scholarly journals Breast Conservation Therapy Verses Modified Radical Mastectomy in T1 – T2 N1 Brest Cancer, a 10-Year Retrospective Local Control and Survival Analysis in an Appalachian Community Hospital

2020 ◽  
Vol 108 (3) ◽  
pp. e62-e63
Author(s):  
S. Vasan ◽  
A. Reddy ◽  
C. Neubert ◽  
C. White
Keyword(s):  
Survival Analysis ◽  
Local Control ◽  
Community Hospital ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Breast Conservation Therapy ◽  
Modified Radical Mastectomy ◽  
Brest Cancer

Intraoperative Evaluation of Lumpectomy Margins by Imprint Cytology With Histologic Correlation

2002 ◽  
Vol 126 (7) ◽  
pp. 846-848 ◽  
Author(s):  
Andrew J. Creager ◽  
Jo Ann Shaw ◽  
Peter R. Young ◽  
Kim R. Geisinger
Keyword(s):  
Predictive Value ◽  
Community Hospital ◽  
Frozen Section ◽  
Breast Conservation ◽  
Hospital Setting ◽  
Breast Conservation Therapy ◽  
Imprint Cytology ◽  
Recurrence Rates ◽  
Cytologic Examination ◽  
Initial Surgery

Abstract Background.—Several well-controlled studies have demonstrated significantly increased local recurrence rates in patients with low-stage breast carcinoma treated with breast conservation therapy in whom focally positive margins were not reexcised. Imprint cytology is a rapid technique for evaluating surgical margins intraoperatively, thus allowing reexcisions to be performed during the initial surgery. The large majority of studies on the use of intraoperative imprint cytologic examination of breast conservation therapy margins have been performed at university-based academic centers. Objective.—To evaluate the utility of intraoperative imprint cytologic evaluation of breast conservation therapy margins in a community hospital setting. Methods.—We retrospectively reviewed the intraoperative imprint cytology margins of 141 lumpectomy specimens that had been obtained from 137 patients between May 1997 and May 2001. Results.—We evaluated 758 separate margins. On a patient basis, the sensitivity was 80%, the specificity was 85%, the positive predictive value was 40%, the negative predictive value was 97%, and the overall accuracy was 85%. There were no cytologically unsatisfactory margins. Conclusions.—Imprint cytology is an accurate, simple, rapid, and cost-effective method for determining the margin status of breast conservation therapy specimens intraoperatively in the community hospital setting. This method allows a survey of the entire surface area of the lumpectomy specimen, which is not practical using frozen section evaluation.

Nipple-sparing mastectomy: Evaluation of oncologic safety and aesthetic outcomes in 94 patients.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 97-97
Author(s):  
E. C. Millen ◽  
R. R. Pinto ◽  
L. Menezes ◽  
F. C. O. Almeida ◽  
G. Novita ◽  
...  
Keyword(s):  
Breast Conservation ◽  
Tissue Expander ◽  
Radical Mastectomy ◽  
Breast Conservation Therapy ◽  
Axillary Node ◽  
Tertiary Referral Hospital ◽  
Immediate Reconstruction ◽  
Areolar Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

97 Background: The surgical treatment of breast cancer has evolved from radical mastectomy to breast conservation therapy. Today we have another therapeutic dilemma: how to manage the nipple-areolar complex (NAC) in mastectomy offering patients better aesthetic results with oncologic safety. Methods: We analyzed data on 125 consecutive nipple- or skin-sparing mastectomies (SSM) with immediate reconstruction with tissue expander, prosthesis or autologous tissue performed in 94 patients from 2003 to 2010 in a tertiary referral hospital. Nipple-sparing mastectomy (NSM) was performed for treatment disease (n= 94) and prophylaxis of contralateral breast or symmetrization in selected cases (n= 31). Results: Mean patients age was 46.8 years (range 27 to 69 years) and mean follow-up time was 27.2 months (range 2 weeks to 81 months). Twelve patients were stage 0, 41 stage I, 35 stage II A and B and 7 stage III. There were 125 nipple- or areola-sparing mastectomies (31 bilateral and 94 unilateral), including 112 NSM and 13 SSM. On pathologic review, 12 breasts had carcinoma in situ, 83 invasive carcinoma, and 31 breasts were cancer free. Thirteen nipples (13.8%) were compromised by tumor on subareolar biopsy and were removed. The location and type of incision was variable according to the tumor site and previous patient scar. Periareolar incision with prolongation along the inferior pole of breast was the preferred method. Patients with positive axillary node (27.5%) received adjuvant radiotherapy. There was no nipple necrosis. One patient presented local relapse in the skin-sparing group within 24 months. Conclusions: These data demonstrate that NSM is oncologically safe and can be performed with all types of breast reconstruction.

Impact of margin status and re-excision on local control in patients undergoing breast-conservation therapy for ductal carcinoma in situ.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 57-57
Author(s):  
Talha Shaikh ◽  
Tianyu Li ◽  
Fatima Sheikh ◽  
Colin T. Murphy ◽  
Nicholas Zaorsky ◽  
...  
Keyword(s):  
Local Control ◽  
Ductal Carcinoma In Situ ◽  
Hormonal Therapy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Significant Difference ◽  
The Impact

57 Background: The purpose of this study was to identify the impact of final surgical margin (SM) status, SM width, and re-excision on outcomes in patients with ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Methods: The study population consisted of women diagnosed with DCIS undergoing BCT between 1989-2014. All women received adjuvant whole breast radiation plus a boost. The primary endpoint was local control (LC) defined as an ipsilateral breast failure. A negative SM was defined as > 2 mm, close SM was defined as > 0 to < 2 mm, and a positive SM was defined as tumor at the inked SM. Cox proportional hazards model was used to determine predictors of outcomes on multivariate analysis (MVA). Actuarial incidence of LC was estimated using the Kaplan-Meier method. Results: A total of 498 patients were included. The median age was 58 (range 30-91) and the median follow-up was 8.3 years (3 months-27 years). A total of 400 patients had a final negative SM, 87 had a close SM, and 11 had a positive SM. A total of 172 patients received adjuvant hormonal therapy, 265 patients required at least one re-excision. Patients with positive or close SMs were more likely to receive a radiation dose > 60 Gy (p < 0.001) and undergo re-excision (p < 0.01). The 10-year LC rates were not significantly different between patients with a negative (93.5%), close (91.8%), or positive (100%) SM (p = 0.57). There was no difference in 10-year LC rates according to a SM width of 0-1 mm (100%), > 1 to 2 mm (88.5%), or > 2 mm (93.5%) (p = 0.85). On univariate analysis, there was no significant difference in LC when comparing negative versus close or positive (p = 1.0) SMs. There was no difference in LC in patients undergoing re-excision for initial close or positive SMs (p = 0.55). On MVA, after controlling for age, dose, hormonal therapy, comedo subtype, and grade, there were no factors associated with LC. Conclusions: This large single-institution experience demonstrates that risks of local failure remain poorly characterized. Re-excision and whole breast radiation plus boost resulted in excellent LC for women with DCIS. Our data suggests that trials aimed at personalized de-intensified local therapy are warranted.

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