The lobar approach to breast ultrasound imaging and surgery
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Breast cancer is a lobar disease in the sense that, at the earliest stages, the cancer is structurally confined to a single sick lobe. The subgross morphology of breast carcinoma is often complex, as multiple invasive foci are frequently present and the ductal system often contains an extensive in situ component. Adequate preoperative visualization of all of the malignant structures within the affected breast and preoperative mapping of the lesions in relation to the surrounding normal structures are essential for successful image-guided breast surgery and therefore are key factors in assuring adequate local control of the disease. We advocate use of the lobar approach in ultrasound imaging (ducto-radial echography) and breast-conserving surgery based on the lobar anatomy of the breast, the sick lobe theory, our extensive clinical experience with the approach, and favorable long-term patient outcomes. Despite abundant evidence demonstrating the advantages of the lobar approach, the number of breast centers using it in practice is still limited. In this review, we aim to call attention to the advantages of the lobar approach from the theoretical, imaging, and surgical points of view.
KeywordsBreast anatomy Breast cancer Sick lobe theory Lobar ultrasound Breast-conserving surgery
Conflict of interest
Dr. Amy, Dr. Durante, and Dr. Tot have no financial interest or other relationship with any manufacturer of any product or provider of any service mentioned in this article.
Additional informed consent was obtained from all the patients for whom identifying information is included in this article.
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