De-escalation in breast cancer surgery

Shubeck, Sarah P.; Morrow, Monica; Dossett, Lesly A.

doi:10.1038/s41523-022-00383-4

Cited by 25 publications

(17 citation statements)

References 34 publications

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“…23 Focus is henceforth shifting to de-escalation of surgery in the breast. 24 And although this direction is for both non-invasive and invasive cancers, non-operative management of invasive cancers pose greater challenges than that of non-invasive cancers.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Pathological Complete Response Using Vacuum-Assisted Biopsy in Breast Cancer Patients Who Have Clinical and Radiological Complete Response After Neo-Adjuvant Chemotherapy

Khare,

Santosh,

Laroiya

et al. 2023

Breast Cancer�(Auckl)

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Background: Any treatment protocol that leads to complete elimination of surgery may lead to a better patient acceptance of breast cancer treatments. Objectives: We conducted this study to assess the feasibility of preoperative vacuum-assisted biopsies in identifying pathological complete response (pCR) and its accuracy in correlation to final histopathology report (HPR), in an Indian setting. Methods: This was a prospective study conducted between October 1, 2019, and March 31, 2021. Patients with early breast cancer, estrogen and progesterone receptors negative and either Her2 positive or negative, and who were fit to undergo marker placement at the centre of the tumour and to receive third-generation chemotherapy (4 cycles of 3 weekly doxorubicin and cyclophosphamide followed by 4 cycles of 3 weekly docetaxel) were included in the study. Following the enrolment, a tissue marker was placed at the centre of the tumour and appropriate chemotherapy was started. Patients who achieved clinical complete response were subjected to ultrasound-guided vacuum-assisted biopsy (VAB) from the tumour bed before surgery. Pathology results of the VAB and resected specimen were then compared. Descriptive statistics were used in the study. Results: Eighteen patients were enrolled in the study, with a mean age of 43.6 ± 9.8 years. However, only 10 were eligible for VAB procedure, and sensitivity and specificity were calculated based on the results of these 10 patients only. Vacuum-assisted biopsy showed sensitivity of 50% and specificity of 100% in identifying pCR. Combination of mammography, ultrasonography, and VAB showed sensitivity of 77.8% and specificity of 66.7% in identifying pCR. Conclusion: Vacuum-assisted biopsy of tumour bed may not be sensitive enough to eliminate surgery even in patients who have had exceptional response to neo-adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Assessment of Pathological Complete Response Using Vacuum-Assisted Biopsy in Breast Cancer Patients Who Have Clinical and Radiological Complete Response After Neo-Adjuvant Chemotherapy

Khare,

Santosh,

Laroiya

et al. 2023

Breast Cancer�(Auckl)

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“…In particular, current recommendations for surgical de-escalation include the avoidance of unnecessary reexcisions for tumor-free but supposedly "close" margins after BCS. Further, experimental approaches such as omitting breast surgery altogether e.g., in selected women with DCIS or in case of a clinical complete response to PST, are currently under investigation [1,2]. BCS is in general accompanied by radiotherapy.…”

Section: Local Therapy Of the Breastmentioning

confidence: 99%

Real de-escalation or escalation in disguise?

Banys‐Paluchowski¹,

Rubio²,

Ditsch³

et al. 2023

The Breast

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“…Most of these have focused on deimplementation of radiological imaging and preoperative workups, with less than 5% of recommendations targeting low-value surgical procedures thereby missing out on a great opportunity [4]. Some of these recommendations include avoiding axillary lymph node dissection in clinically node negative axilla in Stage I and II Carcinoma breast without sentinel lymph node assessment, avoiding routine Cholecystectomy in asymptomatic cholelithiasis and possibility of active surveillance for low grade localized carcinoma prostate [4,5]. It is clear that so much more can be done.…”

Section: What About Low Value Surgical Care?mentioning

confidence: 99%