ASO Author Reflections: Oncoplastic Surgery Does Not Compromise Surveillance Imaging
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Oncoplastic Surgery Does Not Compromise Surveillance Imaging Angelena Crown, MD1,2, and Janie Grumley, MD3 Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington; 2Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 3Margie Peterson Breast Center, John Wayne Cancer Institute, Providence Saint John’s Health Center, Santa Monica, California
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PAST Oncoplastic surgery (OPS) combines wide local excision with plastic surgery incisions and volume displacement techniques to facilitate breast conserving surgery (BCS) without compromising oncologic outcomes.1 OPS has been associated with many benefits, including lower rates of inadequate margins and complications, improved cosmesis and quality of life, as well as a reduced need for additional operations, which translates into expedited initiation of adjuvant therapies.2 Additionally, OPS has expanded indications for breast conservation by enabling larger resections while maintaining the aesthetics of the breast, allowing women with larger spans of disease to consider BCS.3,4 With national trends indicating widespread implementation of OPS, concerns regarding the ability to effectively follow patients with surveillance imaging after tissue rearrangement techniques used in OPS have emerged. Indeed, some small retrospective series have suggested that OPS may have a deleterious effect on surveillance imaging and lead to an increased rate of unnecessary biopsies.
ASO Author Reflections is a brief invited commentary on the article, ‘‘Evaluating need for additional imaging and biopsy after oncoplastic breast conserving surgery,’’ Ann Surg Oncol. (2020). https://doi.org/ 10.1245/s10434-020-08500-y. Ó Society of Surgical Oncology 2020 First Received: 1 May 2020 J. Grumley, MD e-mail: [email protected]
Despite the increasing application of OPS, there is minimal data evaluating the rates of additional imaging and biopsy following OPS compared to traditional BCS. PRESENT We performed a retrospective review of a prospectively maintained database to identify all women with clinical stage 0–III breast cancer who underwent definitive BCS at Virginia Mason Medical Center between 2009 and 2018.5 We observed no difference in the rates of additional imaging beyond standard diagnostic views between patients who underwent traditional BCS and patients who underwent OPS (BCS 26.7% vs OPS 25.9%, NS). Need for core needle biopsy (CNB) was higher in the traditional BCS group over the entire follow-up interval (BCS 18.9% vs OPS 9.3%, p \ 0.01) but was similar when only the first 3 years after surgery were considered. OPS did not compromise early detection of recurrence as ductal carcinoma in situ comprised the majority (70%) of malignant findings on CNB in the OPS group despite similar rates of malignant biopsies in the two groups (BCS 54% vs OPS 45%, NS). Importantly, the rates of benign findings on CNB were similar between groups (BCS 38.3% vs OPS
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