Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

Volders, José H.; Negenborn, Vera L.; Spronk, P.E.R.; Krekel, N.M.A.; Schoonmade, Linda J.; Meijer, Sybren; Rubio, Isabel T.; Tol, M.P. van den

doi:10.1007/s10549-017-4598-5

Cited by 65 publications

(44 citation statements)

References 57 publications

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“…The development of an accurate MRI-based measurement tool is of particular necessity for patients receiving NAC and BCS, a matter that needs to be urgently addressed. Our predictive equation may help to estimate accurately tumor size and to reduce the high rate (2–40%) of tumors on ink reported in patients undergoing BCS after NAC [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Direct comparison of magnetic resonance imaging and pathological shrinkage patterns of triple-negative breast cancer after neoadjuvant chemotherapy

et al. 2020

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Background: We aimed to investigate the usefulness of magnetic resonance imaging (MRI) and histopathological shrinkage patterns to formulate a predictive equation for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients. Methods: We enrolled 34 TNBC patients who underwent MRI before and after NAC. The MRI and histopathological shrinkage patterns were analyzed and classified into five categories-types I and II (concentric shrinkage without or with surrounding lesions, respectively), type III (shrinkage with residual multinodular lesions), type IV (diffuse contrast enhancement in the entire quadrant), and non-visualization. The residual tumor sizes following MRI and histopathological examination were also compared. Results: The most common MRI and histopathological shrinkage pattern was type I (41.2% and 38.2%, respectively), followed by non-visualization (26.5% and 32.4%, respectively); the concordance rate between MRI and histopathological shrinkage patterns was 41.2%. There was a strong correlation between MRI tumor size and pathological tumor size (r = 0.89). Based on these findings, a predictive equation for pathological tumor size was formulated as follows: pathological tumor size (mm) = 1.1502 × (MRI tumor size [mm]) + 8.4277. Conclusions: Our equation may aid accurate preoperative assessment. Further studies are needed to determine its predictive value and applicability.

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Section: Discussionmentioning

confidence: 99%

Direct comparison of magnetic resonance imaging and pathological shrinkage patterns of triple-negative breast cancer after neoadjuvant chemotherapy

et al. 2020

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“…20,21 A recent systematic review of the available literature concluded that currently there is insufficient evidence to suggest that neoadjuvant chemotherapy improves surgical outcomes of BCS. 20 A retrospective study comparing the outcomes of OBS (45 patients) against standard BCS (214 patients) following neoadjuvant chemotherapy found higher rates of margin re-excision and completion mastectomy in the OBS group (31% versus 27% and 24% versus 18%, respectively). 21 In our work, despite of the rate of neoadjuvant chemotherapy being 1.5 times higher in the OBS group, this showed lower rates of margin re-excision and completion mastectomy than the WLE group.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of neoadjuvant chemotherapy on surgical margins is still controversial 20,21 . A recent systematic review of the available literature concluded that currently there is insufficient evidence to suggest that neoadjuvant chemotherapy improves surgical outcomes of BCS 20 . A retrospective study comparing the outcomes of OBS (45 patients) against standard BCS (214 patients) following neoadjuvant chemotherapy found higher rates of margin re‐excision and completion mastectomy in the OBS group (31% versus 27% and 24% versus 18%, respectively) 21 .…”

Section: Discussionmentioning

confidence: 99%

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

Garreffa

Kankam

Bali

et al. 2020

ANZ Journal of Surgery

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Background: Pre-operative breast tumour radial dimensions often determine the choice between simple wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the three-dimensional interplay between tumour and surgical specimen dimensions in the two cohorts. Methods: Demographic, tumour and treatment data were collected for all patients undergoing OBS by a single surgeon and compared with a randomly selected cohort of WLE patients treated. The relationship between tumour and specimen medio-lateral, superoinferior and antero-posterior dimensions were explored in both groups. Subgroup analyses were performed in the OBS cohort (parenchymal displacement versus replacement). Results: We identified 60 OBS patients (63 breasts), comparing them with 60 WLE patients. Pre-operative tumour estimated size was significantly larger in the OBS cohort and concordant with macroscopic tumour radial dimensions and final microscopic tumour size. Surgical specimen weight was more than 3.5 times higher in the OBS group and its radial dimensions were almost double. No significant difference was observed for the anteroposterior dimensions. The rate of margin re-excisions and completion mastectomies were lower in the OBS cohort. WLE patients with positive margins had a lower tumour-tospecimen ratio, whereas, the requirement for further surgery in the OBS cohort was associated with larger tumour dimensions. Conclusion: Despite larger tumour dimensions, OBS is not inferior to WLE in providing clear surgical margins. Our analysis of the three-dimensional spatial relationship between cancer and surgical specimen, although not completely conclusive, can be helpful in the selection of the most appropriate surgical approach for every patient.

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“…NACT is associated with higher rates of local recurrence compared to ACT, which might be explained by the higher rates of breast conserving surgery among NACT-treated patients compared to patients undergoing primary breast surgery [48]. Several studies have shown difficulties in achieving tumor-free margins when performing primary breast conserving surgery, and a considerable number of reoperations are performed to obtain radical tumor excision [49]. Contributing factors might be difficulties associated with evaluating tumor size with imaging post-NACT [50,51].…”

Section: Mammographymentioning

confidence: 99%

Neoadjuvant breast cancer treatment response; tumor size evaluation through different conventional imaging modalities in the NeoDense study

et al. 2020

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Background: Neoadjuvant chemotherapy (NACT) is offered to an increasing number of breast cancer (BC) patients, and comprehensive monitoring of treatment response is of utmost importance. Several imaging modalities are available to follow tumor response, although likely to provide different clinical information. We aimed to examine the association between early radiological response by three conventional imaging modalities and pathological complete response (pCR). Further, we investigated the agreement between these modalities pre-, during, and post-NACT, and the accuracy of predicting pathological residual tumor burden by these imaging modalities post-NACT. Material and methods: This prospective Swedish cohort study included 202 BC patients assigned to NACT (2014-2019). Breast imaging with clinically used modalities: mammography, ultrasound, and tomosynthesis was performed pre-, during, and post-NACT. We investigated the agreement of tumor size by the different imaging modalities, and their accuracy of tumor size estimation. Patients with a radiological complete response or radiological partial response (!30% decrease in tumor diameter) during NACT were classified as radiological early responders. Results: Patients with an early radiological response by ultrasound had 2.9 times higher chance of pCR than early radiological non-responders; the corresponding relative chance for mammography and tomosynthesis tumor size measures was 1.8 and 2.8, respectively. Post-NACT, each modality, separately, could accurately estimate tumor size (within 5 mm margin compared to pathological evaluation) in 43-46% of all tumors. The diagnostic precision in predicting pCR post-NACT was similar between the three imaging modalities; however, tomosynthesis had slightly higher specificity and positive predictive values. Conclusion: Breast imaging modalities correctly estimated pathological tumor size in less than half of the tumors. Based on this finding, predicting residual tumor size post-NACT is challenging using conventional imaging. Patients with early radiological non-response might need improved monitoring during NACT and be considered for changed treatment plans.

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Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

Cited by 65 publications

References 57 publications

Direct comparison of magnetic resonance imaging and pathological shrinkage patterns of triple-negative breast cancer after neoadjuvant chemotherapy

Direct comparison of magnetic resonance imaging and pathological shrinkage patterns of triple-negative breast cancer after neoadjuvant chemotherapy

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

Neoadjuvant breast cancer treatment response; tumor size evaluation through different conventional imaging modalities in the NeoDense study

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