Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

Abstract

Background: Pre-operative breast tumour radial dimensions often determine the choice between simple wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the three-dimensional interplay between tumour and surgical specimen dimensions in the two cohorts. Methods: Demographic, tumour and treatment data were collected for all patients undergoing OBS by a single surgeon and compared with a randomly selected cohort of WLE patients treated. The relationship between tumour and specimen medio-lateral, superoinferior and antero-posterior dimensions were explored in both groups. Subgroup analyses were performed in the OBS cohort (parenchymal displacement versus replacement). Results: We identified 60 OBS patients (63 breasts), comparing them with 60 WLE patients. Pre-operative tumour estimated size was significantly larger in the OBS cohort and concordant with macroscopic tumour radial dimensions and final microscopic tumour size. Surgical specimen weight was more than 3.5 times higher in the OBS group and its radial dimensions were almost double. No significant difference was observed for the anteroposterior dimensions. The rate of margin re-excisions and completion mastectomies were lower in the OBS cohort. WLE patients with positive margins had a lower tumour-tospecimen ratio, whereas, the requirement for further surgery in the OBS cohort was associated with larger tumour dimensions. Conclusion: Despite larger tumour dimensions, OBS is not inferior to WLE in providing clear surgical margins. Our analysis of the three-dimensional spatial relationship between cancer and surgical specimen, although not completely conclusive, can be helpful in the selection of the most appropriate surgical approach for every patient.

External validation of a multivariable prediction model for positive resection margins in breast-conserving surgery

“…This could be due to a higher proportion of patients with dense breasts (C or D) in the validation cohort, although we do not have data on mammographic breast density from the development cohort, as this was not routinely performed at the Swedish site. Another difference between the cohorts was the fraction of oncoplastic surgical procedures, a technique which have shown to reduce the percentages of positive margins after BCS due to larger volume of excised breast tissue [36,37] although it is still debated [38,39]. In the development cohort more oncoplastic surgeries were performed.…”

‘PartBreCon’ study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps

“…73.4% of patients had a breast cup size of A-C, and with T2 median tumour size of 26 mm, BCS was feasible, with most achieving clear margins. A single-centre series [ 24 ] compared tumour and specimen 3-dimensional measurements in mammaplasty (n = 31) versus flaps (n = 29). Although the anteroposterior tumour dimension in the flap was significantly lower than mammaplasty (13.6 vs 19.3 mm; p = 0.036), radial tumour dimensions were non-significantly different between the two.…”

Use of tumour bed boost radiotherapy in volume replacement oncoplastic breast surgery: A systematic review

“…Volume replacement OBS, with its inherent application to larger tumours, results in larger resections specimens (and thus larger surgical cavity) in comparison to simple BCS [31,32] as well as larger RT boost volumes, especially when a rim of native breast tissue adjacent to the tumour bed is included to the non-displaced surgical cavity. Such a larger boost volume may impair the longterm aesthetic outcome due to boost-related adverse effects such as local fibrosis or fat necrosis [12].…”