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Surgical Oncology Evaluation and Management of Breast Diseases

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Diagnosis and Management of Breast Tumors

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Abstract

For women with breast complaints or symptoms, history and physical exam are the first step toward diagnosis, followed by breast imaging with mammograms and sometimes ultrasound (US). Management of benign conditions is presented. For diagnosis of breast masses or abnormalities found on screening, needle biopsy should almost always be the first approach to a tissue diagnosis. Breast conservation should be the preferred approach to surgical management of most breast cancers, facilitated by imaging, neoadjuvant systemic therapy and oncoplastic techniques. Lymph node staging has become less radical over the past two decades, with sentinel node biopsy supplanting complete node dissection in most cases. Several options for reconstruction are available for women who need or choose total mastectomy.

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References

  1. Moriarty AT, et al. Cytology of spontaneous nipple discharge—is it worth it? Performance of nipple discharge preparations in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. Arch Pathol Lab Med. 2013;137:1039–42.

    Article  PubMed  Google Scholar 

  2. Kalu ON, Chow C, Wheeler A, Kong C, Wapnir I. The diagnostic value of nipple discharge cytology: breast imaging complements predictive value of nipple discharge cytology. J Surg Oncol. 2012;106:381–5.

    Article  PubMed  Google Scholar 

  3. Dawes LG, Bowen C, Venta LA, Morrow M. Ductography for nipple discharge: no replacement for ductal excision. Surgery. 1998;124:685–91.

    Article  CAS  PubMed  Google Scholar 

  4. King TA, Carter KM, Bolton JS, Fuhrman GM. A simple approach to nipple discharge. Am Surg. 2000;66:960–5.

    CAS  PubMed  Google Scholar 

  5. Simmons R, et al. Nonsurgical evaluation of pathologic nipple discharge. Ann Surg Oncol. 2003;10:113–6.

    Article  PubMed  Google Scholar 

  6. Cabioglu N, et al. Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. J Am Coll Surg. 2003;196:354–64.

    Article  PubMed  Google Scholar 

  7. Liberman L, et al. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol. 2006;186:1328–34.

    Article  PubMed  Google Scholar 

  8. Tatarian T, et al. Intraductal papilloma with benign pathology on breast core biopsy: to excise or not? Ann Surg Oncol. 2016;23:2501–7.

    Article  PubMed  Google Scholar 

  9. Moon HJ, Jung I, Kim MJ, Kim EK. Breast papilloma without atypia and risk of breast carcinoma. Breast J. 2014;20:525–33.

    Article  PubMed  Google Scholar 

  10. Wyss P, Varga Z, Rossle M, Rageth CJ. Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J. 2014;20:394–401.

    Article  PubMed  Google Scholar 

  11. Menes TS, et al. Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium. Am J Surg. 2014;207:24–31.

    Article  PubMed  Google Scholar 

  12. Shamonki J, et al. Management of papillary lesions of the breast: can larger core needle biopsy samples identify patients who may avoid surgical excision? Ann Surg Oncol. 2013;20:4137–44.

    Article  PubMed  Google Scholar 

  13. Swapp RE, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 2013;20:1900–5.

    Article  PubMed  Google Scholar 

  14. Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 2013;20:94–101.

    Article  PubMed  Google Scholar 

  15. Mansel RE, Dogliotti L. European multicentre trial of bromocriptine in cyclical mastalgia. Lancet. 1990;335:190–3.

    Article  CAS  PubMed  Google Scholar 

  16. Mansel RE, Wisbey JR, Hughes LE. Controlled trial of the antigonadotropin danazol in painful nodular benign breast disease. Lancet. 1982;1:928–30.

    Article  CAS  PubMed  Google Scholar 

  17. Pye JK, Mansel RE, Hughes LE. Clinical experience of drug treatments for mastalgia. Lancet. 1985;2:373–7.

    Article  CAS  PubMed  Google Scholar 

  18. Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget’s disease of the nipple. Breast Cancer Res Treat. 2013;141:1–12.

    Article  PubMed  Google Scholar 

  19. Chen CY, Sun LM, Anderson BO. Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer. 2006;107:1448–58.

    Article  PubMed  Google Scholar 

  20. Yim JH, Wick MR, Philpott GW, Norton JA, Doherty GM. Underlying pathology in mammary Paget’s disease. Ann Surg Oncol. 1997;4:287–92.

    Article  CAS  PubMed  Google Scholar 

  21. Helme S, Harvey K, Agrawal A. Breast-conserving surgery in patients with Paget’s disease. Br J Surg. 2015;102:1167–74.

    Article  CAS  PubMed  Google Scholar 

  22. Siu AL, U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279–96. Epub PMID 26757170

    Google Scholar 

  23. Oeffinger KC, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314:1599–614.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Burkett BJ, Hanemann CW. A review of supplemental screening ultrasound for breast cancer: certain populations of women with dense breast tissue may benefit. Acad Radiol. 2016;23:1604–9.

    Article  PubMed  Google Scholar 

  25. Melnikow J, et al. Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:268–78.

    Google Scholar 

  26. Hooley RJ, et al. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology. 2012;265:59–69.

    Article  PubMed  Google Scholar 

  27. Hodgson R, et al. Systematic review of 3D mammography for breast cancer screening. Breast. 2016;27:52–61. doi:10.1016/j.breast.2016.01.002. Epub 2016 Mar 25.

    Article  PubMed  Google Scholar 

  28. Gilbert FJ, Tucker L, Young KC. Digital breast tomosynthesis (DBT): a review of the evidence for use as a screening tool. Clin Radiol. 2016;71:141–50.

    Article  PubMed  Google Scholar 

  29. Morrow M, Waters J, Morris E. MRI for breast cancer screening, diagnosis, and treatment. Lancet. 2011;378:1804–11.

    Article  PubMed  Google Scholar 

  30. Kuhl CK, et al. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014;32:2304–10.

    Article  PubMed  Google Scholar 

  31. Mango VL, et al. Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection? Eur J Radiol. 2015;84:65–70.

    Article  PubMed  Google Scholar 

  32. Friese CR, Neville BA, Edge SB, Hassett MJ, Earle CC. Breast biopsy patterns and outcomes in Surveillance, Epidemiology, and End Results-Medicare data. Cancer. 2009;115:716–24.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Williams RT, et al. Needle versus excisional biopsy for noninvasive and invasive breast cancer: report from the National Cancer Data Base, 2003–2008. Ann Surg Oncol. 2011;18:3802–10.

    Article  PubMed  Google Scholar 

  34. James TA, Mace JL, Virnig BA, Geller BM. Preoperative needle biopsy improves the quality of breast cancer surgery. J Am Coll Surg. 2012;215:562–8.

    Article  PubMed  Google Scholar 

  35. Burkhardt JH, Sunshine JH. Core-needle and surgical breast biopsy: comparison of three methods of assessing cost. Radiology. 1999;212:181–8.

    Article  CAS  PubMed  Google Scholar 

  36. VandenBussche CJ, et al. Reflex estrogen receptor (ER) and progesterone receptor (PR) analysis of ductal carcinoma in situ (DCIS) in breast needle core biopsy specimens: an unnecessary exercise that costs the United States $35 million/y. Am J Surg Pathol. 2016;40:1090–9.

    Article  PubMed  Google Scholar 

  37. Hartmann LC, Degnim AC, Santen RJ, Dupont WD, Ghosh K. Atypical hyperplasia of the breast—risk assessment and management options. N Engl J Med. 2015;372:78–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Khan S, et al. Papillary lesions of the breast: to excise or observe? Breast J. 2017.

    Google Scholar 

  39. Donaldson AR, Sieck L, Booth CN, Calhoun BC. Radial scars diagnosed on breast core biopsy: frequency of atypia and carcinoma on excision and implications for management. Breast. 2016;30:201–7. doi:10.1016/j.breast.2016.06.007. Epub 2016 Jun 29.

    Article  PubMed  Google Scholar 

  40. Kalife ET, Lourenco AP, Baird GL, Wang Y. Clinical and radiologic follow-up study for biopsy diagnosis of radial scar/radial sclerosing lesion without other atypia. Breast J. 2016;22:637–44.

    Article  PubMed  Google Scholar 

  41. Leong RY, Kohli MK, Zeizafoun N, Liang A, Tartter PI. Radial scar at percutaneous breast biopsy that does not require surgery. J Am Coll Surg. 2016;223:712–6.

    Article  PubMed  Google Scholar 

  42. Kim EM, et al. Isolated radial scar diagnosis by core-needle biopsy: is surgical excision necessary? Springerplus. 2016;5:398. doi:10.1186/s40064-016-1993-z. eCollection 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Bloomquist EV, et al. A randomized prospective comparison of patient-assessed satisfaction and clinical outcomes with radioactive seed localization versus wire localization. Breast J. 2016;22:151–7.

    Article  PubMed  Google Scholar 

  44. Langhans L, et al. Radioguided surgery for localization of nonpalpable breast lesions a mini-review. Curr Radiopharm. 2016;9:114–20.

    Article  CAS  PubMed  Google Scholar 

  45. Chan BK, Wiseberg-Firtell JA, Jois RH, Jensen K, Audisio RA. Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev. 2015;12:CD009206.

    Google Scholar 

  46. Diego EJ, et al. Localizing high-risk lesions for excisional breast biopsy: a comparison between radioactive seed localization and wire localization. Ann Surg Oncol. 2014;21:3268–72.

    Article  PubMed  Google Scholar 

  47. Cox CE, et al. Pilot study of a new nonradioactive surgical guidance technology for locating nonpalpable breast lesions. Ann Surg Oncol. 2016;23:1824–30.

    Article  PubMed  Google Scholar 

  48. Allen SS, Froberg DG. The effect of decreased caffeine consumption on benign proliferative breast disease: a randomized clinical trial. Surgery. 1987;101:720–30.

    CAS  PubMed  Google Scholar 

  49. Gumm R, Cunnick GH, Mokbel K. Evidence for the management of mastalgia. Curr Med Res Opin. 2004;20:681–4.

    Article  CAS  PubMed  Google Scholar 

  50. Chase C, Wells J, Eley S. Caffeine and breast pain: revisiting the connection. Nurs Womens Health. 2011;15:286–94.

    Article  PubMed  Google Scholar 

  51. Horner NK, Lampe JW. Potential mechanisms of diet therapy for fibrocystic breast conditions show inadequate evidence of effectiveness. J Am Diet Assoc. 2000;100:1368–80.

    Article  CAS  PubMed  Google Scholar 

  52. Kaufman CS, et al. Office-based ultrasound-guided cryoablation of breast fibroadenomas. Am J Surg. 2002;184:394–400.

    Article  PubMed  Google Scholar 

  53. Zhao Z, Wu F. Minimally-invasive thermal ablation of early-stage breast cancer: a systemic review. Eur J Surg Oncol. 2010;36:1149–55.

    Article  CAS  PubMed  Google Scholar 

  54. Manenti G, et al. Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy. Eur Radiol. 2011;21:2344–53.

    Article  PubMed  Google Scholar 

  55. Tafra L, et al. Pilot trial of cryoprobe-assisted breast-conserving surgery for small ultrasound-visible cancers. Ann Surg Oncol. 2003;10:1018–24.

    Article  PubMed  Google Scholar 

  56. Khosravi-Shahi P. Management of non metastatic phyllodes tumors of the breast: review of the literature. Surg Oncol. 2011;20:e143–8.

    Article  PubMed  Google Scholar 

  57. Tan BY, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68:5–21.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Spitaleri G, et al. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol. 2013;88:427–36.

    Article  PubMed  Google Scholar 

  59. Shaaban M, Barthelmes L. Benign phyllodes tumours of the breast: (over) treatment of margins—a literature review. Eur J Surg Oncol. 2016;10. Epub PMID 27939569

    Google Scholar 

  60. Guillot E, et al. Management of phyllodes breast tumors. Breast J. 2011;17:129–37.

    Article  PubMed  Google Scholar 

  61. Chen WH, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91:185–94.

    Article  PubMed  Google Scholar 

  62. Kim YJ, Kim K. Radiation therapy for malignant phyllodes tumor of the breast: an analysis of SEER data. Breast. 2016;32:26–32. doi:10.1016/j.breast.2016.12.006.

    Article  PubMed  Google Scholar 

  63. Adesoye T, et al. Current trends in the management of phyllodes tumors of the breast. Ann Surg Oncol. 2016;23:3199–205.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Barth RJ Jr, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16:2288–94.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Van Zee KJ, Pérez GO, Minnard E, Cohen MA. Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge. Cancer. 1998;82:1874–80.

    Article  PubMed  Google Scholar 

  66. Irusen H, Rohwer AC, Steyn DW, Young T. Treatments for breast abscesses in breastfeeding women. Cochrane Database Syst Rev. 2015; doi:10.1002/14651858.CD010490.pub2.

  67. Marchant DJ. Inflammation of the breast. Obstet Gynecol Clin North Am. 2002;29:89–102.

    Article  PubMed  Google Scholar 

  68. Giess CS, Golshan M, Flaherty K, Birdwell RL. Clinical experience with aspiration of breast abscesses based on size and etiology at an academic medical center. J Clin Ultrasound. 2014;42:513–21.

    Article  PubMed  Google Scholar 

  69. Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther. 2014;12:753–62.

    Article  CAS  PubMed  Google Scholar 

  70. Wang K, Ye Y, Sun G, Xu Z. The Mammotome biopsy system is an effective treatment strategy for breast abscess. Am J Surg. 2013;205:35–8.

    Article  PubMed  Google Scholar 

  71. Taffurelli M, et al. Recurrent periductal mastitis: surgical treatment. Surgery. 2016;160:1689–92.

    Article  PubMed  Google Scholar 

  72. Lannin DR. Twenty-two year experience with recurring subareolar abscess and lactiferous duct fistula treated by a single breast surgeon. Am J Surg. 2004;188:407–10.

    Article  PubMed  Google Scholar 

  73. Sheybani F, Sarvghad M, Naderi HR, Gharib M. Treatment for and clinical characteristics of granulomatous mastitis. Obstet Gynecol. 2015;125:801–7.

    Article  CAS  PubMed  Google Scholar 

  74. Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging. 2016;7:531–9.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol. 2016;12:1381–94.

    Article  CAS  PubMed  Google Scholar 

  76. Gautam S, Tebo JM, Hamilton TA. IL-4 suppresses cytokine gene expression induced by IFN- gamma and/or IL-2 in murine peritoneal macrophages. J Immunol. 1992;148:1725–30.

    Google Scholar 

  77. Mooney KL, Bassett LW, Apple SK. Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 2016;29:1471–84.

    Article  CAS  PubMed  Google Scholar 

  78. Russo IH, Russo J. Hormonal approach to breast cancer prevention. J Cell Biochem. 2000;34:1–6.

    Article  CAS  Google Scholar 

  79. Chlebowski RT, Collyar DE, Somerfield MR, Pfister DG, American Society of Clinical Oncology Breast Cancer Technology Assessment Working Group. American Society of Clinical Oncology technology assessment on breast cancer risk reduction strategies: tamoxifen and raloxifene. J Clin Oncol. 1999;17:1939–55.

    Article  CAS  PubMed  Google Scholar 

  80. Fisher B, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.

    Article  CAS  PubMed  Google Scholar 

  81. Mocellin S, Pilati P, Briarava M, Nitti D. Breast cancer chemoprevention: a network meta-analysis of randomized controlled trials. J Natl Cancer Inst. 2015;108. djv318.

    Google Scholar 

  82. Brem RF, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 2008;190:637–41.

    Article  PubMed  Google Scholar 

  83. Liberman L, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol. 1999;173:291–9.

    Article  CAS  PubMed  Google Scholar 

  84. Lehman CD, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356:1295–303.

    Article  CAS  PubMed  Google Scholar 

  85. Liberman L, et al. MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol. 2003;180:333–41.

    Article  PubMed  Google Scholar 

  86. Esserman L, et al. Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol. 1999;17:110–9.

    Article  CAS  PubMed  Google Scholar 

  87. Mameri CS, Kemp C, Goldman SM, Sobral LA, Ajzen S. Impact of breast MRI on surgical treatment, axillary approach, and systemic therapy for breast cancer. Breast J. 2008;14:236–44.

    Article  PubMed  Google Scholar 

  88. Hlawatsch A, Teifke A, Schmidt M, Thelen M. Preoperative assessment of breast cancer: sonography versus MR imaging. AJR Am J Roentgenol. 2002;179:1493–501.

    Article  PubMed  Google Scholar 

  89. Hollingsworth AB, Stough RG, O’Dell CA, Brekke CE. Breast magnetic resonance imaging for preoperative locoregional staging. Am J Surg. 2008;196:389–97.

    Article  PubMed  Google Scholar 

  90. Grady I, Gorsuch-Rafferty H, Hadley P. Preoperative staging with magnetic resonance imaging, with confirmatory biopsy, improves surgical outcomes in women with breast cancer without increasing rates of mastectomy. Breast J. 2012;18:214–8.

    Article  PubMed  Google Scholar 

  91. Quan ML, et al. Magnetic resonance imaging detects unsuspected disease in patients with invasive lobular cancer. Ann Surg Oncol. 2003;10:1048–53.

    Article  CAS  PubMed  Google Scholar 

  92. Bedrosian I, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer. 2003;98:468–73.

    Article  PubMed  Google Scholar 

  93. Solin LJ, Orel SG, Hwang WT, Harris EE, Schnall MD. Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol. 2008;26(3):386–91.

    Article  PubMed  Google Scholar 

  94. Turnbull L, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010;375:563–71.

    Article  PubMed  Google Scholar 

  95. Turnbull LW, et al. Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE). Health Technol Assess. 2010;14:1–182.

    Article  CAS  PubMed  Google Scholar 

  96. Peters NH, et al. Preoperative MRI and surgical management in patients with nonpalpable breast cancer: the MONET—randomised controlled trial. Eur J Cancer. 2011;47:879–86.

    Article  CAS  PubMed  Google Scholar 

  97. Pilewskie M, et al. Effect of MRI on the management of ductal carcinoma in situ of the breast. Ann Surg Oncol. 2013;20:1522–9.

    Article  PubMed  Google Scholar 

  98. Carlson RW, et al. Invasive breast cancer. J Natl Compr Cancer Netw. 2011;9:136–222.

    Article  CAS  Google Scholar 

  99. Gianni L, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer. J Clin Oncol. 2009;27:2474–81.

    Article  CAS  PubMed  Google Scholar 

  100. Fisher B, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997;15:2483–93.

    Article  CAS  PubMed  Google Scholar 

  101. Chen AM, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson Cancer Center experience. J Clin Oncol. 2004;22:2303–12.

    Article  PubMed  Google Scholar 

  102. Peintinger F, et al. The safety of breast-conserving surgery in patients who achieve a complete pathologic response after neoadjuvant chemotherapy. Cancer. 2006;107:1248–54.

    Article  PubMed  Google Scholar 

  103. Shen J, et al. Effective local control and long-term survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy. Ann Surg Oncol. 2004;11:854–60.

    Article  PubMed  Google Scholar 

  104. Shin HC, et al. Breast-conserving surgery after tumor downstaging by neoadjuvant chemotherapy is oncologically safe for stage III breast cancer patients. Ann Surg Oncol. 2013;20:2582–9.

    Article  PubMed  Google Scholar 

  105. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;30:96–102.

    Article  Google Scholar 

  106. Mittendorf EA, et al. Impact of chemotherapy sequencing on local-regional failure risk in breast cancer patients undergoing breast-conserving therapy. Ann Surg. 2013;257:173–9.

    Article  PubMed  Google Scholar 

  107. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:188–94.

    Article  PubMed  Google Scholar 

  108. Kaviani A, et al. From radical mastectomy to breast-conserving therapy and oncoplastic breast surgery: a narrative review comparing oncological result, cosmetic outcome, quality of life, and health economy. ISRN Oncol 2013;742462:1–6.

    Google Scholar 

  109. Nijenhuis MV, Rutgers EJ. Who should not undergo breast conservation? Breast. 2013;22(Suppl 2):S110–4. doi:10.1016/j.breast.2013.07.021.

    Article  PubMed  Google Scholar 

  110. Holland R, et al. The presence of an extensive intraductal component following limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990;8:113–8.

    Article  CAS  PubMed  Google Scholar 

  111. Schnitt SJ, Connolly JL, Harris JR, Cohen RB. Pathologic predictors of early local recurrence in stage I and II breast cancer treated by primary radiation therapy. Cancer. 1984;53:1049–57.

    Article  CAS  PubMed  Google Scholar 

  112. Osteen RT, Steele GD Jr, Menck HR, Winchester DP. Regional differences in surgical management of breast cancer. CA Cancer J Clin. 1992;42:39–43.

    Article  CAS  PubMed  Google Scholar 

  113. Osteen RT, et al. Identification of patients at high risk for local recurrence after conservative surgery and radiation therapy for stage I and II breast cancer. Arch Surg. 1987;122:1248–53.

    Article  CAS  PubMed  Google Scholar 

  114. Gage I, et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1995;33:245–51.

    Article  CAS  PubMed  Google Scholar 

  115. Gage I, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78:1921–8.

    Article  CAS  PubMed  Google Scholar 

  116. Houssami N, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010;46:3219–32.

    Article  PubMed  Google Scholar 

  117. Fowble BL, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys. 1994;30:23–33.

    Article  CAS  PubMed  Google Scholar 

  118. Recht A, et al. The effect of young age on tumor recurrence in the treated breast after conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 1988;14:3–10.

    Article  CAS  PubMed  Google Scholar 

  119. Bartelink H, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–87.

    Article  CAS  PubMed  Google Scholar 

  120. Bonnier P, et al. Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer. 1995;62:138–44.

    Article  CAS  PubMed  Google Scholar 

  121. Borger J, et al. Risk factors in breast-conservation therapy. J Clin Oncol. 1994;12:653–60.

    Article  CAS  PubMed  Google Scholar 

  122. Mamounas EP, et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol. 2010;28:1677–83.

    Article  PubMed  PubMed Central  Google Scholar 

  123. Litiere S, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13:412–9.

    Article  PubMed  Google Scholar 

  124. Miles RC, et al. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol. 2012;19:1153–9.

    Article  PubMed  Google Scholar 

  125. Bartelink H, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259–65.

    Article  PubMed  Google Scholar 

  126. Chiba A, et al. Trends in neoadjuvant endocrine therapy use and impact on rates of breast conservation in hormone receptor-positive breast cancer: a national cancer data base study. Ann Surg Oncol. 2016;24(2):418–24. doi:10.1245/s10434-016-5733-y. Epub ahead of print.

    Article  PubMed  Google Scholar 

  127. Grisotti A, Calabrese C. Conservative treatment of breast cancer: reconstructive problems. In: Spear SL, Willey SC, Robb GL, Hammond DC, Nahabedian MY, editors. Surgery of the breast: principles and art. Philadelphia, PA: Lippincott, Williams & WIlkins; 2006. p. 147–78.

    Google Scholar 

  128. Audretsch WP. Reconstruction of the partial mastectomy defect: classification and method. In: Spear SL, Willey SC, Robb GL, Hammond DC, Nahabedian MY, editors. Surgery of the breast: principles and art. Philadelphia, PA: Lippincott, Williams & WIlkins; 2006. p. 179–216.

    Google Scholar 

  129. Brunnert KE. The Osnabrueck experience with reconstruction of the partial mastectomy defect. In: Spear SL, Willey SC, Robb GL, Hammond DC, Nahabedian MY, editors. Surgery of the breast: principles and art. Philadelphia, PA: Lippincott, Williams & WIlkins; 2006. p. 217–43.

    Google Scholar 

  130. Clough KB, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237:26–34.

    Article  PubMed  PubMed Central  Google Scholar 

  131. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91.

    Article  PubMed  Google Scholar 

  132. Down SK, Jha PK, Burger A, Hussien MI. Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J. 2013;19:56–63.

    Article  PubMed  Google Scholar 

  133. Fitzal F, et al. Breast-conserving therapy for centrally located breast cancer. Ann Surg. 2008;247:470–6.

    Article  PubMed  Google Scholar 

  134. Kronowitz SJ, et al. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 2007;120:1755–68.

    Article  CAS  PubMed  Google Scholar 

  135. Haloua MH, et al. A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg. 2013;257:609–20.

    Article  PubMed  Google Scholar 

  136. Galimberti V, et al. Long-term follow-up of 5262 breast cancer patients with negative sentinel node and no axillary dissection confirms low rate of axillary disease. Eur J Surg Oncol. 2014;40:1203–8.

    Article  CAS  PubMed  Google Scholar 

  137. Krag DN, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.

    Article  PubMed  PubMed Central  Google Scholar 

  138. Veronesi U, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg. 2010;251:595–600.

    Article  PubMed  Google Scholar 

  139. Krag DN, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8.

    Article  CAS  PubMed  Google Scholar 

  140. Ashikaga T, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102:111–8.

    Article  PubMed  PubMed Central  Google Scholar 

  141. Johnson CB, Boneti C, Korourian S, Adkins L, Klimberg VS. Intraoperative injection of subareolar or dermal radioisotope results in predictable identification of sentinel lymph nodes in breast cancer. Ann Surg. 2011;254:612–8.

    Article  PubMed  Google Scholar 

  142. Vu HN, et al. Intraoperative injection of radiocolloid for sentinel node biopsy in breast cancer. J Nucl Med Technol. 2013;41:263–7.

    Article  PubMed  Google Scholar 

  143. Li Q, Carr A, Ito F, Teitz-Tennenbaum S, Chang AE. Polarization effects of 4-1BB during CD28 costimulation in generating tumor-reactive T cells for cancer immunotherapy. Cancer Res. 2003;63:2546–52.

    CAS  PubMed  Google Scholar 

  144. Giuliano AE, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  145. Donker M, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15:1303–10.

    Article  PubMed  PubMed Central  Google Scholar 

  146. Choi HY, et al. Preoperative axillary lymph node evaluation in breast cancer: current issues and literature review. Ultrasound Q. 2017;33(1):6–14.

    Article  PubMed  Google Scholar 

  147. Barco I, et al. Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients. Clin Transl Oncol. 2016;19:704–710

    Google Scholar 

  148. Tunon-de-Lara C, et al. The role of sentinel lymph node biopsy and factors associated with invasion in extensive dcis of the breast treated by mastectomy: the Cinnamome prospective multicenter study. Ann Surg Oncol. 2015;22:3853–60.

    Article  PubMed  PubMed Central  Google Scholar 

  149. Boughey JC, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  150. Mamounas E, et al. Sentinel node biopsy (SNB) following neoadjuvant chemotherapy in breast cancer (BC): results from NSABP B-27. Abstracts from the Society of Surgical Oncology 54th Annual Cancer Symposium, 21; 2001. [Ref type: Abstract].

    Google Scholar 

  151. Kuehn T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609–18.

    Article  PubMed  Google Scholar 

  152. Xing Y, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 2006;93:539–46.

    Article  CAS  PubMed  Google Scholar 

  153. Kelly AM, Dwamena B, Cronin P, Carlos RC. Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta analysis. Acad Radiol. 2009;16:551–63.

    Article  PubMed  Google Scholar 

  154. van Deurzen CH, et al. Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: a systematic review. Eur J Cancer. 2009;45:3124–30.

    Article  PubMed  Google Scholar 

  155. Hunt KK, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg. 2009;250:558–66.

    PubMed  Google Scholar 

  156. Hieken TJ, Boughey JC, Jones KN, Shah SS, Glazebrook KN. Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer. Ann Surg Oncol. 2013;20:3199–204.

    Article  PubMed  Google Scholar 

  157. Diego EJ, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Ann Surg Oncol. 2016;23:1549–53.

    Article  PubMed  Google Scholar 

  158. Caudle AS, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol. 2016;34:1072–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  159. Mamounas EP, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30:3960–6.

    Article  PubMed  PubMed Central  Google Scholar 

  160. Liu J, et al. The role of postmastectomy radiotherapy in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes after neoadjuvant chemotherapy: an analysis from the NCDB. Oncotarget. 2016;7:24848–59.

    Article  PubMed  Google Scholar 

  161. Chapman CH, Jagsi R. Postmastectomy radiotherapy after neoadjuvant chemotherapy: a review of the evidence. Oncology (Williston Park). 2015;29:657–66.

    Google Scholar 

  162. Garg AK, Buchholz TA. Influence of neoadjuvant chemotherapy on radiotherapy for breast cancer. Ann Surg Oncol. 2015;22:1434–40.

    Article  PubMed  Google Scholar 

  163. 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 

  164. Fisher B, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. New Engl J Med. 1995;333:1456–61.

    Article  CAS  PubMed  Google Scholar 

  165. Fisher B, et al. 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;347:1233–41.

    Article  PubMed  Google Scholar 

  166. Morrow M. Rethinking the local therapy of breast cancer: integration of biology and anatomy. Ann Surg Oncol. 2015;22:3168–73.

    Article  PubMed  Google Scholar 

  167. McKenzie-Johnson T, Grover A, Bear HD. Appropriate margin width in breast-conserving surgery. Curr Breast Cancer Rep. 2010;2:67–74.

    Article  Google Scholar 

  168. Cellini C, et al. Factors associated with residual breast cancer after re-excision for close or positive margins. Ann Surg Oncol. 2004;11:915–20.

    Article  CAS  PubMed  Google Scholar 

  169. Zavagno G, et al. Role of resection margins in patients treated with breast conservation surgery. Cancer. 2008;112:1923–31.

    Article  PubMed  Google Scholar 

  170. Dillon MF, et al. Identifying patients at risk of compromised margins following breast conservation for lobular carcinoma. Am J Surg. 2006;191:201–5.

    Article  PubMed  Google Scholar 

  171. Smitt MC, Nowels K, Carlson RW, Jeffrey SS. Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys. 2003;57:979–85.

    Article  PubMed  Google Scholar 

  172. Swanson GP, Rynearson K, Symmonds R. Significance of margins of excision on breast cancer recurrence. Am J Clin Oncol. 2002;25:438–41.

    Article  PubMed  Google Scholar 

  173. McCahill LE, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307:467–75.

    Article  PubMed  Google Scholar 

  174. Morrow M, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302:1551–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  175. O’Sullivan MJ, Li T, Freedman G, Morrow M. The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery. Ann Surg Oncol. 2007;14:3133–40.

    Article  PubMed  Google Scholar 

  176. Moran MS, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer. Ann Surg Oncol. 2014;21:704–16.

    Article  PubMed  Google Scholar 

  177. Jaffre I, et al. Margin width should not still enforce a systematic surgical re-excision in the conservative treatment of early breast infiltrative ductal carcinoma. Ann Surg Oncol. 2013;20:3831–8.

    Article  PubMed  Google Scholar 

  178. Adams BJ, et al. The role of margin status and reexcision in local recurrence following breast conservation surgery. Ann Surg Oncol. 2013;20:2250–5.

    Google Scholar 

  179. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32(14):1507–15.

    Article  PubMed  Google Scholar 

  180. Morrow M, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016;23:3801–10.

    Article  PubMed  PubMed Central  Google Scholar 

  181. Silverstein MJ. An argument against routine use of radiotherapy for ductal carcinoma in situ. Oncology (Williston Park). 2003;17:1511–33.

    Google Scholar 

  182. MacDonald HR, et al. Margin width as the sole determinant of local recurrence after breast conservation in patients with ductal carcinoma in situ of the breast. Am J Surg. 2006;192:420–2.

    Article  PubMed  Google Scholar 

  183. Silverstein MJ, Lagios MD. Treatment selection for patients with ductal carcinoma in situ (DCIS) of the breast using the University of Southern California/Van Nuys (USC/VNPI) prognostic index. Breast J. 2015;21:127–32.

    Article  PubMed  Google Scholar 

  184. Henry-Tillman R, Johnson AT, Smith LF, Klimberg VS. Intraoperative ultrasound and other techniques to achieve negative margins. Semin Surg Oncol. 2001;20:206–13.

    Article  CAS  PubMed  Google Scholar 

  185. Cox CE, et al. Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg. 1991;126:490–3.

    Article  CAS  PubMed  Google Scholar 

  186. Moore MM, et al. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg. 2001;233:761–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  187. Sauter ER, et al. Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions. Cancer. 1994;73:2607–12.

    Article  CAS  PubMed  Google Scholar 

  188. Allweis TM, et al. A prospective, randomized, controlled, multicenter study of a real-time, intraoperative probe for positive margin detection in breast-conserving surgery. Am J Surg. 2008;196:483–9.

    Article  PubMed  Google Scholar 

  189. Nguyen FT, et al. Intraoperative evaluation of breast tumor margins with optical coherence tomography. Cancer Res. 2009;69:8790–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  190. Rizzo M, et al. The effects of additional tumor cavity sampling at the time of breast-conserving surgery on final margin status, volume of resection, and pathologist workload. Ann Surg Oncol. 2010;17:228–34.

    Article  PubMed  Google Scholar 

  191. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012;19:3236–45.

    Article  PubMed  PubMed Central  Google Scholar 

  192. Hequet D, Bricou A, Delpech Y, Barranger E. Surgical management modifications following systematic additional shaving of cavity margins in breast-conservation treatment. Ann Surg Oncol. 2011;18:114–8.

    Article  PubMed  Google Scholar 

  193. Cabioglu N, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458–71.

    Article  PubMed  Google Scholar 

  194. Chagpar AB, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373:503–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  195. Gibbs ER, Kent RB III. Modified V-Y advancement technique for mastectomy closure. J Am Coll Surg. 1998;187:632–3.

    Article  CAS  PubMed  Google Scholar 

  196. Hieken TJ, Boolbol SK, Dietz JR. Nipple-sparing mastectomy: indications, contraindications, risks, benefits, and techniques. Ann Surg Oncol. 2016;23:3138–44.

    Article  PubMed  Google Scholar 

  197. Yu P. Breast reconstruction at the MD Anderson Cancer Center. Gland Surg. 2016;5:416–21.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University Health (VCU HEALTH), Richmond, VA, USA

    Harry D. Bear MD, PhD

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Editors and Affiliations

  1. Department of Pathology, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Michael Ola Idowu

  2. Department of Radiology Breast Imaging Section, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Priti Anilkumar Shah

  3. Division of Hematology Oncology and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Mary Helen Hackney

  4. Department of Pathology, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Margaret Mary Grimes

  5. Division of Hematology Oncology, Department of Internal Medicine, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Charles Edward Geyer, Jr.

  6. Department of Radiation Oncology, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Douglas William Arthur

  7. Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University Health (VCU HEALTH), Richmond, Virginia, USA

    Harry Douglas Bear

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Bear, H.D. (2018). Surgical Oncology Evaluation and Management of Breast Diseases. In: Idowu, M., et al. Diagnosis and Management of Breast Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-57726-5_3

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