Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review

Oncologic Safety of Immediate Oncoplastic Surgery Compared with Standard Breast-Conserving Surgery for Patients with Invasive Lobular Carcinoma

BACKGROUND

Invasive lobular carcinoma (ILC) of the breast grows in a diffuse pattern, resulting in a high risk of positive margins at surgical resection. Oncoplastic approaches have been shown to reduce this risk, but concerns persist around the safety of immediate oncoplastic surgery for those with ILC. This study evaluated the short- and long-term oncologic outcomes of immediate oncoplastic surgery for patients with ILC.

METHODS

This study retrospectively analyzed an institutional database of stages I to III ILC patients who underwent breast-conserving surgery (BCS) with or without immediate oncoplastic surgery (oncoplastic closure or oncoplastic reduction mammoplasty [ORM]). The study compared positive margin rates, rates of successful BCS, and recurrence-free survival (RFS) by type of surgery.

RESULTS

For 494 patients the findings showed that the use of immediate ORM was associated with significantly lower odds of positive margins (odds ratio [OR], 0.34; 95 % confidence interval [CI], 0.17-0.66; p = 0.002). Both lumpectomy with oncoplastic closure and ORM were significantly associated with higher rates of successful BCS than standard lumpectomy (94.2 %, 87.8 %, and 73.9 %, respectively; p < 0.001). No difference in RFS was observed between those undergoing immediate oncoplastic surgery and those undergoing standard lumpectomy alone.

CONCLUSIONS

The patients with stages I to III ILC who underwent immediate oncoplastic surgery had significant benefits including lower odds of positive margins and higher rates of successful BCS, with both types of immediate oncoplastic surgery showing similar RFS compared with lumpectomy alone. This supports the oncologic safety of immediate oncoplastic surgery for diffusely growing tumors such as ILC, providing it an ideal option for patients desiring BCS.

A Nomogram to Predict Noninflammatory Skin Involvement of Invasive Breast Cancer

Purpose

The aim of this study was to develop and assess a nomogram to predict noninflammatory skin involvement of invasive breast cancer.

Methods

We developed a prediction model based on SEER database, a training dataset of 89202 patients from January 2010 to December 2016. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation.

Results

Predictors contained in the prediction nomogram included use of age, race, grade, tumor size, stage-N, ER status, PR status, and Her-2 status. The model shows good discrimination with a C-index of 0.857 (95% confidence interval: 0.807–0.907) and good calibration. High C-index value of 0.847 could still be reached in the internal validation.

Conclusion

This study constructed a novel nomogram with accuracy to help clinicians access the risk of noninflammatory skin involvement by tumor. The assessment of clinicopathologic factors can predict the individual probability of skin involvement and provide assistance to the clinical decision-making.