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NCI CANCERLIT^® Search: Surgery for Breast Cancer - July 2002

National Cancer Institute^®
Last Modified: July 1, 2002

Risk-reduction mastectomy: clinical issues and research needs.
0.2% ropivacaine epidurally provides better analgesia and recovery than general anesthesia for patients undergoing oncological mastectomy.
Limited incision with plastic bag removal for a large fibroadenoma.
Analysis of the recourse to conservative surgery in the treatment of breast tumors.
Percutaneous minimally invasive stereotactic primary radiotherapy for breast cancer.
Factors affecting genetic testing and decisions about prophylactic surgery.
Timing of radiotherapy in breast cancer conserving treatment.
A novel technique of upper extremity revascularization: the retrohumeral approach.
Surgical technique of intraoperative radiotherapy in conservative treatment of limited-stage breast cancer.
Important technical considerations for skin-sparing mastectomy with sentinel lymph node dissection.
Radical faith: the right stuff?
Do women treated for breast cancer at teaching hospitals really fare better?
Do women treated for breast cancer at teaching hospitals really fare better?
Do women treated for breast cancer at teaching hospitals really fare better?
Do women treated for breast cancer at teaching hospitals really fare better?
Do women treated for breast cancer at teaching hospitals really fare better?
Do women treated for breast cancer at teaching hospitals really fare better?
Postmastectomy radiation in patients with four or more positive nodes.
[Selection criteria for breast conservation in patients with early breast carcinoma]
Postoperative radiotherapy following mastectomy for high-risk breast cancer. A randomised trial.
Lumpectomy and breast radiotherapy in breast cancer patients with a family history of breast cancer, ovarian cancer, or both.
Skin-sparing mastectomy using a modified Wise pattern.
Breast reconstruction in the von Recklinghausen disease patient.
Anterolateral thigh flap for postmastectomy breast reconstruction.
Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience.
Prospective evaluation of the morbidity of axillary clearance for breast cancer (Br J Surg 2001; 88: 114-7).
Adjuvant radiotherapy in breast cancer. Are there factors that allow selection of patients who do not require adjuvant radiotherapy following
[Role of biopsy of signaling ("sentinel") lymph nodes in the assessment of regional lymph collectors in patients with breast cancer]
Device delivers local radiation after breast-lump removal.
Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease.
Early operable breast cancer.
Adenoid cystic breast cancer.
Conservative surgery and radiation therapy for macroscopically multiple ipsilateral invasive breast cancers.
[Organizational aspects of the one-staged reconstruction of mammary glands after performance of mastectomy]
Skin-sparing mastectomy--increasing the options of patients with breast cancer.
[Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery. Feasibility study and review of the literature]
Radiation-induced angiosarcoma of the breast: case report and self-criticism of therapeutic approach.
Breast conservation is an effective option in Black, medically indigent patients.
Longer waits for breast cancer surgery in Quebec could be good news.
Persistence of tumor DNA in plasma of breast cancer patients after mastectomy.
Efficacy of subcutaneous and topical local anaesthesia for pain relief after resection of malignant breast tumours.
Granular cell breast tumour: diagnosis and outcome.
Prospective comparison of stereotactic core biopsy and surgical excision as diagnostic procedures for breast cancer patients.
Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy.
Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation.
Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast
Sentinel node biopsy for breast cancer: a critical analysis.
[The role of tele-thoracoscopic parasternal lympho-dissection in the diagnosis and treatment of breast cancer]
[One stage skin-sparing breast repair after mastectomy]
[Contemporary treatment methods in primary breast carcinoma]

1
UI - 11535704
AU - Stefanek M; Hartmann L; Nelson W
TI - Risk-reduction mastectomy: clinical issues and research needs.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1297-306
AD - Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. ms496r@nih.gov
Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.

2
UI - 11793980
AU - Doss NW; Ipe J; Crimi T; Rajpal S; Cohen S; Fogler RJ; Michael R;
TI - Gintautas J 0.2% ropivacaine epidurally provides better analgesia and recovery than general anesthesia for patients undergoing oncological mastectomy.
SO - Proc West Pharmacol Soc 2001;44():191-3
AD - Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, New York, NY 11212, USA.

3
UI - 12027993
AU - Rojananin S; Ratanawichitrasin A
TI - Limited incision with plastic bag removal for a large fibroadenoma.
SO - Br J Surg 2002 Jun;89(6):787-8
AD - Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10120, Thailand. siart@mahidol.ac.th

4
UI - 12088253
AU - Schifano P; Scarinci M; Borgia P; Perucci CA
TI - Analysis of the recourse to conservative surgery in the treatment of breast tumors.
SO - Tumori 2002 Mar-Apr;88(2):131-6
AD - Department of Epidemiology, Local Health Unit RME, Rome, Italy. prevanalisi1@asplazio.it
AIMS AND BACKGROUND: Conservative surgery is the treatment of choice for malignant tumors, at least up to stage II. The aim of this study was to analyze the recourse to conservative surgery for breast tumors and its determinants (ie, characteristics of hospitals and patients). METHODS: The study was conducted in Italy's Lazio region and was based on administrative data of the regional Hospital Information System, a database on hospitalizations. We selected all regional hospitalizations for therapeutic breast surgery over 1997, classifying them as either "conservative" or "non-conservative". The other variables considered were type of hospital, number of beds, volume of activity (average annual number of hospitalizations for breast cancer surgery), specific diagnosis, severity of cancer, and patient's age, place of residence, and socioeconomic level. A logistic model was used for multivariate analysis. RESULTS: A total of 7235 hospitalizations were analyzed, 3570 (49%) for malignant tumors and 3665 (51%) for benign disease. The logistic model showed that the factors most closely correlated with conservative surgery were age (OR = 2.2; 95% Cl: 1.8-2.6, for the age group <50 years compared to >70 years); severity of cancer (OR = 0.6; 95% Cl: 0.5-0.8, for non-localized compared to localized tumors), and volume of activity of the hospital (OR = 1.3; 95% CI: 1.0-1.6, for hospitals with >70 operations/year compared to those with <20 operations/year). The study also revealed that surgery for malignant tumors was performed by both high-volume and low-volume hospitals throughout the region. CONCLUSIONS: The association between conservative surgery and younger age, even after controlling for the severity of cancer, points to the need to encourage adherence to the existing guidelines. The association between conservative surgery and high-volume hospitals and the finding that a high proportion of breast operations is performed in low-volume facilities suggest that further efforts should be made to promote admission to high-volume hospitals.

5
UI - 12067688
AU - Vaidya JS; Hall-Craggs M; Baum M; Tobias JS; Falzon M; D'Souza DP;
TI - Morgan S Percutaneous minimally invasive stereotactic primary radiotherapy for breast cancer.
SO - Lancet Oncol 2002 Apr;3(4):252-3
AD - Department of Surgery, University College, London, UK. j.vaidya@ucl.ac.uk

6
UI - 11899370
AU - Mahon SM
TI - Factors affecting genetic testing and decisions about prophylactic surgery.
SO - Clin J Oncol Nurs 2001 May-Jun;5(3):117-20
AD - St. Louis University, Division of Hematology/Oncology, St. Louis, MO, USA.
Both of the articles reviewed here as well as the references, suggest that very little is actually known about the impact of many aspects of genetic testing. How decision are made about genetic testing in people who do not have cancer, how the results of testing are used used to guide care, and ultimately how people adjust to prophylactic surgery, which is the most effective form of prevention currently available to those who do have a mutation are not completely clear. This has many implications for practice in general. Oncology nurses who build relationships with those diagnosed with cancer and their families may be one of the best groups of professionals to provide the education and counseling individuals and families need prior to making any decision about genetic testing. Just as many responses to cancer exist, so do many responses to finding out the results of mutation status. Oncology nurses are challenged to help facilitate adjustment to learning that one carries a mutation that significantly increases risk of developing cancer. More nursing research needs to be conducted on how to facilitate this adjustment. Dealing with the unknown can be a frightening experience. Little is known about the long-term effectiveness of prophylactic mastectomy and oophorectomy in unaffected mutation-positive individuals. Most of what is known is based on retrospective review. Nurses are challenged to interpret this information, along with its inherent strengths and weaknesses, to individuals so they can make the best possible decisions. The psychosocial needs of those who undergo prophylactic surgery are not clearly understood. Surgery can have many psychological outcomes, and how individuals adjust to these changes is not clear. More nursing research is needed not only to understand these needs but also to design interventions to facilitate and improve adjustment to not only the information that one is mutation positive but also to prophylactic surgery. People who do not have cancer but have a high risk for cancer because of their genetic background need comprehensive and consistent care by knowledgeable healthcare providers. Although these individuals have not been diagnosed with cancer, they have complex psychosocial needs related to their family history and the decisions being made about prevention strategies. Oncology nurses can help fill this gap in care and provide the necessary support these individuals need.

7
UI - 12027411
AU - Ruo Redda MG; Verna R; Guarneri A; Sannazzari GL
TI - Timing of radiotherapy in breast cancer conserving treatment.
SO - Cancer Treat Rev 2002 Feb;28(1):5-10
AD - Department of Radiation Oncology, University of Turin, San Giovanni Batista Hospital, Via Genova 3, 10126 Turin, Italy.
The optimal timing and sequencing of adjuvant radiotherapy and chemotherapy after breast-conserving surgery for early invasive breast cancer is controversial. Several studies demonstrated that postoperative radiation therapy significantly reduces the incidence of breast recurrences. For patients who do not need systemic treatment, the interval between surgery and the start of radiotherapy should not exceed eight weeks. For node-positive and high-risk patients receiving breast-conserving treatment, adjuvant chemotherapy should be administered prior to radiotherapy, but the delay of radiation should not exceed 20-24 weeks. Side effects and complications of radiotherapy can be expected to increase when chemotherapy is administered concurrently. In particular, antracycline-based chemotherapy regimens increase the damage to heart muscle and coronary arteries: to avoid the risk of ischemic cardiovascular disease, radiotherapy must be performed after the end of systemic treatment. Copyright 2002 Published by Elsevier Science Ltd.

8
UI - 12042742
AU - Marone L; Nigri G; LaMuraglia GM
TI - A novel technique of upper extremity revascularization: the retrohumeral approach.
SO - J Vasc Surg 2002 Jun;35(6):1277-9
AD - Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
Although the standard approach for inflow to the brachial artery is directly from the subclavian or the carotid artery, unusual scenarios exist when this direct route is not accessible. We present a case of a patient after right radical mastectomy and radiation therapy for breast cancer with severe ischemic symptoms of the dominant right upper extremity. Angiography revealed an occluded right subclavian artery with a paucity of distal collaterals across the right shoulder. A reversed vein graft was constructed from the right common carotid artery to the right brachial artery and was tunneled with a retrohumeral approach to avoid the previously operated and irradiated field. The patient has remained asymptomatic with a patent graft at 2 years.

9
UI - 12049547
AU - Intra M; Gatti G; Luini A; Galimberti V; Veronesi P; Zurrida S; Frasson
TI - A; Ciocca M; Orecchia R; Veronesi U Surgical technique of intraoperative radiotherapy in conservative treatment of limited-stage breast cancer.
SO - Arch Surg 2002 Jun;137(6):737-40
AD - Breast Division, University of Milan, Italy. mattia.intra@ieo.it
At the European Institute of Oncology, Milan, Italy, we have focused our interest on the use of intraoperative radiation therapy (IORT) in limited-stage breast cancer that is conservatively treated. A new technique to perform IORT was applied in 185 patients from July 1, 1999, to October 31, 2001. As the surgeon plays a crucial role in this procedure in selecting the patients, performing the breast resection, preparing the gland as a target to receive IORT, delivering the radiation directly to the mammary gland via a dedicated applicator, and, finally, reconstructing the breast, each phase of the surgical technique has been completely standardized and is described herein. The use of IORT in the conservative treatment of breast cancer could allow the course of external fractionated-dose radiation therapy to be completely avoided; IORT dramatically reduces radiation exposure of the skin, lung, and subcutaneous tissues and avoids the irradiation of the contralateral breast, which contributes to a very low incidence of radiation-induced sequelae. In our experience, IORT for limited-stage breast carcinoma is easy to perform and only briefly prolongs the duration of the surgical procedure.

10
UI - 12049553
AU - Kuerer HM; Krishnamurthy S; Kronowitz SJ
TI - Important technical considerations for skin-sparing mastectomy with sentinel lymph node dissection.
SO - Arch Surg 2002 Jun;137(6):747

11
UI - 6900346
AU - Annas GJ
TI - Radical faith: the right stuff?
SO - Nurs Law Ethics 1980 Apr;1(4):3, 7

12
UI - 11501445
AU - Barron P
TI - Do women treated for breast cancer at teaching hospitals really fare better?
SO - CMAJ 2001 Jul 24;165(2):147, 149

13
UI - 11501446
AU - Myers RE
TI - Do women treated for breast cancer at teaching hospitals really fare better?
SO - CMAJ 2001 Jul 24;165(2):147; discussion 149, 151

14
UI - 11501447
AU - Muckle TJ
TI - Do women treated for breast cancer at teaching hospitals really fare better?
SO - CMAJ 2001 Jul 24;165(2):147; discussion 149, 151

15
UI - 11501448
AU - Willard P
TI - Do women treated for breast cancer at teaching hospitals really fare better?
SO - CMAJ 2001 Jul 24;165(2):149; discussion 149, 151

16
UI - 11501449
AU - Fingerote RJ
TI - Do women treated for breast cancer at teaching hospitals really fare better?
SO - CMAJ 2001 Jul 24;165(2):149; discussion 149, 151

17
UI - 11501450
AU - Higgins BP
TI - Do women treated for breast cancer at teaching hospitals really fare better?
SO - CMAJ 2001 Jul 24;165(2):149; discussion 149, 151

18
UI - 12079136
AU - Timothy SK; Teng S; Stolier AJ; Bolton JS; Fuhrman GM
TI - Postmastectomy radiation in patients with four or more positive nodes.
SO - Am Surg 2002 Jun;68(6):539-44; discussion 544-5
AD - Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
Postmastectomy radiotherapy (PMR), a local therapeutic modality, is recommended to treat breast cancer patients with multiple involved axillary lymph nodes (a marker of increased systemic risk). Bothered by this conceptually flawed treatment approach we evaluated the impact of PMR on the treatment of women with four or more involved axillary lymph nodes. We identified 1164 patients treated from 1982 through 1999 with mastectomy. We reviewed the records of the 223 who demonstrated four or more positive axillary lymph nodes. Of these 128 were treated by mastectomy only and 95 by PMR. The mastectomy-only group demonstrated a mean tumor size of 3.5 cm, a median of seven axillary nodes involved, and a median of 24.9 nodes harvested. The PMR group had a mean tumor size of 4.3 cm with nine positive nodes out of a median total of 23.3 harvested. The difference in mean tumor size was statistically significant (P = 0.01). The locoregional recurrence (10.9% vs 12.6%), distant recurrence rates (42.2% vs 35.8%), and 5-year survival (51% vs 55%) were not statistically different between the mastectomy-only group versus the PMR group, respectively. Adding PMR to breast cancer treatment demonstrated no improvement in outcome. Despite limitations of this retrospective study the results strongly support evaluation of PMR by a high-quality randomized prospective trial.

19
UI - 11935695
AU - Baichev G
TI - [Selection criteria for breast conservation in patients with early breast carcinoma]
SO - Akush Ginekol (Sofiia) 2002;42(1):26-8
During the past two decades, breast-conserving therapy (excision of the tumor and axillary lymphadenectomy followed by irradiation) for early stage breast carcinoma has become firmly established as an equivalent treatment approach to mastectomy. The purpose of this review as to examine the risk factors for local recurrence after breast-conserving therapy. Better mammographic evaluation, better margin assessment, recognition of an extensive intraductal component and the use of adjuvant systemic therapy has improved the logo-regional control.

20
UI - 12008199
AU - Morgan DA; Berridge J; Blamey RW
TI - Postoperative radiotherapy following mastectomy for high-risk breast cancer. A randomised trial.
SO - Eur J Cancer 2002 May;38(8):1107-10
AD - Department of Clinical Oncology, Nottingham City Hospital, NG5 1PB, Nottingham, UK. david.morgan@nottingham.ac.uk
Grade III, node-positive breast cancer carries a high risk of loco-regional relapse after simple mastectomy. A randomised trial was conducted to assess whether this would be significantly reduced by postoperative radiotherapy. Between 1985 and 1991, 76 patients who had undergone a simple mastectomy and axillary sampling, and whose tumours had been found to be grade III and node-positive, were randomised to receive postoperative radiotherapy to the chest wall and axilla or no further loco-regional treatment. Radiotherapy was delivered with 8 MV X-rays to the axilla and supraclavicular fossa and with 8 MeV electrons to the chest wall, to a dose of 45 Gy in 15 fractions over 3 weeks. All patients have been followed-up until death, or for a minimum of 10 years. All loco-regional recurrences occurred within the first 4 years after mastectomy. There were 26 such events in the 40 patients randomised to the 'watch' policy (65%), as opposed to 9 out of 36 (25%) who received radiotherapy (P<0.01). Ten-year survival was 39% in the radiotherapy arm as opposed to 25% in the no radiotherapy arm. Recruitment to the trial was closed in 1991, when a preliminary safety analysis revealed the size of the effect of radiotherapy, and from then on all node-positive patients with grade III tumours have routinely been given this treatment. Further follow-up has confirmed this finding, as borne out by these 10-year results, which shows that radiotherapy has a significant impact on reducing loco-regional recurrence in patients at high risk after mastectomy. There is an apparent survival benefit although, because of the small numbers in this trial, this has not reached statistical significance.

21
UI - 12047472
AU - Leonard CE; Sedlacek S; Shapiro H; Hey D; Liang X; Howell K; Vernon B;
TI - Ponce J; Smith L Lumpectomy and breast radiotherapy in breast cancer patients with a family history of breast cancer, ovarian cancer, or both.
SO - Breast J 2002 May-Jun;8(3):154-61
AD - Rocky Mountain Cancer Centers; Department of Radiation Oncology, Denver, Colorado 80110, USA.
This article presents an outcomes review of breast cancer patients identified from the cancer registries of four area hospitals. These patients had family histories of breast cancer, ovarian carcinoma, or both and were treated with conservative surgery and radiation to the involved breast. Patients were as follows: group 1, one first-degree relative ( n = 165, one synchronous bilateral breast cancer); group 2, > or =2 first-degree relatives ( n = 21); group 3, one second-degree relative ( n = 20); and group 4, > or =2 second-degree relatives ( n = 18). The total of patients and breast cancer events was 224 and 225, respectively. Group 5 was a subgroup of 53 patients with a substantial risk (>10%) of a BRCA1 or BRCA2 mutation. After a median follow-up of 3.9 years, 5 patients had local failure (2%), and 5 developed a contralateral breast cancer (2%). There were no significant differences in local failure rates between groups (p = 1.0): group 1, 5 of 166 (3%); group 2, 0 of 21 (0%); group 3, 0 of 20 (0%); and group 4, 0 of 18 (0%). Local failure for group 5 was 2% (1 of 53). Four of 143 patients (3%) with a minimum 3 years of follow-up (median, 5.6 years) had local failure, and 5 (4%) developed a contralateral breast cancer. A univariate analysis was statistically significant for differentiation only (well, 0 of 67; moderately, 1 of 57 [1.8%]; poor, 3 of 26 [11.5%], p = 0.008). Overall survival for groups 1-4 did not differ significantly. Although follow-up has been relatively short, we have not found that breast cancer patients with various degrees of family histories of breast/ovarian carcinoma have had a detrimental outcome when treated with conservative therapy.

22
UI - 12087257
AU - Skoll PJ; Hudson DA
TI - Skin-sparing mastectomy using a modified Wise pattern.
SO - Plast Reconstr Surg 2002 Jul;110(1):214-7
AD - Department of Plastic, Reconstructive, and Maxillo-Facial Surgery, Groote Schuur Hospital, University of Cape Town, 162 Longmarket Street, Cape Town 8001, South Africa. paul@plasticsurgeon.co.za

23
UI - 12087295
AU - Yamamoto Y; Kanazawa H; Sugihara T
TI - Breast reconstruction in the von Recklinghausen disease patient.
SO - Plast Reconstr Surg 2002 Jul;110(1):357-8

24
UI - 12087235
AU - Wei FC; Suominen S; Cheng MH; Celik N; Lai YL
TI - Anterolateral thigh flap for postmastectomy breast reconstruction.
SO - Plast Reconstr Surg 2002 Jul;110(1):82-8
AD - Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan. fcw2007@adm.cgmh.org.tw
Most postmastectomy defects are reconstructed by use of lower abdominal-wall tissue either as a pedicled or free flap. However, there are some contraindications for using lower abdominal flaps in breast reconstruction, such as inadequate soft-tissue volume, previous abdominoplasty, lower paramedian or multiple abdominal scars, and plans for future pregnancy. In such situations, a gluteal flap has often been the second choice. However, the quality of the adipose tissue of gluteal flaps is inferior to that of lower abdominal flaps, the pedicle is short, and a two-team approach is not possible because creation of the gluteal flap requires that the patient's position be changed during the operation. In 2000, five cases of breast reconstructions were performed with anterolateral thigh flaps in the authors' institution. Two of them were secondary and three were immediate unilateral breast reconstructions. The mean weight of the specimen removed was 350 g in the three patients who underwent immediate reconstruction, and the mean weight of the entire anterolateral thigh flap was 410 g. Skin islands ranged in size from 4 x 8 cm to 7 x 22 cm, with the underlying fat pad ranging in size from 10 x 12 cm to 14 x 22 cm. The mean pedicle length was 11 cm (range, 7 to 15 cm). All flaps were completely successful, except for one that involved some fat necrosis. The quality of the skin and underlying fat and the pliability of the anterolateral thigh flap are much superior to those of gluteal flaps and are similar to those of lower abdominal flaps. In thin patients, more subcutaneous fat can be harvested by extending the flap under the skin. Use of a thigh flap allows a two-team approach with the patient in a supine position, and no change of patient position is required during the operation. However, the position of the scar may not be acceptable to some patients. Therefore, when an abdominal flap is unavailable or contraindicated, the creation of an anterolateral thigh flap for primary and secondary breast reconstruction is an alternative to the use of lower abdominal and gluteal tissues.

25
UI - 12087236
AU - Losken A; Carlson GW; Bostwick J 3rd; Jones GE; Culbertson JH; Schoemann
TI - M Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience.
SO - Plast Reconstr Surg 2002 Jul;110(1):89-97
AD - Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
Recent trends in breast reconstruction have transitioned toward the skin-sparing type of mastectomy and immediate reconstruction using autologous tissue. This study was designed to document trends in the management of patients with unilateral breast cancer and to determine how they influence management of the contralateral breast.All patients who underwent unilateral breast reconstruction at Emory University Hospitals from January of 1975 to December of 1999 were reviewed. The cohort was stratified by timing of reconstruction (immediate versus delayed), method of reconstruction, and mastectomy type (skin-sparing versus non-skin-sparing). The methods of reconstruction included implant, latissimus dorsi flap, and transverse rectus abdominis musculocutaneous (TRAM) flap. Contralateral procedures to achieve symmetry included augmentation, mastopexy, augmentation/mastopexy, and reduction. A total of 1394 patients were evaluated, including 689 delayed and 705 immediate reconstructions. Sixty-seven percent of delayed-reconstruction patients (462 of 689) had a symmetry procedure performed on the opposite breast, compared with 22 percent for the immediate-reconstruction patients (155 of 705) (p 26
UI - 11412274
AU - Kennedy RJ; Bradley J; Parks RW; Kirk SJ
TI - Prospective evaluation of the morbidity of axillary clearance for breast cancer (Br J Surg 2001; 88: 114-7).
SO - Br J Surg 2001 Jun;88(6):891

27
UI - 12032441
AU - Loncaster J; Dodwell D
TI - Adjuvant radiotherapy in breast cancer. Are there factors that allow selection of patients who do not require adjuvant radiotherapy following breast-conserving surgery for breast cancer?
SO - Minerva Med 2002 Apr;93(2):101-7
AD - Yorkshire Centre for Clinical Oncology, Cookridge Hospital, Leeds, UK.
Postoperative adjuvant radiotherapy is used to reduce local recurrences following breast-conserving surgery for early breast cancer. This review examines factors that may be used to select patients at low risk of local failure following breast-conserving surgery alone.

28
UI - 12101557
AU - Semiglazov VF; Kanaev SV; Semiglazov VV; Petrovskii SG; Ivanov VG;
TI - Nurgaziev KSh; Arzumanov AS [Role of biopsy of signaling ("sentinel") lymph nodes in the assessment of regional lymph collectors in patients with breast cancer]
SO - Vopr Onkol 2002;48(1):106-9

29
UI - 12132509
AU - Anonymous
TI - Device delivers local radiation after breast-lump removal.
SO - Health News 2002 Jul;8(7):8

30
UI - 12065797
AU - Wolff AC; Davidson NE
TI - Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease.
SO - Oncologist 2002;7(3):239-45
AD - The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and The Johns Hopkins University School of Medicine, Baltimore, Maryland 21231-1000, USA. awolff@jhmi.edu
The greater use of screening has changed the stage distribution of breast cancer, and an increasing number of patients are diagnosed with earlier stages of the disease. Still, locally advanced breast cancer (LABC) remains a major clinical problem in the United States and a common presentation in many parts of the world. There is no standard definition of LABC. One commonly used includes patients with large primary tumors greater than 5 cm (T3) or with skin/chest wall involvement (T4), and/or fixed axillary (N2) or ipsilateral internal mammary (N3) lymph node involvement. According to the tumor node metastasis staging, these usually include stage IIIa (T0-2N2 or T3N1-2) and stage IIIb (T4Nx or TxN3) disease. Inflammatory breast cancer (T4d) is included in most classifications despite its distinct clinical behavior and worse prognosis overall, but it serves as an example of combined modality intervention. Historically, the term LABC has been applied to those clinical presentations where the disease is considered inoperable. However, these therapeutic principles (including preoperative or primary systemic therapy [PST]) are increasingly being applied to patients presenting with tumors greater than 5 cm and negative lymph nodes (stage IIb-T3N0) or even smaller tumors, who are considered to have operable disease and a better outcome than those traditionally classified as having LABC. PST is increasingly being used in otherwise operable stage I and II patients aiming at greater rates of breast conservation and earlier efficacy assessment. This article reviews many of these issues and ongoing research questions.

31
UI - 12057163
AU - Wolff AC; Davidson NE
TI - Early operable breast cancer.
SO - Curr Treat Options Oncol 2000 Aug;1(3):210-20
AD - The Johns Hopkins Oncology Center, Cancer Research Building, Room 189, 1650 Orleans Street, Baltimore, MD 21231-1000, USA.
Early operable breast cancer is a potentially curable disease. However, a substantial number of patients are at risk for systemic recurrence and death. Breast conservation therapy (BCT) should be considered the preferred surgical option for most women with early operable breast cancer. Adjuvant systemic chemotherapy or hormonal therapy can substantially reduce, although not eliminate, the risk of recurrence and death. Neoadjuvant or primary systemic therapy (PST) in operable breast cancer slightly increases the number of women treated with breast conservation versus mastectomy. Although PST may identify women who are likely to have a better prognosis (those with a pathologic complete response), current PST strategies do not offer a survival advantage over standard adjuvant approaches. Early results of high-dose chemotherapy trials thus far have not shown any advantage over conventional dose therapy in high-risk patients with 10 or more positive lymph nodes. The role of adjuvant radiation therapy after mastectomy for all patients with high-risk early operable breast cancer is not fully defined.

32
UI - 12095593
AU - McClenathan JH; de la Roza G
TI - Adenoid cystic breast cancer.
SO - Am J Surg 2002 Jun;183(6):646-9
AD - Department of Surgery, Kaiser Permanente Medical Center, 900 Kiely Blvd., Santa Clara, CA 95051, USA. james.mcclenathan@ncal.kaiperm.org
BACKGROUND: Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers. METHODS: Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast. Follow-up also was done for these patients. RESULTS: Adenoid cystic carcinoma of the breast was diagnosed in 22 of 27,970 patients treated for breast cancer at KPNCR from 1960 through 2000. All 22 patients were female and were available for follow-up. Mean age of patients at diagnosis was 61 years (range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast led to initial suspicion of a tumor; in 4 (23%) of the 22 patients, mammography led to suspicion of a tumor. Median tumor size was 20 mm. Pain was a prominent symptom. Surgical management evolved from radical and modified radical mastectomy to simple mastectomy or lumpectomy during the study period, during which time 1 patient died of previous ordinary ductal carcinoma of the contralateral breast, and 7 died of unrelated disease. At follow-up, 12 of the 13 remaining patients were free of disease; 1 patient died of the disease; and 1 patient remained alive despite late occurrence of lymph node and pulmonary metastases. CONCLUSIONS: Whether breast-preserving surgery with radiotherapy is as effective as mastectomy for treating adenoid cystic carcinoma of the breast has not been determined.

33
UI - 12095594
AU - Cho LC; Senzer N; Peters GN
TI - Conservative surgery and radiation therapy for macroscopically multiple ipsilateral invasive breast cancers.
SO - Am J Surg 2002 Jun;183(6):650-4
AD - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
BACKGROUND: The presence of macroscopically multiple ipsilateral invasive breast cancer (MMIIBC) has been considered a contraindication for breast conservation. Early series reported high rates of local recurrence. A treatment regimen was developed to accommodate patient requests for breast conservation in MMIIBC. METHODS: We reviewed medical records of the 15 MMIIBC patients who underwent partial mastectomy followed by radiation between 1989 and 1997. All patients had 2 or more separate macroscopic tumors greater than 2 mm in diameter. After tumor excision, all specimens were evaluated; the protocol required surgical months), 14 patients (93%) were alive without evidence of disease. One patient died of systemic disease without local recurrence. CONCLUSIONS: In selected cases, the combination of breast conservative surgery and radiation therapy with systemic therapy results in acceptable local-regional control. Patients who present with MMIIBC with clear surgical margins should be considered for breast conservation.

34
UI - 11944249
AU - Saienko VF; Driuk MF; Driuk MM
TI - [Organizational aspects of the one-staged reconstruction of mammary glands after performance of mastectomy]
SO - Klin Khir 2001 Nov;(11):5-7
The femoral mammarial glands reconstruction after performance of mastectomy have become an ordinary procedure in USA and in countries of Europe. Primary reconstructions owes following advantages: high cosmetic effect, small psychological trauma of female patient, lesser cost of treatment of such patients in comparison with corresponding indices for postponed performance of reconstruction. In Ukraine such operations were not nearly performed yet. An organizational aspects of one-staged reconstruction of mammarial glands using auto tissues after performance of mastectomy for the mammarial glands cancer were presented, basing on literature data and the authors own experience.

35
UI - 12082965
AU - Panieri E; Hudson DA
TI - Skin-sparing mastectomy--increasing the options of patients with breast cancer.
SO - S Afr J Surg 2002 Feb;40(1):3-4

36
UI - 12094415
AU - Pomel C; Missana MC; Lasser P
TI - [Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery. Feasibility study and review of the literature]
SO - Ann Chir 2002 May;127(5):337-42
AD - Departement de chirurgie generale, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France. pomel@igr.fr
STUDY AIM: Breast reconstructive surgery with latissimus dorsi flap is routinely performed with a long dorsal scar ransom. To reduce the scar the authors propose an endoscopic technique to harvest the pure latissimus dorsal flap. We evaluate our first experience. PATIENTS AND using an endoscopic pure muscular latissimus dorsal flap for breast reconstruction surgery. RESULTS: Mean operative time is 116 min. No open conversion was necessary. One patient was transfused. The average lymphatic drainage was of 2520 ml with removal of the drainage on postoperative day 15. CONCLUSION: The endoscopic harvesting of the latissimus dorsi pure muscular flap, brings less scar than the open surgery.

37
UI - 12094424
AU - Anania G; Parodi PC; Sanna A; Rampino E; Marcotti E; Di Loreto C; Zuiani
TI - C; Donini A Radiation-induced angiosarcoma of the breast: case report and self-criticism of therapeutic approach.
SO - Ann Chir 2002 May;127(5):388-91
AD - Departement of Surgery, Radiology and Anestesiology, Sezione di Clinica Chirurgica, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
Angiosarcoma (AS) of the breast is a rare and highly aggressive vascular cancer. It presents as a primitive or radioinduced form. The case of a 46-year-old woman who underwent quadrantectomy of the breast plus axillary lymph node dissection and radiotherapy postoperatively (QUART) for ductal infiltrant carcinoma is reported in the following. Ten years later, the patient underwent mastectomy with immediate reconstruction, for local recurrence that was diagnosed as an AS of the breast at final pathological examination. She did not receive any adjuvant treatment due to local post-operative complications related to breast reconstruction. We criticize our therapeutic approach and we recommend more attention about local recurrence suggesting that tru-cut needle biopsy of local recurrence of the breast after QUART, should be the correct diagnostic approach.

38
UI - 12078926
AU - Burri SH; Landry JC; Davis LW
TI - Breast conservation is an effective option in Black, medically indigent patients.
SO - J Natl Med Assoc 2002 Jun;94(6):453-8
AD - Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.
The purpose of the study was to evaluate the efficacy of lumpectomy and postoperative radiotherapy in an African-American, medically indigent population. From 1980 through 1996, a retrospective chart review was undertaken of the patients treated with radiotherapy after lumpectomy at an inner city hospital, whose patients are primarily African American and uninsured. One hundred and one patients were treated with breast conservation during this time. Of those, 72 were African American and with invasive carcinoma. The data were analyzed using JMP IN (SAS Institute). The study found that African-American patients with invasive carcinoma had 95.2% local control at 5 years and 87.9% at 10 years. The disease-free survival was 84.6% at 5 years and 65.3% at 10 years. Patients that received less than 50 Gray to the tumor bed had inferior local control, disease-free survival, and overall survival (p < 0.0001 for all three). The 5-year and 10-year local control for DCIS, in a limited number of patients, was 95.2%. We conclude that lumpectomy followed by radiotherapy is an effective treatment strategy in the high-risk population of African-American, medically indigent patients. The local control and disease-free survival compare favorably to published controls in this traditionally high-risk patient population.

39
UI - 11760971
AU - Hebert-Croteau N; Villeneuve D
TI - Longer waits for breast cancer surgery in Quebec could be good news.
SO - CMAJ 2001 Nov 13;165(10):1300-1

40
UI - 11829433
AU - Silva JM; Garcia JM; Dominguez G; Silva J; Miralles C; Cantos B; Coca S;
TI - Provencio M; Espana P; Bonilla F Persistence of tumor DNA in plasma of breast cancer patients after mastectomy.
SO - Ann Surg Oncol 2002 Jan-Feb;9(1):71-6
AD - Department of Medical Oncology, Clinica Puerta de Hierro, Madrid, Spain.
BACKGROUND: We investigated tumor DNA changes before and after mastectomy in the plasma of breast cancer patients with no disseminated disease and eventually investigated these changes' relationship to specific pathological parameters of the tumors. METHODS: We studied 41 patients. DNA extracted from tumor and normal breast tissues, mononuclear blood cells, and plasma was used for molecular studies. Alterations in the microsatellite markers D17S855, D17S654, D16S421, TH2, D10S197, and D9S161, as well as point mutations in the p53 gene and aberrant methylation of p16(INK4a), were used to identify and characterize tumor and plasma DNA. A number of tumor clinicopathological parameters were analyzed in each patient. RESULTS: We found that 18 (44%) of the 27 patients with alterations in tumor DNA presented the same plasma DNA alteration before mastectomy, and persistence of the same molecular features was detected in plasma DNA 4 to 6 weeks postmastectomy in 8 (19.5%) patients. Patients with vascular invasion, more than three lymph node metastases, and higher histological grade at diagnosis displayed plasma DNA after mastectomy with a significant difference. CONCLUSIONS: Persistence of plasma DNA with features of tumor DNA may be present after mastectomy in breast cancer patients, and its relation to bad-prognosis histological parameters may suggest undetectable micrometastatic disease.

41
UI - 11848236
AU - Pettersson N; Perbeck L; Hahn RG
TI - Efficacy of subcutaneous and topical local anaesthesia for pain relief after resection of malignant breast tumours.
SO - Eur J Surg 2001 Nov;167(11):825-30
AD - Department of Surgery, Huddinge University Hospital, Stockholm, Sweden.
OBJECTIVE: Infiltration and topical application of local anaesthetics close to the surgical wound may be used to prevent postoperative pain. We evaluated the efficacy of these treatments after breast surgery for cancer. DESIGN: Double-blind randomised trial with two treatment groups and one control group. SETTING: University hospital, Sweden. INTERVENTIONS: Patients were allocated to treatment with bupivacaine infiltration (n = 29), topical application of lignocaine/prilocaine (n = 31), or no local treatment (n = 30). MAIN OUTCOME MEASURES: Difference and time related patterns in pain scores measured on a visual analogue scale (VAS), and morphine consumption. RESULTS. None of the local anaesthetics significantly reduced the VAS score or morphine consumption. However, fewer patients in the anaesthetic groups had high VAS scores than controls, the 75 centile for the mean score after operation being 2.7, 2.0 and 2.1 for the controls, infiltration, and topical anaesthetic groups, respectively. The controls had higher scores from 6 hours postoperatively onwards. The corresponding median morphine consumption was 24.5, 18.5, and 16.2 mg. CONCLUSIONS. Local anaesthesia slightly reduced the overall pain scores and the morphine consumption, but was of potential clinical value only in the patients who had the highest pain scores.

42
UI - 11848242
AU - Balzan SM; Farina PS; Maffazzioli L; Riedner CE; Guedes Neto EP; Fontes
TI - PR Granular cell breast tumour: diagnosis and outcome.
SO - Eur J Surg 2001 Nov;167(11):860-2
AD - Department of Surgery, Irmandade da Santa Casa de Misericordia de Porto Alegre and Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre, Brazil. balzan@portoweb.com.br

43
UI - 11923621
AU - Mokbel K; Elkak AE
TI - Prospective comparison of stereotactic core biopsy and surgical excision as diagnostic procedures for breast cancer patients.
SO - Ann Surg 2002 Apr;235(4):605

44
UI - 12062612
AU - DiBiase SJ; Komarnicky LT; Heron DE; Schwartz GF; Mansfield CM
TI - Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy.
SO - Int J

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