Patient-Reported Satisfaction after Prophylactic Operations of the Breast

Background: Prophylactic mastectomies in carriers of mutations in BRCA1 or BRCA2 are becoming increasingly more accepted. We investigated the outcome after prophylactic mastectomy, especially regarding satisfaction with the procedure, in a monocenter study. Methods: BRCA1/2 mutation carriers and non-carriers with elevated pedigree-based cancer risk were followed prospectively in a structured surveillance program between 2000 and 2017. A retrospective telephone survey was conducted among all patients with documented prophylactic mastectomy. Complications and satisfaction with the decision for prophylactic mastectomy were recorded. Results: 39 patients who opted for a prophylactic mastectomy (38 BRCA1/2 mutation carriers and 1 noncarrier) were interviewed. Mostly nipple-sparing mastectomy with reconstruction was performed (87%). Half of the patients (22/39; 56.4%) had a history of unilateral breast cancer. The median time since prophylactic mastectomy was 5.6 years. While 61.5% did not report any complications, flap loss was seen in 15% (3/20) and moderate limitations in everyday life were present in 20% (7/35). An improvement in quality of life was noticed by 82% after prophylactic mastectomy and no patient expressed regret with regard to the decision. Conclusions: Prophylactic mastectomy is a procedure with risk for long-term complications in some cases. Our results confirm high satisfaction with the decision and improved quality of life

Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): a prospective international multicenter study.

OBJECTIVE To assess the diagnostic performance of preoperative application of the Enzian classification (cEnzian) using surgical findings as reference standard DESIGN: A prospective international non-interventional study SETTING: 12 endometriosis centers in four European countries (Austria, Germany, Switzerland, and Czech Republic) POPULATION: 1062 women with endometriosis surgery METHODS: Extent of endometriosis was preoperatively classified using the cEnzian classification based on gynecological examination and/or transvaginal ultrasound (TVS) and/or magnetic resonance imaging (MRI). After subsequent surgery, the surgeon classified the intraoperative findings using the Enzian classification. MAIN OUTCOME MEASURES Sensitivity, specificity, PPV, NPV, LR+, LR- and accuracy were calculated. Conditional frequencies of intraoperative Enzian codings and the corresponding 95 % confidence intervals were computed for each preoperative coding and visualised in plots. RESULTS Although overall consistency of cEnzian and Enzian was poor (35.14 %, 95%-CI 32.26-38.03), high specificities and negative predictive values (NPVs) of the cEnzian compartments could be demonstrated. Looking at the individual parts of the Enzian classification, the poorest diagnostic performance was detected for compartment B and the highest PPVs were found for category 3-lesions (> 3 cm), independently of the compartment. CONCLUSIONS Using the Enzian classification in a non-invasive setting is a useful tool providing us with a 'at a glance' summary of the diagnostic workup regarding deep endometriosis with high specificities and NPVs. An attempt to merge the two new endometriosis classification systems (#Enzian and AAGL 2021) seems reasonable - with consideration of the respective advantages of each other