Numerous prospective clinical trials have demonstrated that breast-conserving surgery + radiotherapy can allow breast cancer patients to achieve the same survival rate as radical surgery, with good cosmetic results. The desire to not lose the breast has become a reality in a subset of breast cancer patients.
Which breast cancers can be breast conserved? The current consensus is that early stage breast cancer with a single lesion, negative pathology at the cut edge and no suspicious microcalcifications in other parts of the breast can be breast conserved. The absolute contraindications of breast-conserving surgery are
1, multicentric lesions that cannot be removed locally through a single incision to achieve cosmetic results;
2. Previous radiotherapy to the affected breast;
3. Breast cancer during pregnancy;
4.Mammogram showing diffuse suspicious or malignant microcalcifications;
5. Positive cutting edge.
The relative contraindications to breast-conserving surgery are
1.Collagen vascular diseases such as scleroderma and lupus erythematosus;
2.Multi-centered lesions located in the same quadrant of the breast;
3. The presence of calcified foci of unknown nature around the tumor;
4. Tumor >5cm; 5. Tumor located in the areola area.
The 2006 NCCN Breast Cancer Clinical Practice Guidelines recommend that in addition to stage T0 ductal carcinoma in situ; stage I breast cancer ≤2cm without axillary lymph node metastasis, stage II and stage IIIA (T3N1M0) breast cancer can also be selected for breast-conserving surgery, that is, even if the tumor is large or has lymph node metastasis in the axilla, breast-conserving surgery can be considered. For these locally advanced breast cancers, NCCN guidelines advocate neoadjuvant chemotherapy (preoperative chemotherapy) first and then breast-conserving surgery after tumor shrinkage, but care should be taken to mark the margins of the original tumor in order to determine the extent of resection. Locally advanced breast cancer with large tumors or lymph node metastasis in the axilla is at risk of high local recurrence after breast-conserving surgery and should be explained to the patient.
To determine whether a patient is suitable for breast-conserving surgery, the following factors should be thoroughly evaluated.
1. the presence of diseases in the medical history that are not suitable for radiotherapy;
2. the size of the breast, the size and location of the tumor;
3. Preoperative imaging to understand the extent and distribution of the lesion;
4. Pathological examination of the cut edge of the mastectomy specimen (intraoperative freezing);
5, to achieve the requirements of the extent of mastectomy while preserving the breast can have a better appearance. Another important factor is the patient’s request and desire, especially for large tumors or locally advanced breast cancer, and the patient and the surgeon should discuss the advantages and disadvantages of breast-conserving treatment and radical surgery.
In general, breast-conserving surgery is a mature technique in the surgical treatment of breast cancer, but there is no absolutely unified standard for indications, and the grasp of breast-conserving indications is not entirely consistent among hospitals, and there is even some controversy on some issues. The 2006 NCCN Breast Cancer Clinical Practice Guidelines, which have reached an international consensus, do not specify the indications for breast conservation, but give authoritative recommendations on the indications. Early stage breast cancer with a single lesion (tumor diameter ≤3 cm, no metastasis in axillary lymph nodes in preoperative clinical examination) is a commonly accepted indication by scholars at home and abroad. With the in-depth research and technical progress, the range of indications for breast-conserving surgery is being expanded under the premise of ensuring efficacy. In the case of a patient, it is advisable to select an experienced breast specialist to determine and perform breast-conserving treatment.