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Zhu M, Mao J, Fang J, Chen D. Safety of Atypical Ductal Hyperplasia at the Nipple Margin in Nipple-Sparing Mastectomy. J Breast Cancer 2024; 27:27.e21. [PMID: 39069781 DOI: 10.4048/jbc.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/16/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE Controversies persist regarding contraindications for nipple-sparing mastectomy (NSM). This study aimed to assess the accuracy of subareolar frozen section analysis and identify risk factors for nipple-areola complex (NAC) recurrence post NSM. METHODS Consecutive cases of primary invasive breast cancer undergoing NSM at our single center from January 2015 to December 2020 were retrospectively reviewed. RESULTS The nipples were retained in 126 patients (127 breasts), and the areola was retained with nipple excision for five breasts. Frozen section analysis demonstrated a sensitivity of 81.8% and specificity of 95.3%. The NAC recurrence rate was 4.3% over a median follow-up period of 48 (30-105) months. An atypical ductal hyperplasia (ADH) at the margin emerged as an independent factor for NAC recurrence in multivariate Cox regression analysis (hazard ratio, 25.464; 95% confidence interval, 1.841-352.145; p = 0.016). Kaplan-Meier survival analysis revealed no statistically significant reduction in overall survival rates (log-rank test, p = 0.660). CONCLUSION Frozen sections of subareolar tissue are reliable and re-excision may be necessary when ADH is detected at the nipple margin in NSM. The NAC recurrence rate was low, and the outcome was favorable following wide local excision.
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Affiliation(s)
- Meizhen Zhu
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
| | - Jiefei Mao
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Jun Fang
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Daobao Chen
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
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Hastings-Robinson A, Chung M, Hayward JH, Ray KM, Price ER, Navarro R, Joe BN, Lee AY. The role of digital mammographic surveillance for detection of asymptomatic recurrence in autologous flap reconstructions. Clin Imaging 2024; 106:110062. [PMID: 38128403 DOI: 10.1016/j.clinimag.2023.110062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/21/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate the utility of digital mammography in detecting asymptomatic malignancy in autologous flap reconstructions after mastectomy. METHODS A retrospective database review identified all mammograms performed on asymptomatic patients with flap reconstructions over a 9-year period (1/1/2009 to 12/31/2017). A negative examination was defined as BI-RADS 1 or 2 and a positive examination was defined as BI-RADS 0, 4, or 5 assigned to the mastectomy side. Malignant outcomes were determined by pathology results. Interval cancers, or false negatives, were defined as locoregional malignant diagnosis within one year of a negative mammogram. Sensitivity, specificity, predictive values, abnormal interpretation rate, and cancer detection rate were calculated. RESULTS 626 mammograms of asymptomatic flap reconstructions were performed in 183 patients. The most common flap type was TRAM (83.5 %, 523/626) and DIEP (13.4 %, 84/626). Most exams (98.2 %, 615/626) were negative, assessed as BI-RADS 1 or 2, with no interval cancers at follow-up. Eleven exams (1.8 %, 11/626) were positive, assessed as BI-RADS 0, 4, or 5. After diagnostic work-up of all BI-RADS 0 exams, 9 cases had a final recommendation for biopsy of which 3 were malignant. Mammography yielded a cancer detection rate of 0.5 % (3/626), abnormal interpretation rate of 1.8 % (11/626), NPV of 100 % (615/615), overall PPV of 27.3 % (3/11), PPV2 (positive predictive value of a biopsy recommendation) of 33.3 % (3/9), sensitivity of 100 % (3/3), and specificity of 98.7 % (615/623). CONCLUSION Digital mammography of asymptomatic autologous flap reconstructions after mastectomy demonstrated high sensitivity and low abnormal interpretation rate. Cancer detection rate was comparable to current national benchmarks for mammographic screening in the general U.S. population without mastectomy.
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Affiliation(s)
| | - Maggie Chung
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - Jessica H Hayward
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - Kimberly M Ray
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - Elissa R Price
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - Ryan Navarro
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - Bonnie N Joe
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - Amie Y Lee
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, USA.
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Fang J, Deng Q, Zhang J, Ma Y, Jin C, Lu J, Hao Y, Ma Y, Liu W, Li Z, Liu G, Mo Y, Xiao Y, Zheng C, Yang Y, Wu T, Zhao C, Zhou X, Zhou P. A Nomogram Based on Conventional and Contrast-Enhanced Ultrasound for Pre-operative Prediction of Nipple-Areola Complex Involvement in Breast Cancer: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2565-2572. [PMID: 37752018 DOI: 10.1016/j.ultrasmedbio.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Accurately predicting nipple-areola complex (NAC) involvement in breast cancer is essential for identifying eligible patients for a nipple-sparing mastectomy. This study was aimed at developing a pre-operative nomogram for NAC involvement in breast cancer using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). METHODS All patients with primary breast cancer confirmed by pre-operative biopsy underwent US and CEUS examinations. Post-operative pathology was used as the gold standard in assessing NAC involvement. Lasso regression was used to select the predictors most associated with NAC involvement. A nomogram was constructed to calculate the diagnostic efficacy. The data were internally verified with 500 bootstrapped replications, and a calibration curve was generated to validate the predictive capability. RESULTS Seventy-six patients with primary breast cancer were included in this study, which included 16 patients (21.1%) with NAC involvement and 60 patients (78.9%) without NAC involvement. Among the 23 features of US and CEUS, Lasso regression selected one US feature and two CEUS features, namely, ductal echo extending from the lesion, ductal enhancement extending to the nipple and focal nipple enhancement. A nomogram was constructed, and the results revealed that the area under the curve, sensitivity, specificity and accuracy were 0.891, 81.3%, 86.7% and 85.5%, respectively. The calibration curve exhibited good consistency between the predicted probability and the actual probability. CONCLUSION The nomogram developed based on US and CEUS had good performance in predicting NAC involvement in breast cancer before surgery, which may facilitate the selection of suitable patients for NAC preservation with greater oncological safety.
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Affiliation(s)
- Jinghui Fang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qiongxia Deng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jingwen Zhang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yuqin Ma
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianghao Lu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yanli Hao
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yuanyuan Ma
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weizong Liu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhengyi Li
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Guowen Liu
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yongpan Mo
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yu Xiao
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chang Zheng
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yajie Yang
- Department of Pathology, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Tingting Wu
- Department of Pathology, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chao Zhao
- Bionic Sensing and Intelligence Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xin Zhou
- Bionic Sensing and Intelligence Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Peng Zhou
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China.
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Wignarajah P, Malata CM, Benson JR. Oncoplastic and reconstructive breast surgery. Front Oncol 2023; 13:1176915. [PMID: 37448512 PMCID: PMC10338173 DOI: 10.3389/fonc.2023.1176915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
This article provides an overview of the principles and techniques of oncoplastic and reconstructive breast surgery for patients with early-stage breast cancer. Oncoplastic breast surgery (OPBS) with partial breast reconstruction is a natural evolution in the application of breast conserving surgery and permits wide surgical resection of tumours that might otherwise mandate mastectomy and whole breast reconstruction. These reconstructive techniques must be optimally selected and integrated with ablative breast surgery together with non-surgical treatments such as radiotherapy and chemotherapy that may be variably sequenced with each other. A multidisciplinary approach with shared decision-making is essential to ensure optimal clinical and patient-reported outcomes that address oncological, aesthetic, functional and psychosocial domains. Future practice of OPBS must incorporate routine audit and comprehensive evaluation of outcomes.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Royal Marsden Hospital NHS Trust, London, United Kingdom
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Charles M Malata
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
| | - John R Benson
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
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Campana LG, Balestrieri N, Menin N. Adjuvant skin-sparing electrochemotherapy in a breast cancer patient with a prosthetic implant: 5-year follow-up outcomes. J Surg Case Rep 2022; 2022:rjac199. [PMID: 35599994 PMCID: PMC9116585 DOI: 10.1093/jscr/rjac199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/16/2022] [Indexed: 11/14/2022] Open
Abstract
A 55-year-old woman with previous skin-sparing mastectomy and prosthetic reconstruction for multifocal ductal carcinoma developed homolateral axillary recurrence. Following nodal dissection, partial periprosthetic capsulectomy and the overlying breast skin excision, the pathology report revealed a positive cutaneous margin. Since further breast skin excision or radiotherapy would have compromised the prosthetic implant, and the patient was adamant about avoiding any endangering intervention, the multidisciplinary recommendation included skin-directed electrochemotherapy (ECT) in the frame of a multimodal treatment strategy. The procedure lasted 20 minutes under mild general sedation and included a bolus of intravenous bleomycin followed by local application of electric pulses using a needle electrode. The postprocedural course was uneventful, except for mild dermatologic toxicity. At 5 years, the patient is disease-free with the implant in situ. This report illustrates the proof-of-concept of adjuvant skin-sparing ECT to sterilize resection margins, preserve a breast implant and highlight procedural details to avert toxicity.
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Affiliation(s)
- Luca G Campana
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
- Department of Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Nicola Menin
- Breast Unit, ULSS 2 Marca Trevigiana, Vittorio Veneto, Italy
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