Residual glandular tissue (RGT) in BRCA1/2 germline mutation carriers with unilateral and bilateral prophylactic mastectomies

Grinstein, Olga; Krug, Barbara; Hellmic, Martin; Siedek, Florian; Malter, Wolfram; Burke, Christina; Schmutzler, Rita K.; Maintz, David; Rhiem, Kerstin

doi:10.1016/j.suronc.2019.04.009

Cited by 22 publications

(37 citation statements)

References 29 publications

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“…In those cases, NSM is the preferred option, allowing better patient-reported outcomes [5,6]. Based on current evidence, risk-reducing mastectomies in BRCA mutations carriers reduce the risk of subsequent breast cancer by 89-95% [7]. The role of NSM in high-risk populations has seldom been reported.…”

Section: Introductionmentioning

confidence: 99%

Nipple Sparing Mastectomy as a Risk-Reducing Procedure for BRCA-Mutated Patients

Rocco

Montagna

Nava

et al. 2021

Genes

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Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral mastectomies with immediate breast reconstruction. We reviewed the literature with the aim of assessing the oncological safety of nipple-sparing mastectomy (NSM) as a risk-reduction procedure in BRCA-mutated patients. Nine studies reporting on the incidence of primary breast cancer post NSM in asymptomatic BRCA mutated patients undergoing risk-reducing bilateral procedures met the inclusion criteria. NSM appears to be a safe option for BRCA mutation carriers from an oncological point of view, with low reported rates of new breast cancers, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life. However, larger multi-institutional studies with longer follow-up are needed to establish this procedure as the best surgical option in this setting.

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Section: Introductionmentioning

confidence: 99%

Nipple Sparing Mastectomy as a Risk-Reducing Procedure for BRCA-Mutated Patients

Rocco

Montagna

Nava

et al. 2021

Genes

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“…19 The limited spatial resolution with MRT makes it hard to discriminate between glandular and fibrotic tissue why small amounts of glandular tissue could be mistaken for ligaments, scar tissue or artefacts and the other way around. 16 So how thin should the skin flaps be to be considered oncological safe, and at the same time leave an acceptable outcome in terms of aesthetics? And if one leaves thicker skin flaps, is some kind of postoperative surveillance motivated?…”

Section: Discussionmentioning

confidence: 99%

Prophylactic mastectomy – Correlation between skin flap thickness and residual glandular tissue evaluated postoperatively by imaging

Andersson¹,

Sund²,

Svensson³

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…According to a newly published review (22), the specificity and sensitivity of detecting residual glandular tissue with MRI is not evaluated, and neither is the clinical significance of this finding. The level of residual glandular tissue has been analyzed in some imaging-based studies (9)(10)(11)23), but often there is one radiologist performing the analysis (23), or when more than one radiologist is involved, conflicting results are discussed between the observers to find a consensus (9).…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic surgery reduces, but does not eliminate, the risk of breast cancer (5,6), with breast cancer diagnosed in approximately 1%-1.9% of all women after surgery (6). Some authors report a clear correlation between skin flap thickness and the amount of residual glandular tissue (7)(8)(9)(10), while others do not (11); however, it is unclear whether an increased amount of residual glandular tissue translates into an increased risk of breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Inter- and intra-observer agreement on evaluating the presence of residual glandular tissue with magnetic resonance tomography following prophylactic mastectomy

et al. 2021

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Background There are no published international consensus or guideline documents regarding appropriate medical follow-up for women with hereditary increased risk of breast cancer who opt for prophylactic mastectomy. Moreover, it is not known whether breast magnetic resonance imaging (MRI) performed after a prophylactic mastectomy is a reproducible method for evaluating whether clinically relevant amounts of residual glandular tissue remains. Purpose To evaluate the inter- and intra-observer agreement on detecting residual glandular tissue with MRI. Material and Methods In total, 40 women previously operated with prophylactic mastectomy underwent MRI and two breast radiologists (R1 and R2) independently assessed the presence of residual glandular tissue. Inter- and intra-rater agreements were assessed using Cohen's kappa (k). Results Residual glandular tissue was found in 69 of 248 quadrants (27.8%) and 32 of 62 breasts (51.6%) by R1 and 77 of 248 quadrants (31.1%) and 35 of 62 breasts (56.5%) by R2. The interrater agreement was observed to be moderate (k = 0.554) and the intra-rater agreement was observed to be substantial (k = 0.623). Conclusion In conclusion, the inter-and intra-rater observer agreement in regard to detection of residual glandular tissue was not excellent, which would be desirable for a method considered reproducible enough to be used as a surveillance tool after the surgical procedure in order to ensure that there is no relevant residual glandular tissue remaining warranting further follow-up. More research is needed, as well as establishment of precise protocols, before using the method in risk assessment of remaining glandular tissue and breast cancer risk.

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Residual glandular tissue (RGT) in BRCA1/2 germline mutation carriers with unilateral and bilateral prophylactic mastectomies

Cited by 22 publications

References 29 publications

Nipple Sparing Mastectomy as a Risk-Reducing Procedure for BRCA-Mutated Patients

Nipple Sparing Mastectomy as a Risk-Reducing Procedure for BRCA-Mutated Patients

Prophylactic mastectomy – Correlation between skin flap thickness and residual glandular tissue evaluated postoperatively by imaging

Inter- and intra-observer agreement on evaluating the presence of residual glandular tissue with magnetic resonance tomography following prophylactic mastectomy

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