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Meshulam-Derazon S, Yaacobi DS, Ben-David MA, Lvovsky A, Hadanny A, Ganor O, Amir A, Ad-El D, Wertman M. Identifying the Variables for Oncoplastic Reconstruction: Preoperative Assessment Tool for Breast Conserving Treatment. Aesthetic Plast Surg 2024; 48:2439-2446. [PMID: 37872221 DOI: 10.1007/s00266-023-03701-8] [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: 07/14/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND A wide range of surgical techniques has been described for breast conservation treatment (Oncoplasty) based on breast size and shape, as well as tumor size and location. However, there is a lack of standardization regarding the indications for oncoplastic reconstruction. This study aims to identify the presurgical parameters associated with poor cosmetic outcomes post-breast conserving treatment. We hope this preoperative model can assist in evaluating whether there is a need for oncoplastic intervention. METHODS The study group involved 136-adult females (age 35-77) who previously undergone breast conserving surgery and radiation, without oncoplastic intervention between 2007 and 2017. Patient demographics, medical and physical parameters were collected, and each patient filled Breast-QTM-questionnaire and six angles' photographs were taken. Patients' photographs were evaluated by 15 board-certified plastic surgeons. Both univariate and multivariate logistic regression analysis was performed to identify potential confounders for poor outcome in each of the experts' and patients' average-grades. RESULTS Our analysis identified several variables correlated with poor surgical outcome: high BMI, high chest-wall-circumference, high breast-width and larger volume-removed. The general-aesthetic-result as evaluated by our experts was favorably influenced by an upper lateral quadrant tumor while the breast shape was negatively influenced by a lower medial quadrant tumor. Interestingly, no correlation was found between the patients' and panel's evaluations, nor did we find any clinically significant parameter related to the patients' reported well-being. CONCLUSION Patients with high BMI, high chest-wall-circumference, large breast-width and larger inferomedial tumors could benefit from early plastic surgery evaluation and intervention. Patient's psychosocial well-being as well as sexual well-being are independent from positive surgical outcome evaluated by plastic surgeons. LEVEL OF EVIDENCE III 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)
- Sagit Meshulam-Derazon
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel
| | - Dafna Shilo Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel.
| | - Merav A Ben-David
- Radiation Oncology Department, Assuta Medical Center, Tel-Aviv, Israel AND Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alex Lvovsky
- Head of Forensic Identification Department, Israel Defense Forces, Medical Corps, Tel Aviv, Israel
| | - Amir Hadanny
- Yitzhak Shamir Medical Center, Affiliated with the Tel Aviv University School of medicine, Zriffin, Israel
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Avraham Amir
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel
| | - Dean Ad-El
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel
| | - Maya Wertman
- Department of Surgery, Kaplan Medical Center, Rehovot and the Hebrew University Medical School, Jerusalem, Israel
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Fearn N, Llanos C, Dylke E, Stuart K, Kilbreath S. Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review. J Cancer Surviv 2023; 17:1669-1687. [PMID: 36301407 PMCID: PMC10539190 DOI: 10.1007/s11764-022-01278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/15/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures. METHOD Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence. RESULTS Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast). CONCLUSIONS Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures. IMPLICATIONS FOR CANCER SURVIVORS There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.
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Affiliation(s)
- Nicola Fearn
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia
| | - Catalina Llanos
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - Elizabeth Dylke
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia
| | - Kirsty Stuart
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | - Sharon Kilbreath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia.
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Harbin Z, Sohutskay D, Vanderlaan E, Fontaine M, Mendenhall C, Fisher C, Voytik-Harbin S, Tepole AB. Computational mechanobiology model evaluating healing of postoperative cavities following breast-conserving surgery. Comput Biol Med 2023; 165:107342. [PMID: 37647782 PMCID: PMC10581740 DOI: 10.1016/j.compbiomed.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through Gaussian process surrogates. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.
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Affiliation(s)
- Zachary Harbin
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - David Sohutskay
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Vanderlaan
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muira Fontaine
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
| | - Carly Mendenhall
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - Carla Fisher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sherry Voytik-Harbin
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Department of Basic Medical Sciences Purdue University, West Lafayette, IN, USA
| | - Adrian Buganza Tepole
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA; Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA.
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4
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Wijesinghe K, Abeywickrama T, Chamara Y, De Silva S, Tharshan S, Jayarajah U, De Silva A. Oncoplastic breast conserving surgery versus standard breast conserving surgery for early and locally advanced breast cancer: a retrospective analysis from Sri Lanka. BMC Surg 2023; 23:273. [PMID: 37697322 PMCID: PMC10496197 DOI: 10.1186/s12893-023-02182-5] [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: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Breast aesthetics is becoming increasingly important in breast cancer surgery due to changes in patient expectations and greater emphasis been placed on the psychosocial outcomes. Studies have shown no difference in local recurrence risk between mastectomy and breast conserving surgery (BCS) and also a higher overall survival rate after BCS. Breast preservation improves the quality of life substantially compared to mastectomy. Oncoplastic breast-conserving surgery (O-BCS) involves tumour excision whilst overcoming the limitations of standard breast conserving surgery (S-BCS) by allowing larger resection volumes, avoiding deformities with better aesthetic results. Our study aims to compare the oncosurgical and aesthetic outcomes of O-BCS versus S-BCS among women in Sri Lanka. METHODS We conducted a retrospective study over a 4-year period including patients who underwent breast conservation surgery for primary non-metastatic breast cancer in two tertiary care units. We assessed outcomes in terms of re-excision rates, resection margin, complications and aesthetic outcomes using a Likert scale questionnaire to grade specific outcomes such as symmetry, volume, nipple position, scar visibility. Non-parametric tests were used for statistical analyses. RESULTS Fifty-four and seventy-three patients underwent S-BCS and O-BCS respectively. The median specimen volume and the maximum tumour diameter were significantly higher in O-BCS [160(range:65-220); 4.2(range: 1.2-5.2)] compared to S-BCS [65(range:45-86); 2.4(range: 1.0-2.6)]. The median closest tumour margin was 16 mm (range:4-25 mm) in O-BCS while 6 mm (range:<1 - 12 mm) in S-BCS (p = 0.01). Close (< 1 mm) and positive margins needing re-excision were seen mostly in S-BCS. Superior aesthetic outcomes with statistical significant difference were reported in the O-BCS compared to S-BCS group with better symmetry, volume, nipple position and scar visibility. The re-excision rates were significantly lower in O-BCS group. There was no significant difference in the operative time and complications while the aesthetic outcomes were significantly superior in OBCS. CONCLUSIONS Overall, Level 2 perforator flap based reconstruction had superior aesthetic outcomes. O-BCS is safe and more aesthetically acceptable with no difference in oncological outcome and operative time. More consideration should be given to aesthetic parameters such as scar visibility, nipple position, breast volume and shape when considering the best surgical option for the patients.
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Affiliation(s)
- Kanchana Wijesinghe
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka.
| | | | - Yohan Chamara
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka
| | - Sumali De Silva
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Umesh Jayarajah
- University Surgical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - Ajith De Silva
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Muradali D, Fletcher GG, Cordeiro E, Fienberg S, George R, Kulkarni S, Seely JM, Shaheen R, Eisen A. Preoperative Breast Magnetic Resonance Imaging: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline. Curr Oncol 2023; 30:6255-6270. [PMID: 37504323 PMCID: PMC10378361 DOI: 10.3390/curroncol30070463] [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: 05/12/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The use of preoperative breast magnetic resonance imaging (MRI) after the diagnosis of breast cancer by mammography and/or ultrasound is inconsistent. METHODS After conducting a systematic review and meta-analysis comparing preoperative breast MRI versus no MRI, we reconvened to prepare a clinical practice guideline on this topic. RESULTS Based on the evidence that MRI improved recurrence, decreased the rates of reoperations (re-excisions or conversion mastectomy), and increased detection of synchronous contralateral breast cancer, we recommend that preoperative breast MRI should be considered on a case-by-case basis in patients diagnosed with breast cancer for whom additional information about disease extent could influence treatment. Based on stronger evidence, preoperative breast MRI is recommended in patients diagnosed with invasive lobular carcinoma for whom additional information about disease extent could influence treatment. For both recommendations, the decision to proceed with MRI would be conditional on shared decision-making between care providers and the patient, taking into account the benefits and risks of MRI as well as patient preferences. Based on the opinion of the Working Group, preoperative breast MRI is also recommended in the following more specific situations: (a) to aid in surgical planning of breast conserving surgery in patients with suspected or known multicentric or multifocal disease; (b) to identify additional lesions in patients with dense breasts; (c) to determine the presence of pectoralis major muscle/chest wall invasion in patients with posteriorly located tumours or when invasion of the pectoralis major muscle or chest wall is suspected; (d) to aid in surgical planning for skin/nipple-sparing mastectomies, autologous reconstruction, oncoplastic surgery, and breast conserving surgery with suspected nipple/areolar involvement; and (e) in patients with familial/hereditary breast cancer but who have not had recent breast MRI as part of screening or diagnosis.
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Affiliation(s)
- Derek Muradali
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Glenn G Fletcher
- Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Ralph George
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Supriya Kulkarni
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Jean M Seely
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Rola Shaheen
- Department of Radiology, Queen's University, Kingston, ON K7L 3N6, Canada
- Diagnostic Imaging, Peterborough Regional Health Centre, Peterborough, ON K9J 7C6, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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6
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Harbin Z, Sohutskay D, Vanderlaan E, Fontaine M, Mendenhall C, Fisher C, Voytik-Harbin S, Tepolea AB. Computational Mechanobiology Model Evaluating Healing of Postoperative Cavities Following Breast-Conserving Surgery. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.26.538467. [PMID: 37162899 PMCID: PMC10168325 DOI: 10.1101/2023.04.26.538467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through the Gaussian Process. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.
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Affiliation(s)
- Zachary Harbin
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - David Sohutskay
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Vanderlaan
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muira Fontaine
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
| | - Carly Mendenhall
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - Carla Fisher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sherry Voytik-Harbin
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Department of Basic Medical Sciences Purdue University, West Lafayette, IN, USA
| | - Adrian Buganza Tepolea
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
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7
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Fearn N, Meybodi F, Kilbreath S, Dylke E, Llanos C, Swanton C, Stuart K. Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging. Lymphat Res Biol 2022. [PMID: 36154463 DOI: 10.1089/lrb.2022.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC). Methods and Results: Retrospective three-dimensional surface imaging (3D-SI) of 100 breasts taken before or after breast conserving surgery for breast cancer were retrieved for reliability analysis. Three assessors followed a standardized measurement technique using two software programs, Vectra® 3D Analysis Module (VAM) and Breast Sculptor®. Mean breast volume was 489.9 ± 206 cc using VAM and 480.1 ± 229.1 cc using Breast Sculptor. Lin's concordance showed poor agreement between programs (0.81-0.88). Measurements using VAM had excellent intra- and inter-rater reliability with SEM = 4.1% for one assessor and 8.7% for multiple assessors. Breast Sculptor also had excellent intra-rater and substantial inter-rater reliability but the SEM was much larger at 14.5% (intra-rater) and 19.1% (inter-rater). The SDC value was lowest for VAM and a single rater with 56 cc indicating a meaningful change beyond measurement error. Conclusion: Breast volume measurements captured with 3D-SI using VECTRA-XT are highly reliable, but the volumes, SEM, and SDC varied between the two software programs. Measurement error was lowest with VAM software. Although the usefulness of VECTRA-XT and VAM software to detect change in breast volume is promising, further solutions to reduce measurement error are required to improve clinical utility to measure breast lymphedema.
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Affiliation(s)
- Nicola Fearn
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Farid Meybodi
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Sharon Kilbreath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Elizabeth Dylke
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catalina Llanos
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Carmen Swanton
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Kirsty Stuart
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia.,Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
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8
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Joukainen S, Laaksonen E, Vanninen R, Kaarela O, Sudah M. Dual-Layer Rotation: A Versatile Therapeutic Mammoplasty Technique. Ann Surg Oncol 2022; 29:6716-6727. [PMID: 35711016 PMCID: PMC9492593 DOI: 10.1245/s10434-022-11977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Background Multifocal or complex breast lesions are a challenge for breast-conserving surgery, particularly surgery in small breasts or those located in the upper inner quadrant. The dual-layer rotation technique exploits the idea of manipulating the skin and glandular tissue in separate layers to fill the resection cavity via vertical mammoplasty if skin excision is not required, except in the central area. Methods The authors performed a retrospective review of consecutive breast cancer patients who underwent DLR mammoplasty between 2017 and 2019 at a single institution. Clinical data, reoperations, surgical complications, delays in adjuvant treatments, and the need for late revisional surgery were evaluated. Aesthetic outcomes were evaluated objectively and subjectively from photographs. Results The study included 46 breasts of 40 patients. Tumors were located in the UIQ (30%, 14/46) or in multiple quadrants (22%, 10/46). One third (33%, 13/40) of the patients had a small breast cup size (A–B). Negative margins were primarily achieved in 45 of the 46 breasts. Major complications occurred in three patients, who needed reoperation, and adjuvant therapy was delayed for one of these patients. Late refinement surgery was needed for two patients. The objective and subjective aesthetic outcomes were good or excellent regardless of the tumor position. Conclusion As a novel oncoplastic approach, DLR mammoplasty offers a one-step procedure to treat selected breast cancer patients with challenging resection defects due to different breast sizes or lesion locations. The technique preserves the breast’s natural appearance.
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Affiliation(s)
- Sarianna Joukainen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Elina Laaksonen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarela
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Mazen Sudah
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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9
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Mátrai Z, Kelemen P, Kósa C, Maráz R, Paszt A, Pavlovics G, Sávolt Á, Simonka Z, Tóth D, Kásler M, Kaprin A, Krivorotko P, Vicko F, Pluta P, Kolacinska-Wow A, Murawa D, Jankau J, Ciesla S, Dyttert D, Sabol M, Zhygulin A, Avetisyan A, Bessonov A, Lázár G. Modern Breast Cancer Surgery 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610377. [PMID: 35783360 PMCID: PMC9240205 DOI: 10.3389/pore.2022.1610377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/29/2022] [Indexed: 12/16/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Affiliation(s)
- Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Péter Kelemen
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Csaba Kósa
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Róbert Maráz
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Attila Paszt
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
| | | | - Ákos Sávolt
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Zsolt Simonka
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
| | - Dezső Tóth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Miklós Kásler
- Minister of Human Capacities, Government of Hungary, Budapest, Hungary
| | - Andrey Kaprin
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Russian Academy of Sciences, Moscow, Russia
| | - Petr Krivorotko
- N.N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Ferenc Vicko
- Medical Faculty Novi Sad, Oncology Institute of Vojvodina Sremska Kamenica, University of Novi Sad, Novi Sad, Serbia
| | - Piotr Pluta
- Department of Surgical Oncology and Breast Diseases, Polish Mother’s Memorial Hospital–Research Institute in Lodz, Lodz, Poland
| | - Agnieszka Kolacinska-Wow
- Department of Head and Neck Cancer Surgery, Medical University of Lodz, Lodz, Poland
- Department of Surgical Oncology, Cancer Center, Medical University of Lodz, Lodz, Poland
| | - Dawid Murawa
- Clinic of Surgical Oncology, Poznan University of Medical Sciences, Poznan, Poland
- General and Oncological Surgery Clinic, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Jerzy Jankau
- Plastic Surgery Department, Medical University of Gdańsk/University Hospitals, Gdansk, Poland
| | - Slawomir Ciesla
- General and Oncological Surgery Clinic, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Daniel Dyttert
- Department of Surgical Oncology, St. Elisabeth Cancer Institute, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Martin Sabol
- Department of Surgical Oncology, St. Elisabeth Cancer Institute, Medical Faculty, Comenius University, Bratislava, Slovakia
| | | | | | - Alexander Bessonov
- Breast Cancer Department of the LOKOD, N.N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - György Lázár
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
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10
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Baliski C, Bakos B. Patient reported outcomes following breast conserving surgery are improved by minimizing re-excisions and excessive breast tissue removal. Am J Surg 2022; 224:716-721. [DOI: 10.1016/j.amjsurg.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
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11
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Karadeniz Cakmak G. Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty. Breast Care (Basel) 2022; 16:559-573. [PMID: 35087359 DOI: 10.1159/000518992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. SUMMARY The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. KEY MESSAGES The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient's satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.
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12
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Nanda A, Hu J, Hodgkinson S, Ali S, Rainsbury R, Roy PG. Oncoplastic breast-conserving surgery for women with primary breast cancer. Cochrane Database Syst Rev 2021; 10:CD013658. [PMID: 34713449 PMCID: PMC8554646 DOI: 10.1002/14651858.cd013658.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oncoplastic breast-conserving surgery (O-BCS) involves removing the tumour in the breast and using plastic surgery techniques to reconstruct the breast. The adequacy of published evidence on the safety and efficacy of O-BCS for the treatment of breast cancer compared to other surgical options for breast cancer is still debatable. It is estimated that the local recurrence rate is similar to standard breast-conserving surgery (S-BCS) and also mastectomy, but the aesthetic and patient-reported outcomes may be improved with oncoplastic techniques. OBJECTIVES Our primary objective was to assess oncological control outcomes following O-BCS compared with other surgical options for women with breast cancer. Our secondary objective was to assess surgical complications, recall rates, need for further surgery to achieve adequate oncological resection, patient satisfaction through patient-reported outcomes, and cosmetic outcomes through objective measures or clinician-reported outcomes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via OVID), Embase (via OVID), the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov on 7 August 2020. We did not apply any language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and non-randomised comparative studies (cohort and case-control studies). Studies evaluated any O-BCS technique, including volume displacement techniques and partial breast volume replacement techniques compared to any other surgical treatment (partial resection or mastectomy) for the treatment of breast cancer. DATA COLLECTION AND ANALYSIS Four review authors performed data extraction and resolved disagreements. We used ROBINS-I to assess the risk of bias by outcome. We performed descriptive data analysis and meta-analysis and evaluated the quality of the evidence using GRADE criteria. The outcomes included local recurrence, breast cancer-specific disease-free survival, re-excision rates, complications, recall rates, and patient-reported outcome measures. MAIN RESULTS We included 78 non-randomised cohort studies evaluating 178,813 women. Overall, we assessed the risk of bias per outcome as being at serious risk of bias due to confounding; where studies adjusted for confounding, we deemed these at moderate risk. Comparison 1: oncoplastic breast-conserving surgery (O-BCS) versus standard-BCS (S-BCS) The evidence in the review found that O-BCS when compared to S-BCS, may make little or no difference to local recurrence; either when measured as local recurrence-free survival (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.61 to 1.34; 4 studies, 7600 participants; very low-certainty evidence) or local recurrence rate (HR 1.33, 95% CI 0.96 to 1.83; 4 studies, 2433 participants; low-certainty evidence), but the evidence is very uncertain due to most studies not controlling for confounding clinicopathological factors. O-BCS compared to S-BCS may make little to no difference to disease-free survival (HR 1.06, 95% CI 0.89 to 1.26; 7 studies, 5532 participants; low-certainty evidence). O-BCS may reduce the rate of re-excisions needed for oncological resection (risk ratio (RR) 0.76, 95% CI 0.69 to 0.85; 38 studies, 13,341 participants; very low-certainty evidence), but the evidence is very uncertain. O-BCS may increase the number of women who have at least one complication (RR 1.19, 95% CI 1.10 to 1.27; 20 studies, 118,005 participants; very low-certainty evidence) and increase the recall to biopsy rate (RR 2.39, 95% CI 1.67 to 3.42; 6 studies, 715 participants; low-certainty evidence). Meta-analysis was not possible when assessing patient-reported outcomes or cosmetic evaluation; in general, O-BCS reported a similar or more favourable result, however, the evidence is very uncertain due to risk of bias in the measurement methods. Comparison 2: oncoplastic breast-conserving surgery (O-BCS) versus mastectomy alone O-BCS may increase local recurrence-free survival compared to mastectomy but the evidence is very uncertain (HR 0.55, 95% CI 0.34 to 0.91; 2 studies, 4713 participants; very low-certainty evidence). The evidence is very uncertain about the effect of O-BCS on disease-free survival as there were only data from one study. O-BCS may reduce complications compared to mastectomy, but the evidence is very uncertain due to high risk of bias mainly resulting from confounding (RR 0.75, 95% CI 0.67 to 0.83; 4 studies, 4839 participants; very low-certainty evidence). Data on patient-reported outcome measures came from single studies; it was not possible to meta-analyse the data. Comparison 3: oncoplastic breast-conserving surgery (O-BCS) versus mastectomy with reconstruction O-BCS may make little or no difference to local recurrence-free survival (HR 1.37, 95% CI 0.72 to 2.62; 1 study, 3785 participants; very low-certainty evidence) or disease-free survival (HR 0.45, 95% CI 0.09 to 2.22; 1 study, 317 participants; very low-certainty evidence) when compared to mastectomy with reconstruction, but the evidence is very uncertain. O-BCS may reduce the complication rate compared to mastectomy with reconstruction (RR 0.49, 95% CI 0.45 to 0.54; 5 studies, 4973 participants; very low-certainty evidence) but the evidence is very uncertain due to high risk of bias from confounding and inconsistency of results. The evidence is very uncertain for patient-reported outcome measures and cosmetic evaluation. AUTHORS' CONCLUSIONS The evidence is very uncertain regarding oncological outcomes following O-BCS compared to S-BCS, though O-BCS has not been shown to be inferior. O-BCS may result in less need for a second re-excision surgery but may result in more complications and a greater recall rate than S-BCS. It seems that O-BCS may give better patient satisfaction and surgeon rating for the look of the breast, but the evidence for this is of poor quality, and due to lack of numerical data, it was not possible to pool the results of different studies. It seems O-BCS results in fewer complications compared with surgeries involving mastectomy. Based on this review, no certain conclusions can be made to help inform policymakers. The surgical decision for what operation to proceed with should be made jointly between clinician and patient after an appropriate discussion about the risks and benefits of O-BCS personalised to the patient, taking into account clinicopathological factors. This review highlighted the deficiency of well-conducted studies to evaluate efficacy, safety and patient-reported outcomes following O-BCS.
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Affiliation(s)
- Akriti Nanda
- Department of Breast Surgery, Oxford University Hospitals, Oxford, UK
| | - Jesse Hu
- Division of Breast Surgery, National University Health System, Singapore, Singapore
| | - Sarah Hodgkinson
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Sanah Ali
- Medical School, Oxford University, Oxford, UK
| | | | - Pankaj G Roy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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13
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Fitzal F, Bolliger M, Dunkler D, Geroldinger A, Gambone L, Heil J, Riedel F, de Boniface J, Andre C, Matrai Z, Pukancsik D, Paulinelli RR, Ostapenko V, Burneckis A, Ostapenko A, Ostapenko E, Meani F, Harder Y, Bonollo M, Alberti ASM, Tausch C, Papassotiropoulos B, Helfgott R, Heck D, Fehrer HJ, Acko M, Schrenk P, Trapp EK, Gunda PT, Clara P, Montagna G, Ritter M, Blohmer JU, Steffen S, Romics L, Morrow E, Lorenz K, Fehr M, Weber WP. Retrospective, Multicenter Analysis Comparing Conventional with Oncoplastic Breast Conserving Surgery: Oncological and Surgical Outcomes in Women with High-Risk Breast Cancer from the OPBC-01/iTOP2 Study. Ann Surg Oncol 2021; 29:1061-1070. [PMID: 34647202 PMCID: PMC8724061 DOI: 10.1245/s10434-021-10809-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
Introduction Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI. Supplementary information The online version contains supplementary material available at 10.1245/s10434-021-10809-1.
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Affiliation(s)
- Florian Fitzal
- Department of General Surgery and Breast Health Center, Medical University Vienna, Vienna, Austria.
| | - Michael Bolliger
- Department of General Surgery and Breast Health Center, Medical University Vienna, Vienna, Austria
| | - Daniela Dunkler
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Angelika Geroldinger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Luca Gambone
- Department of General Surgery and Breast Health Center, Medical University Vienna, Vienna, Austria
| | - Jörg Heil
- Departement of Obstetrics and Gynecology, Breast Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- Departement of Obstetrics and Gynecology, Breast Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Departemt of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
| | - Camilla Andre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Zoltan Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Dávid Pukancsik
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Regis R Paulinelli
- Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil
| | - Valerijus Ostapenko
- National Cancer Institute Vilnius Lithuania, Vilnius, Lithuania.,Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
| | - Arvydas Burneckis
- National Cancer Institute Vilnius Lithuania, Vilnius, Lithuania.,Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
| | - Andrej Ostapenko
- National Cancer Institute Vilnius Lithuania, Vilnius, Lithuania.,Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
| | - Edvin Ostapenko
- National Cancer Institute Vilnius Lithuania, Vilnius, Lithuania.,Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
| | - Francesco Meani
- Centro di Senologia della Svizzera Italiana (CSSI), Lugano, Switzerland.,Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Yves Harder
- Centro di Senologia della Svizzera Italiana (CSSI), Lugano, Switzerland.,Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Marta Bonollo
- Centro di Senologia della Svizzera Italiana (CSSI), Lugano, Switzerland.,Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Andrea S M Alberti
- Centro di Senologia della Svizzera Italiana (CSSI), Lugano, Switzerland.,Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | | | - Ruth Helfgott
- Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Dietmar Heck
- Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Hans-Jörg Fehrer
- Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Markus Acko
- Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Peter Schrenk
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elisabeth K Trapp
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Paliczek Clara
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Giacomo Montagna
- Breast Center, University Hospital of Basel, Basel, Switzerland.,Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mathilde Ritter
- Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité University Hospital Campus Charité-Mitte, Berlin, Germany
| | - Sander Steffen
- Clinical Cancer Registry, Charité Comprehensive Cancer Center (CCCC), University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany
| | - Laszlo Romics
- New Victoria Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Elizabeth Morrow
- Department of Academic Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Katharina Lorenz
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Mathias Fehr
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Walter Paul Weber
- Breast Center, University Hospital of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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14
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Boukovalas S, Liu J, Asaad M, Schaverien MV, Akay C, Garvey PB, Hwang RF, Offodile AC. Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy. J Am Coll Surg 2021; 233:445-456.e2. [PMID: 34111529 DOI: 10.1016/j.jamcollsurg.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Financial toxicity (FT) can lead to decreased quality of life and poor treatment outcomes. However, there is limited published data on the extent to which the various surgical treatment approaches for early-stage breast cancer are determinants for FT. STUDY DESIGN We performed a single-institution cross-sectional survey of adult female patients with stage 0 to II breast cancer undergoing unilateral breast-conserving therapy or unilateral mastectomy. FT was measured using the Comprehensive Score for Financial Toxicity (COST) survey. Propensity matching was performed to optimize comparability of study groups. A multivariate regression model was used to identify factors associated with worsening FT as a robustness check. Our secondary end point was prevalence of coping strategies associated with cost of cancer care. RESULTS Among 294 patients who met inclusion criteria, 203 underwent breast-conserving therapy and 91 received mastectomy. We generated 72 total matched pairs and noted no differences in demographic and socioeconomic characteristics. Of these, 55 pairs had complete COST information, which was comparable on adjusted analysis (26.6 vs 24.7; p = 0.481). High annual income (β = 4.83; p < 0.001) and supplemental insurance (β = 5.37; p < 0.001) were significantly associated with higher COST scores, while change in employment status (β = -4.81; p < 0.001) correlated significantly with lower COST scores. No significant differences were observed in coping strategies. CONCLUSIONS Choice of BCT or mastectomy was not associated with a differential risk for FT in early-stage cancer. Decisions on ablative approach should be made based on patient preferences and disease-specific criteria. Transparent counseling on FT for high-risk populations promotes patient-centricity.
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Affiliation(s)
- Stefanos Boukovalas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Malke Asaad
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark V Schaverien
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Catherine Akay
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rosa F Hwang
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anaeze C Offodile
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX; Baker Institute for Public Policy, Rice University, Houston, TX.
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15
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Li J, Zhong G, Wang K, Kang W, Wei W. Tumor-to-Gland Volume Ratio versus Tumor-to-Breast Ratio as Measured on CBBCT: Possible Predictors of Breast-Conserving Surgery. Cancer Manag Res 2021; 13:4463-4471. [PMID: 34113172 PMCID: PMC8184154 DOI: 10.2147/cmar.s312288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022] Open
Abstract
Background Breast-conserving surgery plus postoperative radiotherapy is the standard surgical treatment mode for early breast cancer. Currently, there are no clear predictive indicators to determine whether a patient can choose breast-conserving surgery, which mainly depends on the surgeon’s clinical experience and subjective judgment. Cone-beam breast computed tomography (CBBCT) reconstructs the breast 3D image from three mutually perpendicular angles, helping surgeons to locate and accurately measure the volume of the tumor, mammary gland, and breast. We used CBBCT to retrospectively measure the tumor-to-gland volume ratio and tumor-to-breast volume ratio in breast cancer cases. Then, we analyzed the correlation between the surgical methods and ratios in breast cancer patients. Methods We collected 100 patients undergoing breast-conserving surgery as the study group, and 100 patients undergoing mastectomy as the control group. All patients chose the surgical approach after comprehensive consideration of examination results and assessment of patient condition. Patients underwent CBBCT examination before surgery. We retrospectively measured the volume of tumor, mammary glands and breast, then calculated tumor-to-gland and tumor-to-breast volume ratios. Results Tumor volume and the ratios of the two groups statistically differed (P < 0.001), while the mammary gland and breast volume did not (P > 0.05). The average tumor-to-gland volume ratio was 4.32% in the study group and 10.74% in the control group, and the average tumor-to-breast volume ratio was 0.74% in the study group and 1.36% in the control group. In breast-conserving surgery, the 95% reference range of tumor-to-gland ratio is (0, 12.90%), and the 95% reference range of tumor-to-breast ratio is (0, 2.17%). Conclusion The tumor-to-gland volume ratio and tumor-to-breast volume ratio measured using CBBCT are correlated with the choice of surgical methods (breast-conserving surgery or mastectomy) for breast cancer patients. This can be used as possible predictor of breast-conserving surgery to help surgeons.
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Affiliation(s)
- Jiawei Li
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - Guobin Zhong
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - Keqiong Wang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - Wei Kang
- Dominant Cultivation Discipline of Guangxi Medical University Cancer Hospital (Medical Imaging Department), Guangxi Key Clinical Specialty (Medical Imaging Department), Nanning, Guangxi, People's Republic of China
| | - Wei Wei
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
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16
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de Oliveira-Junior I, da Silva IDA, da Silva FCB, da Silva JJ, Sarri AJ, Paiva CE, Vieira RADC. Oncoplastic Surgery in Breast-Conserving Treatment: Patient Profile and Impact on Quality of Life. Breast Care (Basel) 2021; 16:243-253. [PMID: 34248465 PMCID: PMC8248771 DOI: 10.1159/000507240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast-conserving treatment (BCT) provides better quality of life (QL) than mastectomy without reconstruction. Oncoplastic surgery (OS) encompasses a series of surgical techniques, increasing the indications for BCT, but few studies have evaluated the impact on QL in patients who undergo BCT with OS. MATERIALS AND METHODS A prospective, cross-sectional study was conducted in women who underwent BCT. We evaluated the characteristics of patients who underwent BCT with and without OS and the associated QL. QL was assessed through the EORTC QLQ-30, EORTC QLQ-BR23, and Breast Cancer Treatment Outcome Scale (BCTOS) questionnaires. RESULTS A total of 300 patients underwent BCT, 72 underwent breast OS, and 37 underwent bilateral surgery. Patients who underwent OS were younger (p = 0.004), had a higher level of education (p = 0.01), had a smaller time interval since the end of treatment (p = 0.02), had tumours with greater dimensions (p = 0.003), and were more likely to receive neoadjuvant chemotherapy (p = 0.05). Based on the QL questionnaires, no difference was observed between the groups. Breast symmetry was not associated with high patient satisfaction (p = 0.55). CONCLUSION Despite the fact that OS was performed in patients with worse tumour conditions and in more demanding patients, OS allowed similar cosmetic results to classical BCT.
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Affiliation(s)
- Idam de Oliveira-Junior
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Sao Paulo, Brazil
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Medical School, Sao Paulo State University − UNESP, Sao Paulo, Brazil
| | - Igor de Araujo da Silva
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Sao Paulo, Brazil
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Fabíola Cristina Brandini da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Department of Physiotherapy, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Jonathas José da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Department of Physiotherapy, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Almir José Sarri
- Department of Physiotherapy, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Carlos Eduardo Paiva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - René Aloisio da Costa Vieira
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Sao Paulo, Brazil
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Medical School, Sao Paulo State University − UNESP, Sao Paulo, Brazil
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
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17
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Hauerslev KR, Overgaard J, Damsgaard TE, Hvid HM, Balling E, Fischer L, Christiansen P. Oncoplastic breast surgery versus conventional breast conserving surgery - a prospective follow-up study of subjective loco-regional late morbidity. Acta Oncol 2021; 60:750-759. [PMID: 33788646 DOI: 10.1080/0284186x.2021.1900907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and aim: Few studies have focused on the symptoms of loco-regional morbidity in shoulders, arms, and breasts related to oncoplastic breast surgery (OPS). This study aimed to determine if a difference exists in the prevalence or variety of subjective symptoms of shoulder, arm, and breast morbidity in patients undergoing OPS compared with patients receiving conventional breast conserving surgery (C-BCS). Cosmetic result and body image were included as secondary endpoints.Methods: This prospective follow-up study with 18 months of questionnaire-based follow-up included women with breast cancer or ductal carcinoma in situ. They were divided into two groups - C-BCS or OPS - depending on type of surgery performed. Furthermore, patient, disease, and treatment characteristics were recorded.Results: Among 334 completers, 229 (69%) received C-BCS and 105 (31%) received OPS. Participants were comparable regarding age, comorbidity, BMI, re-excision rate (15-16%), and axillary surgery. As for tumor characteristics, a more advanced disease stage was shown in the OPS than in the C-BCS group with larger tumor and lumpectomy size, more multifocality, and the corresponding following systemic adjuvant therapy.The questionnaire revealed that the two groups were comparable with no significant differences in frequency or variety of symptoms of shoulder and arm morbidity. Overall, participants were highly satisfied with the cosmetic results in both groups and no significant inter-group differences were observed.Conclusion: In patients with larger tumors, breast conserving surgery utilizing oncoplastic techniques yields results regarding subjective shoulder, arm, and breast morbidity as well as cosmetic outcome comparable with those of C-BCS performed on smaller tumors.Trial registration: ClinicalTrials.gov, registration number: NCT02159274 (2014).HIGHLIGHTSSubjective symptoms of shoulder, arm, and breast morbidity are comparable when oncoplastic breast surgery is compared to conventional breast conserving surgery.The variety of symptoms of shoulder and arm morbidity following oncoplastic surgery does not differ from symptoms following conventional breast conserving surgery.The cosmetic outcome following oncoplastic breast surgery is comparable to breast conserving surgery without oncoplastic techniques.
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Affiliation(s)
- Katrine Rye Hauerslev
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Helle Mikel Hvid
- Department of Plastic and Breast Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Eva Balling
- Breast Clinic, Regional Hospital Viborg, Viborg, Denmark
| | - Lone Fischer
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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18
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El‐Sherpiny WY, Abdelshafi AM, Ghazaly M, Elnemr AA, Darwish AA, Mlees MA. Comparative study between laparoscopically harvested omental flap and glandular flap in immediate reconstruction after conservative surgery in breast cancer. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mohamed Ghazaly
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Ayman A. Elnemr
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Ahmed A. Darwish
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Mohamed A. Mlees
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
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19
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Rautalin M, Jahkola T, Roine RP. Surgery and health-related quality of life - A prospective follow up study on breast cancer patients in Finland. Eur J Surg Oncol 2021; 47:1581-1587. [PMID: 33593622 DOI: 10.1016/j.ejso.2021.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The influence of different surgical approaches on breast cancer patients' Health-related Quality of life (HRQoL) is an important determinant when making decisions on the choice of treatment. Knowledge on how patients actually perceive different surgical treatments regarding long-term HRQoL is still scarce. MATERIALS & METHODS 1065 patients with primary breast cancer operated on from 2008 to 2015 at Helsinki University Hospital, Finland were prospectively followed-up for two years. They filled in two HRQoL questionnaires, the EORTC QLQ C30 - BR 23 and the 15D, at baseline and at 3, 6, 12 and 24 months after surgery. Clinical data on treatments given and the course of recovery were collected from patient records. Patients were divided into four mutually exclusive groups according to surgical method: breast resection (n = 415), oncoplastic resection (n = 248), mastectomy (n = 351) and immediate reconstruction (n = 51). Clinical data were combined with HRQoL scores and analysed as multivariate modelling. RESULTS All groups experienced initially worsening overall HRQoL after baseline. Oncoplastic resection patients had the best body image and their HRQoL reached the highest level after treatments at 12 months whereas the reconstruction patients reached the highest HRQoL level first at 24 months. Mastectomy patients had the lowest scores throughout the 24-month follow-up. CONCLUSION Extensive surgery, in terms of immediate reconstruction, led to slower HRQoL recovery than oncoplastic techniques. Mastectomy patients are at risk of having the lowest HRQoL scores throughout their recovery after surgery.
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Affiliation(s)
- Mervi Rautalin
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Finland.
| | - Tiina Jahkola
- Department of Plastic Surgery, Helsinki University Hospital, Finland
| | - Risto P Roine
- Department of Health and Social Management, University of Eastern, Finland
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20
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Vanni G, Materazzo M, Pellicciaro M, Morando L, Portarena I, Anemona L, D'Angelillo MR, Barbarino R, Chiaravalloti A, Meucci R, Perretta T, Deiana C, Orsaria P, Caspi J, Pistolese CA, Buonomo OC. Does Age Matter? Estimating Risks of Locoregional Recurrence After Breast-conservative Surgery. In Vivo 2021; 34:1125-1132. [PMID: 32354901 DOI: 10.21873/invivo.11884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM In 2016, in the United States, more than 50% of breast cancer (BC) cases were diagnosed in patients older than 60 years of age. Our study aimed to estimate the risk of locoregional recurrence (LR) in patients who underwent breast-conservative treatment (BCT), according to age. PATIENTS AND METHODS This retrospective monocentric study analyzed 613 cases of patients who underwent BCT between 2003 and 2014. Patients were divided into groups according to age: Under70 (under 70 years old) and Over70 (above 70 years old). Margins width, histology results, prognostic and predictive factors were compared. Subgroup analysis was performed for patients who experienced LR. RESULTS LR Incidence among Under70 and Over70 was 5.4% and 1.7%, respectively (p<0.01). Group Over70 is characterized by larger tumors and a lower Ki67 index (p<0.01). CONCLUSION Operation time reduction, better aesthetic results and reduced LR risk support BCT. The Over70 group exhibited better outcomes in terms of LR despite larger tumor dimensions.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ljuba Morando
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Rolando D'Angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Barbarino
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Rosaria Meucci
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.,Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Camilla Deiana
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Jonathan Caspi
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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21
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MRI-Derived Tumour-to-Breast Volume Is Associated with the Extent of Breast Surgery. Diagnostics (Basel) 2021; 11:diagnostics11020204. [PMID: 33573253 PMCID: PMC7912531 DOI: 10.3390/diagnostics11020204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/30/2020] [Accepted: 01/21/2021] [Indexed: 12/31/2022] Open
Abstract
The tumour-to-breast volume ratio (TBVR) is a metric that may help surgical decision making. In this retrospective Ethics-Committee–approved study, we assessed the correlation between magnetic resonance imaging (MRI)-derived TBVR and the performed surgery. The TBVR was obtained using a fully manual method for the segmentation of the tumour volume (TV) and a growing region semiautomatic method for the segmentation of the whole breast volume (WBV). Two specifically-trained residents (R1 and R2) independently segmented T1-weighted datasets of 51 cancer cases in 51 patients (median age 57 years). The intraobserver and interobserver TBVR reproducibility were calculated. Mann-Whitney U, Spearman correlations, and Bland-Altman statistics were used. Breast-conserving surgery (BCS) was performed in 31/51 cases (61%); mastectomy was performed in 20/51 cases (39%). The median TBVR was 2.08‰ (interquartile range 0.70–9.13‰) for Reader 1, and 2.28‰ (interquartile range 0.71–9.61‰) for Reader 2, with an 84% inter-reader reproducibility. The median segmentation times were 54 s for the WBV and 141 s for the TV. Significantly-lower TBVR values were observed in the breast-conserving surgery group (median 1.14‰, interquartile range 0.49–2.55‰) than in the mastectomy group (median 10.52‰, interquartile range 2.42–14.73‰) for both readers (p < 0.001). Large scale prospective studies are needed in order to validate MRI-derived TBVR as a predictor of the type of breast surgery.
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22
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Losken A, Brown CA. How to Optimize Aesthetics for the Partial Mastectomy Patient. Aesthet Surg J 2020; 40:S55-S65. [PMID: 33202013 DOI: 10.1093/asj/sjaa257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aesthetic concern is one of the main driving forces behind the popularity of the oncoplastic approach to breast conservation therapy. Oncoplastic options at the time of lumpectomy include volume replacement techniques such as flaps and volume displacement techniques such as the oncoplastic reduction. These techniques can be employed to ensure preservation of breast shape and contour, size and symmetry, inframammary fold position, and position of the nipple-areola complex. The importance of aesthetic outcomes is not only to improve overall patient satisfaction but also to minimize the need for revisional surgeries for shape and symmetry. The purpose of this review is to discuss ways to optimize the aesthetic result and to review the evidence behind aesthetic outcomes.
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Affiliation(s)
- Albert Losken
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
| | - Ciara A Brown
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
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23
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Vanni G, Pellicciaro M, Materazzo M, Dauri M, D'angelillo RM, Buonomo C, De Majo A, Pistolese C, Portarena I, Mauriello A, Servadei F, Giacobbi E, Chiaravalloti A, Buonomo OC. Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency. Breast Cancer 2020; 28:137-144. [PMID: 32734327 PMCID: PMC7391474 DOI: 10.1007/s12282-020-01137-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023]
Abstract
Introduction COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. Materials and methods From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. Results No statistical difference was found in complications rate, clinical data and surgical procedures (p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC (p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC (p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST (p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. Conclusion In the “COVID-19 era”, fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy
| | - Rolando Maria D'angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
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24
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Vanni G, Materazzo M, Santori F, Pellicciaro M, Costesta M, Orsaria P, Cattadori F, Pistolese CA, Perretta T, Chiocchi M, Meucci R, Lamacchia F, Assogna M, Caspi J, Granai AV, DE Majo A, Chiaravalloti A, D'Angelillo MR, Barbarino R, Ingallinella S, Morando L, Dalli S, Portarena I, Altomare V, Tazzioli G, Buonomo OC. The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey. In Vivo 2020; 34:1685-1694. [PMID: 32503830 DOI: 10.21873/invivo.11962] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). PATIENTS AND METHODS In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. RESULTS A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. CONCLUSION Working in a COVID-19-hospital represents a factor that negatively affects psychosocial well-being. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Costesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Francesca Cattadori
- UO Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.,Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Massimo Assogna
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Adriano DE Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Maria Rolando D'Angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Barbarino
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ljuba Morando
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Stefania Dalli
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Giovanni Tazzioli
- Oncologic Breast Surgery Unit, Azienda Ospedaliero-Universitaria Policlinico Hospital of Modena, Modena, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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25
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Feißt M, Heil J, Stolpner I, von Au A, Domschke C, Sohn C, Kieser M, Rauch G, Hennigs A. Psychometric validation of the Breast Cancer Treatment Outcome Scale (BCTOS-12): a prospective cohort study. Arch Gynecol Obstet 2019; 300:1679-1686. [PMID: 31705285 DOI: 10.1007/s00404-019-05362-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The Breast Cancer Treatment Outcome Scale (BCTOS) is a questionnaire to evaluate the aesthetic and functional outcome after breast conserving surgery (BCS). The original BCTOS with its 22 items on three subscales was refined to a shorter, improved, and easier to administer patient-reported outcome measure, the BCTOS-12. The BCTOS-12 consists of 12 items on two distinct subscales, the Functional Status and the Aesthetic Status. The aim of this study was to validate the BCTOS-12 in a prospective cohort. METHODS For this study, 239 breast cancer patients were included preoperatively, and 204 patients completed the BCTOS-12 and EORTC QLQ C30 BR23 shortly after their BCS, corresponding to a follow-up rate of 85%. The item-factor structure was examined by confirmatory factor analysis. The reliability was calculated by McDonald's Omega for estimating internal consistency. The convergent validity was assessed by Spearman's rank correlation coefficients between the related scales of the questionnaires. RESULTS The BCTOS-12 showed a robust item-factor structure and a good internal consistency with McDonald's Omega of 0.89 for the Aesthetic Status and 0.90 for the Functional Status. A high convergent and divergent validity was indicated by correlations between the subscales of the EORTC QLQ C30 BR23 and the BCTOS-12. CONCLUSION Overall, the results demonstrate a successful psychometric validation of the BCTOS-12. The BCTOS-12 is a refined, improved, and now validated, instrument. It can be used in clinical studies and routine management for the evaluation of the aesthetic and functional outcome after BCS.
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Affiliation(s)
- Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Institute of Biometry and Clinical Epidemiology, Charité University Hospital Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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26
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Hashem T, Morsi A, Farahat A, Zaghloul T, Hamed A. Correlation of Specimen/Breast Volume Ratio to Cosmetic Outcome After Breast Conserving Surgery. Indian J Surg Oncol 2019; 10:668-672. [PMID: 31857762 DOI: 10.1007/s13193-019-00973-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022] Open
Abstract
Breast conserving surgery (BCS) is currently the standard of care for early breast cancer. One of the key determinants for the line of treatment in breast cancer is the size of the tumor in relation to the breast size. The aim of this study is to determine the effect of the ratio of the excised specimen to breast volume on the cosmetic outcome after conventional BCS. This is a retrospective study conducted on female patients with early stage breast cancer who underwent BCT at National Cancer Institute, Cairo University. The study included 41 patients with stage I and II breast cancer. Breast volume was calculated using mammography, and ratio of the specimen to breast volume was determined. This ratio was correlated with the cosmetic outcome using the BCCT.core software. Thirty-six out of the 41 breast cancer patients completed the study. Favorable outcome (excellent + good) was detected in 52.7% of patients, while 47.3% had unfavorable outcome (fair + poor). Breast volume, tumor site, patients' age, and weight did not seem to alter the cosmetic result. The only statistically significant factors affecting the cosmetic outcome were the specimen volume and the ratio of the specimen to the normal breast volume (p = 0.006 and 0.019 respectively). In order to obtain a satisfactory cosmetic outcome after conventional BCS, the ratio of the excised specimen to breast volume has to be seriously considered.
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Affiliation(s)
- Tarek Hashem
- 1Breast Surgery Unit, National Cancer Institute, Cairo University, Kasr al Aini Street, Cairo, Egypt
| | - Ahmed Morsi
- 1Breast Surgery Unit, National Cancer Institute, Cairo University, Kasr al Aini Street, Cairo, Egypt
| | - Ahmed Farahat
- 1Breast Surgery Unit, National Cancer Institute, Cairo University, Kasr al Aini Street, Cairo, Egypt
| | - Tarek Zaghloul
- 1Breast Surgery Unit, National Cancer Institute, Cairo University, Kasr al Aini Street, Cairo, Egypt
| | - Amira Hamed
- 2Radiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Papanikolaou IG, Dimitrakakis C, Zagouri F, Marinopoulos S, Giannos A, Zografos E, Zografos CG, Kritikou D, Rodolakis A, Zografos GC, Loutradis D. Paving the way for changing perceptions in breast surgery: a systematic literature review focused on oncological and aesthetic outcomes of oncoplastic surgery for breast cancer. Breast Cancer 2019; 26:416-427. [PMID: 30955172 DOI: 10.1007/s12282-019-00968-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emphasis on aesthetic outcomes and quality of life after breast cancer surgery has motivated breast surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of these techniques. This systematic review aims to assess oncological and cosmetic outcomes of OPS. METHODS After a strict selection process with precise inclusion and exclusion criteria, oncologic and aesthetic outcomes of oncoplastic surgery were searched, using the MEDLINE database up to September 30th, 2017. Available published literature was classified in levels of evidence. After a thorough screening process, only studies with the best level of evidence were included on selection. Systematic reviews and meta-analyses were not included for methodological reasons. RESULTS Titles and abstracts of 2.854 citations were identified and after screening 15 prospective studies including 1.391 patients were reviewed and scored in detail. Local relapse was found in 2.8% of cases with a wide range of follow-up (from 6 to 74 months). Close margins were retrieved in 11% of cases and positive margins in 9.4% of cases. Mastectomy was implemented in 6.9% of breast cancer patients to whom OPS was performed. Good cosmetic outcomes were detected in 90.2% of patients undergoing OPS, leaving open issues for who should perform cosmetic evaluation and which method should be used. CONCLUSION Tumor margins, mastectomy rates, and cosmetic outcomes of OPS have to be further improved by standardizing various aspects of OPS. Research efforts should focus on level I evidence assessing both oncological and aesthetic outcomes of OPS and survival rates.
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Affiliation(s)
- I G Papanikolaou
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece.
| | - C Dimitrakakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Marinopoulos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - A Giannos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - E Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Kritikou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Rodolakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - G C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Loutradis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
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Kelemen P, Pukancsik D, Újhelyi M, Sávolt Á, Kovács E, Ivády G, Kenessey I, Kovács T, Stamatiou A, Smanykó V, Mátrai Z. Comparison of clinicopathologic, cosmetic and quality of life outcomes in 700 oncoplastic and conventional breast-conserving surgery cases: A single-centre retrospective study. Eur J Surg Oncol 2019; 45:118-124. [DOI: 10.1016/j.ejso.2018.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/01/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022] Open
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Oncoplastic breast conserving surgery is associated with a lower rate of surgical site complications compared to standard breast conserving surgery. Am J Surg 2019; 217:138-141. [DOI: 10.1016/j.amjsurg.2018.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/22/2022]
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Cardoso MJ, Vrieling C, Cardoso JS, Oliveira HP, Williams NR, Dixon JM. The value of 3D images in the aesthetic evaluation of breast cancer conservative treatment. Results from a prospective multicentric clinical trial. Breast 2018; 41:19-24. [PMID: 29940498 DOI: 10.1016/j.breast.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE BCCT.core (Breast Cancer Conservative Treatment. cosmetic results) is a software created for the objective evaluation of aesthetic result of breast cancer conservative treatment using a single patient frontal photography. The lack of volume information has been one criticism, as the use of 3D information might improve accuracy in aesthetic evaluation. In this study, we have evaluated the added value of 3D information to two methods of aesthetic evaluation: a panel of experts; and an augmented version of the computational model - BCCT.core3d. MATERIAL AND METHODS Within the scope of EU Seventh Framework Programme Project PICTURE, 2D and 3D images from 106 patients from three clinical centres were evaluated by a panel of 17 experts and the BCCT.core. Agreement between all methods was calculated using the kappa (K) and weighted kappa (wK) statistics. RESULTS Subjective agreement between 2D and 3D individual evaluation was fair to moderate. The agreement between the expert classification and the BCCT.core software with both 2D and 3D features was also fair to moderate. CONCLUSIONS The inclusion of 3D images did not add significant information to the aesthetic evaluation either by the panel or the software. Evaluation of aesthetic outcome can be performed using of the BCCT.core software, with a single frontal image.
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Affiliation(s)
- Maria João Cardoso
- Breast Unit, Champalimaud Foundation and Nova Medical School, Lisbon, Portugal.
| | | | | | | | | | - J M Dixon
- Breast Cancer Now Research Unit, Edinburgh, UK
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31
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Yazar SK, Altınel D, Serin M, Aksoy Ş, Yazar M. Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes. Eur J Breast Health 2018; 14:35-38. [PMID: 29322117 DOI: 10.5152/ejbh.2017.3512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/03/2017] [Indexed: 11/22/2022]
Abstract
Objective Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. Material and Methods 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. Results Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. Conclusion Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.
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Affiliation(s)
- Sevgi Kurt Yazar
- Department of Plastic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Dinçer Altınel
- Department of Plastic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Merdan Serin
- Department of Plastic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Şefika Aksoy
- Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Memet Yazar
- Department of Plastic Surgery, Şisli Etfal Training and Research Hospital, İstanbul, Turkey
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Kolacinska A, Hodorowicz-Zaniewska D, Bocian A, Michalik D, Matkowski R, Kurylcio A, Pyka P, Charytonowicz M, Berkan M. Landscape of oncoplastic breast surgery across Poland. POLISH JOURNAL OF SURGERY 2017; 89:14-19. [DOI: 10.5604/01.3001.0010.6735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast-conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two-stage expander followed by implant-based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement.
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Affiliation(s)
- Agnieszka Kolacinska
- Dept of Head and Neck Cancer Surgery, Medical University of Lodz, Dept of Surgical Oncology, Cancer Center, Paderewskiego 4, 93-509 Lodz, Poland
| | - Diana Hodorowicz-Zaniewska
- I Chair of General Surgery, Dept of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Artur Bocian
- Dept of Surgical Oncology, Holy Cross Cancer Center, , Poland
| | - Dariusz Michalik
- Dept of General Surgery, Ministry of the Interior and Administration Hospital, Olsztyn, Poland
| | - Rafal Matkowski
- Chair of Oncology, Dept of Surgical Oncology, Wroclaw, Poland
| | | | - Pawel Pyka
- Dept of Surgical Oncology, District Hospital, Walbrzych, Poland
| | - Michal Charytonowicz
- Dept of Plastic Surgery, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Maciej Berkan
- Dept of Oncological Gynecology with Breast Surgery Division, Copernicus Memorial Hospital, Lodz, Poland
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Abstract
The oncoplastic approach to breast conservation therapy has become a useful and popular option for women with breast cancer who wish to preserve their breast. The initial driving forces were aimed at minimizing the potential for a breast conservation therapy deformity; however, various other benefits have been identified that include broadening the indications for breast conservation therapy in some patients and improved margin control. The various techniques can be categorized into glandular rearrangement techniques such as breast reductions usually in patients with larger breasts or flap reconstruction such as the latissimus dorsi muscle usually in patients with smaller breasts. As the acceptance continues to increase, we are starting to see more outcomes evidence in terms of patient satisfaction, quality of life, complications, and recurrence, to further support the safety and efficacy of the oncoplastic approach.
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