Integrating anatomy, radiology, pathology, and surgery: An alternative approach in resecting multifocal and multicentric breast carcinoma

Tan, Mélissa; Ong, Eugene M. W.; Amy, Dominique; Tot, Tibor

doi:10.1111/tbj.12891

Cited by 7 publications

(6 citation statements)

References 60 publications

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“…The objective of surgery is the adequate resection of unstable 'sick lobe', preferably through BCT, as minimising stress to immune system with less extensive surgery appears to be associated with improved survival outcomes. The optimal operative approach currently involves an integration of disciplines of pathology, radiology, surgery and oncology (45), but genomics may play an increasing important role in the future.…”

Section: Implications For Bctmentioning

confidence: 99%

The sick lobe hypothesis, field cancerisation and the new era of precision breast surgery

Tan¹,

Tot

2018

Gland Surg

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Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick lobe hypothesis, which states that cancer arises from genetically unstable cells through mutations acquired in utero, forms the basis of malignant transformation. These 'at risk' cells line the mammary ductal-lobular system of a single 'sick' lobe and when exposed to noxious events in the surrounding microenvironment, further genetic changes occur which completes conversion to malignancy, in certain defined patterns. This review explores how anatomy, pathology and genomics can merge, not only to guide optimum surgery, but also to provide a more comprehensive portal for precision medicine.

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Section: Implications For Bctmentioning

confidence: 99%

The sick lobe hypothesis, field cancerisation and the new era of precision breast surgery

Tan¹,

Tot

2018

Gland Surg

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“…There was no statistical significance in diagnosis of M/MBC in terms of calcifications (p=0.4), NLs (p=0.52) and AFTs (p=0.17). All these findings are important for the treatment and surgical methods (13).…”

Section: Demographic Data Lesions and Histopathologic Findingsmentioning

confidence: 89%

Effectiveness of Digital Tomosynthesis in Multifocal/Multicentric Breast Cancer: A Pilot Study

Akin¹,

Tuna²,

Altay³

et al. 2019

Bozok Tıp Dergisi

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Amaç: Multifokal/multisentrik meme karsinomu (M/MMK), aynı kadrandan gelişen iki veya daha fazla odak olan olgularda tanımlanır. Dijital tomosentezin (DTS) dijital mamografiye (DM) eklenmesi meme lezyonlarının ve malignitelerin tanısı arttırır. Multifokal lezyon saptanmasında DM'nin düşük duyarlılığı ultrasonografinin (US) eklenmesiyle arttırılır. Ancak Manyetik rezonans görüntüleme (MRG) M/MMK tanısında en yüksek duyarlılığa sahiptir. Çalışmamızda M/MMK'de DTS'in tanısal değerinin US eklenerek ve eklenmeden, MRG ile kaşılaştırılmalı değerlendirilerek, saptanması amaçlanmıştır. Gereç ve Yöntemler: 2014 Nisan-2017 Mart tarihleri arasında M/MMK ön tanısı alan 64 hasta çalışmamıza dahil edilmiştir. DTS, US ve MRG ayrı ayrı değerlendirilmiştir. Değerlendirme tek radyolog tarafından retrospektif olarak yapılmıştır. Lezyonlar ve foküsler, DTS'de kalsifikasyonlar, spiküler kitleler ve asimetrik fibroglandüler doku varlığına göre sınıflanmıştır. Hastaların ortalama değerleri one-way analysis of variance (ANO-VA) ile değerlendirilmiştir. Bağımlı değişkenlerde çapraz tablolar ve Ki-Kare testleri kullanılmıştır. P<0.05. Bulgular: DTS ile 53 meme, 52 hasta M/MMK tanısı almıştır. DTS'in duyarlılığı %76.1, özgüllüğü %83.3'tür (p=0.77). US ile 46 meme, 45 hasta M/MMK tanısı almıştır. Duyarlılık ve özgüllük sırasıyla %74.1 ve %78.8'dir (p=0.1). DTS'e US eklenmesi duyarlılığı %94.2'ye arttırmıştır. Sonuç: MRG lezyonları, lezyon yayılımını ve boyutlarını doğrulukla saptar. M/MMK'de DTS'ye US ve MRG eklenmesi yanlış pozitiflik ve negatifliklerin azalmasının ve operasyon tekrarlarını önler.

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“…This de-escalation of OBS to sBCS appropriately excises the ‘sick segment’ (lobe with anticipated cancerised field) with adequate margins, reduces surgical complications and optimises cosmetic outcomes. Lobar surgery adheres to these principles and may offer an optimum surgical approach for resection of MIBC ( 90 ).…”

Section: Discussionmentioning

confidence: 99%

The unifying concepts of the sick lobe hypothesis, field cancerisation and breast conservation treatment for multiple ipsilateral breast cancers: a narrative review

Tan¹,

Sitoh²

2023

Gland Surg

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Background and Objective: In the past, it was conventionally thought that multiple ipsilateral breast cancer (MIBC) was a contraindication to breast conservation surgery, especially if multicentric foci in different quadrants of the breast were present. However, over time, there has been a growing body of evidence in the literature demonstrating no survival detriment or poorer local control with breast conservation for MIBC. There is, however, a paucity of information integrating anatomy, pathology with surgical treatment of MIBC. Understanding mammary anatomy, pathology of the sick lobe hypothesis and molecular impact of field cancerisation contributes significantly to the understanding of the role of surgical treatment of MIBC. The purpose of this narrative overview is to review the paradigm shifts over time in the use of breast conservation treatment (BCT) for MIBC, and how the concepts of the sick lobe hypothesis and field cancerisation interact with this therapeutic strategy. A secondary objective is to explore the feasibility of surgical de-escalation for BCT in the presence of MIBC.Methods: A PubMed Search was performed for articles relating to BCT, multifocal, multicentric and MIBC. A separate literature search was performed for sick lobe hypothesis and field cancerisation and their interaction for surgical treatment for breast cancer. The available data was then analysed and synergised into a coherent summary of how the molecular and histologic aspects of MIBC interact with surgical therapy.

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Integrating anatomy, radiology, pathology, and surgery: An alternative approach in resecting multifocal and multicentric breast carcinoma

Cited by 7 publications

References 60 publications

The sick lobe hypothesis, field cancerisation and the new era of precision breast surgery

The sick lobe hypothesis, field cancerisation and the new era of precision breast surgery

Effectiveness of Digital Tomosynthesis in Multifocal/Multicentric Breast Cancer: A Pilot Study

The unifying concepts of the sick lobe hypothesis, field cancerisation and breast conservation treatment for multiple ipsilateral breast cancers: a narrative review

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