Imaging plays a central role in the detection and assessment of breast cancer. Breast cancer screening programmes have been well established, as even in the era of modern therapies early detection has a major impact on survival. Time interval and method of breast cancer surveillance programme depends greatly on the individual risk factors and a correct selection and/or combination of methods proved to be useful in women with higher than average risk or in women with dense breasts. In women with clinical symptoms, imaging methods provide reliable differentiation between benign and suspicious processes that need to be evaluated with a biopsy. Each of the three basic imaging methods of the breast—mammography, breast ultrasound and magnetic resonance imaging (MRI) has its advantages and limitations. Additionally, appropriate preoperative marking is a mandatory part of imaging that helps transfer the information from imaging to surgery. In this review, we summarize the data on the use of breast imaging in prevention, diagnostics and staging with a clinical perspective. We emphasize the multimodality approach with combined evaluation of all imaging methods and multidisciplinary team work with close cooperation of various medical specialties, which is essential for planning the proper execution of patient management to ensure the best possible outcome. Practical examples are given in a series of clinical scenarios.
{"title":"Current imaging techniques and impact on diagnosis and survival —a narrative review","authors":"P. Steyerová, A. Burgetová","doi":"10.21037/abs-21-22","DOIUrl":"https://doi.org/10.21037/abs-21-22","url":null,"abstract":"Imaging plays a central role in the detection and assessment of breast cancer. Breast cancer screening programmes have been well established, as even in the era of modern therapies early detection has a major impact on survival. Time interval and method of breast cancer surveillance programme depends greatly on the individual risk factors and a correct selection and/or combination of methods proved to be useful in women with higher than average risk or in women with dense breasts. In women with clinical symptoms, imaging methods provide reliable differentiation between benign and suspicious processes that need to be evaluated with a biopsy. Each of the three basic imaging methods of the breast—mammography, breast ultrasound and magnetic resonance imaging (MRI) has its advantages and limitations. Additionally, appropriate preoperative marking is a mandatory part of imaging that helps transfer the information from imaging to surgery. In this review, we summarize the data on the use of breast imaging in prevention, diagnostics and staging with a clinical perspective. We emphasize the multimodality approach with combined evaluation of all imaging methods and multidisciplinary team work with close cooperation of various medical specialties, which is essential for planning the proper execution of patient management to ensure the best possible outcome. Practical examples are given in a series of clinical scenarios.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43448337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Di Micco, L. Santurro, Gaetano Lapiana, D. Socci, V. Zuber, G. Cisternino, Sara Baleri, Stefano Rottino, R. Ceccarino, O. Gentilini
{"title":"Pre-pectoral implant-based breast reconstruction after mastectomy: a narrative review","authors":"R. Di Micco, L. Santurro, Gaetano Lapiana, D. Socci, V. Zuber, G. Cisternino, Sara Baleri, Stefano Rottino, R. Ceccarino, O. Gentilini","doi":"10.21037/abs-21-147","DOIUrl":"https://doi.org/10.21037/abs-21-147","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42149277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Sugimoto, Shiori Hikichi, M. Takada, Masakazu Toi
Objective: This narrative review describes the recent developments and applications of machine learning (ML), a part of artificial intelligence, concerning breast cancer. Background: The advent of new bioinformatic approaches and artificial intelligence-based computational technologies has led to a shift in the decision-making of oncologists regarding breast cancer diagnostics and treatment processes. Various successful applications of ML on image processing, especially the use of deep neural networks and convolutional neural networks, to detect tumor and lymph nodes regions have been reported. Recent high-throughput molecular quantifications, i.e., quantitative omics techniques have enabled simultaneous monitoring of thousands of molecules to understand the molecular-level pathology. These data, including gene expression, protein, metabolite, and methylation profiling, have been analyzed via deep learning, network analysis, clustering, and dimension reductions to explore intrinsic subtypes and new biomarkers. Clinical-pathological features have been conducted by multivariable analysis to predict various outcomes, e.g., the sensitivity of adjuvant therapy and prognosis. The quantitative relationships among their variables have been visualized as nomograms. To analyze complex structures of a larger number of variables, ML combining multiple clinical-pathological features has been developed to predict the prognosis, metastasis, and treatment outcomes of breast cancer. Methods: We provided the narrative review of ML-related topics especially in the quantitative omics data and clinical-pathological prediction models. Conclusion: ML-based prediction methods are powerful tools and contribute to realizing personalized medicine for breast cancer.
{"title":"Machine learning techniques for breast cancer diagnosis and treatment: a narrative review","authors":"M. Sugimoto, Shiori Hikichi, M. Takada, Masakazu Toi","doi":"10.21037/abs-21-63","DOIUrl":"https://doi.org/10.21037/abs-21-63","url":null,"abstract":"Objective: This narrative review describes the recent developments and applications of machine learning (ML), a part of artificial intelligence, concerning breast cancer. Background: The advent of new bioinformatic approaches and artificial intelligence-based computational technologies has led to a shift in the decision-making of oncologists regarding breast cancer diagnostics and treatment processes. Various successful applications of ML on image processing, especially the use of deep neural networks and convolutional neural networks, to detect tumor and lymph nodes regions have been reported. Recent high-throughput molecular quantifications, i.e., quantitative omics techniques have enabled simultaneous monitoring of thousands of molecules to understand the molecular-level pathology. These data, including gene expression, protein, metabolite, and methylation profiling, have been analyzed via deep learning, network analysis, clustering, and dimension reductions to explore intrinsic subtypes and new biomarkers. Clinical-pathological features have been conducted by multivariable analysis to predict various outcomes, e.g., the sensitivity of adjuvant therapy and prognosis. The quantitative relationships among their variables have been visualized as nomograms. To analyze complex structures of a larger number of variables, ML combining multiple clinical-pathological features has been developed to predict the prognosis, metastasis, and treatment outcomes of breast cancer. Methods: We provided the narrative review of ML-related topics especially in the quantitative omics data and clinical-pathological prediction models. Conclusion: ML-based prediction methods are powerful tools and contribute to realizing personalized medicine for breast cancer.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48436908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Breast infections can be considered lactational or nonlactational, and the guiding principle in treating breast infection is to give antibiotics as early as possible to stop abscess formation. Lactational abscesses are usually caused by Staphylococcus aureus, including MRSA, often due to trauma during breastfeeding. A combination of repeated aspirations and oral antibiotics is usually effective at resolving abscess formation and is the current treatment of choice. Women should be encouraged to continue breastfeeding. Rarely, surgical drainage of lactational abscesses is required, and the development of milk fistula is uncommon. Nonlactational abscess are considered central (periareolar) or peripheral. Periareolar abscesses are common in young women and smokers, and up to half of patients experience recurrent episodes of infection. The underlying cause of recurrent infections is obstructed lactiferous ducts by keratin plugs, and therefore a subareolar abscess will continue to recur unless these ducts are excised by total duct excision. Often, a mammary duct fistula can form due to recurrent infection treated by incision and drainage (I&D), and treatment is again surgical consisting of either opening up the fistula tract and leaving it to granulate or excising the fistula and affected ducts and closing the wound primarily. Peripheral breast abscesses are less common, and most recently treatment has shifted from open surgical drainage to less invasive repeated aspirations using ultrasound-guidance. Advantages to percutaneous aspiration include shorter healing time and improved cosmetic outcomes. For women older than 35 years old and/or at risk for breast cancer, management of breast infections should not forgo recommended screening, and upon resolution of symptoms mammography is recommended.
{"title":"Abscess/infections/periareolar mastitis","authors":"C. Pesce, K. Yao","doi":"10.21037/ABS-21-49","DOIUrl":"https://doi.org/10.21037/ABS-21-49","url":null,"abstract":": Breast infections can be considered lactational or nonlactational, and the guiding principle in treating breast infection is to give antibiotics as early as possible to stop abscess formation. Lactational abscesses are usually caused by Staphylococcus aureus, including MRSA, often due to trauma during breastfeeding. A combination of repeated aspirations and oral antibiotics is usually effective at resolving abscess formation and is the current treatment of choice. Women should be encouraged to continue breastfeeding. Rarely, surgical drainage of lactational abscesses is required, and the development of milk fistula is uncommon. Nonlactational abscess are considered central (periareolar) or peripheral. Periareolar abscesses are common in young women and smokers, and up to half of patients experience recurrent episodes of infection. The underlying cause of recurrent infections is obstructed lactiferous ducts by keratin plugs, and therefore a subareolar abscess will continue to recur unless these ducts are excised by total duct excision. Often, a mammary duct fistula can form due to recurrent infection treated by incision and drainage (I&D), and treatment is again surgical consisting of either opening up the fistula tract and leaving it to granulate or excising the fistula and affected ducts and closing the wound primarily. Peripheral breast abscesses are less common, and most recently treatment has shifted from open surgical drainage to less invasive repeated aspirations using ultrasound-guidance. Advantages to percutaneous aspiration include shorter healing time and improved cosmetic outcomes. For women older than 35 years old and/or at risk for breast cancer, management of breast infections should not forgo recommended screening, and upon resolution of symptoms mammography is recommended.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48195248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: The greatest challenge to nipple areolar complex (NAC) preservation during mastectomy has been ischemic complications which can range from epidermolysis to complete necrosis. Women with macromastia, ptosis, or smokers are at greater risk for these complications. Additional risk factors associated with ischemia that have been described include mastectomy incision placement, reconstruction type, and other known medical comorbidities. In this manuscript techniques for evaluation of skin perfusion patterns with angiography to aid in optimal incision placements and surgical delay are described. Devascularization of the NAC prior to a nipple sparing mastectomy is a surgical delay technique aimed at preventing irreversible skin ischemia. Devascularization consists of separating the NAC and surrounding skin from the underlying breast tissue. Similar to other surgical delay procedures utilized in other plastic reconstructive procedures, blood inflow through the skin is enhanced as a compensatory mechanism after the first stage devascularization. The first stage NAC devascularization can be performed with a lumpectomy procedure in patients with a newly diagnosed cancer and the second stage completion mastectomy is performed after 3 to 6 weeks later after temporary ischemic changes have resolved. The timing for completion mastectomy can also be adjusted for a later time point if more urgent systemic or locoregional treatment is needed. The utilization of a staged devascularization and delayed nipple sparing mastectomy allows more patients to achieve the desired aesthetic goals of nipple areolar preservation while minimizing ischemic complications, and most importantly does not compromise oncologic safety of the breast cancer patient.
{"title":"Protecting nipple-areolar complex perfusion by devascularization and surgical delay","authors":"Jacqueline Tsai, I. Wapnir","doi":"10.21037/ABS-20-111","DOIUrl":"https://doi.org/10.21037/ABS-20-111","url":null,"abstract":": The greatest challenge to nipple areolar complex (NAC) preservation during mastectomy has been ischemic complications which can range from epidermolysis to complete necrosis. Women with macromastia, ptosis, or smokers are at greater risk for these complications. Additional risk factors associated with ischemia that have been described include mastectomy incision placement, reconstruction type, and other known medical comorbidities. In this manuscript techniques for evaluation of skin perfusion patterns with angiography to aid in optimal incision placements and surgical delay are described. Devascularization of the NAC prior to a nipple sparing mastectomy is a surgical delay technique aimed at preventing irreversible skin ischemia. Devascularization consists of separating the NAC and surrounding skin from the underlying breast tissue. Similar to other surgical delay procedures utilized in other plastic reconstructive procedures, blood inflow through the skin is enhanced as a compensatory mechanism after the first stage devascularization. The first stage NAC devascularization can be performed with a lumpectomy procedure in patients with a newly diagnosed cancer and the second stage completion mastectomy is performed after 3 to 6 weeks later after temporary ischemic changes have resolved. The timing for completion mastectomy can also be adjusted for a later time point if more urgent systemic or locoregional treatment is needed. The utilization of a staged devascularization and delayed nipple sparing mastectomy allows more patients to achieve the desired aesthetic goals of nipple areolar preservation while minimizing ischemic complications, and most importantly does not compromise oncologic safety of the breast cancer patient.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47293517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Upper extremity lymphedema remains a significant source of morbidity in breast cancer patients despite significant improvements in breast cancer care. The risk of lymphedema is particularly elevated in patients requiring an axillary lymph node dissection and/or adjuvant radiation to treat their disease. Current treatment options for lymphedema, including conservative management or surgery, are limited and are often aimed at improving symptoms and quality of life rather than curing the disease. In this review we describe immediate lymphatic reconstruction, a novel surgical procedure that is done concurrent with axillary lymph node dissection in an effort to prevent the development of breast cancer-related lymphedema. Based on our growing knowledge of the pathophysiology of lymphedema, microsurgical techniques are used at the time of axillary lymph node dissection to perform a lymphovenous bypass between transected, leaking lymphatic channels and an adjacent, small calibre vein in the axilla. Using several objective metrics for shortand longterm surveillance, patients are monitored for the development of postoperative lymphedema. Early outcomes from using this technique have been promising, both in the literature and within our own institutions, demonstrating significant improvements in rates of postoperative lymphedema. However, future study is still required to better understand the long-term efficacy of immediate lymphatic reconstruction.
{"title":"Immediate lymphatic reconstruction for breast cancer","authors":"A. Seth, D. Singhal","doi":"10.21037/ABS-20-110","DOIUrl":"https://doi.org/10.21037/ABS-20-110","url":null,"abstract":"Upper extremity lymphedema remains a significant source of morbidity in breast cancer patients despite significant improvements in breast cancer care. The risk of lymphedema is particularly elevated in patients requiring an axillary lymph node dissection and/or adjuvant radiation to treat their disease. Current treatment options for lymphedema, including conservative management or surgery, are limited and are often aimed at improving symptoms and quality of life rather than curing the disease. In this review we describe immediate lymphatic reconstruction, a novel surgical procedure that is done concurrent with axillary lymph node dissection in an effort to prevent the development of breast cancer-related lymphedema. Based on our growing knowledge of the pathophysiology of lymphedema, microsurgical techniques are used at the time of axillary lymph node dissection to perform a lymphovenous bypass between transected, leaking lymphatic channels and an adjacent, small calibre vein in the axilla. Using several objective metrics for shortand longterm surveillance, patients are monitored for the development of postoperative lymphedema. Early outcomes from using this technique have been promising, both in the literature and within our own institutions, demonstrating significant improvements in rates of postoperative lymphedema. However, future study is still required to better understand the long-term efficacy of immediate lymphatic reconstruction.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44740924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Velotti, N. Rocco, A. Vitiello, Giovanna Berardi, Martina Pontillo, M. Musella, S. Masone
Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy; Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy Contributions: (I) Conception and design: N Velotti, N Rocco, A Vitiello, M Musella, S Masone; (II) Administrative support: N Velotti, N Rocco, A Vitiello, M Musella, S Masone; (III) Provision of study materials or patients: N Velotti, G Berardi, M Pontillo; (IV) Collection and assembly of data: N Velotti, N Rocco, A Vitiello, G Berardi, M Pontillo; (V) Data analysis and interpretation: N Velotti, N Rocco, A Vitiello, M Musella, S Masone; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Nunzio Velotti. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy. Email: nunzio.velotti@gmail.com.
那不勒斯那不勒斯“费德里科二世”高级生物医学科学部门;那不勒斯的“费德里科二世”、那不勒斯、意大利的税收:(II)行政支持:(III)研究材料或耐心证明:N Velotti, G Berardi, M Pontillo;(四)数据收集与汇总:N Velotti, N Rocco, A Vitiello, G Berardi, M Pontillo;(V)分析和解析数据:N Velotti, N Rocco, A Vitiello, M Musella, S Masone;(VI)手稿写作:所有权威;手稿最终确认:所有权威。他叫南齐奥·维洛蒂。那不勒斯大学“费德里科二世”高级生物医学科学部门，意大利潘西尼5号，80131那不勒斯。电子邮件:南齐奥velotti@gmail。com。
{"title":"Immediate direct-to-implant breast reconstruction with prepectoral vs. subpectoral approach: a narrative review","authors":"N. Velotti, N. Rocco, A. Vitiello, Giovanna Berardi, Martina Pontillo, M. Musella, S. Masone","doi":"10.21037/abs-21-150","DOIUrl":"https://doi.org/10.21037/abs-21-150","url":null,"abstract":"Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy; Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy Contributions: (I) Conception and design: N Velotti, N Rocco, A Vitiello, M Musella, S Masone; (II) Administrative support: N Velotti, N Rocco, A Vitiello, M Musella, S Masone; (III) Provision of study materials or patients: N Velotti, G Berardi, M Pontillo; (IV) Collection and assembly of data: N Velotti, N Rocco, A Vitiello, G Berardi, M Pontillo; (V) Data analysis and interpretation: N Velotti, N Rocco, A Vitiello, M Musella, S Masone; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Nunzio Velotti. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy. Email: nunzio.velotti@gmail.com.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42687618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. González, Gastón Berman, H. Ursino, Jorgelina Cavallero, M. E. Azar, Martín Ipiña, D. Mansilla, O. Sturla
Head of Mastology Department, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina; Head of Breast Unit, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina; Staff Physicians, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina; Outpatient Clinic, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina Contributions: (I) Conception and design: E González; (II) Administrative support: ME Azar; (III) Provision of study materials or patients: H Ursino; (IV) Collection and assembly of data: J Cavallero; (V) Data analysis and interpretation: G Berman; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Eduardo González. Mastology Department, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina. Email: egonzalez57@hotmail.com.
阿根廷布宜诺斯艾利斯大学“Angel H Roffo”肿瘤研究所乳腺科主任；阿根廷布宜诺斯艾利斯大学“Angel H Roffo”肿瘤研究所乳腺科主任；阿根廷布宜诺斯艾利斯大学“Angel H Roffo”肿瘤研究所工作人员物理学家；阿根廷布宜诺斯艾利斯大学“Angel H Roffo”肿瘤研究所门诊部贡献：（i）概念和设计：E Gonzalez；（二） 行政支持：我随机；（三） 提供研究材料或患者：H URSINO；（四） 数据收集和汇编：J Cavallero；（五） 数据分析和解释：G Berman；（六） 手写：所有作者；（七） 手稿的最终批准：所有作者。通讯地址：爱德华多·冈萨雷斯。阿根廷布宜诺斯艾利斯大学“Angel H Roffo”肿瘤研究所乳腺科。电子邮件：egonzalez57@hotmail.com.
{"title":"Breast-conserving surgery and immediate autologous fat transfer with or without neoadjuvant treatment: indications, technique, cosmetic and oncologic outcomes","authors":"E. González, Gastón Berman, H. Ursino, Jorgelina Cavallero, M. E. Azar, Martín Ipiña, D. Mansilla, O. Sturla","doi":"10.21037/abs-21-131","DOIUrl":"https://doi.org/10.21037/abs-21-131","url":null,"abstract":"Head of Mastology Department, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina; Head of Breast Unit, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina; Staff Physicians, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina; Outpatient Clinic, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina Contributions: (I) Conception and design: E González; (II) Administrative support: ME Azar; (III) Provision of study materials or patients: H Ursino; (IV) Collection and assembly of data: J Cavallero; (V) Data analysis and interpretation: G Berman; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Eduardo González. Mastology Department, Instituto de Oncología “Ángel H Roffo”, Universidad de Buenos Aires, Buenos Aires, Argentina. Email: egonzalez57@hotmail.com.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41665025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Mastectomy and reconstructive procedures have been refined over the decades, allowing for aesthetic outcomes close to the native breast shape and in symmetry with the contralateral intact breast or even to improve breasts appearance and symmetry. Similarly, improvements in radiation oncology can help reduce treatment related toxicity and improve outcomes. However, postmastectomy radiation therapy (PMRT) is associated with poor cosmetic outcomes and increased rate complications in patients who undergo breast reconstruction. Radiation therapy planning should be guided by disease stage, risk of recurrence, correct definition of the target volumes and treatment objectives. Currently, there are guidelines endorsed by European Society for Radiotherapy and Oncology (ESTRO) for target volume delineation for breast cancer and elective nodal volumes, including after immediate reconstruction. Correct target volume delineation, along with meticulous radiation planning, total dose and fractionation, dose homogeneity, and organs at risk (OAR) doses are significant for reducing radiation-induced toxicity. Currently, tremendous efforts are done by different groups to improve aesthetic outcomes without compromising disease outcomes in breast cancer patients who are candidates for mastectomy and radiation therapy. The current paper summarizes key principles in PMRT, considering new surgical techniques for immediate breast reconstruction and new, partly experimental radiation techniques including future trials and proton beam irradiation.
{"title":"Radiation therapy in breast cancer: a narrative review on current standards and future perspectives","authors":"O. Kaidar-Person, B. Offersen","doi":"10.21037/abs-21-16","DOIUrl":"https://doi.org/10.21037/abs-21-16","url":null,"abstract":": Mastectomy and reconstructive procedures have been refined over the decades, allowing for aesthetic outcomes close to the native breast shape and in symmetry with the contralateral intact breast or even to improve breasts appearance and symmetry. Similarly, improvements in radiation oncology can help reduce treatment related toxicity and improve outcomes. However, postmastectomy radiation therapy (PMRT) is associated with poor cosmetic outcomes and increased rate complications in patients who undergo breast reconstruction. Radiation therapy planning should be guided by disease stage, risk of recurrence, correct definition of the target volumes and treatment objectives. Currently, there are guidelines endorsed by European Society for Radiotherapy and Oncology (ESTRO) for target volume delineation for breast cancer and elective nodal volumes, including after immediate reconstruction. Correct target volume delineation, along with meticulous radiation planning, total dose and fractionation, dose homogeneity, and organs at risk (OAR) doses are significant for reducing radiation-induced toxicity. Currently, tremendous efforts are done by different groups to improve aesthetic outcomes without compromising disease outcomes in breast cancer patients who are candidates for mastectomy and radiation therapy. The current paper summarizes key principles in PMRT, considering new surgical techniques for immediate breast reconstruction and new, partly experimental radiation techniques including future trials and proton beam irradiation.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49259962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
About one out of eight women will be dealing with breast cancer throughout their life. The prevalence of this disease has jet-fueled breast cancer research, causing an immense leap in treatment modalities over the last decades. A better understanding of the disease, its subtypes, its genome and its treatment strategies has allowed us to evolve from aggressive to targeted, from debulking to breast conserving and from avoiding death to ensuring quality of life after survival. Despite major advances in medical therapy, surgery remains an indispensable step in breast cancer treatment. The novelties in breast conserving surgery and reconstructive surgery have made the treatment more versatile, which allows the oncoplastic team to provide a tailor-made surgical plan for each patient. The treatment regimen must aim for synergism between the different treatment modalities, without compromising either the oncological or reconstructive objective. While adjuvant therapy may downstage the tumor and make breast conservative surgery possible, adjuvant treatments like radiotherapy might also compromise the reconstructive outcome. Most patients who undergo breast conserving surgery are treated with radiotherapy, whereas the indication for postmastectomy radiotherapy (PMRT) is mainly based on tumor stage and the extent of lymph node involvement. Radiotherapy of the breast is indicated after breast conserving surgery for all invasive tumors, most ductal carcinoma in situ and Paget’s disease. It will also be applied when mastectomy margins were not clear from disease or when the tumors appeared to be more than 4 cm in diameter. Locoregional radiotherapy is indicated when nodal disease is confirmed (≥N1) and will be more extensive according to the degree of nodal disease. In patients needing PMRT, the definite reconstruction can be delayed by placing an expander in the mastectomy pocket. Although the consequences of radiotherapy on the autologous reconstructed breast is the subject of discussion, the literature suggests a higher occurrence of fat necrosis, late flap failure and decreased esthetic outcome from radiotherapy after free flap breast reconstruction (1). Since autologous breast reconstruction requires proper organization regarding surgery time and available surgeons, it is not advisable to rely on a preoperative diagnosis to decide whether or not to proceed with an autologous reconstruction. A problem arises in clinical node-negative breast cancer patients, where the definite tumor and nodal staging is not complete until full tumor and sentinel node resection. It is logistically not feasible to foresee both immediate and delayed reconstructive surgery depending on an intraoperative decision. Therefore, the sentinel first principle was introduced in our center. This paper outlines the algorithm applied in our center, in which the sentinel procedure is done in a separate surgery before the mastectomy for definite staging. This method, called the “sentinel fi
{"title":"Timing of post mastectomy radiotherapy in immediate or delayed- immediate breast reconstruction: an algorithm to the sentinel first principle","authors":"Lisa Ramaut, M. Vanhoeij, M. Hamdi","doi":"10.21037/abs-21-51","DOIUrl":"https://doi.org/10.21037/abs-21-51","url":null,"abstract":"About one out of eight women will be dealing with breast cancer throughout their life. The prevalence of this disease has jet-fueled breast cancer research, causing an immense leap in treatment modalities over the last decades. A better understanding of the disease, its subtypes, its genome and its treatment strategies has allowed us to evolve from aggressive to targeted, from debulking to breast conserving and from avoiding death to ensuring quality of life after survival. Despite major advances in medical therapy, surgery remains an indispensable step in breast cancer treatment. The novelties in breast conserving surgery and reconstructive surgery have made the treatment more versatile, which allows the oncoplastic team to provide a tailor-made surgical plan for each patient. The treatment regimen must aim for synergism between the different treatment modalities, without compromising either the oncological or reconstructive objective. While adjuvant therapy may downstage the tumor and make breast conservative surgery possible, adjuvant treatments like radiotherapy might also compromise the reconstructive outcome. Most patients who undergo breast conserving surgery are treated with radiotherapy, whereas the indication for postmastectomy radiotherapy (PMRT) is mainly based on tumor stage and the extent of lymph node involvement. Radiotherapy of the breast is indicated after breast conserving surgery for all invasive tumors, most ductal carcinoma in situ and Paget’s disease. It will also be applied when mastectomy margins were not clear from disease or when the tumors appeared to be more than 4 cm in diameter. Locoregional radiotherapy is indicated when nodal disease is confirmed (≥N1) and will be more extensive according to the degree of nodal disease. In patients needing PMRT, the definite reconstruction can be delayed by placing an expander in the mastectomy pocket. Although the consequences of radiotherapy on the autologous reconstructed breast is the subject of discussion, the literature suggests a higher occurrence of fat necrosis, late flap failure and decreased esthetic outcome from radiotherapy after free flap breast reconstruction (1). Since autologous breast reconstruction requires proper organization regarding surgery time and available surgeons, it is not advisable to rely on a preoperative diagnosis to decide whether or not to proceed with an autologous reconstruction. A problem arises in clinical node-negative breast cancer patients, where the definite tumor and nodal staging is not complete until full tumor and sentinel node resection. It is logistically not feasible to foresee both immediate and delayed reconstructive surgery depending on an intraoperative decision. Therefore, the sentinel first principle was introduced in our center. This paper outlines the algorithm applied in our center, in which the sentinel procedure is done in a separate surgery before the mastectomy for definite staging. This method, called the “sentinel fi","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41821875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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