue without compression on the flap pedicle or bulge in the lateral sector of the gland. The authors have used this modification in 18 patients. The average tumor size was 2.8 cm (range, 1.2 to 5.4 cm) and the average weight of the specimens was 46.6 g (range, 14 to 110 g). Two patients had a tumor in the upper-inner quadrant close to the breast meridian, two in a central-lateral tumor location, and 14 in the upper-outer quadrant. Early complications occurred in four cases: two seromas of the wound, one partial flap necrosis with revision and resection of the flap, and one cellulite in the axillary region after axillary dissection because of long-standing lymphorrhea and drainage. The proposed modification of the lateral thoracic artery perforator/lateral intercostal artery perforator flap technique in partial breast reconstruction can lead to better aesthetic results and improved safety.

A case of ALK-positive histiocytosis with multiple lesions in the unilateral breast: A case report.

Introduction and importancePrimary ALK-positive histiocytosis of the breast is rare. Here, we report a case of ALK-positive histiocytosis with multiple unilateral breast lesions.Case presentationOur patient was a 38-year-old female with primary ALK-positive histiocytosis of the breast with multiple lesions. There were no lesions in other organs, and the patient was considered surgically resectable and underwent a left total mastectomy and sentinel lymph node biopsy. Histopathologically, there were at least three lesions in the left breast in upper inner quadrant (UIQ), upper quadrant (UQ), and upper outer quadrant (UOQ). All lesions showed spindle-shaped tumor cells that were positive for CD163 and ALK and negative for AE1/AE3. Fluorescence in situ hybridization (FISH) showed ALK and KIF5B rearrangements, suggesting the presence of the KIF5B-ALK fusion gene. In conclusion, this case was confirmed to be ALK-positive histiocytosis with multiple lesions in the unilateral breast. The patient underwent surgery and was discharged without complications.Clinical discussionReports of ALK-positive histiocytosis are very rare, and reports of primary cases in the breast are even rarer. The basic treatment for ALK-positive histiocytosis is surgical resection; however, ALK inhibitors may be effective in unresectable or disseminated cases. Accurate diagnosis at the time of initial treatment is necessary to expand the treatment options.ConclusionThis is the first case of ALK-positive histiocytosis with multiple lesions in the unilateral breast.

Распространенность периферической дистрофии сетчатки у детей младшего возраста Республики Бурятия

Purpose. To assess the frequency of occurrence of peripheral vitreochorioretinal dystrophy (PVCRD) in young children with myopia of various degrees. Material and methods.The analysis of 75 patients' medical histories with myopia of various degrees at the age from 8 to 10 years (9.4±0.51 years) was carried out. Results. Out of the total number of children examined, 19 people (25.33%) had PVCRD. Of these, boys – 36.85%, girls – 63.15%. In 32.15%, bilateral changes were observed, in 67.85% – one eye. In 26 (74.28%) children, dystrophy of the «snail trace» type was detected, in 5 (14.29%) – vitreoretinal traction, in 4 (11.43%) retinal holes. Retinal dystrophy was found in an equal ratio in myopia of I and III degrees. With myopia of the I degree and axial length (AL) of 24.04 mm, PVCRD was detected in 50% of cases, with myopia of the II degree and AL of 25.07 mm in 7.14%, with myopia of the III degree, AL of 25.36 mm in 42.86%. According to the topographic location, PVCRD was found most often in the upper-inner quadrant in 43.33%, in the same ratio – 20.0% in the lower-inner and upper-outer quadrant, less often in the lowerouter quadrant – 16.67%. Preventive restrictive retinal laser coagulation of the was performed in all children with a prognostically unfavorable form of PVCRD. Conclusion. Regardless of the degree of myopia or other type of refraction, it is necessary to examine children in conditions of maximum druginduced mydriasis by direct ophthalmoscopy using a Goldman lens or a Panfundus lens in order to adequately assess changes in the retinal periphery, diagnose pathological changes in a timely manner and conduct preventive laser therapy. Key words: dystrophy, myopia, children, laser coagulation

Off the shelf volume replacement in breast conserving surgery - Oxidised regenerated cellulose for upper inner quadrant defects

Background The upper inner quadrant (UIQ) of the breast has remained a challenge even with oncoplastic surgery. Scar placement and access often contradict each other in this cosmetically sensitive area where even small volume excision can leave obvious deformities. Various methods described require expertise and/or sophisticated products. We present a technique for UIQ cancer excision using a hidden breast crease access incision and oxidised regenerated cellulose (ORC), SURGICEL® (Johnson & Johnson, Somerville, NJ, US), a biodegradable product to fill the defect.

Does The Quadrant of Location Change The Prognosis of A Breast Lump? A Cytomorphological Study

Introduction: Tumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ). Whether tumour location is prognostic is unclear. To determine whether tumour location is prognostic, associations between tumour site and clinicopathological characteristics were evaluated. Materials and Methods: All patients enrolled in the Clinical Breast Care Project whose tumour site—UOQ, upper inner quadrant (UIQ), central, LIQ, lower outer quadrant (LOQ)—was determined by a single, dedicated breast pathologist were included in this study. Patients with multicentric disease (n = 73) or tumours spanning multiple quadrants were excluded from further analysis. Clinicopathological characteristics were analysed using chi-square tests for univariate analysis with multivariate analysis performed using principal components analysis (PCA) and multiple logistic regression. Significance was defined as P < 0.05. Results: Of the patients with defined tumour location, 30 had bilateral disease. Tumour location in the UOQ (51.5%) was significantly higher than in the UIQ (15.6%), LOQ (14.2%), central (10.6%), or LIQ (8.1%). Tumours in the central quadrant were significantly more likely to have higher tumour stage (P = 0.003) and size (P < 0.001), metastatic lymph nodes (P < 0.001), and mortality (P = 0.011). After multivariate analysis, only tumour size and lymph node status remained significantly associated with survival. Conclusions: Evaluation of tumour location as a prognostic factor revealed that although tumours in the central region are associated with less favourable outcome, these associations are not independent of location but rather driven by larger tumour size. Tumours in the central region are more difficult to detect mammographically, resulting in larger tumour size at diagnosis and thus less favorable prognosis. Together, these data demonstrate that tumour location is not an independent prognostic factor.

Cytomorphological Study of Breast Lesions in Correlation with Quadrant Location to Assess Prognosis

Abstract: Introduction: Tumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ). Whether tumour location is prognostic is unclear. To determine whether tumour location is prognostic, associations between tumour site and clinicopathological characteristics were evaluated. Materials and Methods: All patients enrolled in the Clinical Breast Care Project whose tumour site—UOQ, upper inner quadrant (UIQ), central, LIQ, lower outer quadrant (LOQ)—was determined by a single, dedicated breast pathologist were included in this study. Patients with multicentric disease (n = 73) or tumours spanning multiple quadrants were excluded from further analysis. Clinicopathological characteristics were analysed using chi-square tests for univariate analysis with multivariate analysis performed using principal components analysis (PCA) and multiple logistic regression. Significance was defined as P < 0.05. Results: Of the patients with defined tumour location, 30 had bilateral disease. Tumour location in the UOQ (51.5%) was significantly higher than in the UIQ (15.6%), LOQ (14.2%), central (10.6%), or LIQ (8.1%). Tumours in the central quadrant were significantly more likely to have higher tumour stage (P = 0.003) and size (P < 0.001), metastatic lymph nodes (P < 0.001), and mortality (P = 0.011). After multivariate analysis, only tumour size and lymph node status remained significantly associated with survival. Conclusions: Evaluation of tumour location as a prognostic factor revealed that although tumours in the central region are associated with less favourable outcome, these associations are not independent of location but rather driven by larger tumour size. Tumours in the central region are more difficult to detect mammographically, resulting in larger tumour size at diagnosis and thus less favourable prognosis. Together, these data demonstrate that tumour location is not an independent prognostic factor.

The poor prognosis of lower-inner quadrant breast cancer in patients who received neoadjuvant chemotherapy.

The elevated risk for recurrence in breast cancer patients after receiving neoadjuvant chemotherapy (NAC) is still controversial. The purpose of this paper was to investigate the prognostic significance of tumor location concerning the survival of patients with breast cancer treated with NAC. The clinical information of 676 patients with stage II-III breast carcinoma who were being treated with NAC between March 2009 and 2014 was investigated. The primary tumor sites were categorized into three groups: outer quadrant, upper-inner quadrant, and lower-inner/central quadrant. According to the results of multivariate analyses, the number of tumor locations, nuclear grade, and the initial clinical stage was associated with disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS). When stratified into subgroups, tumors in the lower-inner/central quadrant were associated with a significantly worse prognosis in patients not treated with postmastectomy radiation therapy (PMRT) and in patients in the human epidermal growth factor receptor 2 (HER-2)-enriched and triple-negative subgroups. The primary tumor site is likely to be a critical feature that affects the prognosis of breast cancer tumors treated with NAC. To address the poor prognosis related to inner-quadrant participation in breast carcinoma, more aggressive NAC with internal mammary node radiotherapy (IMN-RT) should be conducted.

Invasive solid papillary carcinoma with neuroendocrine differentiation of the breast: a case report and literature review

BackgroundSolid papillary carcinoma (SPC) of the breast is a rare breast cancer that accounts for less than 1% of all breast cancers. The optimal clinical management of SPC remains controversial. Here, we report a case of invasive SPC with neuroendocrine differentiation in addition to review of the current literature.Case presentationA premenopausal 46-year-old female presented with a mass in her left breast that tended to increase in size over a 10-month period. Mammography and ultrasonography revealed a mass in the left upper-inner quadrant. The resulting images suggested a category 3 breast tumor according to the Breast Imaging Reporting and Data System (BI-RADS). A core needle biopsy (CNB) was performed, and the pathological findings showed a solid papillary pattern and atypical cells suggestive of noninvasive SPC. After a left partial mastectomy and sentinel lymph node biopsy (SLNB), the specimens were sent for histopathological analysis for further investigation. Postoperative pathological findings suggested invasive SPC. Whole-breast radiation therapy and adjuvant hormonal therapy were performed as postoperative treatments. Three years after surgery, multiple lung metastases were detected, and the patient was treated with a gonadotropin-releasing hormone agonist and an aromatase inhibitor. Five months later, multiple liver metastases and bone metastases appeared, and oral 5-fluorouracil was chosen for the subsequent treatment. The patient has been treated for 5 years to date, and she is continuing to take oral 5-fluorouracil and is alive without any further disease progression.ConclusionsWe report a rare case of premenopausal invasive SPC with multiple metastases. Further study is needed to clarify the molecular characteristics and clinical behaviors of SPC and to explore the optimal treatment strategy.

Abstract P4-12-25: Dosimetric comparison of breast and pan nodal radiotherapy techniques to estimate the risk of developing a second primary cancer in the upper inner quadrant of the contralateral breast

Abstract Purpose: To quantify estimates of risk in young patients (<40 years) of an upper inner quadrant (UIQ) contralateral breast (CB) cancer after breast and locoregional lymph node radiotherapy that includes internal mammary chain. Comparison of two optimal photon techniques with proton beam therapy (PBT). Methods and Materials: In 14 patients’ CT datasets from the HeartSpare Plus dosimetry study(1) the CB was further subdivided into quadrants. Three radiotherapy techniques for breast and pan nodal radiotherapy were analysed: Wide Tangents in voluntary Breath Hold (WT-vBH), Volumetric-Modulated Arc Radiotherapy in vBH (VMAT-vBH) and PBT in Free Breathing. (PBT-FB). Mean dose to the whole CB, and contralateral UIQ for each patient across three techniques was calculated. The statistical significance of differences between the mean doses to UIQ across the three techniques were analysed using Friedman’s test followed by Wilcoxon signed rank comparison. Based on estimates of CB cancer risks from the WECARE study (2) and assuming the patients were under 40 years of age, the dose to UIQ was converted to Rate Ratios (RR), both overall and with >5 years follow up. Results: The mean dose and range to CB UIQ (Gy) for WT-vBH was 4.7 (0.5-11.0), VMAT-vBH was 3.9 (0.5-6.8) and PBT-FB 0.5 (0.1-1.7) p value <0.01. PBT-FB achieves a statistically significantly lower dose than either WT-vBH or VMAT-vBH. For a patient under 40 years followed for > 5 years this translates into a Rate Ratio (RR) with 95% confidence interval (CI) of 6.9 (1.5-19.9) for WT-vBH, 6.3 (1.4 – 18.0) for VMAT-vBH and 1.2 (0.5-3.0) for PBT-FB. WT-vBHVMAT-vBHPBT-FBDose to whole CB (Gy) mean (and range)1.6 (0.3-3.2)1.5 (0.3-3.5)0.2 (0.1-0.8)Dose to UIQ CB (Gy) mean (and range)4.7 (0.5-11.0)3.9 (0.5 – 6.8)0.5 (0.1 –1.7)RR (with 95% CI) of UIQ CB cancer In woman <404.8 (1.7-10.4)4.4 (1.7-9.4)1.1 (0.6 –1.9)RR (with 95% CI) of UIQ CB cancer in woman <40 followed for >5 years6.9 (1.5 -19.9)6.3 (1.4-18.0)1.2 (0.5 –3.0) Conclusion: Women <40 years of age have an elevated long term risk of a second primary cancer in the UIQ of CB which is higher for optimal photon techniques than proton beam therapy. Refernces 1. Ranger A, Dunlop A, Hutchinson K, et al. A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain. Clin. Oncol. 2018;30:346–353. 2. Stovall M, Smith SA, Langholz BM, et al. Dose to the Contralateral Breast From Radiotherapy and Risk of Second Primary Breast Cancer in the WECARE Study. Int. J. Radiat. Oncol. Biol. Phys. 2008;72:1021–1030. Citation Format: Sarah Settatree, Douglas Brand, Alison Ranger, Alex Dunlop, Anna Kirby. Dosimetric comparison of breast and pan nodal radiotherapy techniques to estimate the risk of developing a second primary cancer in the upper inner quadrant of the contralateral breast [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 P4-12-25.

Effect of the primary tumor location on the prognosis of breast invasive ductal carcinoma patients treated with radical mastectomy

Objective: To analyze the clinicopathological features and prognosis of breast invasive ductal carcinoma patients receiving radical mastectomy according to the primary tumor location. Methods: From January 2008 to December 2008, 993 patients with breast invasive ductal carcinoma received radical mastectomy in Tianjin Medical University Cancer Institute and Hospital. Patients were grouped according to the primary tumor location when breast cancer was diagnosed. The clinicopathological characteristics and follow-up information of them was collected and analyzed retrospectively. Results: Of the 993 patients, primary tumor located in the upper-outer quadrant (UOQ) in 556 patients (56.0%), the lower-outer quadrant (LOQ) in 97 (9.8%), the central portion in 99 (10.0%), the upper-inner quadrant (UIQ) in 186 (18.7%), and the lower-inner quadrant (LIQ) in 55 (5.5%). Patients in the central portion tended to have larger tumors, and more patients in the upper-inner quadrant received endocrine therapy. The estimated 5-year disease-free survival (DFS) rates of patients with primary lesion in the UOQ, LOQ, central portion, UIQ and LIQ were 90.3%, 88.7%, 79.8%, 86.0% and 72.7%, respectively, with significant differences (P<0.001). The 5-year overall survival (OS) rates were 97.5%, 96.9%, 90.9%, 94.1% and 87.3%, respectively, with significant differences (P<0.001). Multivariate analysis showed that 5-year recurrence and metastasis risks were significantly increased in patients with primary lesion in the central portion, UIQ and LIQ compared to other groups (P<0.001), and 5-year mortality risks were increased in these three groups (P=0.002). Conclusion: Primary lesion located in central portion and inner quadrant is an independent adverse prognostic factor for patients with breast invasive ductal carcinoma patients receiving radical mastectomy.

Surgical Outcomes of Intraconal Cavernous Venous Malformation According to Their Location in Four Right-Angled Sectors.

The present study evaluated the surgical outcomes of intraconal cavernous venous malformation according to their location in 4 right-angled sectors. Data regarding the surgical method and approach, surgical outcome, and postoperative complications were retrospectively analyzed for 18 patients with intraconal cavernous venous malformations that were surgically treated at the authors’ center between March 2006 and May 2017. The lesion location was defined using 2 perpendicular lines connecting the optic disc and the 4 surrounding rectus muscles in the coronal plane, which resulted in the formation of 4 right-angled sectors (upper-outer quadrant, upper-inner quadrant, lower-inner quadrant, and lower-outer quadrant). Accordingly, there were 3, 3, 8, and 4 lesions in the upper-outer, upper-inner, lower-outer, and lower-inner quadrants, respectively. Ten patients received anterior orbitotomy and 8 received lateral orbitotomy. There were no recurrences during the follow-up period. All patients exhibited reduced proptosis after surgery. Vision improved in 4 patients and remained unchanged in 14. Five patients experienced ocular movement limitation (1 permanent and 4 temporary), 1 developed an inferomedial blowout fracture, 2 developed a temporary sensory deficit, and 1 developed temporary ptosis. The authors’ findings suggest that intraconal cavernous venous malformations most frequently occur in the lower-outer quadrant. Although most lesions can be removed via anterior orbitotomy, large lesions located near the orbital apex or on the orbital wall require lateral orbitotomy. Ocular movement limitation is a common complication and can become permanent in rare cases, necessitating close monitoring. Lesion location and surgical approach do not seem to influence the postoperative complication rate.

Abstract 1215: Epidemiology of breast malignancies in sub-Saharan Africa: A ten-year retrospective evaluation of 2,419 patients at a major tertiary institution in Southwestern Nigeria

Abstract Background: There is limited information on the epidemiology and clinical presentation of breast cancer in Sub-Saharan Africa. This analysis evaluated the prevalence, characteristics of the disease over a ten-year period, as well as the impact of sociodemographic factors on late breast cancer presentation in Lagos State University Teaching Hospital (LASUTH) Lagos, a major tertiary institution in Nigeria, the most populous country in Africa. Objectives: The aim of this study is to determine the epidemiological variants of all breast cancer cases at LASUTH, 2007- 2017. Materials and Methods: There was no restriction on gender or age groups. Late presentation was defined by symptomatic presentation. Tumors were characterized by histological subtypes. Mean, frequencies and percentages were performed using STATA/IC 12.1 for Windows. Results: A total of 2419 breast cancer patients were seen during the ten-year period. There were more female malignancies (n=2380, 98.4%) compared to male malignancies (n=39, 1.6%). The prevalence of breast cancer was found to be 37.5%. The overall mean age (years) was 47.27, the age range was 19 to 91 years. Increased risk of late presentation (n=1910, 79%). Overall higher presentation were made from christians (n= 1849, 76.4%), married individuals (n=2089, 86.4%), people in unskilled professions such as traders (n=808, 33.4%) and people with a tertiary level of education (n= 239, 12.8%). As the primary level of treatment, most of the patients had mastectomy (n=1533, 63.4%), chemotherapy (n=600, 24.8%) and radiotherapy (n=51, 2.1%). The topography of all reported cases include upper-outer quadrant of breast (n=433, 17.9%), axillary tail of breast (n=381, 15.8%), overlying lesion of breast (n=144, 11.5%), lower-inner quadrant of breast (n=133, 5.5%), upper-inner quadrant of breast (n=92, 3.8%), nipple (n=77, 3.2%), lower-outer quadrant of breast (n= 75, 3.1%) and the central portion of breast (n= 42, 1.7%). The three most common morphologies were Pleomorphic carcinoma (n=717, 29.6%), Infiltrating duct carcinoma (n=630, 26%) and giant cell type of the malignant tumor (322, 13.3%). Conclusion: Our study shows that breast cancers usually present mostly in young women in Nigeria, and shows the influence of culture on late presentation. Therefore we should institute deliberate public health education and counseling in our social institutions such as religious circles that are designed particularly to favour the peculiar demographics of the population to prevent late presentation. In addition, cross-sectional studies of breast cancer tumors in younger women (before the age of 40) should be explored to better understand the disease and further understanding too of breast cancers in African American women. Citation Format: Funlayo O. Buraimoh, Abiodun O. Popoola. Epidemiology of breast malignancies in sub-Saharan Africa: A ten-year retrospective evaluation of 2,419 patients at a major tertiary institution in Southwestern Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1215.

Tumor Site and Breast Cancer Prognosis

IntroductionVarious factors affect breast cancer prognosis; however, little information is available regarding the role of primary tumor site. The purpose of this study was to compare the survival and clinicopathologic characteristics of patients with breast cancer by primary tumor location. Materials and MethodsWe analyzed a prospectively collected single-institution breast cancer registry. Univariate and multivariable analyses were used to evaluate the association of tumor site with positive lymph node status, presence of metastasis, time to recurrence or death, and events of recurrence or death. Patients with tumors originating from the upper-outer quadrant were the reference group. ResultsFrom 2003 to 2015, 5295 patients with breast cancer were identified. Tumors originated from the upper-outer quadrant (36.2%), upper-inner quadrant (13.1%), lower-outer quadrant (9.8%), lower-inner quadrant (7.6%), nipple (1.2%), axillary tail (0.3%), or overlapping (24.7%). Tumors originated from overlapping lesions (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.36-1.83) had higher odds of positive axillary lymph nodes, whereas tumors from the upper-inner (OR, 0.68; 95% CI, 0.56-0.84) and lower-inner quadrant (OR, 0.72; 95% CI, 0.56-0.93) had lower odds. Tumors from the lower-outer quadrant were associated with lower risk of death (hazard ratio, 0.64; 95% CI, 0.46-0.88), whereas tumors from overlapping lesions had higher risk (hazard ratio, 1.28; 95% CI, 1.05-1.55). ConclusionThe site of primary tumor may be an important characteristic affecting the prognosis of patients with breast cancer.

Oncoplastic resection of breast cancers located in the upper-inner quadrants: a safe and effective surgical technique

The combination of breast conserving surgery (BCS) together with plastic surgery techniques (oncoplastic breast surgery) is a useful surgical tool matching the radical oncological excision while preserving breast cosmesis. Upper-inner quadrant resections represent a challenge for breast surgeons. The aim of this study was to identify a reproducible technique to repair upper-inner quadrant defects with oncoplastic glandular reshaping in order to obtain a satisfactory aesthetic outcome together with a radical excision of the breast cancer. During the period from March 2014 to March 2016, 32 patients with an upper-inner quadrant’s breast cancer were treated at our Department. Post-operative complications, negative margins of resection rates and cosmetic outcome (both patient-reported and surgeon-reported) were assessed. At a mean follow-up of 14 months (range 6–24), the complication rate was 25% (wound dehiscence, seroma formation, hematoma, marginal skin necrosis and partial NAC necrosis). Surgical margins of resection were negative in all procedures, and the overall satisfaction with the cosmetic outcome assessed by the patient was considered excellent in 17 cases (53.1%) and in 19 cases (59.4) when assessed by the surgeon. The proposed technique represents a valuable and reproducible solution for the challenging reshaping that follows upper-inner quadrantectomies due to its low complication rates, high free margins of resection rates and excellent cosmetic outcomes. Level of Evidence: Level IV, therapeutic study.

ONCOPLASTIC RESECTION OF THE MAMMARY GLAND WITH A SLIDING DERMOGLANDULARY FLAP WITH A Z-SHAPED INCISION

Oncoplastic resections are a radical surgical treatment for breast cancer, as well as a method for the rehabilitation of patients, since operations are classified as organ preserving. When the tumor node is localized in the upper-inner quadrant of the breast, it is difficult to achieve good aesthetic results. One of the solutions to the problem is the use of a sliding flap with a Z-shaped incision. In P. Hertsen MORI from 2014 to 2016, the operation with the use of a sliding flap was performed in 13 patients. The prevalence of the process, patients were distributed as follows: ТisN0 М0–1, Т1N0 М0–7, Т2N0 М0–3, Т1N1 М0–2 .Molecular subtypes distribution was the following — luminal type A— 8, luminal type B — 3, triple-negative subtype — 1 patient. Localization of the tumor site in the breast: the upper-internal quadrant — 9, upper — 1, lowerinner quadrant — 3 .The upper Zshaped flap was used in 10 patients, the lower Zshaped flap in 3 cases. Postoperative period in all patients was without com plications. The wound healed by primary intention in all patients. Cosmetic effect was good. The observation period is from 6 months to 2 years, the median is 1.1 years. Data for local recurrence and distant metastases were not detected. 2 patients had only surgical treatment, in the remaining 8 cases, radiation therapy with or without drug therapy. In all cases the operation is performed on one breast, correction of the second breast was not required.The article presents the clinical observation of patients with oncoplastic resection of the Zshaped flap, a detailed procedure of the operation.

Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy: An aesthetic and functional prospective cohort study

BackgroundBreast-conserving surgery (BCS) is considered the standard treatment for early-stage breast cancer. However, fair to poor cosmetic outcomes following conventional BCS have been observed in as many as one-third of cases. The aim of this study was to determine the critical tumor-to-breast volume ratio for each quadrant of the breast beyond which conventional BCS would no longer offer acceptable cosmetic and functional results or satisfactory quality of life for the patient. MethodsA prospective cohort study was performed between December 2011 and December 2013 involving 350 patients younger than 70 years with early-stage unifocal (T ≤ 30 mm) breast cancer who underwent wide excision and axillary sentinel lymph node biopsy followed by whole-breast irradiation. Using validated panels and software (the Breast Cancer Treatment Outcome Scale [BCTOS], EORTC Cancer Quality of Life Questionnaire number C30-BR23, and Breast Cancer Conservative Treatment – cosmetic results [BCCT.core] software), quality of life and aesthetic and functional parameters and their changes in correlation to the percentage of breast volume excised were statistically analyzed. ResultsThe maximum percentages of breast volume that were resectable by conventional BCS without resulting in unacceptable aesthetic and functional outcomes or decreased quality of life were 18–19% in the upper-outer quadrant (p < 0.0001), 14–15% in the lower-outer quadrant (p < 0.0001), 8–9% in the upper-inner quadrant (p < 0.0001), and 9–10% in the lower-inner quadrant (p < 0.0001). ConclusionAided by the calculated cut-off values for each breast quadrant, breast surgeons might render more objective decisions regarding performing conventional BCS, using oncoplastic techniques or choosing mastectomy with immediate reconstruction.

Cosmetic Outcome after Interstitial Brachytherapy Accelerated Partial Breast Irradiation Is Related to the Location of the Lumpectomy Cavity

Cosmetic Outcome after Interstitial Brachytherapy Accelerated Partial Breast Irradiation Is Related to the Location of the Lumpectomy Cavity

Prognostic implication of the tumor location according to molecular subtypes in axillary lymph node-positive invasive ductal cancer in a Korean population.

Previous studies have not considered the axillary lymph node status when investigating the prognostic role of tumor location according to each molecular subtype. The present study aimed to investigate the prognostic implication of tumor location according to each molecular subtype in Korean invasive ductal carcinoma (IDC) patients with axillary lymph node metastasis. Data from 7856 Korean IDC women with axillary lymph node metastasis were retrospectively analyzed. According to tumor location, patients were divided into the following groups: upper-outer quadrant, lower-outer quadrant, upper-inner quadrant, lower-inner quadrant (LIQ), and central group. Overall survival (OS) and breast cancer-specific survival (BCSS) were evaluated according to tumor location and molecular subtype. A subgroup analysis based on tumor size categorization was also performed. The patients' mean age was 47.97 ± 9.64 years, and the median follow-up time was 90 months. The LIQ group showed significantly worse prognosis in OS and BCSS (76.4 and 83.3 %, respectively) compared with the other groups, which was only significant in human epidermal growth factor receptor 2 (HER2) overexpression and triple-negative (TN) subtypes. In the subgroup analysis according to tumor size, the LIQ group showed a significantly worse prognosis in OS and BCSS compared with the other groups, in HER2 and TN subtypes, and only in patients with more than T2 stage. In Korean IDC patients with axillary lymph node metastasis, LIQ tumor location was associated with poor prognosis among those with HER2 and TN molecular subtypes and especially in those with more than T2 stage.