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Li S, Li X, Li D, Zhao Q, Zhu L, Wu T. A meta-analysis of randomized controlled trials comparing breast-conserving surgery and mastectomy in terms of patient survival rate and quality of life in breast cancer. Int J Qual Health Care 2024; 36:mzae043. [PMID: 38753325 PMCID: PMC11141600 DOI: 10.1093/intqhc/mzae043] [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: 10/08/2023] [Revised: 02/20/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024] Open
Abstract
The study aimed to assess the effects of breast-conserving surgery (BCS) versus mastectomy on survival and quality of life in Stages I, II, and III breast cancer, providing solid evidence for clinical decisions. We conducted a meta-analysis of randomized controlled trials on breast cancer treatments, searching databases such as PubMed and the Cochrane Library to compare BCS, and mastectomy's effects on survival and quality of life. A combined total of 16 734 patients in the control group and 17 435 patients in the experimental group were included in this analysis. This meta-analysis used RevMan 5.3 (Cochrane Collaboration, Copenhagen, Denmark) software for analysis. Our meta-analysis of 34 169 patients from 11 studies showed that BCS significantly reduced the overall recurrence rate at a median follow-up of 29 months, with a mean difference of 1.27 and a 95% confidence interval of 1.19-1.36, strongly supporting its effectiveness (P < .00001). Furthermore, our analysis found no significant increase in 5-year local recurrence rates for BCS versus mastectomy, indicating its long-term effectiveness with a mean difference of 1.13 (95% confidence interval: [1.03, 1.24], P = .01). Additionally, there was a notable decrease in tissue ischaemic necrosis among patients who had received BCS, with a mean difference of 0.37 (95% confidence interval: [0.33, 0.42], P < .00001), underscoring its benefits and long-term viability. BCS resulted in fewer cases of tissue ischaemic necrosis and higher body image scores compared with mastectomy, suggesting that it is a preferable option for better cosmetic outcomes and potentially favourable effects on prognosis and quality of life.
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Affiliation(s)
- Shuangjian Li
- Department of Breast Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Oncology, Urumqi, Xinjiang 830011, China
| | - Xin Li
- Department of Operating Room, The First People’s Hospital of Urumqi Economic and Technological Development Zone, Toutunhe District, Urumqi 830011, Xinjiang, China
| | - Dan Li
- Department of Breast Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Oncology, Urumqi, Xinjiang 830011, China
| | - Qian Zhao
- Department of Breast Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Oncology, Urumqi, Xinjiang 830011, China
| | - Liping Zhu
- Department of Breast Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Oncology, Urumqi, Xinjiang 830011, China
| | - Tao Wu
- Department of Breast Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Oncology, Urumqi, Xinjiang 830011, China
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Veluponnar D, Dashtbozorg B, Jong LJS, Geldof F, Da Silva Guimaraes M, Vrancken Peeters MJTFD, van Duijnhoven F, Sterenborg HJCM, Ruers TJM, de Boer LL. Diffuse reflectance spectroscopy for accurate margin assessment in breast-conserving surgeries: importance of an optimal number of fibers. BIOMEDICAL OPTICS EXPRESS 2023; 14:4017-4036. [PMID: 37799696 PMCID: PMC10549728 DOI: 10.1364/boe.493179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 10/07/2023]
Abstract
During breast-conserving surgeries, it remains challenging to accomplish adequate surgical margins. We investigated different numbers of fibers for fiber-optic diffuse reflectance spectroscopy to differentiate tumorous breast tissue from healthy tissue ex vivo up to 2 mm from the margin. Using a machine-learning classification model, the optimal performance was obtained using at least three emitting fibers (Matthew's correlation coefficient (MCC) of 0.73), which was significantly higher compared to the performance of using a single-emitting fiber (MCC of 0.48). The percentage of correctly classified tumor locations varied from 75% to 100% depending on the tumor percentage, the tumor-margin distance and the number of fibers.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Lynn-Jade S. Jong
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Freija Geldof
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Theo J. M. Ruers
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lisanne L. de Boer
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Lee EG, Kim SK, Han JH, Lee DE, Jung SY, Lee S. Surgical outcomes of localization using indocyanine green fluorescence in breast conserving surgery: a prospective study. Sci Rep 2021; 11:9997. [PMID: 33976314 PMCID: PMC8113252 DOI: 10.1038/s41598-021-89423-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
We investigated localization and safe resection margins for breast cancer patients undergoing breast conserving surgery (BCS) using ultrasound-guided indocyanine green fluorescence (ICG-F) marking. From April 2016 to March 2019, we prospectively enrolled 114 patients who underwent BCS using US-guided ICG-F marking and we compared these results with 300 patients who underwent BCS using US-guided skin marking from January 2012 to December 2016. Clinical features, identification rates, status of resection margins, and re-operation rates were analyzed. The ICG-F identification rate was 100% (114/114). The mean approach time for resection of the lesion ICG-F using group was about 13 min. The positive rate of frozen resection margins was 10.5% using ICG-F and 25.0% using sono-guided skin marking (p < 0.01). The rate of additional intraoperative resection was significantly lower in the ICG-F marking group compared to that in the sono-guided skin marking group (8.8% vs. 23.3%, p < 0.01). The rate of final positive resection margins was 3.5% in the ICG-F using group and 14.7% in the sono-guided skin marking group (p < 0.01). The rate of re-operation was 4.4% in the ICG-F using group and 4% in the sono-guided group (p = 0.79). At follow-up after the operation using ICG-F, no complications occurred. Using ICG-F during BCS could be a safe, sophisticated method for localization.
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Affiliation(s)
- Eun-Gyeong Lee
- Department of Surgery, Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, South Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, South Korea
| | - Jai Hong Han
- Department of Surgery, Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, South Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Core Center, Research Institute of National Cancer Center, Goyang, South Korea
| | - So-Youn Jung
- Department of Surgery, Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, South Korea.
| | - Seeyoun Lee
- Department of Surgery, Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, South Korea.
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Esgueva A, Rodríguez-Revuelto R, Espinosa-Bravo M, Salazar JP, Rubio IT. Learning curves in intraoperative ultrasound guided surgery in breast cancer based on complete breast cancer excision and no need for second surgeries. Eur J Surg Oncol 2019; 45:578-583. [DOI: 10.1016/j.ejso.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/11/2018] [Accepted: 01/11/2019] [Indexed: 01/05/2023] Open
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Carlino G, Rinaldi P, Giuliani M, Rella R, Bufi E, Padovano F, Ciardi C, Romani M, Belli P, Manfredi R. Ultrasound-guided preoperative localization of breast lesions: a good choice. J Ultrasound 2018; 22:85-94. [PMID: 30367356 DOI: 10.1007/s40477-018-0335-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of the study was to verify whether ultrasound (US)-guided preoperative localization of breast lesions is an adequate technique for correct and safe surgical resection and to contribute positively and effectively to this topic in the literature with our results. METHODS From June 2016 to November 2016, 155 patients with both benign and malignant breast lesions were selected from our institute to undergo US localization before surgery. The lesions included were: sonographically visible and nonpalpable lesions; palpable lesions for which a surgeon had requested US localization to better evaluate the site and extension; sonographically visible, multifocal breast lesions, both palpable and nonpalpable. US localization was performed using standard linear transducers (Siemens 18 L6, 5.5-8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solutions). The radiologist used a skin pen to mark the site of the lesion, and the reported lesion's depth and distance from the nipple and pectoral muscle were recorded. The lesions were completely excised by a team of breast surgeons, and the surgical specimens were sent to the Radiology Department for radiological evaluation and to the Pathology Department for histological assessment. RESULTS In 155 patients who underwent to preoperative US localization, 188 lesions were found, and the location of each lesion was marked with a skin pen. A total of 181 lesions were confirmed by the final histopathologic exam (96.28%); 132 of them (72.92%) were malignant, and 124 of these (93.93%) showed free margins. CONCLUSIONS US-guided preoperative localization of sonographically visible breast lesions is a simple and nontraumatic procedure with high specificity and is a useful tool for obtaining accurate surgical margins.
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Affiliation(s)
- Giorgio Carlino
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Pierluigi Rinaldi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Michela Giuliani
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Rossella Rella
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Enida Bufi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Federico Padovano
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Chiara Ciardi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maurizio Romani
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Paolo Belli
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
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6
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Volders JH, Negenborn VL, Haloua MH, Krekel NMA, Jóźwiak K, Meijer S, van den Tol PM. Breast-specific factors determine cosmetic outcome and patient satisfaction after breast-conserving therapy: Results from the randomized COBALT study. J Surg Oncol 2018; 117:1001-1008. [PMID: 29473960 DOI: 10.1002/jso.25012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES To identify breast-specific factors and the role of tumor, treatment, and patient-related items in influencing patient opinion on cosmesis and satisfaction after breast-conserving therapy (BCT). METHODS Data from the randomized COBALT study was used. At 3, 12, and 36 months, 128 patients with T1-T2 breast cancer completed a questionnaire on breast-specific factors and overall cosmetic outcome and patient satisfaction, using a 4-point Likert scale. RESULTS There was a strong positive correlation between breast-specific factors, overall cosmetic outcome,and satisfaction at all time-points. Excellent/good cosmetic outcomes and satisfaction decreased during follow-up. A shift was noted in the degree of influence of the various breast-specific factors. At 3 years, symmetry factors such as size, shape, and nipple position largely determined a patient's opinion on the final cosmesis, followed by firmness. The risk of an unacceptable outcome was associated with young age and large excision volumes. CONCLUSION A questionnaire including breast-specific questions provides important information on final cosmetic results and satisfaction after BCT. These outcomes can also be of great value as quality indicators and pre-operative counseling. The major influence of breast-specific factors on asymmetry underlines the importance of achieving an optimal excision volume at the initial procedure.
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Affiliation(s)
- José H Volders
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Max H Haloua
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M A Krekel
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Zhang F, Zhang J, Meng QX, Zhang X. Ultrasound combined with fine needle aspiration cytology for the assessment of axillary lymph nodes in patients with early stage breast cancer. Medicine (Baltimore) 2018; 97:e9855. [PMID: 29443748 PMCID: PMC5839868 DOI: 10.1097/md.0000000000009855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to explore the clinical usefulness of ultrasound-guided fine needle aspiration cytology (USG-FNAC) for the evaluation of axillary lymph nodes in patients with early stage breast cancer (BC) among the Chinese Han female population.Around 124 patients with early stage BC were included in this retrospective study. All patients underwent USG-FNAC (group A). Patients with proven metastasis also underwent axillary lymph node dissection (ALND) (group B). In addition, sentinel lymph node biopsy (SLNB) was performed 2 to 5 hours prior to the surgery.The sensitivity, specificity, accuracy, and positive predictive value (PPV) of axillary ultrasound were 75.0%, 75.0%, 75.0%, and 82.6%, respectively, while for USG-FNAC, they were 80.8%, 100.0%, 88.7%, and 100.0%, respectively. Significant differences were found in specificity, accuracy, and PPV between the 2 procedures (P < .05).The results of this study demonstrated that USG-FNAC was effective for selecting patients with early stage BC using ALND or SLNB among the Chinese Han female population.
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Affiliation(s)
| | - Jing Zhang
- Department of Anatomy, Mudanjiang Medical University
| | - Qing-xin Meng
- Department of Functional Section, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Xin Zhang
- Department of Functional Section, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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Breast-conserving therapy for breast cancer: Cosmetic results and options for delayed reconstruction. J Plast Reconstr Aesthet Surg 2017; 70:1336-1344. [DOI: 10.1016/j.bjps.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/10/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023]
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9
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Arko D, Čas Sikošek N, Kozar N, Sobočan M, Takač I. The value of ultrasound-guided surgery for breast cancer. Eur J Obstet Gynecol Reprod Biol 2017; 216:198-203. [DOI: 10.1016/j.ejogrb.2017.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/16/2022]
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González SJ, Mooney B, Lin HY, Zhao X, Kiluk JV, Khakpour N, Laronga C, Lee MC. 2-D and 3-D Ultrasound for Tumor Volume Analysis: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:775-781. [PMID: 28187928 DOI: 10.1016/j.ultrasmedbio.2016.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
Ultrasound (US) allows real-time tumor assessment. We evaluated the volumetric limits of 2-D and 3-D US, compared with magnetic resonance imaging (MRI), with a prospective institutional review board-approved clinical evaluation of US-to-MRI volumetric correlation. US images of pre- and post-neoadjuvant breast cancers were obtained. Volume discrepancy was evaluated with the non-parametric Wilcoxon signed-rank test. Expected inter-observer variability <14% was evaluated as relative paired difference (RPD); clinical relevance was gauged with the volumetric standard error of the mean (SEM). For 42 patients, 133 of 170 US examinations were evaluable. For tumors ≤20 cm3, both highly correlated to MRI with RPD within inter-observer variability and Pearson's correlation up to 0.86 (0.80 before and 0.86 after neoadjuvant chemotherapy, respectively). Lesions 20-40 cm3 had US-to-MRI discrepancy within inter-observer variability for 2-D (RPD: 13%), but not 3-D (RPD: 27%) US (SEM: 1.47 cm3 for 2-D, SEM: 2.28 cm3 for 3-D), suggesting clinical utility. Tumors >40 cm3 correlated poorly. Tumor volumes ≤20 cm3 exhibited a good correlation to MRI. Studies of clinical applications are warranted.
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Affiliation(s)
- Segundo J González
- Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Blaise Mooney
- Diagnostic Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Hui-Yi Lin
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Xiuhua Zhao
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - John V Kiluk
- Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Nazanin Khakpour
- Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Christine Laronga
- Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - M Catherine Lee
- Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
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Volders JH, Negenborn VL, Haloua MH, Krekel NMA, Jóźwiak K, Meijer S, M van den Tol P. Cosmetic outcome and quality of life are inextricably linked in breast-conserving therapy. J Surg Oncol 2017; 115:941-948. [PMID: 28334419 DOI: 10.1002/jso.24615] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/26/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Cosmetic results and quality of life (QoL) are increasingly important in the treatment of breast cancer. This study was designed to determine the relationship between QoL and both subjectively and objectively measured cosmetic outcomes of breast-conserving therapy (BCT), and its course over time. METHODS A total of 128 breast cancer patients who underwent BCT as part of a prospective randomized controlled trial were included. QoL was measured using the EORTC QLQ-C30 and QLQ-BR23 at baseline, 3, 6, 12, and 36 months. Cosmetic outcome was determined by patient self-evaluation, panel evaluation, and BCCT.core software. RESULTS By 36 months, all QoL factors except arm symptoms had returned to baseline or improved. After adjustment for patient and tumor characteristics, a significantly better QoL in terms of body image, pain, and arm and breast symptoms was found for good/excellent cosmetic outcomes compared to fair/poor outcomes, as measured by both patient self-evaluation and panel evaluation. The BCCT.core showed no correlation with any QoL factors. CONCLUSION There is a high correlation between poor cosmetic outcome and low scores on quality of life indicators, underlining the importance of achieving a good cosmetic outcome after BCT.
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Affiliation(s)
- José H Volders
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Max H Haloua
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M A Krekel
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
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12
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Haloua MH, Volders JH, Krekel NMA, Lopes Cardozo AMF, de Roos WK, de Widt-Levert LM, van der Veen H, Rijna H, Bergers E, Jóźwiak K, Meijer S, van den Tol MP. Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT). Ann Surg Oncol 2016; 23:30-7. [PMID: 26486999 PMCID: PMC4695494 DOI: 10.1245/s10434-015-4906-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 01/06/2023]
Abstract
Background Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). Objective The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). Methods A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either USS (65 patients) or PGS (69 patients). Cosmetic outcomes were assessed by a three-member panel using computerized software Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and by patient self-evaluation, including patient satisfaction. Time points for follow-up were 3, 6, and 12 months after surgery. Overall cosmetic outcome and patient satisfaction were scored on a 4-point Likert scale (excellent, good, fair, or poor), and outcomes were analyzed using a multilevel, mixed effect, proportional odds model for ordinal responses. Results Ultrasound-guided breast-conserving surgery achieved better cosmetic outcomes, with 20 % excellence overall and only 6 % rated as poor, whereas 14 % of PGS outcomes were rated excellent and 13 % as poor. USS also had consistently lower odds for worse cosmetic outcomes (odds ratio 0.55, p = 0.067) than PGS. The chance of having a worse outcome was significantly increased by a larger lumpectomy volume (ptrend = 0.002); a volume >40 cc showed odds 2.78-fold higher for a worse outcome than a volume ≤40 cc. USS resulted in higher patient satisfaction compared with PGS. Conclusion Ultrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes.
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Affiliation(s)
- Max H. Haloua
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - José H. Volders
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M. A. Krekel
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Wifred K. de Roos
- />Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | - Henk van der Veen
- />Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Herman Rijna
- />Department of Surgery, Kennemergasthuis, Haarlem, The Netherlands
| | - Elisabeth Bergers
- />Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- />Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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13
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Sastry R, Bi WL, Pieper S, Frisken S, Kapur T, Wells W, Golby AJ. Applications of Ultrasound in the Resection of Brain Tumors. J Neuroimaging 2016; 27:5-15. [PMID: 27541694 DOI: 10.1111/jon.12382] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 12/23/2022] Open
Abstract
Neurosurgery makes use of preoperative imaging to visualize pathology, inform surgical planning, and evaluate the safety of selected approaches. The utility of preoperative imaging for neuronavigation, however, is diminished by the well-characterized phenomenon of brain shift, in which the brain deforms intraoperatively as a result of craniotomy, swelling, gravity, tumor resection, cerebrospinal fluid (CSF) drainage, and many other factors. As such, there is a need for updated intraoperative information that accurately reflects intraoperative conditions. Since 1982, intraoperative ultrasound has allowed neurosurgeons to craft and update operative plans without ionizing radiation exposure or major workflow interruption. Continued evolution of ultrasound technology since its introduction has resulted in superior imaging quality, smaller probes, and more seamless integration with neuronavigation systems. Furthermore, the introduction of related imaging modalities, such as 3-dimensional ultrasound, contrast-enhanced ultrasound, high-frequency ultrasound, and ultrasound elastography, has dramatically expanded the options available to the neurosurgeon intraoperatively. In the context of these advances, we review the current state, potential, and challenges of intraoperative ultrasound for brain tumor resection. We begin by evaluating these ultrasound technologies and their relative advantages and disadvantages. We then review three specific applications of these ultrasound technologies to brain tumor resection: (1) intraoperative navigation, (2) assessment of extent of resection, and (3) brain shift monitoring and compensation. We conclude by identifying opportunities for future directions in the development of ultrasound technologies.
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Affiliation(s)
- Rahul Sastry
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Sarah Frisken
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William Wells
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Guan L, Xu G. Damage effect of high-intensity focused ultrasound on breast cancer tissues and their vascularities. World J Surg Oncol 2016; 14:153. [PMID: 27230124 PMCID: PMC4882851 DOI: 10.1186/s12957-016-0908-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/20/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a noninvasive therapy that makes entire coagulative necrosis of a tumor in deep tissue through the intact skin. There are many reports about the HIFU's efficacy in the treatment of patients with breast cancer, but randomized clinical trials are rare which emphasize on the systematic assessment of histological changes in the ablated tumor vascularities, while clinical trials utilizing bevacizumab and other anti-angiogenic drugs in breast cancer have not demonstrated overall survival benefit. The purpose of this study is to evaluate the damage effect of HIFU on breast cancer tissues and their vascularities. METHODS Randomized clinical trials and the modality of treat-and-resect protocols were adopted. The treated outcome of all patients was followed up in this study. The target lesions of 25 breast cancer patients treated by HIFU were observed after autopsy. One slide was used for hematoxylin-eosin (HE) staining, one slide was used for elastic fiber staining by Victoria blue and Ponceau's histochemical staining, and one slide was used for vascular endothelial cell immunohistochemical staining with biotinylated-ulex europaeus agglutinin I (UEAI); all three slides were observed under an optical microscopic. One additional slide was systematically observed by electron microscopy. RESULTS The average follow-up time was 12 months; no local recurrence or a distant metastatic lesion was detected among treated patients. Histological examination of the HE slides indicated that HIFU caused coagulative necrosis in the tumor tissues and their vascularities: all feeder vessels less than 2 mm in diameter in the insonated tumor were occluded, the vascular elasticity provided by fibrin was lost, the cells were disordered and delaminated, and UEAI staining of the target lesions was negative. Immediately after HIFU irradiation, the tumor capillary ultrastructure was destroyed, the capillary endothelium was disintegrated, the peritubular cells were cavitated, and the plasma membrane was incomplete. CONCLUSIONS HIFU ablation can destroy all proliferating tumor cells and their growing vascularities simultaneously; this may break interdependent vicious cycle of tumor angiogenesis and neoplastic cell growth that results in infinite proliferation. While it cannot cause tumor resistance to HIFU ablation, it may be a new anti-angiogenic strategy that needs further clinical observation and exploration. Furthermore, the treatment indications of HIFU ablation were reviewed and discussed in this manuscript.
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MESH Headings
- Adult
- Aged
- Angiogenesis Inhibitors/therapeutic use
- Breast Neoplasms/blood supply
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/blood supply
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/blood supply
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/therapy
- Case-Control Studies
- Female
- Follow-Up Studies
- High-Intensity Focused Ultrasound Ablation/adverse effects
- Humans
- Lymphatic Metastasis
- Mastectomy
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/blood supply
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Neovascularization, Pathologic/pathology
- Prognosis
- Young Adult
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Affiliation(s)
- Liming Guan
- Department of Obstetrics and Gynaecology, Zhabei District Central Hospital, No. 619, Zhonghuaxin Road, Zhabei District, Shanghai, 200000, China.
| | - Gang Xu
- Department of Radiotherapy, Tumor Hospital, Peking University, No. 69, Wanfeng Road, Fengtai District, Beijing, 100000, China
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Rubio IT, Esgueva-Colmenarejo A, Espinosa-Bravo M, Salazar JP, Miranda I, Peg V. Intraoperative Ultrasound-Guided Lumpectomy Versus Mammographic Wire Localization for Breast Cancer Patients After Neoadjuvant Treatment. Ann Surg Oncol 2016; 23:38-43. [DOI: 10.1245/s10434-015-4935-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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16
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Visgauss JD, Eward WC, Brigman BE. Innovations in Intraoperative Tumor Visualization. Orthop Clin North Am 2016; 47:253-64. [PMID: 26614939 DOI: 10.1016/j.ocl.2015.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the surgical management of solid tumors, adequacy of tumor resection has implications for local recurrence and survival. The standard method of intraoperative identification of tumor margin is frozen section pathologic analysis, which is time-consuming with potential for sampling error. Intraoperative tumor visualization has the potential to significantly improve surgical cancer care across disciplines, by guiding accuracy of biopsies, increasing adequacy of resections, directing adjuvant therapy, and even providing diagnostic information. We provide an outline of various methods of intraoperative tumor visualization developed to aid in the real-time assessment of tumor extent and adequacy of resection.
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Affiliation(s)
- Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University, Box 3312 DUMC, Durham, NC 27710, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University, Box 3312 DUMC, Durham, NC 27710, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University, Box 3312 DUMC, Durham, NC 27710, USA.
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Coburger J, Scheuerle A, Kapapa T, Engelke J, Thal DR, Wirtz CR, König R. Sensitivity and specificity of linear array intraoperative ultrasound in glioblastoma surgery: a comparative study with high field intraoperative MRI and conventional sector array ultrasound. Neurosurg Rev 2015; 38:499-509; discussion 509. [DOI: 10.1007/s10143-015-0627-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/02/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022]
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18
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Najafi M, Afsham N, Abolmaesumi P, Rohling R. A closed-form differential formulation for ultrasound spatial calibration: single wall phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1079-1094. [PMID: 25701520 DOI: 10.1016/j.ultrasmedbio.2014.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/17/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Calibration is essential in freehand 3-D ultrasound to find the spatial transformation from the image coordinates to the sensor coordinate system. Ease of use, simplicity, precision and accuracy are among the most important factors in ultrasound calibration, especially when aiming to make calibration more reliable for day-to-day clinical use. We introduce a new mathematical framework for the simple and popular single-wall calibration phantom with a plane equation pre-determination step and the use of differential measurements to obtain accurate measurements. The proposed method provides a novel solution for ultrasound calibration that is accurate and easy to perform. This method is applicable to both radiofrequency (RF) and B-mode data, and both linear and curvilinear transducers. For a linear L14-5 transducer, the point reconstruction accuracy (PRA) of reconstructing 370 points is 0.73 ± 0.23 mm using 100 RF images, whereas the triple N-wire PRA is 0.67 ± 0.20 mm using 100 B-mode images. For a curvilinear C5-2 transducer, the PRA using the proposed method is 0.86 ± 0.28 mm on 400 points using 100 RF images, whereas N-wire calibration gives a PRA of 0.80 ± 0.46 mm using 100 B-mode images. Therefore, the accuracy of the proposed variation of the single-wall method using RF data is practically similar to the N-wire method while offering a simpler phantom with no need for accurate design and construction.
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Affiliation(s)
- Mohammad Najafi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Narges Afsham
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Purang Abolmaesumi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Rohling
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada; Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
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Coburger J, Scheuerle A, Thal DR, Engelke J, Hlavac M, Wirtz CR, König R. Linear array ultrasound in low-grade glioma surgery: histology-based assessment of accuracy in comparison to conventional intraoperative ultrasound and intraoperative MRI. Acta Neurochir (Wien) 2015; 157:195-206. [PMID: 25559430 DOI: 10.1007/s00701-014-2314-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In low-grade glioma (LGG) surgery, intraoperative differentiation between tumor and most likely tumor-free brain tissue can be challenging. Intraoperative ultrasound can facilitate tumor resection. The aim of this study is to evaluate the accuracy of linear array ultrasound in comparison to conventional intraoperative ultrasound (cioUS) and intraoperative high-field MRI (iMRI). METHODS We prospectively enrolled 13 patients harboring a LGG of WHO Grade II. After assumed near total removal, a resection control was performed using navigated cioUS, navigated lioUS, and iMRI. We harvested 30 navigated biopsies from the resection cavity and compared the histopathological findings with the respective imaging results. Spearman's rho was calculated to test for significant correlations. Sensitivity and specificity as well as receiver operating characteristics (ROC) were calculated to assess test performance of each imaging modality. RESULTS Imaging results of lioUS correlated significantly (p < 0.009) with iMRI. Both iMRI and lioUS correlated significantly with final histopathological diagnosis (p < 0.006, p < 0.014). cioUS did not correlate with other imaging findings or with final diagnosis. The highest sensitivity for residual tumor detection was found in iMRI (83 %), followed by lioUS (79 %). The sensitivity of cioUS was only 21 %. Specificity was highest in cioUS (100 %), whereas iMRI and lioUS both achieved 67 %. ROC curves showed fair results for iMRI and lioUS and a poor result for cioUS. CONCLUSIONS Intraoperative resection control in LGGs using lioUS reaches a degree of accuracy close to iMRI. Test results of lioUS are superior to cioUS. cioUS often fails to discriminate solid tumors from "normal" brain tissue during resection control. Only in lesions <10 cc cioUS does show good accuracy.
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Affiliation(s)
- Jan Coburger
- Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr. 2, 89312, Günzburg, Germany,
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Wang K, Ren Y, Huang R, He JJ, Feng WL, Kong YN, Xu F, Zhao L, Song QK, Li J, Zhang BN, Fan JH, Xie XM, Zheng S, Qiao YL. Application of intraoperative frozen section examination in the management of female breast cancer in China: a nationwide, multicenter 10-year epidemiological study. World J Surg Oncol 2014; 12:225. [PMID: 25034137 PMCID: PMC4105393 DOI: 10.1186/1477-7819-12-225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 07/04/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intraoperative frozen section examination (IFSE) during breast cancer surgery can partly reflect the status of surgical treatment since the surgical method used directly determines the purpose of IFSE use in disease management. This study aims to investigate the application of, changing trends in, and factors influencing IFSE in the management of female breast cancer in China. METHODS We collected the sociodemographic and clinical data of 4,211 breast cancer patients between 1999 and 2008 and statistically analyzed these data using χ2 or Fisher's exact tests. RESULTS A total of 2,283 (54.22%) patients with breast cancer underwent IFSE. During the 10-year study period, IFSE use was associated with an increase in the number of sentinel lymph node biopsies (SLNB) and breast-conserving surgeries (BS) performed, with significant regional differences noted in this trend (P < 0.05). Patients' education, occupation, age, tumor size estimated by preoperative palpation, and the use of imaging examinations affected the purpose of IFSE use (P < 0.05). CONCLUSIONS Our results show that the purpose of IFSE in the surgical treatment of breast cancer in China is gradually approaching that in developed countries. We believe that policymakers must address the differences in breast cancer treatment based on the socioeconomic status of patients. Lastly, the use of IFSE for determining tumor characteristics should be avoided as far as possible, and patient education and breast cancer screening programs tailored to the Chinese population should be established. Our findings may guide the formulation of breast cancer control strategies in China and other low-income countries.
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Affiliation(s)
- Ke Wang
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong Universtiy, 277 Yanta West Road, Xi’an 710061, P.R. China
| | - Yu Ren
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong Universtiy, 277 Yanta West Road, Xi’an 710061, P.R. China
| | - Rong Huang
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jian-Jun He
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong Universtiy, 277 Yanta West Road, Xi’an 710061, P.R. China
| | - Wei-Liang Feng
- Department of Breast Surgery, Zhejiang Cancer Hospital, No. 38 Banshanqiao Guanji Road, Hangzhou 310022, P.R. China
| | - Ya-Nan Kong
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East, Guangzhou 510060, P.R. China
| | - Feng Xu
- Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, No. 139 Renminzhonglu, Changsha 410011, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital, No. 44 Xiaoyanhe Road, Dadong District, Shenyang 110041, P.R. China
| | - Qing-Kun Song
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Jing Li
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Bao-Ning Zhang
- Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East, Guangzhou 510060, P.R. China
| | - Shan Zheng
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
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The role of intraoperative ultrasound in breast-conserving surgery of nonpalpable breast cancer. Wien Klin Wochenschr 2014; 126:90-4. [PMID: 24442857 DOI: 10.1007/s00508-013-0470-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/06/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This retrospective study was undertaken to evaluate the role of intraoperative ultrasound in breast-conserving surgery of nonpalpable breast cancer. METHODS The data about 125 patients with preoperatively diagnosed breast cancer operated with the help of intraoperative ultrasound between January 2009 and December 2012 were retrospectively analyzed. RESULTS The mean volume of the excised tissue was 42.1 cm(3) (± 22.0 cm(3)). Immediate re-excision after ultrasound examination of the excised tissue was performed in 27 patients (21.6 %). Secondary procedure owing to positive histological margins was necessary only in four patients (3.2 %). CONCLUSIONS Intraoperative ultrasound offers some advantages in comparison with other localization techniques for nonpalpable breast cancer surgery.
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Sajid MS, Hutson KH, Rapisarda IF, Bonomi R. Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [PMID: 23728694 DOI: 10.1002/14651858.cd009557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fibrin glue (FG) combines fibrinogen and thrombin, under the presence of factor XIII and calcium chloride, and produces a 'fibrin clot' as would occur through the natural clotting cascade. FG is thought to close over any small vessels including lymphatics that are too small for conventional surgical closure, thereby reducing seroma formation, seroma incidence and related comorbidities. OBJECTIVES To assess the evidence on the effectiveness of FG in people undergoing breast and axillary surgery and to establish whether FG is an efficient modality to prevent postoperative seroma and seroma-related outcomes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's (CBCG) Specialised Register (9 December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2012), MEDLINE (9 December 2011), EMBASE (9 December 2011), LILACS (22 October 2012), SCI-E (22 October 2012), the World Health Organization's International Clinical Trial Registry (9 December 2011) and ClinicalTrials.gov (22 October 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of FG in terms of reducing the postoperative seroma incidence and related comorbidities in people undergoing breast and axillary surgery. DATA COLLECTION AND ANALYSIS At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. The pooled analysis of the extracted data was achieved by the statistical analysis on Review Manager software. The quality of studies was assessed using The Cochrane Collaboration's 'Risk of bias' tool. MAIN RESULTS The search of four standard electronic databases yielded 119 potentially relevant studies but only 18 RCTs involving 1252 people were found suitable for statistical analysis. There was significant heterogeneity among trials and the majority of trials were of poor quality. The use of FG under skin flaps following breast and axillary surgery failed to reduce the incidence of postoperative seroma (risk ratio (RR) 1.02; 95% Confidence Interval (CI) 0.90 to 1.16, P value = 0.73), mean volume of seroma (standardised mean difference (SMD) -0.25; 95% CI -0.92 to 0.42, P value = 0.46), wound infection (RR 1.05; 95% CI 0.63 to 1.77, P value = 0.84), postoperative complications (RR 1.13; 95% CI 0.63 to 2.04, P value = 0.68) and length of hospital stay (SMD -0.2; 95% CI -0.78 to 0.39, P value = 0.51). FG reduced the total volume of drained seroma (SMD -0.75, 95% CI -1.24 to -0.26, P value = 0.003) and duration of persistent seromas requiring frequent aspirations (SMD -0.59; CI 95% -0.95 to -0.23, P value = 0.001). AUTHORS' CONCLUSIONS FG did not influence the incidence of postoperative seroma, the mean volume of seroma, wound infections, complications and the length of hospital stays in people undergoing breast cancer surgery. Due to significant methodological and clinical diversity among the included studies this conclusion may be considered weak and biased. Therefore, a major multicentre and high-quality RCT is required to validate these findings.
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Affiliation(s)
- Muhammad S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, Worthing, UK.
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Sajid MS, Hutson KH, Rapisarda IF, Bonomi R. Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery. Cochrane Database Syst Rev 2013; 2013:CD009557. [PMID: 23728694 PMCID: PMC8094277 DOI: 10.1002/14651858.cd009557.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Fibrin glue (FG) combines fibrinogen and thrombin, under the presence of factor XIII and calcium chloride, and produces a 'fibrin clot' as would occur through the natural clotting cascade. FG is thought to close over any small vessels including lymphatics that are too small for conventional surgical closure, thereby reducing seroma formation, seroma incidence and related comorbidities. OBJECTIVES To assess the evidence on the effectiveness of FG in people undergoing breast and axillary surgery and to establish whether FG is an efficient modality to prevent postoperative seroma and seroma-related outcomes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's (CBCG) Specialised Register (9 December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2012), MEDLINE (9 December 2011), EMBASE (9 December 2011), LILACS (22 October 2012), SCI-E (22 October 2012), the World Health Organization's International Clinical Trial Registry (9 December 2011) and ClinicalTrials.gov (22 October 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of FG in terms of reducing the postoperative seroma incidence and related comorbidities in people undergoing breast and axillary surgery. DATA COLLECTION AND ANALYSIS At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. The pooled analysis of the extracted data was achieved by the statistical analysis on Review Manager software. The quality of studies was assessed using The Cochrane Collaboration's 'Risk of bias' tool. MAIN RESULTS The search of four standard electronic databases yielded 119 potentially relevant studies but only 18 RCTs involving 1252 people were found suitable for statistical analysis. There was significant heterogeneity among trials and the majority of trials were of poor quality. The use of FG under skin flaps following breast and axillary surgery failed to reduce the incidence of postoperative seroma (risk ratio (RR) 1.02; 95% Confidence Interval (CI) 0.90 to 1.16, P value = 0.73), mean volume of seroma (standardised mean difference (SMD) -0.25; 95% CI -0.92 to 0.42, P value = 0.46), wound infection (RR 1.05; 95% CI 0.63 to 1.77, P value = 0.84), postoperative complications (RR 1.13; 95% CI 0.63 to 2.04, P value = 0.68) and length of hospital stay (SMD -0.2; 95% CI -0.78 to 0.39, P value = 0.51). FG reduced the total volume of drained seroma (SMD -0.75, 95% CI -1.24 to -0.26, P value = 0.003) and duration of persistent seromas requiring frequent aspirations (SMD -0.59; CI 95% -0.95 to -0.23, P value = 0.001). AUTHORS' CONCLUSIONS FG did not influence the incidence of postoperative seroma, the mean volume of seroma, wound infections, complications and the length of hospital stays in people undergoing breast cancer surgery. Due to significant methodological and clinical diversity among the included studies this conclusion may be considered weak and biased. Therefore, a major multicentre and high-quality RCT is required to validate these findings.
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Affiliation(s)
- Muhammad S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, Worthing, UK.
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A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg 2013; 257:609-20. [PMID: 23470508 DOI: 10.1097/sla.0b013e3182888782] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The primary objectives of this systematic review on oncoplastic breast surgery (OPBS) were to evaluate the oncological and cosmetic outcomes of OPBS. The secondary objectives were to assess morbidity, quality of life, and applied algorithms. BACKGROUND Breast-conserving therapy (BCT) has become the standard of care, and survival is now excellent. Consequently, the focus of BCT has increasingly shifted to cosmetic outcome, quality of life, and patient satisfaction. Nonetheless, excision of certain tumors still presents a considerable challenge. Specialized approaches combining oncological surgery and plastic surgery techniques are collectively referred to as OPBS. A summary of OPBS outcomes would facilitate decision-making and best treatment selection by both clinicians and patients. METHODS Using specific inclusion and exclusion criteria to analyze 2090 abstracts on the topic of OPBS published between 2000 and 2011, the authors evaluated each study with respect to design and outcomes. RESULTS A total of 88 articles were identified for potential inclusion and reviewed in detail by the lead authors. No randomized controlled trials were identified. Eleven prospective observational or comparative studies fulfilled inclusion criteria and were selected. In these studies, 80% to 93% of the tumors were invasive. Tumor-free resection margins were observed in 78% to 93%, resulting in a 3% to 16% mastectomy rate. Local recurrence was observed in 0% to 7% of the patients. Good cosmetic outcome was obtained in 84% to 89% of patients. However, most studies showed significant weaknesses including lack of robust design and important methodological shortcomings, negatively influencing generalizability. CONCLUSIONS This systematic review reveals that current evidence supporting the efficacy of OPBS is based on poorly designed and underpowered studies. Given the increasing importance and application of OPBS, there is a pressing need for robust comparative studies, including both randomized controlled trials and well-designed, multicenter prospective longitudinal studies.
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Haloua MH, Krekel NMA, Coupé VMH, Bosmans JE, Lopes Cardozo AMF, Meijer S, van den Tol MP. Ultrasound-guided surgery for palpable breast cancer is cost-saving: results of a cost-benefit analysis. Breast 2013; 22:238-43. [PMID: 23478199 DOI: 10.1016/j.breast.2013.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/09/2013] [Accepted: 02/06/2013] [Indexed: 01/27/2023] Open
Abstract
Ultrasound-guided surgery (USS) has recently been proven to result in a significant reduction of tumour-involved surgical margins, for patients with palpable invasive breast cancer. The objective of this economic evaluation alongside a randomised trial was to evaluate the costs and benefits of USS compared to palpation-guided surgery (PGS). The hospital perspective was used. On the cost side of the analysis, resource use related to baseline treatment was taken into account and on the benefit side, resource use related to additional treatments was included. On the cost side, the difference in costs per patient was €193 (95% CI €153-€233) with higher costs in the USS group. On the benefit side, the difference in costs per patient was -€349 (95% CI -€591 to -€103) with higher costs in the PGS group. This resulted in a cost decrease of -€154 (95% CI -€388 to €81) in the USS group compared to the PGS group. Intra-operative use of a US system during BCS reduces the rate of tumour-involved margins and thereby the costs of additional treatments.
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Affiliation(s)
- M H Haloua
- Department of Surgical Oncology, VU University Medical Centre, Amsterdam, The Netherlands.
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Krekel NMA, Haloua MH, Lopes Cardozo AMF, de Wit RH, Bosch AM, de Widt-Levert LM, Muller S, van der Veen H, Bergers E, de Lange de Klerk ESM, Meijer S, van den Tol MP. Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol 2012; 14:48-54. [PMID: 23218662 DOI: 10.1016/s1470-2045(12)70527-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast-conserving surgery for palpable breast cancer is associated with tumour-involved margins in up to 41% of cases and excessively large excision volumes. Ultrasound-guided surgery has the potential to resolve both of these problems, thereby improving surgical accuracy for palpable breast cancer. We aimed to compare ultrasound-guided surgery with the standard for palpable breast cancer-palpation-guided surgery-with respect to margin status and extent of healthy breast tissue resection. METHODS In this randomised controlled trial, patients with palpable T1-T2 invasive breast cancer were recruited from six medical centres in the Netherlands between October, 2010, and March, 2012. Eligible participants were randomly assigned to either ultrasound-guided surgery or palpation-guided surgery in a 1:1 ratio via a computer-generated random sequence and were stratified by study centre. Patients and investigators were aware of treatment assignments. Primary outcomes were surgical margin involvement, need for additional treatment, and excess healthy tissue resection (defined with a calculated resection ratio derived from excision volume and tumour diameter). Data were analysed by intention to treat. This trial is registered at http://www.TrialRegister.nl, number NTR2579. FINDINGS 134 patients were eligible for random allocation. Two (3%) of 65 patients allocated ultrasound-guided surgery had tumour-involved margins compared with 12 (17%) of 69 who were assigned palpation-guided surgery (difference 14%, 95% CI 4-25; p=0·0093). Seven (11%) patients who received ultrasound-guided surgery and 19 (28%) of those who received palpation-guided surgery required additional treatment (17%, 3-30; p=0·015). Ultrasound-guided surgery also resulted in smaller excision volumes (38 [SD 26] vs 57 [41] cm(3); difference 19 cm(3), 95% CI 7-31; p=0·002) and a reduced calculated resection ratio (1·0 [SD 0·5] vs 1·7 [1·2]; difference 0·7, 95% CI 0·4-1·0; p=0·0001) compared with palpation-guided surgery. INTERPRETATION Compared with palpation-guided surgery, ultrasound-guided surgery can significantly lower the proportion of tumour-involved resection margins, thus reducing the need for re-excision, mastectomy, and radiotherapy boost. By achieving optimum resection volumes, ultrasound-guided surgery reduces unnecessary resection of healthy breast tissue and could contribute to improved cosmetic results and quality of life. FUNDING Dutch Pink Ribbon Foundation, Osinga-Kluis Foundation, Toshiba Medical Systems.
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Affiliation(s)
- Nicole M A Krekel
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, Netherlands
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Sajid MS, Hutson K, Kalra L, Bonomi R. The role of fibrin glue instillation under skin flaps in the prevention of seroma formation and related morbidities following breast and axillary surgery for breast cancer: A meta-analysis. J Surg Oncol 2012; 106:783-795. [DOI: 10.1002/jso.23140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Atkins J, Al Mushawah F, Appleton CM, Cyr AE, Gillanders WE, Aft RL, Eberlein TJ, Gao F, Margenthaler JA. Positive margin rates following breast-conserving surgery for stage I-III breast cancer: palpable versus nonpalpable tumors. J Surg Res 2012; 177:109-15. [PMID: 22516344 DOI: 10.1016/j.jss.2012.03.045] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 03/08/2012] [Accepted: 03/22/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Margin status is a significant risk factor for local recurrence. We sought to examine whether the method of tumor localization predicted the margin status and the need for re-excision for both nonpalpable and palpable breast cancer. METHODS We identified 358 consecutive breast cancer patients who were treated with breast-conserving therapy (BCT) from 1999 to 2006. Data included patient and tumor characteristics, method of localization (needle versus palpation), and pathologic outcomes. Descriptive statistics were used for data summary and data were compared using χ(2). RESULTS Of 358 patients undergoing BCT, 234 (65%) underwent needle localization for a nonpalpable tumor and 124 (35%) underwent a palpation-guided procedure. Patients undergoing palpation-guided procedures were younger and had larger tumors at a more advanced pathologic stage of disease than those undergoing needle localization procedures (P < 0.05 for each). Patient race, tumor grade, presence of lymphovascular invasion, biomarker profile, and nodal status were not significantly different between the two groups (P > 0.05). Overall, 137 patients (38%) had one or more positive margins: 90 of 234 (38%) who had a needle localization procedure and 47 of 124 (38%) who had a palpation-guided procedure (P > 0.05). The number of margins affected did not differ significantly between the two groups. CONCLUSION Although patients with palpable breast cancer had larger tumors than those with nonpalpable breast cancer, the incidence and number of positive margins was similar to those who had needle localization for nonpalpable tumors. Improved methods of localization are needed to reduce the rate of positive margins and the need for re-excision.
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Affiliation(s)
- Jordan Atkins
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Krekel NMA, Lopes Cardozo AMF, Muller S, Bergers E, Meijer S, van den Tol MP. Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound--feasibility and surgeons' learning curve. Eur J Surg Oncol 2011; 37:1044-50. [PMID: 21924854 DOI: 10.1016/j.ejso.2011.08.127] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/04/2011] [Accepted: 08/22/2011] [Indexed: 12/19/2022] Open
Abstract
AIMS To evaluate if intra-operative guidance with ultrasonography (US) could improve surgical accuracy of palpable breast cancer excision, and to evaluate the performance of surgeons during training for US-guided excision. MATERIALS AND METHODS Thirty female patients undergoing breast-conserving surgery for palpable T1-T2 invasive breast cancer were recruited. Three individual breast surgeons, assisted by US, targeted and excised the tumours. The main objective was to obtain adequate resection margins with optimal resection volumes. The specimen volume, tumour diameter and histological margin status were recorded. The specimen volume was divided by the optimal resection volume, defined as the spherical tumour volume plus a 1.0-cm margin. The resulting calculated resection ratio (CRR) indicated the amount of excess tissue resected. RESULTS All tumours were correctly identified during surgery, 29 of 30 tumours (96.7%) were removed with adequately negative margins, and one tumour was removed with focally positive margins. The median CRR was 1.0 (range, 0.4-2.8), implying optimal excision volume. For all breast surgeons, CRR improved during the training period. By the 8th procedure, all surgeons showed proficiency in performing intra-operative breast US. CONCLUSION Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological and cosmetic outcomes.
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Affiliation(s)
- N M A Krekel
- Department of Surgical Oncology, VU University Medical Centre, De Boelelaan 1117, Amsterdam, The Netherlands.
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Fisher CS, Mushawah FA, Cyr AE, Gao F, Margenthaler JA. Ultrasound-guided lumpectomy for palpable breast cancers. Ann Surg Oncol 2011; 18:3198-203. [PMID: 21861232 DOI: 10.1245/s10434-011-1958-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND We sought to determine the re-excision rate following lumpectomy for palpable breast cancers using intraoperative ultrasound (US). A secondary aim was to investigate the impact on surgical decision-making. METHODS We identified 73 women who underwent US-guided lumpectomy for palpable breast cancer between 2006 and 2010. A cohort of 124 women who underwent palpation-guided lumpectomy was used for a comparison group. Data included patient demographics, tumor characteristics, intraoperative findings, and pathologic outcomes. Descriptive statistics were used for data summary and compared by chi-square or t test, as appropriate. RESULTS A total of 73 women underwent US-guided lumpectomy, and 124 women underwent palpation-guided lumpectomy (median age 55 years). Patients undergoing palpation-guided lumpectomy had smaller tumors that were more likely to be HER2/neu amplified compared with patients undergoing US-guided lumpectomy (P < 0.05 for each). There were no differences between the 2 groups with respect to patient age, tumor grade, and estrogen/progesterone receptor status (P > 0.05 for each). Re-excision rates were similar in both groups [17 (23%) in the US group versus 31 (25%) in the palpation group; P > 0.05]. In the US group, 45 patients (62%) had additional shave margins taken based on US interrogation of the specimen, and 12 patients (16%) were spared a 2nd procedure based on the use of intraoperative US. CONCLUSIONS Although palpable breast cancers can be excised based on direct palpation or needle localization, we believe that US guidance provides an excellent tool to aid the breast surgeon. Only 10% of patients had a positive margin on final pathology as a result, and the overall re-excision rate was acceptable.
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Affiliation(s)
- Carla S Fisher
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Mook J, Klein R, Kobbermann A, Unzeitig A, Euhus D, Peng Y, Sarode V, Moldrem A, Leitch AM, Andrews V, Teotia S, Rao R. Volume of Excision and Cosmesis with Routine Cavity Shave Margins Technique. Ann Surg Oncol 2011; 19:886-91. [DOI: 10.1245/s10434-011-1982-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Indexed: 01/06/2023]
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