Breast Cancer in the Tissue of the Contralateral Breast Reduction

TL;DR

This paper discusses a new protocol to improve the detection and treatment of contralateral breast cancer in patients undergoing breast reduction surgery.

Contribution

The paper introduces a new protocol for examining contralateral breast reduction tissue to enhance CBC diagnosis and treatment planning.

Findings

CBC or in situ lesions have been incidentally discovered in symmetrizing surgery specimens.

Resection in pieces and lack of marking make tumor assessment challenging.

The new protocol aims to improve diagnostic precision and treatment decisions.

Abstract

Breast cancer is the most prevalent malignancy among women globally. Early diagnosis and treatment improvements are leading to a growing population of survivors. This has increased the risk of developing contralateral breast cancer (CBC), a distinct occurrence in the opposite breast of a previously diagnosed patient. The treatment options for breast cancer are often mastectomy or lumpectomy. Patients with lumpectomy frequently undergo a contralateral reduction procedure to achieve more symmetry after the primary breast cancer surgery. The reduction specimen is usually routinely examined by pathology to check for malignancies. The excision in pieces and the absence of specific markers or ink make an examination of tumor size and margin status more challenging, impacting treatment decisions. A new protocol introduced in July 2022 seeks to improve diagnostic precision and treatment planning via excision in toto and by marking and inking excised reduction tissue to examine and treat potential CBC more effectively.

Breast cancer is the most prevalent malignancy among women worldwide, and the increasing number of survivors is due to advances in early diagnosis and treatment efficacy. Consequently, the risk of developing contralateral breast cancer (CBC) among these survivors has become a concern. While surgical intervention with lumpectomy is a widely used primary approach for breast cancer, post-operative breast asymmetry is a potential concern. Many women opt for symmetrizing reduction procedures to improve aesthetic outcomes and quality of life. However, despite careful radiological screening, there is a chance of accidentally finding CBC. To address this, tissue excised during symmetrizing surgery is examined pathologically. In some cases, CBC or in situ lesions have been incidentally discovered in these specimens, prompting a need for a more thorough examination. Resection in pieces and the absence of surgical marking and pathological inking of the margin have made it challenging to precisely identify tumor location and assess tumor size and margin status, hampering adjuvant treatment decisions. A new protocol introduced in July 2022 aims to enhance the precision of CBC diagnosis, allowing for tailored treatment plans, including re-excision, systemic adjuvant therapy, or radiation therapy.

Figures