Single-incision for breast-conserving surgery through round block technique

Aims and objectives: The purpose of this study was to assess the feasibility of using the single-incision round block technique in breast-conserving surgery with sentinel lymph node (SLN) retrieval for breast cancer without compromising oncological safety. Materials and methods: A retrospective observational case-control study was conducted from January 2017 to October 2021. The study population consisted of two groups. In both groups, breast-conserving surgery was carried out through the round-block technique. In group A, SLN retrieval was performed using the round-block incision (study group), while in group B, SLN retrieval was conducted through a second skin incision in the axilla (control group). The study was approved by the local ethics committee Zurich (BASEC-Nr. 2020-02857), and written informed consent was obtained from all participants. Results: Overall, 134 patients met the inclusion criteria, of whom 86 women underwent breast-conserving surgery and SLN retrieval using the single-incision approach (group A), and 48 women underwent conventional surgery, using two independent incisions for tumour resection and SLN retrieval (group B). The overall success rate in group A regarding SLN retrieval was 97.7%, whereas most tumours were located in the upper outer (47.7%) and upper inner quadrant (27.9%). Although the technique was equally successful in the other quadrants, the share of tumours in the lower outer, and the lower inner quadrant, and the retroareolar region was smaller, representing 17.4%, 3.5% and 3.5%, respectively. The median number of dissected lymph nodes was two, with a positivity rate of 24.4%. The occurrence of axillary neuralgia and axillary skin retraction was significantly higher in group B along with tendentially more axillary seroma formation. There were no significant differences regarding reintervention rates, in terms of complications, resection margins, locoregional recurrences, or deaths with a mean follow-up of 11 months. Conclusions: The single-incision method through the round block technique is as safe and effective as the standard two-incision approach regarding nodal staging and resection margins, and seems to be applicable for tumours in all breast quadrants. Keywords: Benelli; Breast-conserving surgery; Minimal-access breast surgery; Round block; Single-incision

Screening für Mammakarzinom und risikoadaptiertes Vorgehen

Mammakarzinom ist die häufigste Krebserkrankung der Frau weltweit mit 2 Millionen Neuerkrankungen jährlich [1] und die zweithäufigste krebsbedingte Todesursache [2]. Etwa 6.000 Neudiagnosen werden jährlich in der Schweiz registriert. Das Lebenszeitrisiko (LZR) einer Frau, an Brustkrebs zu erkranken, liegt bei 12–13 %. So erscheint eine entsprechende Vorsorge im Sinne einer Sekundärprävention sinnvoll. Die Möglichkeit eines Mammakarzinomscreenings sollte allen Frauen, welche dafür berechtigt sind, angeboten und erläutert werden. Zusätzlich besteht nebst dem Screening als Sekundärprävention die Möglichkeit einer Primärprävention für Frauen mit moderatem bis hohem Brustkrebsrisiko (endokrine Prävention, prophylaktische risikoreduzierende Operationen). Für Frauen mit Risikokonstellation müssen individuelle Screeningmodalitäten in der Beratung berücksichtigt werden. Da die Richtlinien und Screeningprogramme international wie auch national variieren, soll dieser Artikel eine Übersicht über die derzeit bestehenden Empfehlungen in der Schweiz bieten. Dabei soll zudem ein Schwerpunkt auf die differenzierte Vorgehensweise bei Risikosituationen gelegt werden

Mastodynie – wie soll man «Brustschmerz» abklären und behandeln?

Mastodynie ist ein häufig auftretendes Krankheitsbild, das uns im klinischen Alltag regelmässig begegnet. Da die Ursachenpalette äusserst breit von physiologischen Veränderungen bis Malignität reichen kann, ist die Diagnosefindung nicht immer einfach. Der Ausschluss der Malignität führt bereits bei vielen Betroffenen zu einer grossen Entlastung und zu besserem Umgang mit den Beschwerden. Nach einer sorgfältigen Abklärung kann die adäquate Therapie je nach Form der Mastodynie eingeleitet werden. Grundsätzlich lässt sich sagen: Die medikamentöse Therapie der zyklusunabhängigen Form ist unbefriedigend, operative Vorgehensweisen sind bei symptomatischen Befunden zu diskutieren. Grössere operative Massnahmen stellen hingegen bei der zyklischen Mastodynie keine erfolgversprechende Option dar und hier ist strenge Zurückhaltung geboten. Nicht jede Mastodynie benötigt zwingend ein therapeutisches Vorgehen. Das Konzept muss individuell angepasst an den Leidensdruck festgelegt werden. Bekannt sind Spontanremissionen von ca. 20–30 %. Dabei steht die Remission der zyklischen Mastodynie in Zusammenhang mit hormonellen Ereignissen (z.B. Beginn Einnahme einer Antibabypille, Schwangerschaft, Menopause)

Risikoadaptiertes Screening auf Mammakarzinom

Das Mammakarzinom ist die häufigste Krebserkran-kung der Frau weltweit mit 2 Millionen Neuerkran-kungen jährlich (1) und die zweithäufigste krebsbe-dingte Todesursache (2). Zirka 6000 Neudiagnosenwerden jährlich in der Schweiz registriert

Discrepancies between radiological and histological findings in preoperative core needle (CNB) and vacuum-assisted (VAB) breast biopsies

BACKGROUND: Ultrasound (US)-guided breast biopsy is a routine diagnostic method used to correlate imaging finding to a histological diagnosis which is still the gold standard in preoperative diagnostics. The accuracy of US-guided breast biopsies relies on a precise radiologic-histopathologic correlation, which is discussed amongst an interdisciplinary team of gynecologists, radiologists and pathologists. However, false-negative or non-diagnostic biopsy results occur. Hence, a thorough and honest discussion to clarify the reason for discrepancies and to decide the next diagnostic step between specialists of the different disciplines is warranted. In this retrospective study, we analyzed discrepant findings between imaging and pathology results on preoperative breast biopsies. METHODS: Core and vacuum-assisted breast biopsies from 232 patients were included in this study. Inclusion criteria were (1) non-diagnostic (B1) category on histology independent from imaging category and (2) histological benign (B2) category with a BIRADS 5 (Breast Imaging Reporting and Data System) rating on imaging. Histological diagnoses were retrieved from all cases. Follow-up data were available in most cases. RESULTS: 138 biopsies were classified as B1, 94 biopsies as B2 category. 51 of 138 B1 cases (37%) underwent re-biopsy. Re-biopsy found malignancy (B5) in 19 of 51 cases, and B3/4 (premalignant) lesions in 3 of 51 cases. All B2 cases underwent second-look imaging-diagnosis, in 57 of 94 cases (66%) consecutive direct surgery or re-biopsy. Of these, malignancy was diagnosed histologically in 26 of 57 cases (45.6%). CONCLUSION: Determining imaging-pathology concordance after US-guided breast biopsy is essential. Discrepant cases and further diagnostic steps need to be discussed with an interdisciplinary approach

Prepectoral implant-based breast reconstruction with TiLOOP® Bra Pocket – a single-centre retrospective study

Background: Prepectoral implant-based reconstruction using synthetic meshes is feasible with good outcomes. We present our data using TiLOOP® Bra Pocket, a novel ready-to-use mesh pocket which acts as an internal bra and prevents the implant from dislocating or twisting. Materials and methods: A single-centre retrospective cohort study was performed to assess short-term complication rates and cosmetic outcomes in patients with prepectoral implant-based reconstruction using the TiLOOP® Bra Pocket. The primary endpoint was complication rates during the first 6 months. The secondary endpoint was the cosmetic outcome after 6 to 12 months, which was judged by two breast surgeons using the Harvard score. Results: A total of 63 breasts (43 patients) were reconstructed using the TiLOOP® Bra Pocket between 2018 and 2020, 57 were immediate reconstructions. The overall complication rate was 30,2% (n = 19/63). Major complications occurred in seven breasts (n = 7/63; 11,1%) and minor complications occurred in 12 breasts (12/63; 19,0%). The unplanned revision rate was 12,7%. The cosmetic outcome was good (Harvard score: mean 3, range 1-4; SD 0,75). Seventeen cosmetic complications were observed (17/63; 27,0%) and six cosmetic revision surgeries were performed (6/63; 9,5%). Conclusion: The use of the TiLOOP® Bra Pocket is convenient and standardized because the pocket is preformed and does not require to be sewn first. Cosmetic outcome is good; however, the surgical morbidity needs to be addressed in future reconstructions. Careful patient selection and preparation techniques are vital in order to achieve acceptable complication rates and satisfying cosmetic results. Keywords: Implant; Mesh; Prepectoral breast reconstruction; TiLOOP® Bra Pocket