Volume of breast tissue excised during breast-conserving surgery in patients undergoing preoperative systemic therapy

Valejo, Fernando Antonio Mourão; Tiezzi, Daniel Guimarães; Mandarano, Larissa Raquel Mouro; Sousa, Christiani Bisinoto de; Andrade, Jurandyr Moreira de

doi:10.1590/s0100-72032013000500006

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…*Including n = 90 abstracts eligible for inclusion but are conference abstracts only and were therefore excluded. 0 Articles by Tiezzi et al [ 31 ] and Valejo et al [ 55 ] report on the same group of study participants From Ref. [ 22 ] …”

Section: Resultsmentioning

confidence: 99%

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

Volders

Negenborn

Spronk

et al. 2017

Breast Cancer Res Treat

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PurposeNeoadjuvant chemotherapy (NACT) is increasingly used in breast cancer treatment. One of the main goals of NACT is to reduce the extent of local surgery of the breast and axilla. The aim of this study was to determine surgical outcomes for patients receiving breast-conserving therapy (BCT) after NACT, including margin status plus secondary surgeries, excision volumes, and cosmetic outcomes.MethodsA systematic review was performed in accordance with PRISMA principles. Pubmed, MEDLINE, Embase, and the Cochrane Library were searched for studies investigating the results of BCT following NACT. The main study outcomes were margin status, additional local therapies, excision volumes, and cosmetic outcomes. Non-comparative studies on NACT were also included. Exclusion criteria were studies with less than 25 patients, and studies excluding secondary mastectomy patients.FindingsOf the 1219 studies screened, 26 studies were deemed eligible for analysis, including data from 5379 patients treated with NACT and 10,110 patients treated without NACT. Included studies showed wide ranges of tumor-involved margins (2–39.8%), secondary surgeries (0–45.4%), and excision volumes (43.2–268 cm3) or specimen weight (26.4–233 g) after NACT. Most studies were retrospective, with a high heterogeneity and a high risk of bias. Cosmetic outcomes after NACT were reported in two single-center cohort studies. Both studies showed acceptable cosmetic outcomes.InterpretationThere is currently insufficient evidence to suggest that NACT improves surgical outcomes of BCT. It is imperative that clinical trials include patient outcome measures in order to allow monitoring and meaningful comparison of treatment outcomes in breast cancer.

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Section: Resultsmentioning

confidence: 99%

“…Only one study reported a resection ratio, with a median CRR in the primary surgery and neoadjuvant therapy groups of 3.3 and 2.0, respectively ( p < 0.0001). This implies that the excision volumes were 2–3.3 times as large as they should be [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

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

Volders

Negenborn

Spronk

et al. 2017

Breast Cancer Res Treat

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“…One report 23 estimated optimum excision volume using the volume of tumor mass resected with the addition of a 1 cm margin based on prior studies demonstrating that malignant breast cancer cells rarely extend more than 1 cm from the primary tumor. 24 The actual volume resected was Abbreviations: DCIS, ductal carcinoma in-situ; NAT, neoadjuvant therapy; pCR, pathologic complete response.…”

Section: Discussionmentioning

confidence: 99%

Can Radiologic Tumor Size Following Neoadjuvant Therapy Reliably Guide Tissue Resection in Breast Conserving Surgery in Patients with Invasive Breast Cancer?

Walcott-Sapp

Srour

Lee³

et al. 2020

The American Surgeon

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Optimum tissue resection volume for patients with invasive breast cancer undergoing breast conserving surgery following neoadjuvant therapy (NAT) is not known. We compared positive margin and in-breast tumor recurrence (IBTR) between 2 groups that were created based on radiologic tumor size (RTS (cm3)) at diagnosis, RTS post-NAT, and volume of tissue resected (VTL): Pre-NAT group, patients with VTL closer to RTS at diagnosis, and post-NAT group, patients with VTL closer to post-NAT RTS. 82 patients with 84 breast cancers treated with NAT between 2007 and 2017 who had pre- and post-NAT imaging were identified from a prospectively maintained database. RTS at diagnosis, RTS post-NAT, and VTL were determined. Clinical and treatment characteristics, IBTR, and disease-free survival (DFS) were compared between pre-NAT (n = 51) and post-NAT (n = 33) groups. Compared to post-NAT patients, pre-NAT patients had smaller RTS at presentation (9.2 vs. 33.5 cm3, P < .001) and post-NAT (1.2 vs. 8.2 cm3, P = .024). At median follow-up of 4 years, there were no differences between groups in pathologic tumor size, positive margin rate, adjuvant therapy, IBTR, or DFS. Resection volumes that matched RTS on post-NAT imaging were not associated with increased positive margins or IBTR. It may be appropriate to use post-NAT imaging to guide lumpectomy volume.

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“…Not all tumors fluoresced, particularly those <2 cm diameter. This represents another possible limitation of this approach, as tumors resected in breast conserving surgery in human patients are often 2 cm diameter or less [35]. The lack of fluorescence in smaller benign tumors may have occurred because of a lack of tumor neovasculature required for ICG accumulation via the EPR effect.…”

Section: Plos Onementioning

confidence: 99%

Intraoperative near-infrared imaging can identify canine mammary tumors, a spontaneously occurring, large animal model of human breast cancer

et al. 2020

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Introduction Current methods of intraoperative margin assessment in breast conserving surgery are impractical, unreliable, or time consuming. We hypothesized that intraoperative near-infrared (NIR) imaging with an FDA-approved NIR optical contrast agent could identify canine mammary tumors, a spontaneous large animal model of human breast cancer, during surgery. Methods Dogs with mammary tumors underwent a standard of care lumpectomy or mastectomy with wide surgical margins 20 hours after indocyanine green administration (3 mg/kg IV). During surgery, NIR imaging was performed on tumors and wound margins in situ and tumors and lymph nodes ex vivo. Following resection, the wound bed was examined for residual fluorescence. Fluorescence intensity was determined by signal-to-background ratio (SBR). All tumors, areas of residual fluorescence, and lymph nodes underwent histopathologic analysis. Results There were 41 mammary tumors in 16 female dogs. Twenty tumors were malignant and 21 were benign. Twenty-eight tumors were fluorescent (mean SBR 1.5±0.2). Sensitivity of fluorescence for all malignant tumors was 80% (16/20) and 93.3% (14/15) for malignant tumors > 2 cm. Specificity for malignancy was low (< 2cm = 55%; > 2cm = 30%). Tumors > 2 cm were more likely to be fluorescent (OR 6.05, 95% CI 1.50-24.44, P = 0.011) but not more

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Volume of breast tissue excised during breast-conserving surgery in patients undergoing preoperative systemic therapy

Cited by 12 publications

References 22 publications

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

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

Can Radiologic Tumor Size Following Neoadjuvant Therapy Reliably Guide Tissue Resection in Breast Conserving Surgery in Patients with Invasive Breast Cancer?

Intraoperative near-infrared imaging can identify canine mammary tumors, a spontaneously occurring, large animal model of human breast cancer

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