The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery

고승상,전이경,강성수,허민희 한국유방암학회 2017 Journal of breast cancer Vol.20 No.2

Purpose: Intraoperative frozen-section analysis of the lumpectomy margin during breast-conserving surgery (BCS) is an excellent method in obtaining a clear resection margin. This study aimed to investigate the usefulness of intraoperative circumferential frozen-section analysis (IOCFS) of lumpectomy margin during BCS for breast cancer, and to find factors that increase the conversion into mastectomy. Methods: From 2007 to 2011, 509 patients with breast cancer underwent IOCFS during BCS. The outer surfaces of the shaved lumpectomy margins were evaluated. A negative margin was defined as no ink on the tumor. All margins were evaluated using the permanent section analysis. Results: Among the 509 patients, 437 (85.9%) underwent BCS and 72 (14.1%) finally underwent mastectomy. Of the 483 pathologically confirmed patients, 338 (70.0%) were truenegative, 24 (5.0%) false-negative, 120 (24.8%) true-positive, and 1 (0.2%) false-positive. Twenty-four patients (4.7%) among total 509 patients had undetermined margins as either atypical ductal hyperplasia or ductal carcinoma in situ in the first IOCFS. The IOCFS has an accuracy of 94.8% with 83% sensitivity, 99.7% specificity, 93.4% negative predictive value, and 99.2% positive predictive value. Sixty-three cases (12.4%) were converted to mastectomy, the first intraoperatively. Of the 446 (87.6%) patients who successfully underwent BCS, 64 patients received additional excisions and 32 were reoperated to achieve clear margin (reoperation rate, 6.3%). Twenty-three of the reoperated patients underwent re-excisions using the second intraoperative frozen section analysis, and achieved BCS. Nine cases were additionally converted to mastectomy. No significant differences in age, stage, and biological factors were found between the BCS and mastectomy cases. Factors such as invasive lobular carcinoma, multiple tumors, large tumor, and multiple excisions increased the conversion to mastectomy. Conclusion: The IOCFS analysis during BCS is useful in evaluating lumpectomy margins and preventing reoperation.

Thoracic interfascial plane block for multimodal analgesia after breast lumpectomy

홍부휘,김여정,오차현,윤수경,윤상원,박현우,이원형,김윤희,고영권 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.2

Background: Thoracic interfascial plane block is useful as a component of multimodal analgesia in patients undergoing mastectomy. However, multimodal analgesia tends not to be provided during lumpectomy as it is one of the less aggressive procedures among breast cancer surgeries. Therefore, we investigated the effects of thoracic interfascial plane block as more effective analgesia after breast lumpectomy. Methods: Forty six patients (20–80 years old, female) with breast cancer scheduled to undergo lumpectomy were randomly assigned to two groups. Postoperative pain control in the control group consisted only of intravenous patient-controlled analgesia (PCA). In the block group, intravenous PCA was used after serratus intercostal fascial plane block and pecto-intercostal fascial plane block. The primary outcome was the 24 h cumulative postoperative fentanyl consumption. Pain severity, additional rescue analgesic requirement, side effects, and patient satisfaction were also evaluated. Results: Postoperative fentanyl consumption in the block group was significantly reduced compared with the control group (median, 88.8 [interquartile range, 48.0, 167.6] vs. 155.2 [88.8, 249.2], P = 0.022). The pain score was significantly lower in the block group only in the post-anesthesia care unit (2.9 ± 1.8 vs. 4.3 ± 2.3, P = 0.022). There were no differences in the incidence of postoperative nausea and vomiting and the requirement for additional analgesics between the groups. The satisfaction score was significantly higher in the block group. Conclusions: Thoracic interfascial plane block after lumpectomy reduces opioid usage and increases patient satisfaction with postoperative pain control. Thoracic interfascial plane block is useful for multimodal analgesia after lumpectomy.

Abdominal Advancement Flap as Oncoplastic Breast Conservation: Report of Seven Cases and Their Cosmetic Results

Tomoko Ogawa,Noriko Hanamura,Masako Yamashita,Minori Ito,Hiroko Kimura,Takashi Nakamura,Yumi Kashikura,Yuki Nohara,Aya Noro 한국유방암학회 2013 Journal of breast cancer Vol.16 No.2

An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up and creates the shape of the inferior portion of the breast by making a neo-inframammary fold. Seven patients underwent remodeling using an AAF or a method combining an AAF with other volume displacement techniques after partial mastectomy. The excision volume ranged from 15% to 35%. AAF with only mobilization of the gland flaps was performed in two cases, with lateral mammoplasty in one case, with the round block technique (RBT) in one case, with a modified RBT in one case, and with medial mammoplasty in two cases. Although one patient treated with a RBT had a partial blood-flow insufficiency of the nipple-areola complex, it improved with conservative treatment. The cosmetic results were found to be excellent in three cases, good in three, and fair in one case.

Comparison of Outcomes of Standard and Oncoplastic Breast-Conserving Surgery

Mehmet ali Gulcelik,Lutfi Dogan,Murat Yuksel,Mithat Camlibel,Cihangir Ozaslan,Erhan Reis 한국유방암학회 2013 Journal of breast cancer Vol.16 No.2

Purpose: The aim of this study is to determine and to compare the oncological outcomes of bilateral reduction mammoplasty to standard breast-conserving surgery for breast cancer. Methods: One hundred sixty-two patients who received a quadrantectomy because of breast cancer (group 1) and 106 breast cancer patients with macromastia who underwent breast-conserving surgery via bilateral reduction mammoplasty (group 2) between 2003 and 2010 were enrolled in this study. Results: The mean follow-up time was 37 months for group 1 and 33 months for group 2. Surgical margins were wider than 2 mm in 82.7% and 10 mm in 76.5% of the patients in group 1. Eleven percent of patients had positive surgical margins in this group. When compared to group 2, the rates were 89%, 84%, and 8.4%, respectively. Three patients (1.8%) in group 1 and one patient (0.9%) in group 2 had local recurrence of the disease and received a mastectomy. No statistical significances were noted for either local recurrence or overall survival between the two groups. Conclusion: Bilateral reduction mammoplasty has some advantages as compared to the standard conventional breast-conserving surgery techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates.

A Comparison of Residual Tumor Accuracy Prior to Re-Excision between Breast Magnetic Resonance Imaging and Ultrasonography

오성돈,이정선 한국유방암학회 2014 Journal of Breast Disease Vol.2 No.1

Purpose: We aimed to evaluate the accuracy of breast magnetic resonance imaging (MRI) versus ultrasonography (US) in detecting residual tumor prior to a second re-excision. Methods: Fifty-seven breast cancer patients diagnosed by vacuum-assisted breast biopsy (VABB) or excisional biopsy and scheduled for breast-conserving surgery (BCS) were included. They underwent breast MRI or US after an excisional biopsy or VABB to determine the extent of residual tumor around the excision site or multifocal cancers, followed by immediate curative surgery. We evaluated the correlation between the radiologic and pathologic findings after breast surgery. Results: Pathologic residual tumors were found in 42 patients (73.6%), and 13 patients (22.8%) demonstrated pathologic multifocal breast cancer. When detecting residual tumor using MRI, the sensitivity, specificity, positive predictive value, and negative predictive value were 59.5%, 46.7%, 75.8%, and 29.2%, respectively. For US, the sensitivity, specificity, positive predictive, and negative predictive values were 41.4%, 90%, 92.3%, and 34.6%, respectively. Invasive ductal breast cancers seemed to be more enhancing than ductal carcinoma in situ or extensive intraductal components containing breast cancer. MRI findings of residual tumors were not associated with residual tumor size (positive, 1.16 cm; negative, 1.0 cm; p=0.65). Thirty-nine patients (68.4%) underwent BCS, while 18 patients (31.6%) underwent mastectomy. Conclusion: The MRI accuracy of detecting residual lesions around previous scars was lower than that of US, except for sensitivity; however, other lesions distinct from the primary cancer and multifocal lesions were more frequently identified on MRI than US.

Are the Outcomes of Breast Conservation Surgery Inferior to Those of Mastectomy in Patients with Stage II-IIIA Triple-Negative Breast Cancer?

Seungju Lee,김현열,Youn Joo Jung,Hyun-June Paik,Dong Il Kim,Chang Shin Jung,Seok-Kyung Kang,김지연,이석원,Youngtae Bae 한국유방암학회 2021 Journal of Breast Disease Vol.9 No.2

Purpose: Breast conserving surgery (BCS) is generally not considered for breast cancer because of concerns about the poor prognosis of triple negative breast cancer (TNBC). We assessed the outcomes of BCS and mastectomy for patients with stage II-IIIA TNBC. Methods: The data of 172 breast cancer patients diagnosed with stage II-IIIA TNBC who underwent treatment at Pusan National University Hospital and Pusan National University Yangsan Hospital from 2010 to 2014 were retrospectively analyzed. The patients were divided into the following two groups: patients who underwent BCS (n=101) and those who underwent mastectomy (n=71). The Cox regression model was used to examine the outcomes of both treatments. The median follow-up period was 71 months in the BCS group, and 67 months in the mastectomy group. Results: The median age of the 172 patients was 51 years (range, 22-82 years). In the BCS group, radiation therapy and chemotherapy (p<0.001 and p=0.007, respectively) were performed more frequently. The BCS group had more patients with a high Ki-67 index (p=0.006), while the mastectomy group included more patients with a higher pathologic T (pT) stage (p=0.005). The 5-year loco-regional recurrence-free, disease-free, and overall survival rates of the BCS group versus the mastectomy group were 93.8% versus 95.3%, 89.8% versus 90.7%, and 90.8% versus 86.3%, respectively, but the differences were not statistically significant. Lymphovascular invasion was a risk factor for disease-free survival and advanced stage was an important risk factor for overall survival. Conclusion: In stage II-IIIA TNBC, BCS was not inferior to mastectomy in locoregional recurrence rates, disease-free survival rates, or overall survival rates.

Survival Outcomes of Different Treatment Methods for the Ipsilateral Breast of Occult Breast Cancer Patients with Axillary Lymph Node Metastasis: A Single Center Experience

우상민,백승희,이종원,김희정,유종한,고범석,손귀연,이유라,김한나,안세현,손병호 한국유방암학회 2013 Journal of breast cancer Vol.16 No.4

Purpose: This study compared the survival outcomes of differenttreatment methods for the ipsilateral breast of occult breast cancer(OBC) patients with axillary lymph node metastasis. Methods:A retrospective study was conducted in which forty OBC patientswith axillary lymph node metastasis were identified out of 15,029patients who had been diagnosed with a primary breast cancerat between 1992 and 2010. The patients were categorized intothree treatment groups based on ipsilateral breast management:breast-conserving surgery (BCS) (n=17), mastectomy (n=12),and nonsurgical intervention with or without radiation therapy (Nosurgery with or without radiation therapy [No Op±RT]) (n=11). Allpatients underwent axillary lymph node dissection. Cases wereevaluated based on treatment and potential prognostic factorswith respect to overall survival (OS) and disease-free survival(DFS). Results: During the follow-up period (median follow-up of71.5 months), the overall OS and DFS were 76.9% and 74.9%,respectively. The 5-year treatment-specific OS was 72.0% for theBCS group, 74.0% for the mastectomy group, and 87.5% for theNo Op±RT group (log-rank p=0.49). The 5-year DFS was 70.6%for the BCS group, 66.7% for the mastectomy group, and 90.9%for the No Op±RT group (log-rank p=0.36). Recurrence rates forthe BCS and No Op±RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inverselycorrelated with DFS (log-rank p=0.04 and p<0.01, respectively). Conclusion: There was no difference in survival outcomes betweenthe three treatment methods for the ipsilateral breast (mastectomy,BCS, and No Op±RT) of OBC patients with axillarylymph node metastasis. A large-scale multicenter study is neededto validate the results from this small retrospective study.

임상연구 : 유방절제술을 위한 흉추 경막외마취

옥시영 ( Si Young Ok ),박성원 ( Sung Won Park ),김순임 ( Soon Im Kim ),김선종 ( Sun Chong Kim ),이민혁 ( Min Hyuk Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: Segmental thoracic epidural anesthesia (sTEA) is commonly used for postoperative pain control in chest or upper abdominal surgery. But it is not commonly used for the purpose of pure regional anesthesia. Therefore we investigated the usefulness of sTEA for mastectomy and evaluated the effects of sTEA on respiration and hemodynamics. Methods: Twenty patients scheduled for mastectomy were randomly assigned. Under sitting position, epidural catheter was inserted at T3-4 or T4-5. 20 ml of 0.375% ropivacaine with fentanyl 50μg was injected to maintain anesthesia. The targeted sensory anesthetic dermatomal levels were determined by pinprick and measured at 5 min intervals for the first 15 min after injection of the drugs. If sensory block was not adequate, subsequent 5 ml doses of ropivacaine was injected. Supplemental oxygen (3-6 L/min) was administered through a face mask. After dermatomal level was checked, propofol infusion for sedation was started. Arterial blood sampling was taken for ABGA. Results: Average sensory anesthetic dermatomal levels is C5.5 ± 1.9 - T8.9 ± 2.7. During surgery, hypotension was noted in 25% of patients. It was treated with ephedrine 6 mg i.v. Average PaCO2 is 47.9 ± 7.7 mmHg. Conclusions: Above results suggest that sTEA is suitable for mastectomy as a method of regional anesthesia. (Korean J Anesthesiol 2006; 50: 646~9)

The Use of Absorbable Surgical Mesh after Partial Mastectomy for Improving the Cosmetic Outcome

김형욱,Sang Il Hwang,Cha Kyong Yom,박용래,Won Gil Bae 한국유방암학회 2009 Journal of breast cancer Vol.12 No.3

Purpose: Partial mastectomy without immediate volume replacement can be associated with cosmetic failure. The aim of the present study was to assess cosmesis achieved in patients who underwent partial mastectomy and reconstruction using absorbable surgical mesh. Methods: We used absorbable surgical mesh (Polyglactin 910, Vicryl®) to repair defects after performing partial mastectomy in 25 patients. Endoscopy-assisted partial mastectomy was performed with conservation of the whole skin of the breast and areola. A tailored fan-shape mesh was inserted into the postoperative defect. The cosmetic appearance was evaluated using a simplified five-grade for five-items scoring system at 3 and 6 months after the operation. Results: An excellent or good cosmetic result was obtained in 82.6% of the patients (19/23) after 3 and 6 months, and no major complications were noted. Conclusion: This procedure can be easily performed by general surgeons. Insertion of an absorbable surgical mesh into the postoperative defect could be an effective modality for reconstructing a defect after breast surgery.

Endoscopy-assisted Breast Conserving Surgery for Breast Cancer: A Preliminary Clinical Experience

신혁재,홍영익 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2

Purpose: Breast conserving surgery (BCS) has replaced modified radical mastectomy as the standard treatment for early breast cancer. However, even though the original shape of the breast is preserved, the significant scarring after BCS detracts from the natural appearance of the breast. Endoscopyassisted breast surgery can be performed with small incisions that become inconspicuous after surgery. We report herein on our preliminary clinical experience for the aesthetic and treatment results of endoscopy-assisted BCS (EA-BCS). Methods: We retrospectively analyzed 22 consecutive patients who underwent EA-BCS between June 2006 and February 2008. The skin incisions were made at the periareolar and axillary sites. We performed a dye- and/or radioisotope-guided sentinel lymph node biopsy (SLNB), and we dissected the axillary lymph nodes (level I and II), and excised tissue under endoscopic assistance. We carried out frozen section biopsies to rule out tumor invasion on the resection margins. The following information was obtained: the clinical and histopathological characteristics, the operative procedures, the surgical outcomes, the cosmetic evaluation, and the patients’ satisfaction. Results: The average age of the patients was 52.0 years (range, 32-74 years). The mean tumor size was 2.2 cm (range, 0.7-5.5 cm). All the patients underwent EA-BCS and SLNB. The postoperative complications were as follows: lymphedema in two patients, wound infection in three patients, and a total mastectomy due to positive margins on the final biopsy report in one patient. No locoregional recurrence was observed on the follow-up study (mean, 24.0 months). There were good to excellent aesthetic results for 95% of the evaluated cases. Almost all the patients were satisfied with the outcome of surgery. Conclusion:EA-BCS was a feasible and effective procedure for treating patients with breast cancer and it achieved good aesthetic results with reducing the surgical scarring. However, further study with more patients and long-term follow-up is needed.