Advertisement

Breast Cancer

, Volume 26, Issue 1, pp 84–92 | Cite as

Oncoplastic approach to excisional breast biopsies: a randomized controlled, phase 2a trial

  • Volkan Doğru
  • Muhittin Yaprak
  • Emel Durmaz
  • Özlenen Özkan
  • Ayhan Mesci
  • Ömer Özkan
  • Vahit Özmen
  • Cumhur Arıcı
Original Article
  • 56 Downloads

Abstract

Background

Oncoplastic surgery has been used in breast cancer patients for better cosmetic outcome over the last decades. The aim of this prospective randomized study is to show its place in excisional breast biopsy.

Methods

An oncoplastic approach excision was compared with conventional excisional breast biopsies. The study included 80 patients, of whom half received oncoplastic intervention and half received the conventional. The primary endpoint was the cosmetic result. Patient, surgeon and independent observers rated the results on a four-point scale. Scores other than self-perceived were based on third-month medical photographs.

Results

Between May 20, 2015 and April 27, 2016, 40 patients were randomly assigned to oncoplastic biopsy and 40 patients were assigned to conventional excisional biopsy. Median follow-up was 5.6 months (IQR 3.0–6.0). Self-perceived perfect scoring for general cosmetic outcome was found significantly higher after oncoplastic biopsy (73 0.5%) comparing with control group (32.4%) (p = 0.001). This impact did not change after adjusting patients for potential confounders. Margin clearance rates in malignant cases were comparable in both arms (p = 0.999); four patients in oncoplastic biopsy group (40%) and three patients in control group (33%) had positive margins.

Conclusions

The oncoplastic biopsy achieved better cosmetic results with similar surgical margin positivity rates when compared with conventional breast biopsy. It may be a better biopsy option used for patients requiring excisional breast biopsy.

Keywords

Oncoplastic surgery Excisional breast biopsy Breast cancer 

Notes

Acknowledgements

We gratefully acknowledge the contributions of Anesthesiology and Pathology Department staff at Akdeniz University Hospital and Serkan Sayılıkan Plastic and reconstructive surgeon who was invited to attend as an independent professional observer for the esthetic evaluations.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    National Comprehensive Cancer Network. Breast Cancer. (version 2.2017). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 10 June 2017.
  2. 2.
    National Comprehensive Cancer Network. Breast Cancer Screening and Diagnosis. (version 1.2017). https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. Accessed 10 June 2017.
  3. 3.
    Farshid G, Gill PG. Contemporary indications for diagnostic open biopsy in women assessed for screen-detected breast lesions: a ten-year, single institution series of 814 consecutive cases. Breast Cancer Res Treat. 2017;162(1):49–58.CrossRefGoogle Scholar
  4. 4.
    Fine RE, Whitworth PW, Kim JA, Harness JK, Boyd BA, Burak WE Jr. Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg. 2003;186(4):362–7.CrossRefGoogle Scholar
  5. 5.
    Thompson WR, Bowen JR, Dorman BA, Pricolo VE, Shahinian TK, Soderberg CH. Mammographic localization and biopsy of nonpalpable breast lesions a 5-year study. Arch Surg. 1991;126(6):730–4.CrossRefGoogle Scholar
  6. 6.
    Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, et al. Long term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22(8):2500–8.CrossRefGoogle Scholar
  7. 7.
    Leff DR, Vashisht R, Yongue G, Keshtgar M, Yang GZ, Darzi A. Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery? Breast Cancer Res Treat. 2011;125(3):607–25.CrossRefGoogle Scholar
  8. 8.
    Mukesh MB, Barnett G, Cumming J, Wilkinson JS, Moody AM, Wilson C, et al. Association of breast tumour bed seroma with post-operative complications and late normal tissue toxicity: results from the Cambridge Breast IMRT trial. Eur J Surg Oncol. 2012;38(10):918–24.CrossRefGoogle Scholar
  9. 9.
    Efird J. Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health. 2011;8(1):15–20.CrossRefGoogle Scholar
  10. 10.
    Tezel E, Numanoğlu A. Practical do-it-yourself device for accurate volume measurement of breast. Plast Reconstr Surg. 2000;105(3):1019–23.CrossRefGoogle Scholar
  11. 11.
    Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–61.CrossRefGoogle Scholar
  12. 12.
    Clough KB, Nos C, Salmon RJ, Soussaline M, Durand JC. Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 1995;96(2):363–70.CrossRefGoogle Scholar
  13. 13.
    Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012;99(10):1389–95.CrossRefGoogle Scholar
  14. 14.
    Mcculley SJ, Macmillan RD. Planning and use of therapeutic mammoplasty-Nottingham approach. Br J Plast Surg. 2005;58(7):889–901.CrossRefGoogle Scholar
  15. 15.
    Rose M, Manjer J, Ringberg A, Svensson H. Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery. Eur J Plast Surg. 2014;37:205–14.CrossRefGoogle Scholar
  16. 16.
    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(1):56–63.  https://doi.org/10.1111/tbj.12047.CrossRefGoogle Scholar
  17. 17.
    Liberman L, Dershaw DD, Glassman JR, Abramson AF, Morris EA, LaTrenta LR, et al. Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology. 1997;203:151–7.CrossRefGoogle Scholar
  18. 18.
    Brenner RJ, Fajardo L, Fisher PR, Dershaw DD, Evans WP, Bassett L, et al. Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy. AJR Am J Roentgenol. 1996;166:341–6.CrossRefGoogle Scholar
  19. 19.
    Philpotts LE, Shaheen NA, Carter D, Lange RC, Lee CH. Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun. AJR Am J Roentgenol. 1999;172:683–7.CrossRefGoogle Scholar
  20. 20.
    Kettritz U, Rotter K, Schreer I, Murauer M, Schulz-Wendtland R, Peter D, et al. Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer. 2004;15(2):245–51. 100(.CrossRefGoogle Scholar
  21. 21.
    Shyyan R, Masood S, Badwe RA, Errico KM, Liberman L, Ozmen V, et al. Global summit diagnosis and pathology panel. Breast cancer in limited-resource countries: diagnosis and pathology. Breast J. 2006;12:27–37.CrossRefGoogle Scholar
  22. 22.
    Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373(6):503–10.CrossRefGoogle Scholar
  23. 23.
    Litière S, Werutsky G, Fentiman IS, Rutgers E, Christiaens MR, Van Limbergen E, 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(4):412–9.CrossRefGoogle Scholar
  24. 24.
    Chun K, Velanovich V. Patient-perceived cosmesis and satisfaction after breast biopsy: comparison of stereotactic incisional, excisional, and wire-localized biopsy techniques. Surgery. 2002;131(5):497–501.CrossRefGoogle Scholar
  25. 25.
    Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: analysis of the ideal breast. J Plast Reconstr Aesthet Surg. 2012;65(1):8–16.CrossRefGoogle Scholar
  26. 26.
    Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505–9.CrossRefGoogle Scholar
  27. 27.
    El-Tamer MB. Skin incisions. In: El-Tamer MB (ed) Principles and techniques in oncoplastic breast cancer surgery. Singapore: World Scientific Publ.; 2013. pp. 57–64.Google Scholar
  28. 28.
    Munhoz AM. Periareolar techniques. Oncoplastic and reconstructive anatomy of the breast. In: Urban C, Rietjens M (eds) Oncoplastic and reconstructive breast surgery. Milan: Springer Milan; 2013. pp. 127–38.CrossRefGoogle Scholar
  29. 29.
    Patel KM, Hannan CM, Gatti ME, Nahabedian MY. A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty. Plast Reconstr Surg. 2011;127(6):2167–75.CrossRefGoogle Scholar
  30. 30.
    Fitoussi AD, Berry MG, Famà F, Falcou MC, Curnier A, Couturaud B, et al. Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases [outcomes article]. Plast Reconstr Surg. 2010;125(2):454–62.CrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2018

Authors and Affiliations

  1. 1.Department of General SurgeryPalandöken State HospitalErzurumTurkey
  2. 2.Department of General SurgeryAkdeniz University HospitalAntalyaTurkey
  3. 3.Department of RadiologyAkdeniz University HospitalAntalyaTurkey
  4. 4.Department of Plastic and Reconstructive SurgeryAkdeniz University HospitalAntalyaTurkey
  5. 5.Department of General Surgery, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey

Personalised recommendations