Breast conservation treatment for multifocal and multicentric breast cancers in women with small-volume breast tissue.

BACKGROUND: Breast conservation treatment (BCT) is an established option in the treatment of early breast cancer, but women with small breast volume (SVB) are considered poor candidates for BCT. Multifocal and multicentric breast cancers (MFMCBC) are conventionally considered a relative contraindication to BCT. These arguments form the basis of limited eligibility for BCT for a woman with SVB and MFMCBC. This study was performed to investigate this syllogism. METHODS: Consecutive patients with breast malignancies treated from 2009 to 2011 were included. Patients were deemed to have successful BCT if they had pathologically clear margins and had completed all recommended adjuvant treatment. Those who had MFMCBC based on clinical, imaging and pathological data were selected for detailed evaluation. Comparisons were made with unifocal breast cancer. RESULTS: Data from a total of 160 patients who underwent treatment during the study period were analysed. The mean age was 48.8 years. One hundred and six patients (66.3%) were of Chinese ethnicity, 36 (22.5%) were of other Asian ethnicity and 18 were Caucasian (11.2%). Forty-one (25.6%) patients had clinical evidence of MFMCBC. Of these patients, 35 (85.4%) underwent BCT. After a mean follow-up of 45 months, none of the patients with MFMCBC developed a local recurrence. Two patients with MFMCBC, one who underwent mastectomy and one with BCT, succumbed to cancer from distant disease. CONCLUSION: BCT is feasible in women with MFMCBC in a predominantly Chinese community where majority are expected to have SVB. Further investigation is warranted to confirm the findings.

Optimising Breast Conservation Treatment for Multifocal and Multicentric Breast Cancer: A Worthwhile Endeavour?

BACKGROUND: Breast conservation treatment (BCT) is an accepted treatment modality for early breast cancer. However, multifocal and multicentric breast cancer (MFMCBC) is a relative contraindication to BCT. This study was performed to compare BCT rates in MFMCBC and unifocal tumours and its outcomes. METHODS: A retrospective analysis was performed for patients with breast malignancies who underwent operative treatment between 2009 and 2011. Successful BCT was defined as the ability to obtain clear margins for all tumour foci through a single incision with acceptable resultant cosmesis. RESULTS: A total of 160 patients were analysed, of which 40 were MFMCBC. Thirty-four of the 40 patients with MFMCBC underwent BCT (85 %). After a mean follow-up period of 55 months, there were no local recurrences in patients with MFMCBC. CONCLUSION: BCT was achieved in 85 % of the patients with MFMCBC in this cohort without evidence of poorer local control. Further investigation is needed to confirm this finding for its potential contribution to improved survival outcomes.

Perspectives of Cosmesis following Breast Conservation for Multifocal and Multicentric Breast Cancers.

Background. Contemporary data suggest that breast conservation treatment (BCT) for multifocal and multicentric breast cancer (MFMCBC) may be appropriate with noninferior local control rates. However, there is a paucity of data to evaluate patient's satisfaction with cosmetic outcomes after BCT for MFMCBC. This study was performed to bridge this information gap. Methods. All patients treated at the authors' healthcare facility were included in the study. Patients with MFMCBC who were assessed to be eligible for BCT underwent tumour resection using standard surgical techniques with direct parenchymal closure through a single incision. After at least three years of follow-up, they were invited to participate in a survey regarding their cosmetic outcomes. Results. Of a total of 160 patients, 40 had MFMCBC, of whom 34 (85%) underwent successful BCT. Five-year cancer-specific survival and disease-free survival were 95.7%. Twenty of the 34 patients responded to the survey. No patient rated her cosmetic outcome as "poor." Analysis indicated low agreement between patients' self-assessment and clinician-directed evaluation of aesthetic results. Conclusion. BCT for MFMCBC is feasible with acceptable survival and cosmetic outcomes. However, there appears to be a disparity between patient and clinician-directed evaluation of cosmetic results which warrant further research.

Minimising unnecessary mastectomies in a predominantly Chinese community.

BACKGROUND: Recent data shows that the use of breast conservation treatment (BCT) for breast cancer may result in superior outcomes when compared with mastectomy. However, reported rates of BCT in predominantly Chinese populations are significantly lower than those reported in Western countries. Low BCT rates may now be a concern as they may translate into suboptimal outcomes. A study was undertaken to evaluate BCT rates in a cohort of predominantly Chinese women. METHODS: All patients who underwent surgery on the breast at the authors' healthcare facility between October 2008 and December 2011 were included in the study and outcomes of treatment were evaluated. RESULTS: A total of 171 patients were analysed. Two-thirds of the patients were of Chinese ethnicity. One hundred and fifty-six (85.9%) underwent BCT. Ninety-eight of 114 Chinese women (86%) underwent BCT. There was no difference in the proportion of women undergoing BCT based on ethnicity. After a median of 49 months of follow-up, three patients (1.8%) had local recurrence and 5 patients (2.9%) suffered distant metastasis. Four patients (2.3%) have died from their disease. CONCLUSION: BCT rates exceeding 80% in a predominantly Chinese population are possible with acceptable local and distant control rates, thereby minimising unnecessary mastectomies.

The value of intraoperative frozen section analysis for margin status in breast conservation surgery in a nontertiary institution.

Introduction. Breast conservation treatment (BCT) for early-stage breast malignancies requires negative margins and good cosmesis. Reoperations may be needed to achieve negative margins, which can have an adverse impact on outcomes. This study was performed to evaluate the efficacy of intraoperative frozen section analysis (IFSA) for margin assessment to reduce excision rates. Methods. All patients treated at the authors' private healthcare facility between 2009 and 2011 for breast cancer were included in the study. Those for whom BCT was intended underwent wide excision with IFSA. Six margins of the excised tissue, and the sentinel lymph node (SLN), where appropriate, were submitted for IFSA. Patient demographics, tumour characteristics, number of operations performed, and outcomes were analysed. Results. Of the 161 patients analysed, 138 (85.7%) had successful breast conservation. Four patients required a reoperation for incomplete surgical extirpation. One had a false negative SLN assessment on IFSA, and was returned to the operating room for an axillary dissection. Three patients required reoperations for inadvertently missed multicentric disease. None had false negative margin evaluation with IFSA necessitating reexcision. Conclusion. The use of IFSA allows low rates of reoperation with BCT. Further research is needed to establish consistency in low reexcision rates for cost-effectiveness and optimum resource allocation.