Skip to main content

Lobar Surgery and Pathological Correlations

  • Chapter
  • First Online:
Lobar Approach to Breast Ultrasound

Abstract

The knowledge of the natural history of the breast carcinoma and its origin, the use of all diagnostic methods, and the good preoperatory control of the suspect zone in the lobe allow us in many cases to carry out a limited operation which is rationally and oncologically correct and to always give the greatest importance to the woman’s image, for her well-being. This chapter points out the need to correlate the radial echographic technique introduced by Michel Teboul and conservative breast surgery.

We always closely connect this methodology to the preoperative ultrasound evaluation and the subsequent reevaluation of the removed lobe with the pathologist.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Veronesi U, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.

    Article  PubMed  Google Scholar 

  2. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.

    Article  PubMed  Google Scholar 

  3. Dolfin G, Tagliabue P, Dolfin AM, Indelicato S. Chirurgia conservativa: cosa possiamo fare per evitare la mutilazione? Riv It Ost Gin. 2007;14:66370.

    Google Scholar 

  4. Teboul M. Practical ductal echography. Madrid, Spain: Medgen. S.A; 2004.

    Google Scholar 

  5. Tot T. The clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large-format histological sections. Cancer. 2007;110:2551–60.

    Article  PubMed  Google Scholar 

  6. Durante E. Multimodality imaging and interventional techniques. Ferrara, Italy: IBUS Course Abstracts; 2006.

    Google Scholar 

  7. Amoros J, Dolfin G, Teboul M. Atlas de Ecografia de la Mama. Torino: Ananke; 2009.

    Google Scholar 

  8. Hunt KK, Sahin AA. Too much, too little, or just right? Tumor margins in women undergoing breast-conserving surgery. J Clin Oncol. 2014;32:14–8.

    Article  Google Scholar 

  9. Amy D, Durante E, Tot T. The lobar approach to breast ultrasound imaging and surgery. J Med Ultrasound. 2015;42(3):331–9.

    Article  Google Scholar 

  10. Tot T. The theory of the sick breast lobe and the possible consequences. Int J Surg Pathol. 2007;15:369.

    Article  PubMed  Google Scholar 

  11. Tot T, Gere M, Pekár G, Tarján M, Hofmeyer S, Hellberg D, Lindquist D, Chen TH-H, Yen AM-F, Chiu SY-H, Tabár L. Breast cancer multifocality, disease extent, and survival. Hum Pathol. 2011;42:1761–9.

    Article  PubMed  Google Scholar 

  12. Coombs NJ, Boyages J. Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol. 2005;23:7497–502.

    Article  PubMed  Google Scholar 

  13. La Parra RF, De Roos WK, Contant CM, Bavelaar-Croon CD, Barneveld PC, Bosscha K. A prospective validation study of sentinel lymph node biopsy in multicentric breast cancer: SMMaC trial. Eur J Surg Oncol. 2014;40:1250–5.

    Article  Google Scholar 

  14. Donker M, Straver ME, van Tienhoven G, van de Velde CJ, Mansel RE, Litière S, Werutsky G, Duez NJ, Orzalesi L, Bouma WH, van der Mijle H, Nieuwenhuijzen GA, Veltkamp SC, Helen Westenberg A, Rutgers EJ. Comparison of the sentinel node procedure between patients with multifocal and unifocal breast cancer in the EORTC 10981-22023 AMAROS Trial: identification rate and nodal outcome. Eur J Cancer. 2013;49:2093.

    Article  PubMed  Google Scholar 

  15. Yerushalmi R, Tyldesley S, Woods R, Kennecke HF, Speers C, Gelmon KA. Is breast-conserving therapy a safe option for patients with tumor multicentricity and multifocality? Ann Oncol. 2012;23:876–81.

    Article  CAS  PubMed  Google Scholar 

  16. Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56:979–90.

    Article  CAS  PubMed  Google Scholar 

  17. Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, Hanby A, Brown J. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010;375:563–71.

    Article  PubMed  Google Scholar 

  18. Peters NH, van Esser S, van den Bosch MA, Storm RK, Plaisier PW, van Dalen T, Diepstraten SC, Weits T, Westenend PJ, Stapper G, Fernandez-Gallardo MA, Borel Rinkes IH, van Hillegersberg R, Mali WP, Peeters PH. Preoperative MRI and surgical management in patients with nonpalpable breast cancer: the MONET - randomised controlled trial. Eur J Cancer. 2011;47:879–88627.

    Article  CAS  PubMed  Google Scholar 

  19. Biesemier KW, Alexander C. Enhancement of mammographic-pathologic correlation utilizing large format histology for malignant breast disease. Semin Breast Dis. 2005;8:152–62.

    Article  Google Scholar 

  20. Tot T. The role of large-format histopathology in assessing subgross morphological prognostic parameters: a single institution report of 1000 consecutive breast cancer cases. Int J Breast Cancer. 2012;2012:395–415.

    Google Scholar 

  21. Foschini MP, Flamminio F, Miglio R, et al. The impact of large sections on the study of in situ and invasive duct carcinoma of the breast. Hum Pathol. 2007;38:1736–43.

    Article  PubMed  Google Scholar 

  22. Tot T, Pekár G, Hofmeyer S, et al. The distribution of lesions in 1-14-mm invasive breast carcinomas and its relation to metastatic potential. Virchows Arch. 2009;455:109–15.

    Article  CAS  PubMed  Google Scholar 

  23. Tot T. DCIS, cytokeratins, and the theory of the sick lobe. Virchows Arch. 2005;447:1–8.

    Article  PubMed  Google Scholar 

  24. Osen R, et al. Rosen’s breast pathology. 4th ed. Philadelphia: Wolters Kluwer Health; 2015.

    Google Scholar 

  25. Lobar AD. Ultrasound of the breast. In: Tot T, editor. Breast cancer. London: Springer; 2011. p. 153–62.

    Google Scholar 

  26. Lavoué V, Fritel X, Antoine M, Beltjens F, Bendifallah S, Boisserie-Lacroix M, Boulanger L, Canlorbe G, Catteau-Jonard S, Chabbert-Buffet N, Chamming’s F, Chéreau E, Chopier J, Coutant C, Demetz J, Guilhen N, Fauvet R, Kerdraon O, Laas E, Legendre G, Mathelin C, Nadeau C, Naggara IT, Ngô C, Ouldamer L, Rafii A, Roedlich MN, Seror J, Séror JY, Touboul C, Uzan C, Daraï E, French College of Gynecologists and Obstetricians (CNGOF). Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF): benign breast tumors - short text. Eur J Obstet Gynecol Reprod Biol. 2016;200:16–23.

    Article  PubMed  Google Scholar 

  27. Mitra S, Dey P. Fine-needle aspiration and core biopsy in the diagnosis of breast lesions: a comparison and review of the literature. Cytojournal. 2016;13:18.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wesoła M, Jeleń M. The diagnostic efficiency of fine needle aspiration biopsy in breast cancers - review. Adv Clin Exp Med. 2013;22(6):887–92.

    PubMed  Google Scholar 

  29. National Breast Cancer Centre. Breast fine needle aspiration cytology and core biopsy: a guide for practice. 2004. This book can also be downloaded from the National Breast Cancer Centre website www.nbcc.org.au .

    Google Scholar 

  30. Feoli F, Ameye L, Van Eeckhout P, Paesmans M, Marra V, Arisio R. Liquid-based cytology of the breast: pitfalls unrecognized before specific liquid-based cytology training - proposal for a modification of the diagnostic criteria. Acta Cytol. 2013;57(4):369–76.

    Article  PubMed  Google Scholar 

  31. Willems SM, van Deurzen CH, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol. 2012;65(4):287–92.

    Article  CAS  PubMed  Google Scholar 

  32. Nassar A. Core needle biopsy versus fine needle aspiration biopsy in breast--a historical perspective and opportunities in the modern era. Diagn Cytopathol. 2011;39(5):380–8.

    Article  PubMed  Google Scholar 

  33. Rageth CJ, O’Flynn EA, Comstock C, Kurtz C, Kubik R, Madjar H, Lepori D, Kampmann G, Mundinger A, Baege A, Decker T, Hosch S, Tausch C, Delaloye JF, Morris E, Varga Z. First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016;159(2):203–13.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Park HL, Hong J. Vacuum-assisted breast biopsy for breast cancer. Gland Surg. 2014;3(2):120–728.

    PubMed  PubMed Central  Google Scholar 

  35. Tot T, Ibarra JA. Examination of specimens from patients with ductal carcinoma in situ of the breast using large-format histology sections. Arch Pathol Lab Med. 2009;133(9):1361.

    PubMed  Google Scholar 

  36. Fisher CS, Mushawah FA, Cyr AE, Gao F, Margenthaler JA. Ultrasound-guided lumpectomy for palpable breast cancers. Ann Surg Oncol. 2011;18:3198–203.

    Article  PubMed  Google Scholar 

  37. Luini A, Gatti G, Zurrida S, Caldarella P, Viale G, Rosali dos Santos G, Frasson A. The surgical margin status after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat. 2009;113(2):397–402.

    Article  PubMed  Google Scholar 

  38. Dolfin G, Chebib A, Amy D, Tagliabue P. Carcinoma mammarie et Chirurgie Conservatrice. 30° Seminare Franco-Syrien d’Imagerie Médicale. Tartous, Syrie; 2008.

    Google Scholar 

  39. Volders JH, Haloua MH, Krekel NM, Meijer S, van den Tol PM. Current status of ultrasound-guided surgery in the treatment of breast cancer. World J Clin Oncol. 2016;7(1):44–53.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Krekel N, Zonderhuis B, Muller S, Bril H, van Slooten HJ, de Lange de Klerk E, van den Tol P, Meijer S. Excessive resections in breast-conserving surgery: a retrospective multicentre study. Breast J. 2011;17:602–9.

    Article  PubMed  Google Scholar 

  41. Pan H, Wu N, Ding H, Ding Q, Dai J, Ling L, Chen L, Zha X, Liu X, Zhou W, et al. Intraoperative ultrasound guidance is associated with clear lumpectomy margins for breast cancer: a systematic review and meta-analysis. PLoS One. 2013;8:e74028.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Tot T, Tabár L. Mammographic pathologic correlation of ductal carcinoma in situ of the breast using two- and three-dimensional large histologic sections. Semin Breast Dis. 2005;8:144–51.

    Article  Google Scholar 

  43. Tomoka H, Masataka S, Junko I, et al. Impact of intraoperative specimen mammography on margins in breast-conserving surgery. Mol Clin Oncol. 2016;5:269–72.

    Article  Google Scholar 

  44. Chiappa C, Rovera F, Corben AD, Fachinetti A, De Berardinis V, Marchionini V, Rausei S, Boni L, Dionigi G, Dionigi R. Surgical margins in breast conservation. Int J Surg. 2013;11(Suppl 1):S69–72.

    Article  PubMed  Google Scholar 

  45. Houssami N, Morrow M. Margins in breast conservation: a clinician’s perspective and what the literature tells us. J Surg Oncol. 2014;110(1):2–7.

    Article  PubMed  Google Scholar 

  46. Moehrle M, Breuninger H, Röcken M. A confusing world: what to call histology of three-dimensional tumour margins? J Eur Acad Dermatol Venereol. 2007;21(5):591–5.

    PubMed  CAS  Google Scholar 

  47. Dolfin G, et al. The surgical approach to the “sick lobe” in breast cancer: a new era in management. New York: Springer; 2014.

    Google Scholar 

  48. Tot T. Subgross morphology, the sick lobe hypothesis, and the success of breast conservation. Int J Breast Cancer 2011;2011: Article ID 634021.

    Article  Google Scholar 

Download references

Acknowledgment

Thanks to doctors Anna Maria Dolfin for providing the images and for the help in writing this chapter; Paolo Tagliabue, fellow surgeon; and Riccardo Arisio, pathologist. Thanks to Silvia Botta for pathological drawings.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giancarlo Dolfin M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dolfin, G., Botta, G. (2018). Lobar Surgery and Pathological Correlations. In: Amy, D. (eds) Lobar Approach to Breast Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-61681-0_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61681-0_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61680-3

  • Online ISBN: 978-3-319-61681-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics