Oncological outcomes in oncoplastic breast surgery: a single institution analysis.

Oncoplastic surgery is a well-acknowledged technique that combines conserving treatment in breast cancer with plastic surgery reconstruction. The aim of our analysis is to evaluate the safety of this surgical procedure in the setting of invasive primary breast cancer, and then compare breast oncoplastic surgery with the Veronesi quadrantectomy.We have analyzed 1541 patients who underwent breast surgery for primary breast tumor between October 2004 and May 2018 at Sant'Andrea University Hospital in Rome: 880 women experienced the breast oncoplastic approach, while 660 patients received conservative surgery alone. The median follow-up time was 14 years with a completeness of 70% (1067 pts vs 1554). The statistic comparison across these subpopulations suggested that there are no statistically significant results in term of Overall Survival, Disease Related Survival, Local recurrence or positive margins. Therefore oncoplastic surgery for primary invasive breast cancer represents a feasible procedure and an oncological safe surgical option.

Adenomyoepithelioma of the breast: case report and literature review.

Adenomyoepithelioma are uncommon tumors. The majority of them occur in women in the fifth and sixth decades who usually present with a self-palpated, solitary breast mass or a lesion identified on mammography. We report the case of adenomyoepithelioma of the breast with malignant transformation of both myoepitheliel and epithelial components diagnosed as malignancy during the preoperative stage in a seventy-six year old woman.

Breast-conservative surgery with and without radiotherapy in patients aged 55-75 years with early-stage breast cancer: a prospective, randomized, multicenter trial analysis after 108 months of median follow-up.

OBJECTIVES: Breast-conserving therapy (BCT), including postoperative whole breast irradiation (WBI), is generally accepted as the treatment of choice for most patients with early-stage breast cancer. The question whether WBI is mandatory in all patients remains one of the most controversial issues in BCT. To answer this question, a randomized, prospective, multicentre study was launched in January 2001. Primary endpoints of the study were to assess the cumulative incidence of in-breast-recurrences (IBR) and overall survival (OAS) after conservative surgery (BCS) with or without WBI. METHODS: From January 2001 until December 2005, 749 patients with unifocal infiltrating breast cancer up to 25 mm, 0-3 positive axillary lymph nodes, no extensive intraductal component or lymphvascular invasion from 11 centres in Italy, were randomly assigned to BCS+WBI (arm 1:373 patients) or BCS alone (arm 2:376 patients). Treatment arms were well balanced in terms of baseline characteristics. Systemic adjuvant therapy was administered according to the institutional policies. Kaplan-Meier method was used for survival analysis and log-rank test to evaluate the difference between the two arms. RESULTS (Last analysis 31.12.2012): After median follow-up of 108 months, 12 (3.4%) IBR were observed in arm 1 and 16 (4.4%) in arm 2. OAS was 81.4% in arm 1 and 83.7% in arm 2. There was no statistically significant difference regarding IBR and death in the two treatment groups. CONCLUSIONS: These data are promising and suggest that WBI after BCS can be omitted in selected patients with early stage breast cancer without exposing them to an increased risk of local recurrence and death. Longer follow-up is needed to further consolidate these results.

Secretory breast cancer. Case report.

Secretory carcinoma of the breast is a rare tumor initially described in children but occurring equally in adult population. This unusual breast cancer subtype has a generally favorable prognosis, although several cases have been described in adults with increased aggressiveness and a risk of metastases. However, surgery is still considered the most appropriate treatment for this pathology. We describe the case of a 50 -year-old woman who has undergone a breast conservative surgery for a little tumor, preoperatively diagnosticated by a fine needle aspiration biopsy (FNAB) as a well differentiated infiltrating carcinoma.

Conservative surgery with and without radiotherapy in elderly patients with early-stage breast cancer: a prospective randomised multicentre trial.

Breast conserving therapy (BCT) including postoperative irradiation of the remaining breast tissue is generally accepted as the best treatment for the majority of patients with early-stage breast cancer. The question is whether there is a necessity for irradiating all patients. Between 2001 and 2005, 749 women aged 55-75 years with infiltrating breast carcinoma were randomly assigned to breast conservative surgery, with or without radiotherapy (RT), to evaluate the incidence of in-breast recurrence (IBR). After 5 years of median follow-up, the cumulative incidence of IBR was 2.5% in the surgery-only arm and 0.7% in the surgery plus RT arm. There are no differences in terms of overall survival and distant disease-free survival. The preliminary evaluation suggests that breast irradiation after conservative surgery can be avoided without exposing these patients to an increased risk of distant-disease recurrence. Prolonged follow-up will further clarify the possible risks and late sequelae potentially induced by breast RT.

Modified Wise-pattern reduction mammaplasty, a new tool for upper quadrantectomies: a preliminary report.

BACKGROUND: Quadrantectomy is an oncological safe procedure for early breast cancer, but it often results in poor aesthetic results such as breast shape deformity, more visible if the tumor is located in the upper pole. We suggest the use of a modified Wise-pattern breast reduction in patients with moderate to severe breast hypertrophy and tumor located in upper quadrants that keeps the oncological advantages of the quadrantectomy but with better aesthetical results. MATERIAL AND METHODS: Quadrantectomy of the upper quadrant, immediate breast reconstruction and contralateral breast reduction to obtain symmetry was performed on 11 patients affected by early breast cancer with bra cup size from C to E. To replace the skin area removed with mastectomy from the upper quadrants, a similar-size area from the lower pole was preserved. RESULTS: All patients healed uneventfully within 15 days, and no local or distant recurrences occurred with mean follow-up of 26.5 months (range 19-39 months). In all cases natural breast shape was achieved. The scars were similar to a reduction mammaplasty, and the medial or lateral scar on the upper quadrant did not aesthetically disfigure the décolleté. CONCLUSIONS: Modified Wise-pattern reduction mammaplasty is a valid technique as immediate breast reconstruction to obtain a natural breast mound after upper quadrantectomies on patients with medium/large breasts.

[Peritoneal papillary serous carcinoma in a patient with previous surgery for breast cancer: clinical case]. / [Carcinoma sieroso papillare del peritoneo in paziente già operata di carcinoma mammario. Caso clinico]

The peritoneal papillary serous carcinoma (PPSC) is a rare tumor more frequently revealed in female. The onset mean age is 56 years. It implicate peritoneum, ovary's surface and pelvis. The histology of this disease is similar to papillary serous carcinoma ovary (PSCO). The PPSC histogenesis is probably correlated to coelomatic embryonal epithelium. Clinical characteristics are abdominal swelling, constipation, nausea, emesis, inappetence, feel unwell, lose weight. The cytoreductive surgery and the cisplatinum chemotherapy, and other treatments like immunotherapy and radiotherapy, increase the PSCP patient survival. A case of a 51 years old patient with previous surgery for breast cancer is here described. She show some of the yet described clinical findings. At the surgery we found the typically serous peritoneal localizations. We performed a debulking, and the patient died 14 months after the operation due to the disease progression.

[Breast surgery in HIV-positive women]. / Chirurgia della mammella in pazienti HIV-positive.

The increasing of HIV infection in young women as well as prolonged survival let us to register an important rising of breast cancers in such type of patients. The Authors report the case of a 48 year old HIV-positive woman, who underwent surgery because of the histological positivity for cancer of the right breast. It was decided to perform a quadrantectomy and reconstruction with implant, because of the absence of immunodepression. The Authors discuss about indications for reconstructive surgery in seropositive women with breast cancer.

[Detection, characterization and clinical significance of circulating cancer cells in patients surgically treated for breast cancer]. / Ricerca, caratterizzazione e significato clinico di cellule tumorali circolanti in pazienti operate per cancro della mammella.

Recent technological advances have led to an increasing ability to detect isolated or groups of tumour cells in blood, lymph nodes or bone marrow in patients with different tumour types. However, the clinical evidence of these advances is unclear. The detection and the characterisation of circulating breast cancer cells and the eventually micrometastasis represent an important prognostic factor with therapeutic implications. The number of neoplastic cells being very small, these are not easily detected by using only cytomorphology, possibly associated to immunocytochemistry. In the last decade many studies have been directed in order to identify new assays. In the present review the Authors summarize advantages and disadvantages about two different technical approaches: molecular and immunomagnetic selection with cellular enrichment and immunocytochemistry.

[Day surgery in breast reconstructive surgery: our experience]. / La day surgery nella chirurgia ricostruttiva della mammella: nostra esperienza.

Breast cancer is the most common tumour in Italy in the female population, counting for about 40000 new cases every year. The psychological aspects of breast mutilation and the social and economic implications are receiving increasing attention. Despite of the diffusion of screening programs to detect pre-clinical breast cancers, 30% of patients still undergo radical interventions. Therefore, many women present serious limitations of their social-life that can lead to severe depression since, in occidental countries, the biological function of the breast is less considered than its primary role of femininity and sexuality. The gold-standard is to conceal oncological radicality and aesthetic preservation. The Authors present their experience analysing the techniques employed.

[Total periareolar approach in breast-conserving surgery]. / Approccio periareolare totale nella chirugia conservativa della mammella.

Plastic and oncological breast surgery have to be considered as two aspects of the same treatment. The term "oncoplastic surgery" refers to the use of plastic surgery techniques in breast cancer surgery, in order to avoid and to correct the adverse aesthetic findings. The care of cosmetic sequelae of breast cancer surgery has reached an important therapeutic role for psychological consequences of disease and because of the higher patients expectations of a good aesthetic result. Considering the concept of oncoplastic surgery, since 1999 the authors began to use a periareolar approach in the breast conserving therapy (BCT), associated to axillary dissection performed through the same periareolar incision. This technique is not different from the traditional quadrantectomy in the extension of the glandular resection, while the skin may be preserved in according to the conventional protocols of BCT. Oncological and aesthetic results have proved to be safe and satisfactory.

Clinical use of an imaging probe in breast cancer surgery.

AIMS: Portable cameras allow easy transfer of the detector, and thus of radioisotope imaging, to the operating room. In this paper we describe our preliminary experience in radionuclide imaging of breast cancer with a 22.8 x 22.8 mm(2) field-of-view minicamera called "Imaging Probe" (IP). METHODS: Breast cancer detection by IP was performed to guide biopsy, in particular open biopsy, or help fine-needle or core-needle positioning when the main guidance method was ultrasonography or digital radiography. 99mTc Sestamibi (MIBI) was injected 1 h before imaging and biopsy to 14 patients with suspected or known breast cancer. Scintigraphic images were acquired before and after biopsy in each patient. The surgeon was allowed to take into account scintigraphic images as well as previously performed mammograms and ultrasonography. RESULTS: High-resolution IP images were able to guide biopsy toward cancer or toward washout zones of cancer which are thought to be chemoresistant in seven patients out of 10. Four patients in whom IP and MIBI were unable to guide biopsy were found not to have cancer. CONCLUSIONS: Our study confirms the ability of IP to guide breast biopsy even when our minicamera has to be handled manually by trained physicians during surgery.

Use of mesh to repair the submuscolar pocket in breast reconstruction: a new possible technique.

The reconstruction of the female breast after mastectomy has become a crucial part of primary breast cancer therapy. Setting of an implant is possible only in case of locally abounding soft tissue coverage and when no radiation has before performed. It is necessary a complete integrity of the submuscolar pocket and good blood supply of the skin to avoid failure of the procedure. In Author's experience, started since 1994, an immediate breast reconstruction after mastectomy is performed using gel-silicon implants directly when it was possible or setting first an expander. In six cases the condition of major pectoralis muscle after mastectomy was so foul that an immediate breast reconstruction with prosthesis was not realizable. However, the Authors tried a new technique using polypropylene mesh sutured on the major pectoralis muscle to cover the muscle partially destroyed. Preliminary data from the 6 pts seems to be encouraging.

[Periareolar subcutaneous quadrantectomy: a new approach in breast cancer surgery]. / Quadrantectomia sottocutanea per via periareolare: un nuovo approccio nella chirurgia del cancro della mammella.

Plastic and oncological breast surgery are becoming more and more closer as one surgical treatment. The term "oncoplastic surgery" refers to the use of plastic surgery techniques in breast cancer surgery, in order to avoid and to correct the adverse aesthetic findings. The care of cosmetic sequelae of breast cancer surgery has reached an important therapeutic role for psychological consequences of disease and because of the higher patients expectations of a good aesthetic result. Considering the concept of oncoplastic surgery, since 1999 the Authors began to use a periareloar approach in the breast conserving therapy (BCT), associated to axillary dissection performed through the same periareolar incision. This technique, original from the oncological point of view, is not different from the traditional quadrantectomy in the extension of the glandular resection, while the skin may be preserved in according to the conventional protocols of BCT. Oncological and aesthetic results have proved to be safe and satisfactory.

[Association between breast and colorectal cancer and polyps. Screening and epidemiological study]. / Associazione tra cancro della mammella e polipi e cancro del colon-retto. Studio epidemiologico e di screening.

BACKGROUND: Studies regarding the associations between different types of cancer in the same patient are very few and not always come to the same conclusions. Several hypothesis are suggested and particularly genetic and socioeconomical ones seem to offer an interpretation of this issue. Early detection of a second neoplasm allows to improve prognosis and survival. The knowledge of correlations between tumors help to select a population, with a high risk to develop a second cancer, to be included in a screening program. Nowadays thanks to early detection of breast cancer, ten years survival is more than 75%. Women who had breast cancer now live longer and so could have a higher risk to develop a second cancer. METHODS: From September 1998 to September 1999 in our Department 71 patients operated for breast cancer, underwent screening colonscopy. No patients refused to be included in the study. Mean age was 61 years (range 36-87). Each patient had a clinician interview in order to explain the goals of the study. RESULTS: Results show that among all patients 3 (4.2%) presented a history of colon cancer, 18.3% (13 cases) presented large bowel polyps. In 84.60% patients (11 cases) polyps were found not over 40 cm. This study shows that 93% of patients (66 cases) had a relative with cancer history. CONCLUSIONS: Our results compared with those of other authors seem to show an increased risk for breast cancer patients in developing polyps or colon cancer, so we suggest to insert sigmoidoscopy in standard follow-up of breast cancer patients.

[Randomized prospective study of early removal of drainage in breast cancer surgery]. / Studio prospettico randomizzato sulla rimozione precoce dei drenaggi nella chirurgia del cancro della mammella.

Axillary seroma is absolutely the most frequent complication of breast cancer surgery. The Authors have accrued 100 consecutive breast cancer patients in a randomized study in order to compare seroma incidence by removing drains on 2nd postoperative day (1st arm) versus 3rd postoperative day (2nd arm); 48 patients were accrued in the first arm and 52 in the second. All patients received a standard axillary dissection. Two suction drains were placed. A compressive medication was applied after surgery. Patients started physiotherapy on the 1st postoperative day. The overall seroma prevalence was 21%. We have 8/48 (16%) seromas in the 1st group and 13/52 (25%) in the 2nd. No significant differences were registered between two arms. Clinical seroma was treated by needle aspiration and medication with a steroid. Conclusions coming out from this study are: 1) early drains removal doesn't increase seroma rate; 2) axillary clearance has to be performed removing en bloc the fatty tissue respecting surgical plains; 3) apply a compressive bandaging; 4) early arm physiotherapy; 5) medication with steroid may reduce the fluid formation.

Incidental detection of an in situ lobular carcinoma during the study of an intramammary lymph node: utility of FNA cytology. A case report.

Intramammary lymph nodes appear in routine mammograms and are present in about 5% of patients undergoing mammography. Normal lymph nodes appear with ultrasonography, as well defined echo-poor masses with echogenic centers. This case report is an example of ultrasonography guided with FNA cytology in the diagnostic procedure of non-palpable breast lesions on an outpatient basis and choice of adequate therapy.

Microsatellite instability is correlated with lymph node-positive breast cancer.

We analyzed 81 cases of primary breast carcinoma and 7 cases of fibroadenoma for microsatellite instability at eight loci. Twenty-seven cases (33.3%) manifested aberrant microsatellite alleles: 7 (8.6%) at one locus and 20 (24.7%) at two or more loci [tumors with replication error-positive (RER+) phenotype]. No evidence of microsatellite instability was observed in fibroadenomas. We investigated correlations between RER+ phenotype and clinicopathological characteristics of the carcinomas. The RER+ phenotype was statistically associated with large tumor diameter; of 19 RER+ tumors with measured size, 16 were > 2 cm, compared to 28 of 58 tumors with no evidence of microsatellite instability or with shifts in allele sizes limited to one locus (P

The value of fine needle aspiration cytology in the diagnosis of breast proliferative lesions.

In order to further characterize fine needle aspiration cytology of breast proliferative lesions, we analyzed 723 FNA of patients with palpable breast abnormalities who underwent physical, mammographic and/or echographic examination. In 28 biopsies (3.9%), the final cytologic diagnosis was a proliferative lesion, a group of uncommon breast proliferative diseases not yet explored, in which cytology is sufficiently cellular with plenty of atypical elements but not suspicious of carcinoma. Histologic material was available in 22 cases and represented the basis of this retrospective evaluation. Among the positive proliferative lesions (PPL), 10 cases were infiltrating ductal carcinomas and 1 was a microinvasive carcinoma; whereas for the negative proliferative lesions (NPL), in 8 cases the histologic findings demonstrated fibrocystic changes, in 1 a fibroadenoma and in 1 a cystosarcoma phyllodes. The cytologic criteria utilized to define breast proliferative lesions were the following: increased cellularity, occasional single atypical cells, decreased cellular cohesion, crowded, enlarged and overlapping nuclei with three dimensional groupings with prominent nucleoli and chromatic changes. The cytologic characteristics examined demonstrated that the PPL are characterized by single atypical cells with nuclear alterations such as coarsely granular chromatin with a thick nuclear membrane and numerous prominent nucleoli. These features are common to many malignancies, therefore surgical biopsy confirmation is suggested.

Bullous pemphigoid induced by radiation therapy.

A rare complication occurring in a female patient who underwent conservative surgery and radiation therapy for breast cancer is described. Three weeks after the completion of radiotherapy, a diffuse bullous pemphigoid eruption developed in the irradiated area, spreading thereafter to the whole body. Although systemic cutaneous side effects have been reported after radiation therapy, this is the first occurrence of bullous pemphigoid ever reported in a female patient following treatment for breast cancer. Having made the diagnosis, an effective therapeutic regimen including nicotinamide and tetracycline was started. As the conservative management of breast cancer is now widely adopted, oncologists and physicians should be aware of such rare side effects due to radiation therapy.