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0104 Is surgical excision necessary for benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum assisted biopsy device (Mammotome)?
Thursday, 12 March 2009 Conclusion: Free margins are not enough in ductal carcinomas for a safe oncologic resection, and in those in which a margin of more than 3 mm from the surgical border have not been achieved after a first surgery, re-excision is recommended specially for patients with histological grades II and III in DCIS, and in IDC those greater than 20 mm, positive axillary lymph node involvement and adverse IHC factors (Cerb B2 overexpression, positive p53, and proliferative index MIB 1 over 30%), regardless other characteristics. Clear margins in DCIS are some times difficult to obtain after a first re-excision.
0104
Is surgical excision necessary for benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum assisted biopsy device (Mammotome)?
H. Park1 , J. Song2 . 1 Surgery, Pochon Cha University College of Medicine, 2 Surgery, Kyung Hee University College of Medicine, Seoul, South Korea Goals: Phyllodes tumors are characterized by a double layered epithelial component arranged in cleflike ducts surrounded by a hypercellular spindle-celled stroma. Currently phyllode tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high recurrence rate is an unsolved management problem. If malignant phyllodes tumor is treated inadequately it can shows a propensity for rapid growth and metastatic spread. However benign phyllodes tumors are often indistinguishable from fibroadenoma and can be cured by local surgery. Recently percutaneous removal of benign breast tumor using the Mammotome system has been regarded as a feasible, safe method without serious complications. Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of Mammotome biopsy device in the treatment of benign phyllodes tumor and to identify if surgical excision is necessary for benign phyllodes tumor diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2751 US-guided mammotome excision were performed in 2226 patients at Kangnam Cha hospital. Out of 2751 lesions, 30 lesions were proved to be benign phyllodes tumor. All lesions were removed by 8 gauge probe without any residual lesion. Ultrasonographic follow-up were performed on 3−6 months interval to assess recurrences. Mean follow up period was 33.2 months (max 51 months, min 2 months). Results: Mean patient age was 31.4 years. The average size of lesion was 1.5 cm (SD ±0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable and 26.7% (8 cases) were nonpalpable. 22 lesions (73.8%) were classified as BIRADS category 3, 8 lesions (26.7%) were classified as category 4A by ultrasound. During follow up period local recurrence developed in only 1 patient, local recurrence rate was 3.3%. And there were no distant metastasis. Conclusion: Benign phyllodes tumor found on mammotome excision may not need surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow up ultrasound does not show any residual lesions, especially in small phyllodes tumors less than 3 cm in greatest dimension.
0105
Is there a promotion of metastasis by autologeous breast reconstruction in patients with invasive breast cancer?
A. Smeets1 , K.K. Van Calster1 , H. Wildiers1 , J.J.P. Lobelle1 , M.M. Vandevoort1 , P. Neven1 , R. Paridaens1 , M.M.R. Christiaens1 . 1 Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium Goals: After a mastectomy for an invasive breast cancer, an autologeous breast reconstruction can be performed. However, there is evidence that surgical interventions might promote metastasis. The goals of our study were 1. To investigate the correlation between autologeous breast reconstruction and the development of metastasis. 2. To compare the incidence of metastasis in patients with an without reconstruction. Methods: First, we included patients with an autologeous breast reconstruction between 2000 and 2004 after a mastectomy for an invasive breast cancer. Patients with a contra-lateral tumor, neo-adjuvant therapy or
Poster Session I. Surgery/Sentinels/DCIS
S45
recurrence before reconstruction were excluded. 99 patients were included with a mean FU of 76 months. Next, the incidence of metastasis in reconstructed patients was compared to a control group without reconstruction. For this analysis, only patients between age 30 and 65 at diagnosis and a mastectomy between 2000 and 2004 were included. Reconstruction had to be performed before 2006. 72 patients were included in the reconstruction group, 375 in the control group. Tumor characteristics are similar in both groups (histology, NPI, ER, HER2/neu). The mean FU is 64 months for the reconstruction group, 57 months for the control group. Results: 14% patients with a reconstruction between 2000 and 2004 developed metastasis. Very surprisingly, 13/14 metastasises were diagnosed within 2 years after reconstruction! 11.1% of patients with a mastectomy between 2000 and 2004 developed metastasis and 10.13% of patients from the control group (p= 0.8025). Conclusion: The finding that 13/14 metastasis after reconstruction were diagnosed within 2 years after reconstruction seems to confirm the hypothesis that surgery can promote metastasis. On the other hand do our data not show an increased incidence of distant metastasis in patients who undergo an autologeous breast reconstruction when compared to a control group. A possible explanation could be that this is a retrospective with only a limited number of recurrences in the reconstructive group. Moreover, all patients with a delayed reconstruction have an initial disease free survival which means that their prognosis should be better than the controls. A prospective registration study could be the next step.
0106
The management of the contralateral breast in breast reconstruction in Korean females
J. Jung1 , J. Lee2 , H. Park1 , J. Yang2 , S. Kim3 , Y. Lee4 . 1 Surgery, 2 Plastic Surgery, Kyungpook National University Hospital, 3 Surgery, Daegu Fatima Hospital, 4 Surgery, Hyosung Medical Center, Daegu, South Korea Goals: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. When reconstruction is considered, equal importance may be needed to be placed on contralateral breast. If some woman have unattractive breast, which is small, ptotic or huge, remodelling of the contralateral breast may be desirable. Numerous options may be available to the patient depending upon the individual anatomic and oncologic status for symmetrical shape. Surgical options available for the contralateral breast included breast augmentation with implant, mastopexy, and reduction mammoplasty. Methods: All patients who underwent unilateral breast reconstruction at Kyungpook national university hospital from September of 2006 to February of 2008 were included in the study. The methods of reconstruction included transverse rectus abdominis musculocutaneous (TRAM) flap, latissimus dorsi (LD) flap, and implant. Contralateral procedure to achieve symmetry included augmentation, mastopexy, and reduction. Results: A total of 57 patients were evaluated including 45 immediate, and 12 delayed reconstructions. 26 of these patients underwent augmentation (n = 12), mastopexy (n = 11) [vertical (n = 8), periareola (n = 3)] and reduction (n = 3) [wise pattern (n = 2), vertical (n = 1)] of the contralateral breast. The average age was 44.9 years and the follow up interval was 7 months (poster Table 1). Most of the patients were satisfied with symmetry, clothed appearance, nude appearance, aesthetics, and consistency (poster Table 2). 66% (8/12) of delayed reconstruction had symmetry procedure performed on opposite breast, compared with 40% (18/45) for the immediate-reconstruction patients. There were 6 fat necrosises, one partial flap loss, and one hernia in TRAM and LD flap reconstruction. Two capsular contractures and one skin necrosis at the junction of the inverted ‘T’ closure flaps were observed in implant reconstruction. However, no complications were observed on contralateral breasts underwent symmetrization. Conclusion: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory result with safe. Immediate symmetrization procedure also can avoid secondary operation and offer psychological benefit.
0104
Is surgical excision necessary for benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum assisted biopsy device (Mammotome)?
H. Park1 , J. Song2 . 1 Surgery, Pochon Cha University College of Medicine, 2 Surgery, Kyung Hee University College of Medicine, Seoul, South Korea Goals: Phyllodes tumors are characterized by a double layered epithelial component arranged in cleflike ducts surrounded by a hypercellular spindle-celled stroma. Currently phyllode tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high recurrence rate is an unsolved management problem. If malignant phyllodes tumor is treated inadequately it can shows a propensity for rapid growth and metastatic spread. However benign phyllodes tumors are often indistinguishable from fibroadenoma and can be cured by local surgery. Recently percutaneous removal of benign breast tumor using the Mammotome system has been regarded as a feasible, safe method without serious complications. Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of Mammotome biopsy device in the treatment of benign phyllodes tumor and to identify if surgical excision is necessary for benign phyllodes tumor diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2751 US-guided mammotome excision were performed in 2226 patients at Kangnam Cha hospital. Out of 2751 lesions, 30 lesions were proved to be benign phyllodes tumor. All lesions were removed by 8 gauge probe without any residual lesion. Ultrasonographic follow-up were performed on 3−6 months interval to assess recurrences. Mean follow up period was 33.2 months (max 51 months, min 2 months). Results: Mean patient age was 31.4 years. The average size of lesion was 1.5 cm (SD ±0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable and 26.7% (8 cases) were nonpalpable. 22 lesions (73.8%) were classified as BIRADS category 3, 8 lesions (26.7%) were classified as category 4A by ultrasound. During follow up period local recurrence developed in only 1 patient, local recurrence rate was 3.3%. And there were no distant metastasis. Conclusion: Benign phyllodes tumor found on mammotome excision may not need surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow up ultrasound does not show any residual lesions, especially in small phyllodes tumors less than 3 cm in greatest dimension.
0105
Is there a promotion of metastasis by autologeous breast reconstruction in patients with invasive breast cancer?
A. Smeets1 , K.K. Van Calster1 , H. Wildiers1 , J.J.P. Lobelle1 , M.M. Vandevoort1 , P. Neven1 , R. Paridaens1 , M.M.R. Christiaens1 . 1 Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium Goals: After a mastectomy for an invasive breast cancer, an autologeous breast reconstruction can be performed. However, there is evidence that surgical interventions might promote metastasis. The goals of our study were 1. To investigate the correlation between autologeous breast reconstruction and the development of metastasis. 2. To compare the incidence of metastasis in patients with an without reconstruction. Methods: First, we included patients with an autologeous breast reconstruction between 2000 and 2004 after a mastectomy for an invasive breast cancer. Patients with a contra-lateral tumor, neo-adjuvant therapy or
Poster Session I. Surgery/Sentinels/DCIS
S45
recurrence before reconstruction were excluded. 99 patients were included with a mean FU of 76 months. Next, the incidence of metastasis in reconstructed patients was compared to a control group without reconstruction. For this analysis, only patients between age 30 and 65 at diagnosis and a mastectomy between 2000 and 2004 were included. Reconstruction had to be performed before 2006. 72 patients were included in the reconstruction group, 375 in the control group. Tumor characteristics are similar in both groups (histology, NPI, ER, HER2/neu). The mean FU is 64 months for the reconstruction group, 57 months for the control group. Results: 14% patients with a reconstruction between 2000 and 2004 developed metastasis. Very surprisingly, 13/14 metastasises were diagnosed within 2 years after reconstruction! 11.1% of patients with a mastectomy between 2000 and 2004 developed metastasis and 10.13% of patients from the control group (p= 0.8025). Conclusion: The finding that 13/14 metastasis after reconstruction were diagnosed within 2 years after reconstruction seems to confirm the hypothesis that surgery can promote metastasis. On the other hand do our data not show an increased incidence of distant metastasis in patients who undergo an autologeous breast reconstruction when compared to a control group. A possible explanation could be that this is a retrospective with only a limited number of recurrences in the reconstructive group. Moreover, all patients with a delayed reconstruction have an initial disease free survival which means that their prognosis should be better than the controls. A prospective registration study could be the next step.
0106
The management of the contralateral breast in breast reconstruction in Korean females
J. Jung1 , J. Lee2 , H. Park1 , J. Yang2 , S. Kim3 , Y. Lee4 . 1 Surgery, 2 Plastic Surgery, Kyungpook National University Hospital, 3 Surgery, Daegu Fatima Hospital, 4 Surgery, Hyosung Medical Center, Daegu, South Korea Goals: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. When reconstruction is considered, equal importance may be needed to be placed on contralateral breast. If some woman have unattractive breast, which is small, ptotic or huge, remodelling of the contralateral breast may be desirable. Numerous options may be available to the patient depending upon the individual anatomic and oncologic status for symmetrical shape. Surgical options available for the contralateral breast included breast augmentation with implant, mastopexy, and reduction mammoplasty. Methods: All patients who underwent unilateral breast reconstruction at Kyungpook national university hospital from September of 2006 to February of 2008 were included in the study. The methods of reconstruction included transverse rectus abdominis musculocutaneous (TRAM) flap, latissimus dorsi (LD) flap, and implant. Contralateral procedure to achieve symmetry included augmentation, mastopexy, and reduction. Results: A total of 57 patients were evaluated including 45 immediate, and 12 delayed reconstructions. 26 of these patients underwent augmentation (n = 12), mastopexy (n = 11) [vertical (n = 8), periareola (n = 3)] and reduction (n = 3) [wise pattern (n = 2), vertical (n = 1)] of the contralateral breast. The average age was 44.9 years and the follow up interval was 7 months (poster Table 1). Most of the patients were satisfied with symmetry, clothed appearance, nude appearance, aesthetics, and consistency (poster Table 2). 66% (8/12) of delayed reconstruction had symmetry procedure performed on opposite breast, compared with 40% (18/45) for the immediate-reconstruction patients. There were 6 fat necrosises, one partial flap loss, and one hernia in TRAM and LD flap reconstruction. Two capsular contractures and one skin necrosis at the junction of the inverted ‘T’ closure flaps were observed in implant reconstruction. However, no complications were observed on contralateral breasts underwent symmetrization. Conclusion: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory result with safe. Immediate symmetrization procedure also can avoid secondary operation and offer psychological benefit.