scholarly journals Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mi Young Kim ◽  
Young Jin Suh ◽  
Yeong Yi An
Keyword(s):  
Cancer Detection ◽  
Tumor Recurrence ◽  
Acellular Dermal Matrix ◽  
Breast Conserving Surgery ◽  
Local Tumor ◽  
Local Tumor Recurrence ◽  
Dermal Matrix ◽  
Posterior Portion ◽  
Postoperative Changes ◽  
Acellular Dermal

Abstract Background To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). Methods The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated. Results A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7–2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler. Conclusion AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.

scholarly journals Acellular dermal matrix as filler in breast-conserving surgery: warnings for a careful use

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Gianluca Franceschini ◽  
Riccardo Masetti
Keyword(s):  
Acellular Dermal Matrix ◽  
Breast Conserving Surgery ◽  
Human Origin ◽  
Dermal Matrix ◽  
Adequate Knowledge ◽  
Aesthetic Results ◽  
Dermal Matrices ◽  
Acellular Dermal ◽  
Human Acellular Dermal Matrix ◽  
Host Tissues

AbstractAcellular dermal matrices are biological materials of porcine, bovine, or human origin used as scaffold for reconstructive purpose in plastic surgery; these materials are well-tolerated and safely integrated in host tissues without causing resorption, contracture, and encapsulation thanks to their low antigenicity.Recently, human acellular dermal matrix has been used as a filler in breast-conserving surgery to improve aesthetic results. Adequate knowledge of biomaterials properties, appropriate skill, and careful compliance with some specific recommendations are mandatory in order to optimize outcomes and obtain a work of success.

scholarly journals The Comparison of Breast Reconstruction Using Two Types of Acellular Dermal Matrix after Breast-Conserving Surgery

2021 ◽  
Vol 10 (15) ◽  
pp. 3430
Author(s):  
Jeongshin An ◽  
Hyungju Kwon ◽  
Woosung Lim ◽  
Byung-In Moon ◽  
Nam Sun Paik
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Breast Conserving Surgery ◽  
The Body ◽  
Surgical Time ◽  
Dermal Matrix ◽  
Specimen Weight ◽  
Breast Shape ◽  
Acellular Dermal

Breast reconstruction during breast-conserving surgery (BCS) can improve the breast shape. This study introduces breast reconstruction in BCS with two types of acellular dermal matrix (ADM). The study included 134 patients who underwent BCS due to breast cancer from February 2018 to May 2021. This study was conducted by one surgeon, and is the result of a three-year study. The patient group who underwent BCS using ADM was mainly targeted at patients with minor to severe defects after the operation. The average age of the patients was 51.8 years, and the body mass index (BMI) was 23.8 kg/m. The specimen weight was 30–120 g. The average surgical time, including reconstruction, was 100.4 min, combined with reconstruction. There were minor complications in six patients. The advantage of using ADM is that it can quickly correct the shape of the breast after conventional BCS surgery. Pellet-type ADM, rather than sheet-type, can create a breast shape similar to that before surgery. Breast reconstruction using ADM can be an easy and convenient method for making a better shape from BCS.

scholarly journals Displacement of Surgical Clips in Patients with Human Acellular Dermal Matrix in the Excision Cavity during Whole Breast Irradiation Following Breast-Conserving Surgery

2020 ◽  
Vol 52 (2) ◽  
pp. 388-395
Author(s):  
Wonguen Jung ◽  
Kyubo Kim ◽  
Nam Sun Paik
Keyword(s):  
Acellular Dermal Matrix ◽  
Breast Conserving Surgery ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Dermal Matrix ◽  
Surgical Clips ◽  
Group A ◽  
Group B ◽  
Acellular Dermal ◽  
Excision Cavity

PurposeThe purpose of this study was to investigate the displacement of surgical clips in the excision cavity during whole breast irradiation following breast-conserving surgery (BCS) with or without acellular dermal matrix (ADM) insertion, and to analyze clinicopathologic factors associated with the displacement of surgical clips.Materials and MethodsFrom 2016 to 2017, 100 consecutive breast cancer patients who underwent BCS with the placement of surgical clips (superior, inferior, medial, lateral, and deep sides) in the tumor bed were included in this study. All patients took first planning computed tomography (CT) scan (CT 1) before whole breast irradiation and second CT scan (CT 2) before boost irradiation. Between two sets of planning CT, the displacement of surgical clips was calculated from the ΔX (lateral–medial), ΔY (anterior–posterior), ΔZ (superior–inferior), and three-dimensional (3D) directions. Patients were divided into two groups according to the breast volume replacement with ADM: group A with ADM and group B without ADM.ResultsThe means and 1 standard deviations of 3D displacement for superior, inferior, medial, lateral and deep clips were 5.2±2.9, 5.2±3.2, 5.6±4.5, 5.6±4.3, and 4.9±4.9 mm in entire cohort (n=100); 5.6±2.6, 6.0±3.5, 6.7±5.8, 6.7±5.7, and 6.1±7.4 mm in group A (n=38); 4.9±3.1, 4.8±3.0, 5.0±3.5, 5.0±2.9, and 4.3±2.8 mm in group B (n=62), respectively. The 3D displacements of group A were longer than those of group B, but only significant difference was observed in lateral clip (p=0.047).ConclusionThis study demonstrated displacement of surgical clips during whole breast irradiation in patients with ADM insertion. For patients who had breast volume replacement using ADM, adaptive boost planning should be considered.

Intradural tumor recurrence after resection of extradural metastasis: a rare but potential complication of intraoperative durotomy

2014 ◽  
Vol 20 (6) ◽  
pp. 734-739 ◽  
Author(s):  
Manish K. Kasliwal ◽  
Lee A. Tan ◽  
John E. O'Toole
Keyword(s):  
Tumor Recurrence ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Intramedullary Tumor ◽  
Local Tumor ◽  
Local Tumor Recurrence ◽  
Tumor Dissemination ◽  
Intradural Tumor ◽  
Clinical Consequences ◽  
Clinical Awareness

Spinal metastases are the most common of spinal neoplasms and occur predominantly in an extradural location. Their appearance in an intradural location is uncommon and is associated with a poor prognosis. Cerebrospinal fluid dissemination accounts for a significant number of intradural spinal metastases mostly manifesting as leptomeningeal carcinomatoses or drop metastases from intracranial tumors. The occurrence of local tumor dissemination intradurally following surgery for an extradural spinal metastasis has not been reported previously. The authors describe 2 cases in which local intradural and intramedullary tumor recurrences occurred following resection of extradural metastases that were complicated by unintended durotomy. To heighten clinical awareness of this unusual form of local tumor recurrence, the authors discuss the possible etiology and clinical consequences of this entity.

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