Amitai Yoav, Golan Orit, Barnea Yoav, Klausner Joseph, Menes Tehillah S
Departments of Radiology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Breast Dis. 2018;37(3):115-121. doi: 10.3233/BD-170284.
Oncoplastic reconstruction is increasingly used in the management of women undergoing breast conserving surgery. We examined the findings on breast exam and imaging of patients who underwent breast conservation with or without oncoplastic reconstruction.
We hypothesized that patients undergoing immediate breast reconstruction would present with more palpable and imaging abnormalities compared to lumpectomy alone and undergo therefore more biopsies.
All patients undergoing breast conservation with oncoplastic reconstruction for breast cancer between 2009 and 2014 were included in the study group. The control group was created by matching 4 women that underwent lumpectomy alone during the same week to each patient in the study group. The two groups were compared regarding demographics, tumor characteristics, post-operative complaints, breast exam, imaging and biopsies done during follow-up.
The study group included 67 women who had lumpectomy and immediate oncoplastic reconstruction and 268 women that underwent lumpectomy alone.Patients undergoing immediate oncoplastic reconstruction had more advanced disease; larger mean tumor size (3.1 cm versus 1.9 cm, P < 0.001), higher rate of involved lymph nodes (48% versus 26%; P < 0.001) and use of neoadjuvant treatment (39% versus 15%; P < 0.001).After oncoplastic reconstruction, new lumps (18% versus 5%; P = 0.004) were found more frequently, and there was a higher rate of women undergoing biopsies (31% versus 11%; P < 0.001). This finding remained significant after controlling for age, type of tumor, use of neoadjuvant treatment and volume of tissue removed. Over ninety percent of biopsies in the oncoplastic group were benign, most commonly-fat necrosis (N = 15, 60% of the biopsies).
Immediate oncoplastic reconstruction is associated with increased palpable masses and imaging abnormalities, requiring biopsies. Patients and clinicians should be aware of the benign nature of most of these findings.
肿瘤整形重建术在接受保乳手术的女性治疗中应用日益广泛。我们研究了接受或未接受肿瘤整形重建术的保乳患者的乳房检查及影像学检查结果。
我们推测，与单纯乳房肿块切除术相比，即刻乳房重建术的患者可触及及影像学异常更多，因此活检次数也更多。
2009年至2014年间所有接受乳腺癌肿瘤整形重建术保乳的患者纳入研究组。对照组通过为研究组的每位患者匹配同期仅接受乳房肿块切除术的4名女性而设立。比较两组的人口统计学特征、肿瘤特征、术后主诉、乳房检查、影像学检查及随访期间的活检情况。
研究组包括67例行乳房肿块切除术并即刻进行肿瘤整形重建的女性和268例仅行乳房肿块切除术的女性。接受即刻肿瘤整形重建术的患者疾病分期更晚；平均肿瘤尺寸更大（3.1厘米对1.9厘米，P<0.001），淋巴结受累率更高（48%对26%；P<0.001），新辅助治疗使用率更高（39%对15%；P<0.001）。肿瘤整形重建术后，新肿块发现频率更高（18%对5%；P=0.004），接受活检的女性比例更高（31%对11%；P<0.001）。在对年龄、肿瘤类型、新辅助治疗使用情况及切除组织量进行校正后，这一发现仍具有显著性。肿瘤整形组超过90%的活检为良性，最常见的是脂肪坏死（N=15，占活检的60%）。
即刻肿瘤整形重建术与可触及肿块及影像学异常增加相关，需要进行活检。患者和临床医生应了解这些发现大多为良性。
