Breast conservation therapy versus mastectomy in the surgical management of invasive lobular carcinoma measuring 4 cm or greater

Abel, Mary Kathryn; Brabham, Case; Guo, Ruby; Fahrner-Scott, Kelly; Wong, Jasmine; Alvarado, Michael; Ewing, Cheryl A.; Esserman, Laura J.; Mukhtar, Rita A.

doi:10.1016/j.amjsurg.2020.05.038

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…As such, these patients may not have been considered good candidates for BCS, since many studies of BCS exclude patients with tumors > 4 cm in size. 27 We chose to evaluate pathologic tumor size, as this would most closely approximate posttreatment tumor size, which is typically the basis for surgical decision making. However, discordance between clinical assessment of posttreatment tumor size and pathologic tumor size in patients with ILC increases the challenge of surgical planning.…”

Section: Discussionmentioning

confidence: 99%

Successful Breast Conservation After Neoadjuvant Chemotherapy in Lobular Breast Cancer: The Role of Menopausal Status in Response to Treatment

Ramalingam,

Clelland,

Rothschild

et al. 2023

Ann Surg Oncol

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Background While neoadjuvant chemotherapy (NAC) has been shown to increase rates of breast conservation surgery (BCS) for breast cancer, response rates in invasive lobular carcinoma (ILC) appear lower than other histologic subtypes. Some data suggest higher response rates to NAC in premenopausal versus postmenopausal patients, but this has not been studied in ILC. We evaluated the rates of successful BCS after NAC in patients with ILC stratified by menopausal status. Patients and Methods We analyzed data from a single-institution cohort of 666 patients with stage I–III hormone receptor positive HER-2 negative ILC. We used t-tests, chi-squared tests, and multivariable logistic regression to investigate rates of NAC use, attempted BCS, and associations between NAC and successful BCS by menopausal status. Results In 217 premenopausal and 449 postmenopausal patients, NAC was used more often in the premenopausal group (15.2% vs. 9.8%, respectively, p = 0.041). Among those who attempted breast conservation (51.3% of pre- and 64.8% of postmenopausal cohorts), NAC was not associated with successful BCS in either group. Interestingly, for postmenopausal patients, receipt of NAC was significantly associated with increased rates of completion mastectomy in those who had positive margins at the first attempt at BCS. Conclusion NAC was not associated with successful BCS in either premenopausal or postmenopausal patients with ILC. Although premenopausal patients were more likely to receive NAC, these data suggest that menopausal status may not be a good predictor of response to chemotherapy. Better predictors of response and more efficacious treatment for patients with ILC are needed.

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Section: Discussionmentioning

confidence: 99%

Successful Breast Conservation After Neoadjuvant Chemotherapy in Lobular Breast Cancer: The Role of Menopausal Status in Response to Treatment

Ramalingam,

Clelland,

Rothschild

et al. 2023

Ann Surg Oncol

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“…6 In the present study, Abel et al takes specific aim at ILC tumors measuring 4 cm or greater and finds that while larger tumor size and more advanced nodal stage predict reduced recurrence-free survival (RFS), there were no differences in 5-or 10-year RFS between surgical approaches. 7 The authors conclude that BCS and mastectomy provide similar local control for large ILC tumors.…”

mentioning

confidence: 87%

“…The authors identified no difference in complication rates between BCS and mastectomy in this study, though a re-excision rate of 57% was noted in the BCS group. 7 Similarly, Crown et al found a 51% re-excision rate when performing "extreme oncoplastic" BCS in a cohort of patients traditionally offered mastectomy (multifocal or multicentric tumors and/or disease span 5 cm). 8 With the need for re-excision comes the potential for inadvertent psychological and financial stresses to the patient.…”

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confidence: 95%

Surgical management of invasive lobular carcinoma: Is less more?

Huynh

Tevis

2021

The American Journal of Surgery

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Surgical management of invasive lobular carcinoma: Is less more?In this modern era of breast cancer treatment, the Halsted radical mastectomy may sound the stuff of folklore. In M.J. Silverstein's depiction, it is the removal of the entire breast, pectoral muscles, and axillary lymph nodes, "leaving behind a depression under the clavicle, prominent ribs, and a markedly deformed patient". 1 Fast forward to the present day and you will find little utility for the radical mastectomy, now instead replaced with less extensive operations which produce equivalent oncologic outcomes. With the addition of the Milan and NSABP B-06 trials to the surgical literature, surgeons slowly began to adopt more breast-conserving measures. These studies laid the groundwork for more minimalistic trends and begged the question: Is less more?Breast conserving surgery (BCS) sustained marked increases in use in the early 1990s, particularly in the treatment of invasive ductal carcinoma (IDC). 2 Apprehension toward BCS with invasive lobular carcinoma (ILC) was slower to abate, however, and understandably so. Its tendency toward diffuse growth and multifocality, the difficulty in assessing the true extent of tumor on mammography, or the higher reported re-excision rates may give surgeons pause. 3

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“…It was found that this does not worsen but significantly improves overall survival (OS), [1][2][3][4][5][6][7] even in patients with T3 and T4 tumors. [8][9][10][11][12] Therefore, oncological safety does not prevent the use of BCS in patients with central tumors. Another factor inhibiting the implementation of BCS for central tumors is the technical difficulty of achieving acceptable aesthetic and functional results.…”

Section: Introductionmentioning

confidence: 99%

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience

Zhygulin,

Fedosov

2024

Plastic and Reconstructive Surgery - Global Open

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Background: Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety. Methods: This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed. Results: A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups. Conclusions: Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.

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Breast conservation therapy versus mastectomy in the surgical management of invasive lobular carcinoma measuring 4 cm or greater

Cited by 7 publications

References 23 publications

Successful Breast Conservation After Neoadjuvant Chemotherapy in Lobular Breast Cancer: The Role of Menopausal Status in Response to Treatment

Successful Breast Conservation After Neoadjuvant Chemotherapy in Lobular Breast Cancer: The Role of Menopausal Status in Response to Treatment

Surgical management of invasive lobular carcinoma: Is less more?

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience

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