Breast conservative surgery and local recurrence

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Breast conservation surgery (BCS) aims to preserve breast aesthetics while ensuring oncological safety.
• Evolving understanding of breast cancer (BC) risk factors moves beyond traditional T-size, nodal status, and receptor status to molecular portraits and intrinsic subtypes.

Purpose of the Study:

• To evaluate the oncological and aesthetic outcomes of various BCS techniques.
• To determine if intrinsic subtypes of breast cancer influence local recurrence rates in BCS.
• To identify predictors of local recurrence and mastectomy conversion in BCS patients.

Main Methods:

• Analysis of 1035 BCS patients with primary unilateral breast cancer (2004-2009).
• Evaluation of local recurrence based on tumor location, surgical technique, resection volume, T-size, nodal status, grading, histopathology, intrinsic subtype, and margin status.
• Follow-up of 944 eligible patients over a median of 5.2 years across five surgical techniques.

Main Results:

• Tumor-free margins were achieved in 88.6% of patients during the first surgery.
• Local recurrence was not significantly associated with surgical technique, resection volume, T-size (T1/T2 cohort), or nodal status (N0/N1 cohort).
• Factors significantly linked to local recurrence included high grading (G3), non-luminal HER2-positive BC, and triple-negative breast cancer (TNBC).

Conclusions:

• Oncoplastic principles enable reconstruction of major defects in BCS, yielding favorable oncological and aesthetic results.
• Recurrence risk is primarily influenced by grading, intrinsic subtypes, and non-invasive breast cancer components, rather than traditional prognostic factors in specific patient cohorts.
• Lobular histology, multi-centricity, and ductal carcinoma in situ (DCIS) predict failure of breast preservation, potentially leading to mastectomy conversion.