Oncoplastic breast‐conserving therapy and intraoperative radiotherapy for management of carcinoma in situ of the breast: A single‐center experience

Crown, Angelena; Carlson, Elizabeth; Rocha, Flavio G.; Grumley, Janie

doi:10.1111/tbj.14093

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…A 2019 study by Van la Parra and colleagues examined a large case series of 68 patients and found a positive margin rate of 14.7%, significantly related to a tumor size larger than 5 cm [ 9 ]. Finally, a recent study by Crown et al reported a 16% close margins rate, although none of the 50 patients presented focally involved margins, and no recurrences were noted during a median follow-up of 46 months [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Breast-conserving surgery (BCS) has also expanded thanks to the use of level II oncoplastic techniques, which allow for resections of large lesions involving up to 50% of the total breast volume, without compromising the final breast cosmesis [ 6 ]. These techniques have reduced both the mastectomy and re-excision rates; however, their use in the management of DCIS was reported in only a few studies, with a small series of patients [ 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes

Mason

Leone

Franco

et al. 2022

Cancers

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Oncoplastic level II breast-conserving surgery (OPS2) allows for wider excisions than standard breast-conserving surgery, but the literature on this technique in the treatment of DCIS is scarce. This study compares OPS2 to conservative mastectomy (CM) in patients undergoing surgery for large DCIS. The clinical, radiological, surgical, and post-operative data of 147 patients who underwent either CM or OPS2 for large DCIS between 2007 and 2021 were retrospectively reviewed. The surgical, oncological, and patient-reported outcomes (PRO) were analyzed and compared between the two groups. The surgical outcomes were similar, in terms of margin involvement (p = 0.211), complication rate (p = 0.827), and re-excision rate (p = 1). The rate of additional surgery for cosmetic optimization was significantly lower in the OPS2 group: only 1 (1.8%) patient required surgical adjustments versus 24 (26.4%) patients in the CM group (p < 0.001). The mean hospital stay was lower in the OPS2 group (p < 0.001). The oncological outcomes did not differ between the two groups (p = 0.662). The PRO analysis showed better outcomes in the OPS2 group, which achieved statistical significance in the sexual well-being module (p = 0.015). Skin sensitivity loss was also significantly lower in the OPS2 group (p < 0.001). When feasible, OPS2 should be considered in the treatment of large DCIS, as it is safe and shows high levels of patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes

Mason

Leone

Franco

et al. 2022

Cancers

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“…However, breast conserving surgery [BCS] plus radiation therapy is widely accepted as an alternative as it is equally safe as mastectomy. This progress, together with the use of intraoperative radiation therapy [IORT], the introduction of skin/nipple sparing methods, and the oncoplastic repair of huge surgical defects, has led to the need for intraoperative information regarding the margin status [3] .…”

Section: Introductionmentioning

confidence: 99%

Comparative Study between Intraoperative Ultrasound and Frozen Section in the Assessment of Margins in Conservative Breast Surgery

Nagy,

Attia,

Mahmoud

et al. 2023

International Journal of Medical Arts

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Article informationBackground: Frozen sections [FS] analysis is the most often used intraoperative method for analyzing excisions of breast tumors. However, ultrasound may play a pivotal role and avoids the invasiveness. Aim of the Study:The work's objective was to compare the use of FS versus intraoperative ultrasound [IOUS] in determining an appropriate negative margin for conservative breast surgeryPatients and Methods: With the same inclusion and exclusion criteria, we included 30 patients who were divided into two equal groups, the first for FS and marked as [Group-A], and the second group for IOUS and marked as [Group-B]. Results of FZ and IOUS were compared to the results of histopathology. In addition, the operative time, volumetric resection and short-term recurrence were document. Results:The FZ group had a significantly larger mean value of safety margins than the IOUS group, while the pathological group had the lowest mean value. The FZ had a sensitivity of 80%, specificity of 100%, accuracy of 86.7%, positive predictive value [PPV] of 100%, negative predictive value [NPV] of 71.4%, and Kappa agreement of 0.727 [0.389-1.00], with a pvalue < 0.05 indicating statistical significance. Moreover, the IOUS group's sensitivity, specificity, accuracy, PPV, and NPV were all 100%. Their Kappa agreement was 1.00 [1.00-1.00], and their p-value [p<0.05] indicated statistical significance. Conclusion:When evaluating safety margins in conservative breast surgery, intraoperative ultrasound performs better than frozen sections.

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“… 2 Although surgery plus intra-operative radiotherapy is emerging as a new treatment option for DCIS, the main treatment methods are still mastectomy and breast conservation surgery(BCS) with or without radiotherapy. 3 - 5 In a large population study from the United Kingdom, the percentage of patients who received only BCS, BCS plus radiotherapy, and mastectomy were 26.3%, 40.4%, and 29.8%, respectively. Furthermore, mastectomy was found to be performed more commonly in patients with a tumor of high-grade (36%) compared to that of low-grade (15%).…”

Section: Introductionmentioning

confidence: 99%

The Selection of Treatment Modality for Breast Ductal Carcinoma In Situ: Experience From a Single Institution

You

et al. 2021

Cancer Control

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Purpose: Although breast conservation surgery(BCS) followed by adjuvant radiotherapy is now the mainstream treatment method for breast ductal carcinoma in situ(DCIS), mastectomy is still performed in some patients who refuse to undergo radiation. However, the most effective treatment method for these patients is still unknown. In the current study, we aimed to compare the survival rates between mastectomy and BCS plus adjuvant radiotherapy in patients with DCIS. Materials and Methods: We performed a retrospective study of 333 patients with DCIS from May 2004 to December 2016. There were 209 patents who were treated with BCS and adjuvant radiotherapy, while the remaining of 124 patients underwent mastectomy. The disease-free survival (DFS) and local recurrence-free survival(LRFS) rates were compared between the 2 treatment groups. Cox proportional hazards regression was performed to explore factors associated with DFS and LRFS. Results: The 10-year local recurrence(LR) rates in the mastectomy and BCS plus adjuvant radiotherapy groups were 2.6% and 7.5%, respectively. There was no difference in the LR rate between the 2 groups. Furthermore the DFS rate was also similar between the mastectomy and BCS plus adjuvant radiotherapy groups. Based on the multivariable analysis, age and tumor grade were significantly correlated with the LRFS and DFS rates. In the subgroup analysis based on the factors of age and tumor grade, patients with a tumor grade of III who underwent mastectomy had better LRFS and DFS rates compared to those who received BCS plus radiotherapy. Conclusion: In patients with DCIS, the long-term efficacy was similar between mastectomy and BCS followed by adjuvant radiotherapy. However, in the subgroup of patients with grade III tumors, mastectomy seems to offer a better LRFS and DFS than BCS plus radiotherapy.

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Oncoplastic breast‐conserving therapy and intraoperative radiotherapy for management of carcinoma in situ of the breast: A single‐center experience

Cited by 3 publications

References 21 publications

Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes

Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes

Comparative Study between Intraoperative Ultrasound and Frozen Section in the Assessment of Margins in Conservative Breast Surgery

The Selection of Treatment Modality for Breast Ductal Carcinoma In Situ: Experience From a Single Institution

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