Evaluación de la percepción preoperatoria de la calidad de vida y satisfacción de la mujer con cáncer de mama mediante el cuestionario BREAST-Q™ / Evaluation of the preoperative perception of quality of life and satisfaction of women with breast cancer using the BREAST-Q™ questionnaire

INTRODUCCIÓN: Cerca del 40% de las mujeres intervenidas por un carcinoma mamario refieren estar insatisfechas con la toma de decisiones y con el resultado cosmético de la cirugía. El objetivo del estudio es demostrar la utilidad del cuestionario prequirúrgico BREAST-Q™ para evaluar la satisfacción y calidad de vida de las mujeres con cáncer de mama en un estado basal previo a la cirugía e identificar perfiles de satisfacción. MÉTODOS: Estudio observacional de una corte prospectiva en mujeres con carcinoma de mama donde se evaluó la calidad de vida antes y después de la intervención propuesta mediante el cuestionario prequirúrgico BREAST-Q™. Se presentan los resultados preliminares del estudio, con el análisis de la fase prequirúrgica. Se calcularon los percentiles para cada dominio del cuestionario y se evaluaron las características físicas basales para su posterior análisis. RESULTADOS: La satisfacción media de las pacientes con sus mamas fue de 58,9 ± 16,9. La media de bienestar psicosocial prequirúrgico fue de 70,5 ± 16,1. A las pacientes que se les propuso una cirugía conservadora presentaron una media de bienestar físico de 80,7 ± 18,5 y a las pacientes que se les propuso una mastectomía con reconstrucción fue de 79,9 ± 17,7. La media de score para el bienestar sexual fue de 63,2 ± 20,7. No se encontraron diferencias estadísticamente significativas entre el grupo de mujeres con score bajo y el grupo con score medio o alto en cuanto a las características clinicoepidemiológicas de las pacientes. CONCLUSIONES: La evaluación preoperatoria de las pacientes con cáncer de mama permite una correcta valoración del impacto de la cirugía sobre la satisfacción y calidad de vida, siendo de utilidad para orientar el proceso informativo acerca de las expectativas de los resultados postoperatorios

INTRODUCTION: Almost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. METHODS: Prospective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. RESULTS: The average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics. CONCLUSIONS: Preoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results

Evaluation of the preoperative perception of quality of life and satisfaction of women with breast cancer using the BREAST-Q™ questionnaire. / Evaluación de la percepción preoperatoria de la calidad de vida y satisfacción de la mujer con cáncer de mama mediante el cuestionario BREAST-Q™.

INTRODUCTION: Almost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. METHODS: Prospective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. RESULTS: The average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics CONCLUSIONS: Preoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results.

Evaluation of MRI accuracy after primary systemic therapy in breast cancer patients considering tumor biology: optimizing the surgical planning.

Background We analyzed the accuracy of magnetic resonance imaging (MRI) after primary systemic therapy (PST) according to tumor subtype. Patients and methods Two-hundred and four breast cancer patients treated with PST were studied. MRI findings after PST were compared with pathologic findings, and results were stratified based on tumor subtype. Results Of the two-hundred and four breast cancer patients, eighty-four (41.2%) achieved a pathologic complete response (pCR) in the breast. The MRI accuracy for predicting pCR was highest in triple-negative (TN) and HER2-positive (non-luminal) breast cancer (83.9 and 80.9%, respectively). The mean size discrepancy between MRI-measured and pathologic residual tumor size was lowest in TN breast cancer and highest in luminal B-like (HER2-negative) breast cancer (0.45cm vs. 0.98 cm, respectively; p = 0.003). After breast conserving surgery (BCS), we found a lower rate of positive margins in TN breast cancer and a higher rate of positive margins in luminal B-like (HER2-negative) breast cancer (2.4% vs. 23.6%, respectively). Conclusions If tumor response after PST is assessed by MRI, tumor subtype should be considered when BCS is planned. The accuracy of MRI is highest in TN breast cancer.

Factores de riesgo de afectación de los márgenes quirúrgicos en la cirugía conservadora del cáncer de mama tras quimioterapia neoadyuvante / Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy

INTRODUCCIÓN: La cirugía conservadora de mama tras la quimioterapia neoadyuvante pretende resecar cualquier tumor residual con unos márgenes negativos. El objetivo de este estudio fue analizar los factores clínico-patológicos preoperatorios que influyen sobre el estado de los márgenes de resección tras la cirugía conservadora en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante. MÉTODOS: Estudio retrospectivo de 91 pacientes con cáncer de mama (92 tumores) tratadas con quimioterapia neoadyuvante durante el periodo 2006-2013. Se realizó un análisis de regresión de Cox para identificar las características basales del tumor asociadas con la afectación de los márgenes de resección tras cirugía conservadora de la mama. RESULTADOS: Del total de casos del estudio, 71 tumores se trataron inicialmente mediante cirugía conservadora tras la quimioterapia neoadyuvante. El examen patológico reveló afectación de márgenes en 16 de los 71 casos (22,5%). Se observó una mayor incidencia de márgenes positivos en los tumores con un tamaño inicial superior a 5cm (p = 0,021), en los tumores de bajo grado histológico (p = 0,031) y en los tumores con estatus positivo de los receptores hormonales (p = 0,006). Tras un seguimiento medio de 45,2 meses, 7 de las 71 pacientes tratadas con cirugía conservadora presentaron recidiva de la enfermedad (9,8%). No se observaron diferencias estadísticamente significativas en la supervivencia libre de enfermedad según el estado de los márgenes quirúrgicos (p = 0,596). CONCLUSIONES: Un tamaño tumoral basal superior a 5cm, el bajo grado tumoral y el estatus positivo de los receptores hormonales incrementan el riesgo para la afectación de los márgenes quirúrgicos en la cirugía conservadora de mama tras quimioterapia neoadyuvante

BACKGROUND: Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. METHODS: A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. RESULTS: Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size > 5 cm (P = .021), in cancers with low tumor grade (P = .031), and in patients with hormone receptor-positive cancer (P = .006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P = .596). CONCLUSIONS: A baseline tumor size > 5 cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy

Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy. / Factores de riesgo de afectación de los márgenes quirúrgicos en la cirugía conservadora del cáncer de mama tras quimioterapia neoadyuvante.

BACKGROUND: Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. METHODS: A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. RESULTS: Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596). CONCLUSIONS: A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy.

Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients.

BACKGROUND: The aim, of the study was to estimate the accuracy of magnetic resonance imaging (MRI) in assessing residual disease in breast cancer patients receiving neoadjuvant chemotherapy (NAC) and to identify the clinico-pathological factors that affect the diagnostic accuracy of breast MRI to determine residual tumour size following NAC. PATIENTS AND METHODS: 91 breast cancer patients undergoing NAC (92 breast lesions) were included in the study. Breast MRI was performed at baseline and after completion of NAC. Treatment response was evaluated by MRI and histopathological examination to investigate the ability of MRI to predict tumour response. Residual tumour size was measured on post-treatment MRI and compared with pathology in 89 lesions. Clinicopathological factors were analyzed to compare MRI-pathologic size differences. RESULTS: The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosing invasive residual disease by using MRI were 75.00%, 78.57%, 88.89%, 57.89%, and 76.09% respectively. The Pearson's correlation coefficient (r) between tumour sizes determined by MRI and pathology was r = 0.648 (p < 0.001). The size discrepancy was significantly lower in cancers with initial MRI size ≤ 5 cm (p = 0.050), in cancers with high tumour grade (p < 0.001), and in patients with hormonal receptor-negative cancer (p = 0.033). CONCLUSIONS: MRI is an accurate tool for evaluating tumour response after NAC. The accuracy of MRI in estimating residual tumour size varies with the baseline MRI tumour size, the tumour grade and the hormonal receptor status.