1
|
Balbaloglu H, Tekin H, Yorgancioglu I, Tasdoven I, Tali U, Comert M, Karadeniz Cakmak G. A comparative study of learning curves among general surgery residents for intraoperative ultrasound-guided breast-conserving surgery. Sci Rep 2024; 14:18881. [PMID: 39143184 PMCID: PMC11324754 DOI: 10.1038/s41598-024-70040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/12/2024] [Indexed: 08/16/2024] Open
Abstract
Breast-conserving surgery (BCS) followed by radiotherapy is preferred for early-stage breast cancer because its survival rate is equivalent to that of mastectomy. Achieving negative surgical margins in BCS is crucial to minimize the risk of recurrence. Intraoperative ultrasound (IOUS) enhances surgical accuracy, but its efficacy is operator dependent. This study aimed to compare the success of achieving negative margins using IOUS between an experienced breast surgeon and general surgical residents and to evaluate the learning curve for the residents. A prospective study involving 96 patients with BCS who underwent IOUS guidance was conducted. Both the breast surgeon and residents assessed the surgical margins using IOUS, with the breast surgeon making the final margin adequacy decision. Permanent histopathological analysis was used to confirm the status of the margins and was considered the gold standard for comparison. The breast surgeon accurately assessed the margin status in all 96 cases (100% accuracy), with 93 negative and three positive margins. All of these were ductal carcinomas in situ. Initially, the residents demonstrated low accuracy rates in predicting margin positivity using intraoperative ultrasonography. However, the learning curves of the three residents demonstrated that, with an average 12th case onwards, a significant improvement in the cumulative accuracy rates was observed, which reached the level of the breast surgeon. IOUS is an effective tool for accurately predicting the margin status in BCS, with an acceptable learning curve for novice surgeons. Training and experience are pivotal for optimizing surgical outcomes. These findings support the integration of IOUS training into surgical education programs to enhance proficiency and improve patient outcomes.
Collapse
Affiliation(s)
- Hakan Balbaloglu
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey.
| | - Hatice Tekin
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey
| | - Ipek Yorgancioglu
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey
| | - Ilhan Tasdoven
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey
| | - Ufuk Tali
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey
| | - Mustafa Comert
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey
| | - Guldeniz Karadeniz Cakmak
- Department of General Surgery, Bülent Ecevit University School of Medicine, Bülent Ecevit University, 67630, Esenköy-Kozlu, Zonguldak, Turkey
| |
Collapse
|
2
|
Sanchez AM, De Lauretis F, Bucaro A, Borghesan N, Pirrottina CV, Franco A, Scardina L, Giannarelli D, Millochau JC, Parapini ML, Di Leone A, Marazzi F, Orlandi A, Palazzo A, Fabi A, Masetti R, Franceschini G. Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience. J Clin Med 2024; 13:3665. [PMID: 38999231 PMCID: PMC11242857 DOI: 10.3390/jcm13133665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Oncoplastic surgery (OPS) reliability in the post-neoadjuvant chemotherapy (NACT) setting is still debated due to weak scientific evidences in such scenarios. Methods: Our analysis aims to report results obtained in a retrospective series of 111 patients consecutively treated with level II OPS after NACT at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between 1998 and 2018. The surgical endpoints were the mean specimen volume, rates of positive margins (PMR), re-excision (RR), conversion to mastectomy (CMR), and complications (CR). The oncological endpoints were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). To evaluate the impact of NACT on surgical and oncological outcomes at 302 months, we conducted a propensity score matching, pairing patients in post-NACT and upfront surgery groups. Results: The mean sample volume was 390,796 mm3. We registered a 3.6% of PMR, 1.8% RR, 0.9% CMR, 5% CR. The 10-year OS and 10-year DFS with a median follow-up of 88 months (6-302) were 79% and 76%, respectively, with an LR recurrence rate of 5%. The post-NACT group received significantly larger excised volumes and lower PMR. NACT did not affect surgical and oncological outcomes. Conclusions: Level II OPS can be considered a reliable alternative to mastectomy even in the post-NACT setting.
Collapse
Affiliation(s)
- Alejandro M. Sanchez
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Flavia De Lauretis
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Angela Bucaro
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Niccolo Borghesan
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Chiara V. Pirrottina
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Antonio Franco
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Lorenzo Scardina
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Jenny C. Millochau
- L’Institut Du Sein-The Paris Breast Centre, 75017 Paris, France; (J.C.M.); (M.L.P.)
| | - Marina L. Parapini
- L’Institut Du Sein-The Paris Breast Centre, 75017 Paris, France; (J.C.M.); (M.L.P.)
| | - Alba Di Leone
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
| | - Fabio Marazzi
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Armando Orlandi
- UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.O.); (A.P.)
| | - Antonella Palazzo
- UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.O.); (A.P.)
| | - Alessandra Fabi
- UOSD di Medicina Personalizzata in Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Riccardo Masetti
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Center—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.M.S.); (F.D.L.); (A.B.); (N.B.); (C.V.P.); (A.F.); (A.D.L.); (R.M.); (G.F.)
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| |
Collapse
|
3
|
Bravo EI, Martínez AM, Alvà HP, Sancho DR, López JCA, Sánchez JA, Casa PE, de Las Heras CG, Venegas MAF, Vidal EG, Begines ED, Mur CG, Vicente I, Casamayor C, Cruz S, Barrado AG. Reliability of Magseed® marking before neoadjuvant systemic therapy with subsequent contrast-enhanced mammography in patients with non-palpable breast cancer lesions after treatment: the MAGMA study. Breast Cancer Res Treat 2024:10.1007/s10549-024-07407-6. [PMID: 38898360 DOI: 10.1007/s10549-024-07407-6] [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: 04/19/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To assess the reliability of excising residual breast cancer lesions after neoadjuvant systemic therapy (NAST) using a previously localized paramagnetic seed (Magseed®) and the subsequent use of contrast-enhanced spectral mammography (CESM) to evaluate response. METHODS Observational, prospective, multicenter study including adult women (> 18 years) with invasive breast carcinoma undergoing NAST between January 2022 and February 2023 with non-palpable tumor lesions at surgery. Radiologists marked tumors with Magseed® during biopsy before NAST, and surgeons excised tumors guided by the Sentimag® magnetometer. CESMs were performed before and after NAST to evaluate tumor response (Response Evaluation Criteria for Solid Tumors [RECIST]). We considered intraoperative, surgical, and CESM-related variables and histological response. RESULTS We analyzed 109 patients (median [IQR] age of 55.0 [46.0, 65.0] years). Magseed® was retrieved from breast tumors in all surgeries (100%; 95% CI 95.47-100.0%) with no displacement and was identified by radiology in 106 patients (97.24%), a median (IQR) of 176.5 (150.0, 216.3) days after marking. Most surgeries (94.49%) were conservative; they lasted a median (IQR) of 22.5 (14.75, 40.0) min (95% CI 23.59-30.11 min). Most dissected tumor margins (93.57%) were negative, and few patients (5.51%) needed reintervention. Magseed® was identified using CESM in all patients (100%); RECIST responses correlated with histopathological evaluations of dissected tumors using the Miller-Payne response grade (p < 0.0001) and residual lesion diameter (p < 0.0001). Also 69 patients (63.3%) answered a patient's satisfaction survey and 98.8% of them felt very satisfied with the entire procedure. CONCLUSION Long-term marking of breast cancer lesions with Magseed® is a reliable and feasible method in patients undergoing NAST and may be used with subsequent CESM.
Collapse
Affiliation(s)
- Eva Iglesias Bravo
- Obstetrics and Gynaecology Department, Virgen de Valme University Hospital, Seville, Spain.
- Servicio de Obstetricia y Ginecología, Hospital Universitario Virgen de Valme, Ctra. de Cádiz Km. 548,9, 41014, Seville, Spain.
| | - Antonio Mariscal Martínez
- Breast Diagnostic Imaging Unit (BDIU) Department of Radiology, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Barcelona, Spain
| | - Helena Peris Alvà
- Breast Diagnostic Imaging Unit (BDIU) Department of Radiology, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Barcelona, Spain
| | - Diego Riol Sancho
- Canary Islands University Hospital Complex - Materno Infantil de Canarias (CHUIMI), Canaria University Hospital, Las Palmas, Spain
| | - José Carlos Antela López
- Canary Islands University Hospital Complex - Materno Infantil de Canarias (CHUIMI), Canaria University Hospital, Las Palmas, Spain
| | - Joel Aranda Sánchez
- Canary Islands University Hospital Complex - Materno Infantil de Canarias (CHUIMI), Canaria University Hospital, Las Palmas, Spain
| | - Pilar Escobar Casa
- Radiology Department, Virgen de Valme University Hospital, Seville, Spain
| | | | | | - Eduarda García Vidal
- Obstetrics and Gynaecology Department, Virgen de Valme University Hospital, Seville, Spain
| | | | - Carmen García Mur
- Radiology Department, Miguel Servet University Hospital, Saragossa, Spain
| | - Isabel Vicente
- Gynaecology Department, Miguel Servet University Hospital, Saragossa, Spain
| | - Carmen Casamayor
- Surgery Department, Miguel Servet University Hospital, Saragossa, Spain
| | - Silvia Cruz
- Gynaecology Department, Miguel Servet University Hospital, Saragossa, Spain
| | | |
Collapse
|
4
|
Giuliani G, Vitale R, Brunetti N, Ninniri C, Listorti C, Folli S, Calabrese M, Panizza P, Pau L, Taffurelli M, Tinterri C, Fortunato L. Non-palpable breast lesions localization techniques - A new priority: Results of a Senonetwork survey among breast centers in Italy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108471. [PMID: 39002445 DOI: 10.1016/j.ejso.2024.108471] [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: 03/28/2024] [Revised: 05/18/2024] [Accepted: 06/04/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Non palpable breast tumors are increasingly diagnosed because of screening programs, and their localization during surgery is essential to ensure an adequate resection. Little is known regarding which techniques are used in "real world". MATERIALS AND METHODS A national web-based survey, with a 21-items questionnaire, was conducted among Breast Centers (BCs) in Italy in 2023. RESULTS Among 153 BCs, 110 (72 %) participated. Wire-guided localization was reported to be the most used technique, regardless of the volume of malignant tumors treated by each Center (N = 36, 33 %). However, newer techniques such as Radioactive occult lesion localization and magnetic seeds, were reported to be employed in 34 (31 %) BCs, and more often among high-volume BCs (>300 cases/year) (N = 32, 29 % vs. N = 13, 12 %; p = 0.02). Logistic problems of localization were reported to cause delays to the scheduled surgery at least once or in multiple occasions in 26 (24 %) and in 4 (3.5 %) BCs, respectively. Although the majority of BCs declared they were satisfied (N = 48, 44 %) or somewhat satisfied (N = 41, 37 %) with the procedure used in their center, responders stated that they would change their technique, or that they were strongly considering this possibility in 24 (22 %) and in 38 (35 %) cases, respectively. The main barrier to introducing a new technique was associated with procedure costs (90 BCs, 82 %). CONCLUSIONS There are several critical issues regarding localization techniques at a national level. This should be recognized as a priority because of its impact on both patients and clinical practices.
Collapse
Affiliation(s)
- G Giuliani
- Breast Center, University Hospital of Sassari, Italy
| | - R Vitale
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy; Residency Program, University of Tor Vergata, Rome, Italy
| | - N Brunetti
- Department of Radiology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy; Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | - C Ninniri
- Breast Center, University Hospital of Sassari, Italy
| | - C Listorti
- Breast Center, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - S Folli
- Breast Center, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - M Calabrese
- Department of Radiology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - P Panizza
- Breast Imaging Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Pau
- Europa Donna Italia, Milan, Italy
| | - M Taffurelli
- IRCCS Policlinico S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - C Tinterri
- Humanitas Research Hospital and Cancer Center, Breast Surgery, Rozzano, Italy
| | - L Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| |
Collapse
|
5
|
Dashevsky BZ, Yan P, Liang T, Daniel BL. SCOUT® Localization Using MRI Guidance: Initial Experience. JOURNAL OF BREAST IMAGING 2024:wbae025. [PMID: 38837068 DOI: 10.1093/jbi/wbae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Indexed: 06/06/2024]
Abstract
OBJECTIVE The Food and Drug Administration approved the MRI-compatible wireless SCOUT localization system in April 2022. The purpose of this study was to evaluate feasibility of SCOUT localization under MRI guidance. We present our initial experience adopting MRI-guided SCOUT localization and compare it to MRI-guided wire localization. METHODS Electronic medical records and imaging were retrospectively reviewed for all patients who underwent MRI-guided SCOUT or wire localization at our institution between October 2022 and July 2023. Statistical analysis was performed using 2-sample proportion and Wilcoxon rank-sum tests. RESULTS There were 14 MRI-guided SCOUT and 23 MRI-guided wire localization cases during the study period. All SCOUTs were placed without complication and were considered to be in adequate proximity to the target. There was no significant difference in complication rate (P = .25) or days lapsed from MRI-detected abnormality to surgery (P = .82) between SCOUT and wire cases. SCOUT was placed at time of biopsy for 71% (10/14) of cases. 57% (8/14) of SCOUT cases were used for breast conservation surgery (BCS) compared to 100% (23/23) of wire cases (P <.01), with all 6 SCOUTs not used for BCS placed at time of biopsy. CONCLUSION MRI-guided SCOUT localization is feasible and offers an alternative to MRI-guided wire localization, with no SCOUT complications reported. SCOUT placement at time of biopsy obviates the need for an additional procedure, but predicting appropriateness is challenging, with 60% (6/10) of SCOUTs placed at time of MRI-guided biopsy not used for subsequent localization surgery.
Collapse
Affiliation(s)
- Brittany Z Dashevsky
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela Yan
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tie Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bruce L Daniel
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
6
|
Sarkar DK. Pre-chemotherapy clinically-guided skin tattooing + post-chemotherapy USG-guided skin marking: A time-tested, cost-effective technique for breast lesion localization, before Breast Conservation Surgery (BCS), in a high volume tertiary care cancer hospital. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108370. [PMID: 38734494 DOI: 10.1016/j.ejso.2024.108370] [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: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
Post neoadjuvant chemotherapy tumor localization is a challenge in LMI economy countries. Various options are available in High economy countries. Pre-chemotherapy clinically guided skin tattooing and post chemotherapy USG guided skin marking is a valid technique. In patients with complete clinic-radiological response larger volume resection may be an issue. Head-to-head comparison between skin marking and parenchymal marking is needed to make a conclusive statement.
Collapse
Affiliation(s)
- Diptendra K Sarkar
- Clinical and Research Lead, Breast Service, Dept of Surgery, IPGMER-SSKM Hospitals, Kolkata, India.
| |
Collapse
|
7
|
D'Angelo A, Scardina L, Palma S, Cicero SL, Maresca A, Caprini F, Biondi E, Franco A, Terribile D, Franceschini G, Belli P, Manfredi R. Magnetic seed versus skin tattoo localization of non-palpable breast lesions: a single institution cohort study. Eur Radiol 2024; 34:149-154. [PMID: 37526666 PMCID: PMC10791905 DOI: 10.1007/s00330-023-10008-4] [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: 03/31/2023] [Revised: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE The objective of this retrospective study was to investigate the accuracy and feasibility of magnetic seed compared to skin tattoo in preoperative localization of impalpable breast lesions in terms of accuracy of placement, re-excision and positive margins rates, and breast/surgical specimen volume ratio. METHODS We retrospectively analyzed 77 patients who underwent breast conservative surgery in our center from November 2020 to November 2021, with previous localization with skin tattoo or magnetic seed. RESULTS Thirty-seven magnetic seeds were placed in 36 patients (48.6%) and 40 skin tattoos were performed in the remaining cases (51.4%). The seeds were placed correctly at the two-view mammogram acquired after the insertion in 97.6% (36/37) of cases. With both methods, 100% of the index lesions were completely removed and found in the surgical specimen. The reported re-excision rate was 0% for both groups. A significant difference was observed in the volume of breast parenchyma removed between the two groups, inferior in the seed group (p = 0.046), especially in case of voluminous breasts (p = 0.003) and small lesions (dimension < 8 mm, p = 0.019). CONCLUSIONS Magnetic seed is a non-radioactive localization technique, feasible to place, recommended in case of non-palpable breast lesions, saving the breast parenchyma removed compared with skin tattoo, without reducing the accuracy. CLINICAL RELEVANCE STATEMENT Our findings contribute to the current evidence on preoperative localization techniques for non-palpable breast lesions, highlighting the efficacy of magnetic seed localization for deep and small lesions. KEY POINTS • Magnetic seed is a non-radioactive technique for the preoperative localization of non-palpable breast lesions studied in comparison with skin tattoo. • Magnetic seed is feasible to place in terms of post-placement migration and distance from the target lesion. • Magnetic seed is recommended in case of non-palpable breast lesions, saving the breast parenchyma removed without reducing the accuracy.
Collapse
Affiliation(s)
- Anna D'Angelo
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy.
| | - Lorenzo Scardina
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Simone Palma
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Stefano Lo Cicero
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Alessandro Maresca
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Flavia Caprini
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Ersilia Biondi
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Franco
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniela Terribile
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Paolo Belli
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| |
Collapse
|
8
|
Champion NT, Mooney B, Kim Y, Whiting J, Sun W, Kiluk J, Czerniecki B, Hoover S, Lee MC. Surgeon and Radiologist Evaluation of Electromagnetic Chip Localization for Benign and Malignant Breast Lesions. Ann Surg Oncol 2023; 30:7081-7090. [PMID: 37552349 DOI: 10.1245/s10434-023-13976-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND SmartClipTM is a food and drug administration-approved, electromagnetic chip (EMC) localization system that provides three-dimensional navigation for the excision of soft tissue lesions. The purpose of this study was to analyze the accuracy and feasibility of EMC radiologic and surgical localization for benign and malignant breast lesions. PATIENTS AND METHODS An institutional review board-approved, single institution, prospective study from October 2020 to September 2022 of 38 women undergoing breast conserving surgery with EMC localization of a single lesion > 5 mm on mammogram (MMG) or ultrasound (US) imaging. Surveys from performing breast radiologists and breast surgeons were collected after image-guided localization and surgical excision. RESULTS Seventy-six survey responses from nine radiologists and four surgeons were received. The deployment needle and EMC were highly visible in 86.8% and 76.3% of procedures, respectively. There was no difficulty in deployment for 92.1% of procedures. The EMC was in the correct location on postdeployment MMG in 97.4% of cases. Three instances of EMC migration occurred, one 1 cm from target lesion. The targeted mass and EMC were within the surgical specimen in 97.4% of cases. On specimen radiograph, 39.5% of the EMCs were 0-1 mm from the center of the target lesion, 18.4% were within 2-4 mm, and 23.7% were within 5-10 mm. Mean operating room time for all cases was 65 min. One case required US to localize the target due to console malfunction. CONCLUSION There was successful EMC deployment by radiologists with accurate visualization and successful surgical excision in most cases. The EnVisioTM SmartClipTM system is a reproducible and accurate localization method for benign and malignant breast lesions.
Collapse
Affiliation(s)
| | - Blaise Mooney
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Junmin Whiting
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Weihong Sun
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John Kiluk
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brian Czerniecki
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan Hoover
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | |
Collapse
|
9
|
Jansen BAM, Bargon CA, Huibers AE, Postma EL, Young-Afat DA, Verkooijen HM, Doeksen A. Efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours: systematic review. BJS Open 2023; 7:zrad092. [PMID: 37751322 PMCID: PMC10521764 DOI: 10.1093/bjsopen/zrad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/22/2023] [Accepted: 07/20/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Accurate tumour localization is crucial for precise surgical targeting and complete tumour removal. Indocyanine green fluorescence, an increasingly used technique in oncological surgery, has shown promise in localizing non-palpable breast tumours. The aim of this systematic review was to describe the efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours. METHODS A systematic literature search was performed in PubMed, Embase, and the Cochrane Library, including studies from 2012 to 2023. Studies reporting the proportion of breast tumours identified using indocyanine green fluorescence were included. The quality of the studies and their risk of bias were appraised using the Methodological Index for Non-Randomized Studies ('MINORS') tool. The following outcomes were collected: identification rate, clear resection margins, specimen volume, operative time, re-operation rate, adverse events, and complications. RESULTS In total, 2061 articles were screened for eligibility, resulting in 11 studies, with 366 patients included: two RCTs, three non-randomized comparative studies, four single-arm studies, and two case reports. All studies achieved a 100 per cent tumour identification rate with indocyanine green fluorescence, except for one study, with an identification rate of 87 per cent (13/15). Clear resection margins were found in 88-100 per cent of all patients. Reoperation rates ranged from 0.0 to 5.4 per cent and no complications or adverse events related to indocyanine green occurred. CONCLUSION Indocyanine green fluorescence has substantial theoretical advantages compared with current routine localization methods. Although a limited number of studies were available, the current literature suggests that indocyanine green fluorescence is a useful, accurate, and safe technique for the intraoperative localization of non-palpable breast tumours, with equivalent efficacy compared with other localization techniques, potentially reducing tumour-positive margins.
Collapse
Affiliation(s)
- Britt A M Jansen
- Division of Imaging and Oncology, University Medical Centre (UMC), Utrecht University, Utrecht, The Netherlands
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, St Antonius Hospital, Utrecht, The Netherlands
| | - Claudia A Bargon
- Division of Imaging and Oncology, University Medical Centre (UMC), Utrecht University, Utrecht, The Netherlands
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, St Antonius Hospital, Utrecht, The Netherlands
| | - Anne E Huibers
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
| | - Emily L Postma
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre (UMC), Utrecht University, Utrecht, The Netherlands
- Utrecht University (UU), Utrecht, The Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
| |
Collapse
|
10
|
Kim J, Ko EY, Han BK, Ko ES, Choi JS, Kim H, Kim MK. Characteristics of Breast Charcoal Granuloma: A Delayed Complication Following Tattoo Localization. Diagnostics (Basel) 2023; 13:2800. [PMID: 37685338 PMCID: PMC10486575 DOI: 10.3390/diagnostics13172800] [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: 07/26/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Rationale and Objective: To evaluate the characteristic clinical and imaging findings of charcoal granuloma and suggest features that may differentiate charcoal granuloma from breast cancer. Materials and Methods: This retrospective study included 18 patients with a histologically confirmed breast charcoal granuloma between 2005 and 2021 at a single institution. All patients had a history of breast surgery after ultrasound (US)-guided charcoal marking. Two radiologists analyzed the radiologic findings of charcoal granulomas, including the presence of a mass or calcification; the shape, margin and density of the masses on mammography; and the location, size, shape, margin, orientation, echogenicity, vascularity, presence of an echogenic halo, and posterior acoustic shadowing on US. In cases with available follow-up images, we also investigated whether the size and shape had changed. Results: The median interval between breast surgery and the diagnosis of charcoal granuloma was 2.3 years (range, 0.7-18.3 years). Thirteen lesions (72.2%) were detected on screening images. In 11 (61.1%) cases, the surgical incision was not made in the tattooed skin area. Mammography showed positive findings in 10/15 patients, and most lesions were isodense masses (70%). There were no cases with calcification. On US, all lesions were masses and showed a taller-than-wide orientation (61.1%), round or oval shape (55.6%), and iso- or hyperechogenicity (83.3%). Echogenic halo (27.8%) and posterior acoustic shadowing (16.7%) were uncommon. On Doppler US, only four cases (22.2%) showed increased vascularity. Most were classified as BI-RADS 3 (38.9%) or 4A (50.0%). After biopsy, 12 patients had follow-up mammography and US. The size of the lesion decreased in nine cases and remained unchanged in three cases. A decrease in the lesion size after biopsy showed a negative correlation with the interval between detection on imaging and biopsy (p = 0.04). Conclusion: Charcoal granuloma is most commonly found 2-3 years after surgery and occurs more frequently when the incision site is different from the tattooed skin area. US findings of tall and round or oval masses with iso- or hyperechogenicity without increased vascularity could help to differentiate them from malignancies.
Collapse
Affiliation(s)
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea (B.-K.H.); (E.S.K.); (J.S.C.); (H.K.); (M.K.K.)
| | | | | | | | | | | |
Collapse
|
11
|
elzohery YHAEM, gomaa MM, abdelsalam GM, fadlalla WM, taha SN, ibraheem MH. Comparison of wire-guided localization (WGL) and radio-guided occult lesion localization(ROLL) in localization of non-palpable breast lesions.. [DOI: 10.21203/rs.3.rs-3153699/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Background:
The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions.
The aim of marking the non-palpable breast lesions is to achieve accurate lesion localization, to obtain the better cosmetic result with less tissue loss and to provide negative surgical margin.
Aim:the aim of the study is to compare the wire-guided localization (WGL) technique with the radioguided occult lesion localization (ROLL) technique to assess their accuracy and efficacy in non-palpable breast lesions localization.
Methods:From January 2018 and June2022 a total of 670 patients underwent an excision for non-palpable lesions were enrolled randomly in ROLL group (n = 320 ) and WGL (n =350 ) at Baheya center for Early Detection and Treatment of Breast Cancer.
Results: There were no differences between the two groups in terms of age, localization technique.Both the localization time and the time of operation were decreased with the ROLL. Complete lesion excision with clear margins were reported in (88.2%) of ROLL patients and in (81.8%) of WGL patients. Reoperations were done as a second operation on16( 11.8%)of ROLL patients and on 29( 18.2%) of WGL patients.
Conclusion:This study shows that ROLL is as effective as WGL for non-palpable breast lesions excision. Also, ROLL improve the outcomes by decreasing the duration of surgery, localization time,achieving a higher percentage of clear margin in spite of lower specimen size and scar length.
Collapse
|
12
|
Khoo FJ, Wong J, Stephenson J, Bennett I. Technique of intraoperative ultrasound-guided excision of impalpable breast lesions. Australas J Ultrasound Med 2023; 26:63-66. [PMID: 36960138 PMCID: PMC10030088 DOI: 10.1002/ajum.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The introduction of breast screening programs has led to the increased detection of occult breast lesions requiring diagnostic surgical biopsy or breast-conserving surgery for early-stage breast cancer. Excision of impalpable breast lesions can be challenging. Whilst a variety of techniques have now been described including the use of adjuncts such as hook wires, radioactive seeds, magnetic seeds or radiofrequency devices, many of these modalities are expensive and can be logistically problematic. The technique of surgeon-performed ultrasound-guided excision is a straightforward technique which is safe, cost-efficient and avoids a painful preoperative procedure for patients such as hook wire localisation. Whilst the use of intraoperative ultrasound-guided excision of breast lesions has been widely reported, the actual technique itself has been less well described.
Collapse
Affiliation(s)
- Fuquan Jeremy Khoo
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute, Princess Alexandra HospitalKent StBrisbaneQueenslandAustralia
| | - Jessica Wong
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
| | - James Stephenson
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute, Princess Alexandra HospitalKent StBrisbaneQueenslandAustralia
| | - Ian Bennett
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute, Princess Alexandra HospitalKent StBrisbaneQueenslandAustralia
| |
Collapse
|
13
|
Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14:cancers14225624. [PMID: 36428718 PMCID: PMC9688088 DOI: 10.3390/cancers14225624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Oncoplastic level II breast-conserving surgery (OPS2) allows for wider excisions than standard breast-conserving surgery, but the literature on this technique in the treatment of DCIS is scarce. This study compares OPS2 to conservative mastectomy (CM) in patients undergoing surgery for large DCIS. The clinical, radiological, surgical, and post-operative data of 147 patients who underwent either CM or OPS2 for large DCIS between 2007 and 2021 were retrospectively reviewed. The surgical, oncological, and patient-reported outcomes (PRO) were analyzed and compared between the two groups. The surgical outcomes were similar, in terms of margin involvement (p = 0.211), complication rate (p = 0.827), and re-excision rate (p = 1). The rate of additional surgery for cosmetic optimization was significantly lower in the OPS2 group: only 1 (1.8%) patient required surgical adjustments versus 24 (26.4%) patients in the CM group (p < 0.001). The mean hospital stay was lower in the OPS2 group (p < 0.001). The oncological outcomes did not differ between the two groups (p = 0.662). The PRO analysis showed better outcomes in the OPS2 group, which achieved statistical significance in the sexual well-being module (p = 0.015). Skin sensitivity loss was also significantly lower in the OPS2 group (p < 0.001). When feasible, OPS2 should be considered in the treatment of large DCIS, as it is safe and shows high levels of patient satisfaction.
Collapse
|
14
|
Innovations in the Integrated Management of Breast Cancer. J Pers Med 2022; 12:jpm12040531. [PMID: 35455647 PMCID: PMC9032921 DOI: 10.3390/jpm12040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 12/10/2022] Open
|
15
|
Garzotto F, Comoretto RI, Michieletto S, Franzoso G, Lo Mele M, Gregori D, Bonavina MG, Bozza F, Caumo F, Saibene T. Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis. Breast 2021; 58:93-105. [PMID: 33991806 PMCID: PMC8481910 DOI: 10.1016/j.breast.2021.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022] Open
Abstract
Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic outcome and contribute to organizational aspects improvement in breast-conserving surgery (BCS). However only limited literature is available and clinical studies involving these forefront devices are often small and non-randomized. Furthermore, there is a lack of consensus on free margins and cosmetic outcomes definitions. The objective of the present meta-analysis was to determine the crude clinical outcomes reported for the NWNI techniques on BCS. A literature search was performed of PubMed, Embase and Scopus databases up to February 2021 in order to select all prospective or retrospective clinical trials on pre-operative breast lesion localization done with NWNI devices. All studies were assessed following the PRISMA recommendations. Continuous outcomes were described in averages corrected for sample size, while binomial outcomes were described using the weighted average proportion. Twenty-seven studies with a total of 2103 procedures were identified. The technique is consolidated, showing for both reflectors' positioning and localization nearly the 100% rate of success. The re-excision and clear margins rates were 14% (95% CI, 11-17%) and 87% (80-92%), respectively. Overall, positive margins rates were 12% (8-17%). In studies that compared NWNI and wire localization techniques, positive margin rate is lower for the first techniques (12%, 6-22% vs 17%, 12-23%) and re-excision rate is slightly higher using the latter (13%, 9-19% vs 16%, 13-18%). Pre-operative NWNI techniques are effective in the localization of non-palpable breast lesions and are promising in obtaining clear (or negative) margins minimizing the need for re-excision and improving the cosmetic outcomes. Randomized trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Francesco Garzotto
- Breast Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
| | - Rosanna Irene Comoretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Silvia Michieletto
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Marcello Lo Mele
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, 35121, Italy
| | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | | | - Fernando Bozza
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesca Caumo
- Breast Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| |
Collapse
|
16
|
Gulcelik MA, Dogan L. Unplanned breast-conserving surgery after systemic therapy in locally advanced breast cancer: The results of level II oncoplastic techniques. Int J Clin Pract 2021; 75:e14268. [PMID: 33891352 DOI: 10.1111/ijcp.14268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In patients with breast cancer for whom neoadjuvant chemotherapy (NAC) is planned, it is recommended to mark the primary tumour before treatment (planned surgery). However, surgeons may have to perform breast-conserving surgery on patients whose tumours are not marked (unplanned surgery). This study focused on the results obtained with planned and unplanned level II oncoplastic surgery (OPS) techniques applied to patients after NAC. METHODS Patient groups who underwent planned, unplanned OPS and mastectomy after NAC were compared. Surgical margin status, re-operation and re-excision requirements, ipsilateral breast tumour recurrence (IBTR) and axillary recurrence rates recorded. Long-term local recurrence-free survival (LRFS), disease-free survival and overall survival were evaluated. RESULTS There was no significant difference between the planned and unplanned OPS groups in terms of surgical margin status, re-excision requirement, and mastectomy rates. During an average follow-up period of 43 months, 5.3% and 4% of the patients in the planned OPS group developed IBTR and axillary recurrence, respectively, whereas these rates were 6.6% and 5.3% in the unplanned OPS group. In the mastectomy group, the rates of IBTR and axillary recurrence were found to be 4.1% and 3.8%, respectively. There was no significant difference between the three groups in terms of IBTR (P: .06) and axillary recurrence (P: .08) rates. CONCLUSION Breast conserving surgery can be applied using level II OPS techniques with the post-NAC radiological examination and marking even if primary tumour marking is not done in the pre-NAC period.
Collapse
Affiliation(s)
- Mehmet A Gulcelik
- Department of Surgical Oncology, Gulhane Medical School, University of Health Sciences, Ankara, Turkey
| | - Lutfi Dogan
- Department of Surgical Oncology, University of Health Sciences AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|