Mastectomy Scar Histopathology of Limited Clinical Value

Abstract

This study assesses whether the routine submission of mastectomy scars for histologic examination at the time of delayed breast reconstruction is useful. A retrospective review was performed of all delayed breast reconstructions for breast cancer performed by a single surgeon over a 5-year period from January 2000 to December 2004. One hundred eighty-eight patients underwent delayed breast reconstruction during this period, and of these, 133 scars (1 patient had bilateral scars excised) were submitted for histology where the reconstruction was performed by either transversus rectus abdominus muscle flap (TRAM) or latissimus dorsi myocutaneous flap (LDF) +/- implant. Fifty-six patients had reconstruction performed by tissue expander through the inframammary crease where the original mastectomy scar was not excised and were excluded from the study. One mastectomy scar specimen showed a 2-mm suspicious area of invasive ductal carcinoma consistent with same histopathology at the time of mastectomy. This study corroborates evidence that it is questionable whether routine histopathology of mastectomy scar at the time of delayed breast reconstruction should not be a standard practice.

Histologic Examination of Mastectomy Scars during Breast Reconstruction: A Systematic Review

“…The timing of breast reconstruction postmastectomy varied significantly, from 2 to 168 months, averaging at 19.9 months. 1,3,[12][13][14][15][16][17] A comparison revealed that patients without recurrence underwent reconstruction sooner, at an average of 19.81 months, versus 39 months for those Takeaways Question: Does routine histological examination of mastectomy scars during delayed breast reconstruction contribute to patient outcomes? Findings: Our systematic review encompassed 11 retrospective observational studies, revealing a low recurrence rate of 0.19% in mastectomy scars during delayed reconstruction.…”

“…Six patients (seven scars) experienced recurrence in their mastectomy scars. 1,6,15,17 Detailed information about the characteristics, histological diagnosis, and outcomes of the patients with recurrence is presented in Table 1. Adverse outcomes postreconstruction were reported in 83 patients (2.21%), 5,[12][13][14][15] as detailed at Supplemental Digital Content 1 (http://links.lww.com/PRSGO/D234).…”

Use of Routine Pathologic Evaluation of Nonmalignant Lesions in Hand Surgery: A National Study

“…Experts from other surgical fields such as orthopedic surgery and otolaryngology have arrived at conclusions similar to ours. 1–4,6,7,13,21–27,42,43 We anticipate this demonstration of the “low-yield” of routine pathology evaluation of benign hand lesions on a national level should promote a change in policy towards improving quality and efficiency of healthcare by institute guidelines to protect surgeons from practicing value-based care.…”

Is routine histological examination of mastectomy scars justified? An analysis of 619 scars

“…As only one scar had a “suspicious area of invasive ductal carcinoma” the authors concluded that routine histological examination of mastectomy scars may be of limited value in identifying recurrence. 11 Woerdeman et al examined 728 scars and did not find any evidence of metastatic or de novo tumor. With an estimated cost of € 50 ($ 65)/scar the authors concluded that “the pathologists may very well be the only one to benefit from such an examination”.…”

“…7, 11 The former group analyzed 133 mastectomy scars. As only one scar had a “suspicious area of invasive ductal carcinoma” the authors concluded that routine histological examination of mastectomy scars may be of limited value in identifying recurrence.…”