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Christine D, Christian SF, Ricarda K, Christine K, Daphne GK, Carmen L, Alaa M, Baltzer PAT, Thomas HH, Georg P, Paola C. Risk factors for residual fibroglandular breast tissue following a mastectomy - an overview and retrospective cohort study. BMC Cancer 2024; 24:856. [PMID: 39026150 PMCID: PMC11256640 DOI: 10.1186/s12885-024-12491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Residual fibroglandular breast tissue (RFGT) following a mastectomy is associated with the remaining of occult breast cancer at the time of mastectomy as well as an increased local recurrence risk thereafter. Despite its oncologic implications, data on measures to prevent RFGT are lacking. Therefore, in a first step knowledge of risk factors for RFGT is of uttermost importance in order to allow identification of patients at risk and subsequently adaption of the surgical treatment and potentially prevention of RFGT a priori. METHODS We performed a systematic literature review in PubMed using the MESH terms [residual fibroglandular breast tissue], [residual breast tissue], [mastectomy] and [risk factor] followed by a retrospective data analysis including all patients with a mastectomy treated at the Department of Obstetrics and Gynecology of the Medical University of Vienna, Austria, between 01.01.2015 and 26.02.2020 in order to identify risk factors of RFGT following a mastectomy. The primary aim of the study was to assess a potential difference in RFGT volume between the different types of mastectomy. The secondary objectives of the study were to identify other potential risk factors for RFGT as well as to compare the skin and subcutaneous fat tissue thickness pre- to postoperatively. RESULTS Significantly higher RFGT volumes were observed following a nipple-sparing mastectomy (NSM) compared to a skin-sparing mastectomy (SSM) and radical mastectomy (RME) (p < .001). Furthermore, RFGT volume was significantly associated with the variables: reconstruction (p = .012), acellular dermal matrix (ADM) or mesh (p = .031), patient age (p = .022), preoperative fibroglandular tissue (FGT) volume (p = .012) and preoperative whole breast volume (including the skin envelope and nipple-areola-complex) (p = .030). The reduction in the postoperative compared to preoperative skin envelope thickness measured medially and laterally reached statistical significance in the NSM-cohort (medial p < .001, lateral p = .001) and showed a numerical difference in the RME and SSM-cohort. CONCLUSION Mastectomy type, reconstruction, ADM or mesh, patient age, preoperative FGT volume and whole breast volume were identified as risk factors for RFGT in univariable analysis. The observed reduction in the post- compared to preoperative skin envelope thickness should be avoided considering the known associated increase in risk for ischemic complications.
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Affiliation(s)
- Deutschmann Christine
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Singer F Christian
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Korbatits Ricarda
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Kraus Christine
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Gschwantler-Kaulich Daphne
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Leser Carmen
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Marzogi Alaa
- Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah, 24246, Saudi Arabia
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Helbich H Thomas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Pfeiler Georg
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Clauser Paola
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Kaidar-Person O, Faermann R, Polikar D, Cohen K, Bernstein-Molho R, Morrow M, Boersma LJ, Offersen BV, Poortmans P, Sklair-Levy M, Anaby D. A BRILLIANT-BRCA study: residual breast tissue after mastectomy and reconstruction. Breast Cancer Res Treat 2024:10.1007/s10549-024-07425-4. [PMID: 38980506 DOI: 10.1007/s10549-024-07425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Different types of mastectomies leave different amounts of residual breast tissue. The significance of the residual breast volume (RBV) is not clear. Therefore, we developed an MRI tool that allows to easily assess the RBV. In this study we evaluated factors associated with RBV after skin or nipple sparing mastectomy (SSM/NSM) in breast cancer BRCA pathogenic variant (PV) carriers who underwent both therapeutic and risk reducing SSM/NSM and its relation to breast cancer outcomes using an innovative MRI-based tool. METHODS Data of breast cancer BRCA PV who were treated between 2006 and 2020 were retrieved from of the oncogenetics unit databases. Only patients who underwent SSM/NSM and had a postoperative breast MRI available for analysis were included. Data collected included demographics, clinicopathological features, and outcomes. The MRI tool was developed by a breast cancer imaging laboratory. A logistic regression test and 95% confidence interval (CI) were used to assess the associated risk of increased RBV. A forward stepwise linear regression was used to correlate tumour-patient specific factors and RBV, and a Kaplan-Meier curve to show the probability of locoregional relapse. RESULTS A total of 84 patients undergoing 89 mastectomies were included. At a median follow-up of 98 months, 5 local, 2 regional, and 4 distant recurrences were observed. RBV was not significantly related with breast cancer outcomes (p value = NS). A higher body mass index (BMI) was associated with a higher RBV (p < 0.0001). A larger number of involved axillary nodes was associated with a smaller RBV (p = 0.025). The RBV on the risk-reducing mastectomy side was significantly higher compared to the breast cancer side (p value = 0.007). Local recurrences occurred in the vicinity of the primary tumour.
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Affiliation(s)
- Orit Kaidar-Person
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
- Breast Radiation Unit, The Jusidman Cancer Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
| | - Renata Faermann
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- The Merav High-Risk Clinic - Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Dor Polikar
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Kfir Cohen
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Rinat Bernstein-Molho
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Breast Cancer Institute, The Jusidman Cancer Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liesbeth Jorinne Boersma
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Miri Sklair-Levy
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- The Merav High-Risk Clinic - Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Debbie Anaby
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Deutschmann C, Singer CF, Gschwantler-Kaulich D, Pfeiler G, Leser C, Baltzer PAT, Helbich TH, Kraus C, Korbatits R, Marzogi A, Clauser P. Residual fibroglandular breast tissue after mastectomy is associated with an increased risk of a local recurrence or a new primary breast cancer". BMC Cancer 2023; 23:281. [PMID: 36978031 PMCID: PMC10044359 DOI: 10.1186/s12885-023-10764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Residual fibroglandular breast tissue (RFGT) following a mastectomy has been claimed to be associated with the occurrence of an in-breast local recurrence (IBLR) or new primary tumor (NP). Yet, scientific evidence proving this assumption is lacking. The primary aim of the study was to verify whether RFGT following a mastectomy is a risk factor for an IBLR or NP. METHODS This retrospective analysis included all patients that underwent a mastectomy and were followed up at the Department of Obstetrics and Gynecology of the Medical University of Vienna between 01.01.2015 and 26.02.2020. RFGT volume (assessed on magnetic resonance imaging) was correlated with the prevalence of an IBLR and a NP. RESULTS A total of 105 patients (126 breasts) following a therapeutic mastectomy were included. After a mean follow-up of 46.0 months an IBLR had occurred in 17 breasts and a NP in 1 breast. A significant difference in RFGT volume was observed between the disease-free cohort and the subgroup with an IBLR or NP (p = .017). A RFGT volume of ≥ 1153 mm3 increased the risk by the factor 3.57 [95%CI 1.27; 10.03]. CONCLUSIONS RFGT volume is associated with an increased risk for an IBLR or NP.
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Affiliation(s)
- Christine Deutschmann
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carmen Leser
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Kraus
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ricarda Korbatits
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alaa Marzogi
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Dietzel F, Kolberg L, Vesper AS, Hoffmann J, Nestle-Krämling C, Zwiefel K, Friebe V, Sawicki LM, Bruckmann NM, Jannusch K, Morawitz J, Antoch G, Fehm TN, Kirchner J, Mohrmann S. Factors Influencing Residual Glandular Breast Tissue after Risk-Reducing Mastectomy in Genetically Predisposed Individuals Detected by MRI Mammography. Cancers (Basel) 2023; 15:829. [PMID: 36765786 PMCID: PMC9913581 DOI: 10.3390/cancers15030829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
PURPOSE This study seeks to evaluate MR imaging morphological factors and other covariates that influence the presence of residual glandular tissue after risk-reducing mastectomy in patients with a familial predisposition. METHODS We analyzed women of a high-risk collective with pathogenic mutation (BRCA1 (n = 49), BRCA2 (n = 24), or further mutation (n = 9)). A total of 117 breasts were analyzed, 63 left and 54 right, from a cohort of 81 patients, who were on average 40 years old. The mean follow-up was 63 months (range 12-180 months, SD = 39.67). Retrospective analysis of MR imaging data from 2006-2022 of patients of a high-risk collective (all carriers of a pathogenic mutation) with contralateral (RRCM) or bilateral risk-reducing mastectomy (RRBM) was performed. In the image data the remaining skin flap thickness by distance measurements at eight equally distributed, clockwise points and the retromamillary area, as well as by volumetry of each breast, was elected. Residual glandular tissue was also volumetrized. In addition, patient-related covariates were recorded and their influence on postoperative residual glandular tissue and skin flap thickness was analyzed by uni- and multivariate regressions. RESULTS A significant association with postoperative residual glandular tissue was shown in multivariate analysis for the independent variables breast density, skin flap mean, and surgical method (all p-values < 0.01). A negatively significant association could be seen for the variables preoperative breast volume (p-values < 0.01) and surgeon experience (most p-values < 0.05-<0.1). CONCLUSION Postoperative residual glandular tissue is an important tool for quantifying the risk of developing breast cancer after risk-reducing mastectomy. Different effects on residual glandular tissue were shown for the independent variables breast density, skin flap, surgical method, preoperative breast volume, and surgeon experience, so these should be considered in future surgical procedures preoperatively as well as postoperatively. Breast MRI has proven to be a suitable method to analyze the skin flap as well as the RGT.
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Affiliation(s)
- Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Leoni Kolberg
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
- Department of Obstetrics and Gynecology, Agaplesion Bethesda Krankenhaus Wuppertal, 42109 Wuppertal, Germany
| | - Anne Sophie Vesper
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Jürgen Hoffmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | | | - Karin Zwiefel
- Breast Center, Kliniken der Stadt Köln, 51067 Köln, Germany
| | - Verena Friebe
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Lino M. Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
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Acea-Nebril B, García-Novoa A, García Jiménez L. The PreQ-20 TRIAL: A prospective cohort study of the oncologic safety, quality of life and cosmetic outcomes of patients undergoing prepectoral breast reconstruction. PLoS One 2022; 17:e0269426. [PMID: 35834508 PMCID: PMC9282436 DOI: 10.1371/journal.pone.0269426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Mastectomy currently constitutes a necessary surgical procedure in the oncologic setting and in the context of high risk. Prepectoral breast reconstruction (PBR) has been proposed as a surgical alternative to retropectoral techniques by providing less postoperative morbidity and a better cosmetic result. However, there is a lack of prospective studies that have evaluated its safety and patient-reported satisfaction.
Methods
We conducted a prospective cohort study to assess the safety, quality of life and cosmetic sequelae of PBR in women with breast cancer and high risk. The study’s main objective is to assess the safety of PBR in terms of postsurgical complications and the feasibility of reconstruction (loss of implants). The secondary objectives are to evaluate oncologic safety (local relapses, residual glandular tissue) and to identify factors related to quality of life and cosmetic sequelae. The evaluation of residual tissue will be conducted by MRI 12 to 18 months after the surgery, and the quality-of-life assessment will be performed using the Breast-Q questionnaire. An initial patient evaluation will be conducted 12–18 months after the surgery, and a second evaluation will be performed at 5 years. The estimated sample size is 81 patients.
Discussion
The PreQ-20 study will analyze the impact of PBR on 3 separate measures: safety, quality of life and cosmetic sequelae. Unlike other studies that analyzed these three measures jointly for women with breast cancer and high risk, this study will individualize the results for these 2 patient groups. This differentiation is necessary from the methodological point of view, given that the 2 patient groups have separate clinical and emotional implications. The assessment of these groups will focus on the following aspects: postoperative complications, local relapses, evaluation of residual glandular tissue and incidence rate of primary tumors in the same, the cosmetic sequelae and the satisfaction and the quality-of-life assessment by the patients.
Trial registration
ClinicalTrials.gov: NCT04642508.
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Affiliation(s)
- Benigno Acea-Nebril
- Breast Unit, Department of Surgery, University Hospital Complex A Coruña, A Coruña, Spain
| | - Alejandra García-Novoa
- Breast Unit, Department of Surgery, University Hospital Complex A Coruña, A Coruña, Spain
- * E-mail:
| | - Lourdes García Jiménez
- Breast Unit, Department of Surgery, University Hospital Complex A Coruña, A Coruña, Spain
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Pitiyarachchi O, Phillips KA, Friedlander M. Pregnancy induced hyperplasia of residual breast tissue following risk reducing contralateral mastectomy - simply interesting or a clinically important observation. Cancer Treat Res Commun 2022; 30:100504. [PMID: 34990902 DOI: 10.1016/j.ctarc.2021.100504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
After a diagnosis of breast cancer women with increased genetic risk often have a risk reducing contralateral mastectomy, and may opt for a nipple or skin sparing mastectomy with immediate reconstruction. A variable amount of residual breast tissue remains which may substantially increase in volume during pregnancy. Whether this increases later risk of breast cancer is unknown. We describe the clinical details of 3 patients with a history of unilateral breast cancer, including 2 with a BRCA mutation, who developed hyperplasia of residual breast tissue in the 3rd trimester of a later pregnancy. They all had a delayed contralateral risk reducing skin sparing mastectomy and immediate reconstruction. Pregnancy occurred some years later. We summarise their management, review the literature and raise questions for discussion. All developed prominent hyperplasia of breast tissue in the 3rd trimester that was clinically obvious asymmetrical breast swelling in the reconstructed contralateral breast. MRI demonstrated substantial breast tissue. The risk of breast cancer, particularly in those at high genetic risk developing in the residual breast tissue is unknown but in view of the volume, breast tissue was excised postpartum. This phenomenon of pregnancy induced hyperplasia of breast tissue after risk reducing mastectomy is not well described .There is residual breast tissue following a risk reducing subcutaneous mastectomy. The risk factors include age and skin flap thickness. MRI can demonstrate the residual breast tissue. Pregnancy induced hyperplasia of residual breast tissue may occur after risk reducing mastectomy with a hypothetical increased risk of subsequent breast cancer.
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Affiliation(s)
- Omali Pitiyarachchi
- Department of Medical Oncology, Prince of Wales Hospital, Barker St, Randwick NSW 2031, Australia; Prince of Wales Clinical School, UNSW Medicine, Sydney, New South Wales, Australia
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Barker St, Randwick NSW 2031, Australia; Prince of Wales Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.
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Munhoz AM, Chala L, Melo GD, Azevedo Marques Neto AD, Tucunduva T. Clinical and MRI Evaluation of Silicone Gel Implants with RFID-M Traceability System: A Prospective Controlled Cohort Study Related to Safety and Image Quality in MRI Follow-Up. Aesthetic Plast Surg 2021; 45:2645-2655. [PMID: 34075463 DOI: 10.1007/s00266-021-02355-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND SmoothSilk implants (SSI) are the first generation of implants to incorporate a radio-frequency identification device (RFID-M), a non-invasive traceability system. Although the RFID-M is considered compatible with magnetic resonance imaging (MRI), the size of the artifact and its influence on breast tissue vary. This prospective study assessed safety and MRI issues in a cohort of breast reconstruction patients. METHODS Forty-four SSI were used for breast reconstruction in patients undergoing treatment for breast cancer. All patients were evaluated for magnetic field interactions, MRI-related heating and artifacts in a 1.5-T MRI unit using standard T1/T2-weighted sequences utilized in clinical assessment of breast tissue/implants. RESULTS Mean patient age was 41.5 years (27-53ys) and body mass index was 28+-6.44 kg/m2. In 18/22 patients (81.8%), mastectomies were unilateral. No patients reported local heat/discomfort. All implants showed RFID-M-related artifacts with an estimated mean volume in T1 of 42.9cm3 (26.2-63.6cm3; SD±8.6 and 95% CI, 40.37-45.45) and in T2 of 60.5cm3 (35.4-97.2cm3; SD±14.7 and 95% CI, 56.29-65.01). Artifact volume was smaller in T1 than in T2, to a statistically significant degree (p <0.001). There were no statistically significant differences in artifact volume according to surgical indication, breast side or implant volume. There were 4/44 (9%) cases of minor rotation (<45°). In all cases, adequate analysis of the breast tissue was performed. CONCLUSIONS The results demonstrate that SSI with RFID-M technology presented an artifact volume of 42.9cm3 and 60.5cm3 in T1 and T2 images, respectively. Our findings provide detailed information on the quality and location of MRI artifacts in a reconstructed cohort which can help guide clinical decision-making for patients. To our knowledge, this is the first time RFID-M breast implants have been prospectively evaluated for clinical and MRI issues in a cohort of reconstructive patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Breast Surgery Group, Plastic Surgery Division, Rua Mato Grosso, 306 cj.1706 Higienópolis ZIP, São Paulo, SP, 01239-040, Brazil.
- Plastic Surgery Department - Hospital Moriah, Hospital Sírio-Libanês, Rua Mato Grosso, 306 cj.1706 Higienópolis ZIP, São Paulo, SP, 01239-040, Brazil.
- Post-Graduation Course Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Luciano Chala
- Department of Breast Radiology, Fleury Imaging Center, São Paulo, Brazil
| | - Giselle de Melo
- Department of Breast Radiology, Fleury Imaging Center, São Paulo, Brazil
| | | | - Tatiana Tucunduva
- Department of Breast Radiology, Fleury Imaging Center, São Paulo, Brazil
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Kanana N, Ben David MA, Nissan N, Yagil Y, Shalmon A, Halshtok O, Gotlieb M, Faermann R, Klang E, Samoocha D, Yassin M, Davidson T, Zippel D, Madorsky Feldman D, Friedman E, Kaidar-Person O, Sklair Levy M. Post-mastectomy surveillance of BRCA1/BRCA2 mutation carriers: Outcomes from a specialized clinic for high-risk breast cancer patients. Breast J 2021; 27:441-447. [PMID: 33576117 DOI: 10.1111/tbj.14190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
Female BRCA1/BRCA2 mutation carriers may elect bilateral risk-reducing mastectomy. There is a paucity of data on yield of imaging surveillance after risk-reducing mastectomy. This retrospective study focused on female BRCA1/BRCA2 mutation carriers who underwent bilateral mastectomy either as primary preventative, or as secondary preventative, after breast cancer diagnosis. All participants underwent breast imaging at 6- to 12-month intervals after mastectomy. Data on subsequent breast cancer diagnosis and timing were collected and compared between the groups. Overall, 184 female mutation carriers (134 BRCA1, 45 BRCA2, 5 both BRCA genes) underwent bilateral mastectomy after initial breast cancer diagnosis, between April 1, 2009 and August 31, 2018. During a mean follow-up of 6.2 ± 4.2 years, 13 (7.06%) were diagnosed with breast cancer; 12 ipsilateral (range: 0.4-28.8 years) and 1 contralateral breast cancer, 15.9 years after surgery. On the contrary, among asymptomatic BRCA1 (n = 40) and BRCA2 (n = 13) mutation carriers who underwent primary risk-reducing mastectomy (mean age at surgery 39.5 ± 8.4 years); none has developed breast cancer after a mean follow-up of 5.4 ± 3.4 years. BRCA1/BRCA2 mutation carriers with prior disease who underwent risk-reducing mastectomy after breast cancer diagnosis are still prone for developing ipsi or contralateral breast cancer, and therefore may benefit from continues clinical and imaging surveillance, unlike BRCA1/BRCA2 mutation carriers who undergo primary preventative bilateral mastectomy.
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Affiliation(s)
- Nayroz Kanana
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Meirav A Ben David
- The Oncology Institute, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Noam Nissan
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Yael Yagil
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Anat Shalmon
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Osnat Halshtok
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Michael Gotlieb
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Renata Faermann
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Eyal Klang
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - David Samoocha
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Mohammad Yassin
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Dov Zippel
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Dana Madorsky Feldman
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Eitan Friedman
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel.,The Susanne Levy Gertner Oncogenetics Unit, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel.,The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel.,The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel.,GROW-School for Oncology and Developmental Biology (Maastro, Maastricht University, Maastricht, The Netherlands
| | - Miri Sklair Levy
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel.,The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Kaidar-Person O, Offersen BV, Boersma LJ, de Ruysscher D, Tramm T, Kühn T, Gentilini O, Mátrai Z, Poortmans P. A multidisciplinary view of mastectomy and breast reconstruction: Understanding the challenges. Breast 2021; 56:42-52. [PMID: 33610903 PMCID: PMC7905468 DOI: 10.1016/j.breast.2021.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
The current review paper was written in collaboration with breast cancer surgeons from the European Breast Cancer Research Association of Surgical Trialists (EUBREAST), a breast pathologist from the Danish Breast Cancer Group (DBCG), and representatives from the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer course. Herein we summarize the different mastectomies and reconstruction procedures and define high-risk anatomical areas for breast cancer recurrences, to further specify the challenges in the surgical procedure, histopathological evaluation, and target volumes in case of postmastectomy irradiation, as recommended by the ESTRO guidelines according to the surgical procedure. The paper has original figures and illustrations for all disciplines for in-depth understanding of the differences between the procedures. Mastectomy techniques and reconstruction evolved to improve cosmetic outcomes. Different techniques maybe associated with different amount of residual breast tissue. More data is needed to estimate who are the patients at risk for residual disease or recurrence. Multidisciplinary work needed to individualise treatment for optimal oncological outcomes while maintaining the significant improvements in achieving better cosmesis for these patients.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, At Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands.
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Liesbeth J Boersma
- GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Dirk de Ruysscher
- GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | - Oreste Gentilini
- Breast Surgery Unit, San Raffaele University Hospital, Milan, Italy
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, 1122, Budapest, Ráth György U 7, Hungary
| | - Philip Poortmans
- Iridium Kankernetwerk, 2610, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, 2610, Wilrijk-Antwerp, Belgium
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10
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Bernstein-Molho R, Laitman Y, Galper S, Jacobson G, Boursi B, Gal-Yam EN, Kaufman B, Friedman E, Kaidar-Person O. Locoregional Treatments and Ipsilateral Breast Cancer Recurrence Rates in BRCA1/2 Mutation Carriers. Int J Radiat Oncol Biol Phys 2020; 109:1332-1340. [PMID: 33259931 DOI: 10.1016/j.ijrobp.2020.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE There is a paucity of data on the rates of ipsilateral breast tumor recurrence (IBTR) in BRCA1/2-associated breast cancer (BC). Scarcer yet are outcomes data in BRCA1/2 mutation carriers in the setting of newer mastectomy techniques, such as skin-sparing mastectomies (SSM) and nipple-sparing mastectomies (NSM). METHODS Data were extracted from the medical records of BRCA1/2 carriers who were diagnosed with BC and treated at a single institution between 2006 and 2020. The data extracted included patient demographics, tumor characteristics, disease stage, surgical treatment, use of radiation therapy (RT), and disease outcome. RESULTS Overall, 255 BC patients with BRCA1/2 germline mutations were identified. Of these, 128 (50.2%) underwent a mastectomy (SSM or NSM in 82% of them), 76 (59.4%) without postmastectomy RT (non-PMRT) and 52 (40.6%) with PMRT, whereas 127 (49.8%) elected for breast-conserving treatment (BCT). The non-PMRT group had earlier disease stages (82.3% were Tis and T1N0) compared with the PMRT and BCT groups (3.6% and 48.1%, respectively; P < .05). The IBTR cumulative rate was 9 of 76 (11.8%) in the non-PMRT cohort compared with 0 of 52 in the PMRT group (P = .01) and 6 of 127 (4.7%) in the BCT group (P = .06). The cumulative incidences of IBTR at 5 and 10 years were 9.8% and 27.4%, respectively, in the non-PMRT group versus 2% and 11.3%, respectively, in the BCT group (P = .0183). No significant difference in overall survival was observed at the time of follow-up. CONCLUSIONS BRCA1/2 mutation carriers treated with mastectomy without PMRT had higher rates of IBTR than those who underwent mastectomy and PMRT or BCT, despite earlier stages of disease. The safety of SSM/NSM should be evaluated in a prospective trial.
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Affiliation(s)
- Rinat Bernstein-Molho
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yael Laitman
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shira Galper
- Breast Radiation Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Galia Jacobson
- Breast Radiation Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ben Boursi
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Gastrointestinal Oncology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Einav Nili Gal-Yam
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; The Pinchas Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Bella Kaufman
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; The Meirav High-Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Orit Kaidar-Person
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Breast Radiation Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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11
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Spatial location of local recurrences after mastectomy: a systematic review. Breast Cancer Res Treat 2020; 183:263-273. [PMID: 32661665 DOI: 10.1007/s10549-020-05774-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE We performed a systematic review to document the spatial location of local recurrences (LR) after mastectomy. METHODS A PubMed search was conducted in August 2019 for the following terms: breast [Title/Abstract] AND cancer [Title/Abstract] AND recurrence [Title/Abstract] AND mastectomy [Title/Abstract]. The search was filtered for English language. Exclusion criteria included studies that did not specify the LR location or studies reporting LR associated with inflammatory breast cancer, or other breast cancers such as phyllodes tumours, lymphoma or associated with sarcoma/angiosarcoma. RESULTS A total of 3922 titles were identified, of which 21 publications were eligible for inclusion in the final analysis. A total of 6901 mastectomy patients were included (range 25-1694). The mean LR proportion was 3.5%. Among the total of 351 LR lesions, 81.8% were in the subcutaneous tissue and the skin, while 16% were pectoral muscle recurrences. CONCLUSION Local recurrences are mostly located within the subcutaneous tissue and the skin, assumed to result from unrecognized/subclinical tumour foci left behind after mastectomy, surgical implantation of tumour cells in the wound/scar and/or tumour emboli within the subcutaneous lymphatics. Pectoral muscle recurrences are less frequent and may be attributed to residual disease along the posterior surgical margin and/or lymphatic involvement.
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12
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Gaskin KM, Peoples GE, McGhee DE. The Attachments of the Breast to the Chest Wall: A Dissection Study. Plast Reconstr Surg 2020; 146:11e-22e. [PMID: 32590636 DOI: 10.1097/prs.0000000000006954] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The anatomical descriptions of the attachments of the female breast to the chest wall vary in their structure, location, and terminology within the published literature. METHODS A dissection study of the attachments of the breast to the chest wall was conducted on 18 female embalmed breasts in the coronal (n = 15) and sagittal planes (n = 3). RESULTS Perimeter, posterior wall, and horizontal septum attachments were observed. The perimeter along its entire length was attached to the chest wall. Regional and anatomical variation was observed in this structure and location. Sharp dissection was required to remove it from the chest wall, in contrast to the blunt dissection required to remove the posterior wall and horizontal septum attachments. CONCLUSIONS The breast attaches to the chest wall along its entire perimeter, posterior wall, and horizontal septum, with the perimeter functioning as the primary anchor of the breast to the chest wall. The structure of the perimeter attachment is both periosteal and fascial and requires sharp dissection to remove it from the chest wall. The fascial structures of the posterior wall and horizontal septum require blunt dissection only. The structure of the perimeter has regional variation, and its location on the chest wall has anatomical variation. Detailed anatomical descriptions and illustrations are supported by photographic evidence of cadaver dissections in two planes. Clinical and anatomical terminology are linked, with clinical implications for medical anatomy education, breast modeling, and breast surgery.
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Affiliation(s)
- Kathryn M Gaskin
- From the Anatomy Laboratory, School of Medicine, University of Wollongong
| | - Gregory E Peoples
- From the Anatomy Laboratory, School of Medicine, University of Wollongong
| | - Deirdre E McGhee
- From the Anatomy Laboratory, School of Medicine, University of Wollongong
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13
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Kaidar-Person O, Boersma LJ, Poortmans P, Sklair-Levy M, Offersen BV, Cardoso MJ, de Ruysscher D. Residual Glandular Breast Tissue After Mastectomy: A Systematic Review. Ann Surg Oncol 2020; 27:2288-2296. [PMID: 32390098 DOI: 10.1245/s10434-020-08516-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The goal of mastectomy is remove all of the glandular breast tissue (BGT) without compromising skin flaps viability. The purpose of this systematic review was to localize and/or estimate the amount of residual BGT (rBGT) after mastectomy and to identify factors that could be related to rBGT and/or residual disease. METHODS We conducted a PubMed search. The report was subdivided according to the method used to evaluate the presence of rBGT. A total of 16 publications were included in our final report. Two main methods for identifying rBGT included imaging (i.e., MRI scan) and histological evaluation at the time of mastectomy. RESULTS The rate of rBGT was reported in up to 100% of the patients and was found to be associated mainly with the type of surgical resection, indication, and surgeon's expertise. Residual breast tissue can be found in all areas of the remaining chest wall, mostly in the skin-flaps, and more frequently underneath the nipple-areola complex.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Radiation Unit at Sheba Medical Center, Ramat Gan, Israel. .,GROW-School for Oncology and Developmental Biology or GROW, Maastricht University, Maastricht, The Netherlands.
| | - Liesbeth J Boersma
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Miri Sklair-Levy
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria-Joao Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalilaud Foundation and Nova Medical School, Lisbon, Portugal
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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14
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Poortmans PMP, Takanen S, Marta GN, Meattini I, Kaidar-Person O. Winter is over: The use of Artificial Intelligence to individualise radiation therapy for breast cancer. Breast 2020; 49:194-200. [PMID: 31931265 PMCID: PMC7375562 DOI: 10.1016/j.breast.2019.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/16/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023] Open
Abstract
Artificial intelligence demonstrated its value for automated contouring of organs at risk and target volumes as well as for auto-planning of radiation dose distributions in terms of saving time, increasing consistency, and improving dose-volumes parameters. Future developments include incorporating dose/outcome data to optimise dose distributions with optimal coverage of the high-risk areas, while at the same time limiting doses to low-risk areas. An infinite gradient of volumes and doses to deliver spatially-adjusted radiation can be generated, allowing to avoid unnecessary radiation to organs at risk. Therefore, data about patient-, tumour-, and treatment-related factors have to be combined with dose distributions and outcome-containing databases.
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Affiliation(s)
| | - Silvia Takanen
- Institut Curie, Department of Radiation Oncology, Paris, France
| | - Gustavo Nader Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, Brazil; Department of Radiology and Oncology - Radiation Oncology, Instituto Do Câncer Do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Orit Kaidar-Person
- Radiation Oncology Unit, Breast Radiation Unit, Sheba Tel Ha'shomer, Ramat Gan, Israel
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15
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Grinstein O, Krug B, Hellmic M, Siedek F, Malter W, Burke C, Schmutzler R, Maintz D, Rhiem K. Residual glandular tissue (RGT) in BRCA1/2 germline mutation carriers with unilateral and bilateral prophylactic mastectomies. Surg Oncol 2019; 29:126-133. [PMID: 31196476 DOI: 10.1016/j.suronc.2019.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/21/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prophylactic mastectomy (PME) is increasingly performed in women carrying deleterious BRCA1 and BRCA2 germline mutations. The oncologic risk resulting from residual fibroglandular tissue (RGT) is unknown. METHODS All women who had received a mastectomy and at least one postoperative breast MRI, between 2006 and 2016 were extracted from the register of the Center for Hereditary Breast and Ovarian Cancer Cologne (CHBOC). The index MRI was evaluated in terms of basic clinical data and the morphological criteria of RGT. The RGT volume was measured in diameter and was semi-automatically evaluated using software. RESULTS We identified 169 women carrying BRCA1/2 mutations who underwent prophylactic and curative mastectomy: a total of 338 breasts. RGT was found in 128 of the 338 breasts (37.9%). 68 of the 128 breasts (53.1%) were related to bilateral PME, 37 (28.9%) to unilateral PME and 23 (18.0%) to curative mastectomy. RGT was predominantly unifocal and located in the retroareolar breast region. RGT was observed more often after bilateral PME (p < 0.0001). In this subgroup, the nipple-sparing mastectomy dominated (108 of 136, 79.4%), in contrast to 23 standard mastectomies (23 of 94, 24.5%) in the subgroup of curative mastectomy (23%). There was a trend towards higher amounts of RGT in surgical units with fewer mastectomies performed. During follow-up, two breast cancers were detected after bilateral and unilateral PME, respectively. CONCLUSIONS Our results suggest that the indication for surgery and in particular the selected surgical procedure affect the surgical outcome with respect to RGT. Oncological safety should not be neglected, especially in the high-risk group of BRCA1/2 mutation carriers.
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Affiliation(s)
- Olga Grinstein
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Barbara Krug
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | - Martin Hellmic
- Institute of Medical Statistics and Bioinformatics, University of Cologne, Germany
| | - Florian Siedek
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Wolfram Malter
- Breast Center, Department of Gynaecology and Obstetrics, University Hospital of Cologne, Germany
| | - Christina Burke
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Germany
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16
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Giannotti DG, Hanna SA, Cerri GG, Barbosa Bevilacqua JL. Analysis of Skin Flap Thickness and Residual Breast Tissue After Mastectomy. Int J Radiat Oncol Biol Phys 2018; 102:82-91. [DOI: 10.1016/j.ijrobp.2018.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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