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Christine D, Christian SF, Ricarda K, Christine K, Daphne GK, Carmen L, Alaa M, Baltzer PAT, Thomas HH, Georg P, Paola C. Risk factors for residual fibroglandular breast tissue following a mastectomy - an overview and retrospective cohort study. BMC Cancer 2024; 24:856. [PMID: 39026150 PMCID: PMC11256640 DOI: 10.1186/s12885-024-12491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Residual fibroglandular breast tissue (RFGT) following a mastectomy is associated with the remaining of occult breast cancer at the time of mastectomy as well as an increased local recurrence risk thereafter. Despite its oncologic implications, data on measures to prevent RFGT are lacking. Therefore, in a first step knowledge of risk factors for RFGT is of uttermost importance in order to allow identification of patients at risk and subsequently adaption of the surgical treatment and potentially prevention of RFGT a priori. METHODS We performed a systematic literature review in PubMed using the MESH terms [residual fibroglandular breast tissue], [residual breast tissue], [mastectomy] and [risk factor] followed by a retrospective data analysis including all patients with a mastectomy treated at the Department of Obstetrics and Gynecology of the Medical University of Vienna, Austria, between 01.01.2015 and 26.02.2020 in order to identify risk factors of RFGT following a mastectomy. The primary aim of the study was to assess a potential difference in RFGT volume between the different types of mastectomy. The secondary objectives of the study were to identify other potential risk factors for RFGT as well as to compare the skin and subcutaneous fat tissue thickness pre- to postoperatively. RESULTS Significantly higher RFGT volumes were observed following a nipple-sparing mastectomy (NSM) compared to a skin-sparing mastectomy (SSM) and radical mastectomy (RME) (p < .001). Furthermore, RFGT volume was significantly associated with the variables: reconstruction (p = .012), acellular dermal matrix (ADM) or mesh (p = .031), patient age (p = .022), preoperative fibroglandular tissue (FGT) volume (p = .012) and preoperative whole breast volume (including the skin envelope and nipple-areola-complex) (p = .030). The reduction in the postoperative compared to preoperative skin envelope thickness measured medially and laterally reached statistical significance in the NSM-cohort (medial p < .001, lateral p = .001) and showed a numerical difference in the RME and SSM-cohort. CONCLUSION Mastectomy type, reconstruction, ADM or mesh, patient age, preoperative FGT volume and whole breast volume were identified as risk factors for RFGT in univariable analysis. The observed reduction in the post- compared to preoperative skin envelope thickness should be avoided considering the known associated increase in risk for ischemic complications.
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Affiliation(s)
- Deutschmann Christine
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Singer F Christian
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Korbatits Ricarda
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Kraus Christine
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Gschwantler-Kaulich Daphne
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Leser Carmen
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Marzogi Alaa
- Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah, 24246, Saudi Arabia
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Helbich H Thomas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Pfeiler Georg
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Clauser Paola
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Kaidar-Person O, Faermann R, Polikar D, Cohen K, Bernstein-Molho R, Morrow M, Boersma LJ, Offersen BV, Poortmans P, Sklair-Levy M, Anaby D. A BRILLIANT-BRCA study: residual breast tissue after mastectomy and reconstruction. Breast Cancer Res Treat 2024:10.1007/s10549-024-07425-4. [PMID: 38980506 DOI: 10.1007/s10549-024-07425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Different types of mastectomies leave different amounts of residual breast tissue. The significance of the residual breast volume (RBV) is not clear. Therefore, we developed an MRI tool that allows to easily assess the RBV. In this study we evaluated factors associated with RBV after skin or nipple sparing mastectomy (SSM/NSM) in breast cancer BRCA pathogenic variant (PV) carriers who underwent both therapeutic and risk reducing SSM/NSM and its relation to breast cancer outcomes using an innovative MRI-based tool. METHODS Data of breast cancer BRCA PV who were treated between 2006 and 2020 were retrieved from of the oncogenetics unit databases. Only patients who underwent SSM/NSM and had a postoperative breast MRI available for analysis were included. Data collected included demographics, clinicopathological features, and outcomes. The MRI tool was developed by a breast cancer imaging laboratory. A logistic regression test and 95% confidence interval (CI) were used to assess the associated risk of increased RBV. A forward stepwise linear regression was used to correlate tumour-patient specific factors and RBV, and a Kaplan-Meier curve to show the probability of locoregional relapse. RESULTS A total of 84 patients undergoing 89 mastectomies were included. At a median follow-up of 98 months, 5 local, 2 regional, and 4 distant recurrences were observed. RBV was not significantly related with breast cancer outcomes (p value = NS). A higher body mass index (BMI) was associated with a higher RBV (p < 0.0001). A larger number of involved axillary nodes was associated with a smaller RBV (p = 0.025). The RBV on the risk-reducing mastectomy side was significantly higher compared to the breast cancer side (p value = 0.007). Local recurrences occurred in the vicinity of the primary tumour.
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Affiliation(s)
- Orit Kaidar-Person
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
- Breast Radiation Unit, The Jusidman Cancer Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
| | - Renata Faermann
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- The Merav High-Risk Clinic - Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Dor Polikar
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Kfir Cohen
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Rinat Bernstein-Molho
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Breast Cancer Institute, The Jusidman Cancer Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liesbeth Jorinne Boersma
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Miri Sklair-Levy
- School of Medicine, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- The Merav High-Risk Clinic - Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Debbie Anaby
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Taris N, Luporsi E, Osada M, Thiblet M, Mathelin C. [News in breast oncology genetics for female and male population]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:149-157. [PMID: 38190969 DOI: 10.1016/j.gofs.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Breast oncology genetics emerged almost 30 years ago with the discovery of the BRCA1 and BRCA2 genes. The evolution of analytical practices has progressively allowed access to tests whose results now have a considerable impact on the management of both female and male breast cancers. The Sénologie commission of the Collège national des gynécologues et obstétriciens français (CNGOF) asked five specialists in breast surgery, oncology and oncological genetics to draw up a summary of the oncogenetic testing criteria used and the clinical implications for the female and male population of the test results, with or without an identified causal variant. In the case of proven genetic risk, surveillance, risk-reduction strategies, and the specificities of surgical and medical management (with PARP inhibitors in particular) were updated. METHODS This summary was based on national and international guidelines on the monitoring and therapeutic management of genetic risk, and a recent review of the literature covering the last five years. RESULTS Despite successive technical developments, the probability of identifying a causal variant in a situation suggestive of a predisposition to breast and ovarian cancer remains around 10% in France. The risk of breast cancer in women with a causal variant of the BRCA1, BRCA2, PALB2, TP53, CDH1 and PTEN genes is estimated at between 35% and 85% at age 70. The presence of a causal variant in one of these genes is the subject of different recommendations for men and women, concerning both surveillance, the age of onset and imaging modalities of which vary according to the genes involved, and risk-reduction surgery, which is possible for women as soon as their risk level exceeds 30% and remains exceptionally indicated for men. In the case of breast cancer, PARP inhibitors are a promising new class of treatment for BRCA germline mutations. CONCLUSION A discipline resolutely focused on understanding molecular mechanisms, screening and preventive medicine/surgery, oncology genetics is currently also involved in new medical/surgical approaches, the long-term benefits/risks of which will need to be monitored.
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Affiliation(s)
- Nicolas Taris
- Unité de génétique oncologique, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France.
| | - Elisabeth Luporsi
- Service de génétique, hôpital Femme-Mère-Enfant, CHR de Metz-Thionville, Site de Mercy, 1, allée du Château, 57085 Metz cedex, France.
| | - Marine Osada
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Marie Thiblet
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Carole Mathelin
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
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Mohrmann S, Kolberg L, Jäger B, Hoffmann J, Nestle-Krämling C, Zwiefel K, Friebe V, Sawicki LM, Bruckmann NM, Jannusch K, Morawitz J, Antoch G, Fehm TN, Kirchner J, Dietzel F. Impact of surgical variables on residual glandular tissue in risk-reducing mastectomies: Results of a retrospective monocentric study from a center of the German consortium for hereditary breast and ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107031. [PMID: 37683424 DOI: 10.1016/j.ejso.2023.107031] [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: 04/24/2023] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE Residual glandular tissue (RGT) after risk reducing mastectomy (RRME) is associated with a risk of developing breast cancer for women with a familial predisposition. We aim to examine various surgery-related variables to make risk more easily assessable and to aid in decision-making. MATERIALS AND METHODS Pre- and postoperative breast MRI scans from 2006 to 2021 of patients with proven pathogenic mutation were included. The postoperative remaining skin flap was recorded using distance measurements at 8 equally distributed clockwise points and retromamillary. Each breast was volumetrized, as well as existing RGT. Patient-related covariates were further recorded and their influence on RGT was investigated uni- and multivariately. RESULTS 81 patients (49 with BRCA1, 24 with BRCA2, 9 with other mutations), who were on average 39 years old, had 117 breasts analyzed. The mean follow-up was 71 months. In multivariate analysis, the independent variable skin flap thickness had a positive effect (p ≤ 0.01), while surgeon experience negatively affected RGT (p ≤ 0.05). The incision type was found to impact RGT as well, with nipple-sparing mastectomy (NSM) with inframammary fold incision leading to more RGT (p ≤ 0.01 - p ≤ 0.05), and skin-sparing mastectomy (SSM) with an inverted T incision leading to less (p ≤ 0.01). CONCLUSION Different surgical variables have an impact on postoperative RGT, which is an important tool to quantify the risk of developing breast cancer after RRME. In order to effectively consider these variables in future preoperative/intraoperative management, they must be carefully taken into account.
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Affiliation(s)
- Svjetlana Mohrmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Leoni Kolberg
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany; Department of Obstetrics and Gynecology, Agaplesion Bethesda Krankenhaus Wuppertal, 42109, Wuppertal, Germany.
| | - Bernadette Jäger
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Jürgen Hoffmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | | | - Karin Zwiefel
- Breast Center, Kliniken der Stadt Köln, 51067, Köln, Germany.
| | - Verena Friebe
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
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