A Prospective, Multicenter Registry Study to Evaluate the Clinical Feasibility of Targeted Axillary Dissection (TAD) in Node-positive Breast Cancer Patients.

OBJECTIVE: This study aimed to investigate the feasibility and accuracy of non-radioactive TLN biopsy and TAD in routine clinical practice. BACKGROUND DATA: TAD involves TLN biopsy (TLNB) and sentinel lymph node biopsy and was recently introduced as a new standard for less invasive axillary staging in BC patients undergoing neoadjuvant systemic therapy (NST); however, clinical evidence is limited. METHODS: The SenTa study is a prospective registry study conducted at 50 centers. Patients with invasive BC who nderwent clip insertion into the most suspicious axillary lymph node were eligible. Axillary surgery was performed with or without sentinel lymph node biopsy, TLNB, and/or axillary lymph node dissection (ALND). Main endpoints were the detection rate and FNR of TLNB and TAD after NST. RESULTS: Between 2017 and 2018, 548 consecutive BC patients underwent clip placement into biopsy-confirmed positive lymph nodes. After NST (n = 473), the clipped TLN was intraoperatively resected in 329 of 423 patients [77.8%, 95% confidence interval (CI): 74.0-82.0]. TAD was successful in 199 of 229 patients (detection rate: 86.9%, 95% CI: 81.8-91.0), the SLN and TLN were identical in 129 patient (64.8%). FNRs were 7.2% (8 of 111, 95% CI: 3.1-13.6) for TLNB followed by ALND (n = 203) and 4.3% (2 of 46, 95% CI: 0.5-14.8) for TAD followed by ALND (n = 77). CONCLUSIONS: The SenTa study demonstrates the feasibility of TAD in a real-world cohort of BC patients. Our findings are of great importance for de-escalation of surgical strategies.

Patient-Reported Outcomes and Aesthetic Results after Immediate Breast Reconstruction Using Human Acellular Dermal Matrices: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study.

BACKGROUND: With the increased use of acellular dermal matrices (ADMs) in implant-based breast reconstructions (IBBRs), the evaluation of patient-reported outcomes becomes more important. METHODS: Patients who underwent an immediate human ADM-assisted, submuscular IBBR were included in this noninterventional, multicenter, prospective cohort study. Patients with primary reconstruction (cohort A) and patients with a revision surgery after capsular fibrosis (cohort B) were followed up for 12 months after surgery. Quality of life (EORTC BR-23) and patient and surgeon satisfaction scores (1 ["very satisfied"] to 6 ["not satisfied"]) with the outcome and the aesthetic result evaluated by 2 independent, external experts were assessed. RESULTS: Eighty-four patients were enrolled in the study. The mean patient satisfaction score was 2.1 ± 0.8, with higher satisfaction in cohort B (p = 0.041). The score did not change significantly during the follow-up (p = 0.479). The mean satisfaction score of the surgeons was 2.0 ± 0.7; it was also higher in cohort B (p = 0.016) and showed no changes over time (p = 0.473). The mean aesthetic result was 2.2 ± 0.7. 92.9% of the patients completed at least 1 quality of life questionnaire. Body image and sexual functioning increased during follow-up. One year after surgery, the mean scores were 77.2 ± 22.5 and 44.7 ± 27.3, respectively. CONCLUSION: The level of satisfaction among patients and surgeons and the score of the aesthetic result were constantly high among patients after ADM-assisted IBBR. Higher satisfaction scores could be observed after revision surgery caused by capsular fibrosis (cohort B) compared to primary reconstruction (cohort A). Quality of life increased during the first year after surgery.

Two case reports: Breast schwannoma and a rare case of an axillary schwannoma imitating an axillary lymph node metastasis.

A 79-year-old woman with a newly detected oval circumscribed lump in subcutaneous location on mammography and ultrasound turned out to be a Schwannoma after ultrasound-guided core needle biopsy. A 72-year-old woman with breast cancer in medical history demonstrated a new axillary mass in follow up, initially regarded as a lymph node metastasis. Core needle biopsy did not lead to a sufficient diagnosis. Pathologic examination after intraoperative sampling revealed a Schwannoma. These 2 case reports illustrate the importance of diagnostic imaging and remind to include Schwannomas in the differential diagnosis of breast and axillary masses.

Surgical Studies of Reconstructive Breast Surgery - An Overview of the Topics at the 2019 Annual Meeting of the Working Group for Reconstructive Surgery in Oncology-Gynecology.

This year's annual AWOgyn meeting focused on studies of reconstructive breast surgery. As the majority of breast reconstructions are implant-based, most studies also focused on implant-based reconstruction. Since 2011, the guidelines have recommended using interposed mesh materials as support. The basic idea behind every type of material is to provide coverage and stabilization for the implant by constructing an "internal bra" which will create the appropriate implant shape and maintain the position, stability and flexibility of the implant. The Working Group for Reconstructive Surgery in Oncology-Gynecology (AWOgyn) has undertaken to analyze different materials with regard to indications, success rates and side effects as documented in registers, clinical assessments and study protocols. This has increased application safety and is expected to improve it even further in future. Prospective studies are being carried out to investigate issues such as the optimal material, optimal implant site and best cosmetic results. The first results for porcine and human acellular matrices and for partially resorbable titanium-coated synthetic polypropylene meshes are now available. In 2019, the AWOgyn working group will be launching further studies to evaluate a perforated acellular dermal matrix (Fortiva ® ), a titanium-coated implant pocket (TiLOOP ® Bra Pocket) and a fully resorbable synthetic mesh (TIGR ® mesh).

[Breast Cancer: Diagnostics and Therapy - the Most Important Facts for Internists]. / Mammakarzinom: Diagnostik und Therapie ­ das Wichtigste für den Internisten.

LEARNING OBJECTIVES: After reviewing this article, the participant should be able to: 1. Understand the epidemiology of breast cancer, its incidence and impact. 2. Appreciate the importance of early diagnosis and treatment. 3. Understand the concept of comprehensive breast cancer management and its multidisciplinarity. 4. Be knowledgeable about the entire process required to manage breast cancer, since the early diagnosis until the management of non breast related conditions derived from the treatment. 5. Position their specialty and knowledge in the process and know clearly their role and involvement in the management of the patients with breast cancer. SUMMARY: Breast carcinoma accounts for the majority of the malignant diseases in women. In Germany has an estimated incidence of 70 000 new cases per year, which is 30 % of all the malignancies in women, predominantly between 45 and 83 years old, although it can affect as well younger women and men, the latter, in a very low rate. It is accountable for 17.4 % mortality in the country.The high frequency and impact of the mammary carcinoma had lead to the establishment and standardization of screening programs, encompassing self examination, early and regular consultation, sonography and mammography, aimed to the early detection not only of primary disease but also in recurrent or relapsing disease, and continued following up after treatment. Several treatment strategies and tools have been developed and are being chosen in accordance to the histology and biology of the tumor, the patient condition, the social and familiar status, with the increase of conservation of the mammary gland either by adjuvant or neoadjuvant therapies, with radiotherapy or by breast conserving surgery, improving therefore the quality of living without compromising the disease free survival. Next step in the process is the follow up, intended to maintain the patients the healthiest possible, not only from the malignancy but also minimizing the effects of the treatment strategies, incorporating lifestyle improving measures e.g. sports and nutrition, and alternative medicine resources like acupuncture, hence improving the disease free survival rate, the overall survival and diminishing the disease related impact yet personal, familiar, social and economical.The aim of this CME is to give a thorough review of this multifactorial entity, helping the healthcare professional understand the scientific aspects of it and, through comprehensive reading, provide a clear understanding of their role and degree of involvement in the breast cancer management process.