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For the management of non-palpable breast cancer, accurate pre-operative localisation is essential to achieve complete resection with optimal cosmetic results. Radioguided occult lesions localisation (ROLL) uses the radiotracer, injected intra-tumourally for sentinel lymph node identification to guide surgical excision of the primary tumour. In a multicentre randomised controlled trial, we determined if ROLL is superior to the standard of care (i.e. wire-guided localisation, WGL) for preoperative tumour localisation. Women (> 18 years.) with histologically proven non-palpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomised to ROLL or WGL. Patients allocated to ROLL received an intra-tumoural dose of 120 Mbq technetium-99 m nanocolloid. The tumour was surgically removed, guided by gamma probe detection. In the WGL group, ultrasound- or mammography-guided insertion of a hooked wire provided surgical guidance for excision of the primary tumour. Primary outcome measures were the proportion of complete tumour excisions (i.e. with negative margins), the proportion of patients requiring re-excision and the volume of tissue removed. Data were analysed according to intention-to-treat principle. This study is registered at ClinincalTrials.gov, number NCT00539474. In total, 314 patients with 316 invasive breast cancers were enrolled. Complete tumour removal with negative margins was achieved in 140/162 (86%) patients in the ROLL group versus 134/152 (88%) patients in the WGL group (P = 0.644). Re-excision was required in 19/162 (12%) patients in the ROLL group versus 15/152 (10%) (P = 0.587) in the WGL group. Specimen volumes in the ROLL arm were significantly larger than those in the WGL arm (71 vs. 64 [cm.sup.3], P = 0.017). No significant differences were seen in the duration and difficulty of the radiological and surgical procedures, the success rate of the sentinel node procedure, and cosmetic outcomes. In this first multicentre randomised controlled comparison of ROLL versus WGL in patients with histologically proven breast cancer, ROLL is comparable to WGL in terms of complete tumour excision and re-excision rates. ROLL, however, leads to excision of larger tissue volumes. Therefore, ROLL cannot replace WGL as the standard of care. Keywords Non-palpable * Breast cancer * Wire-guided localisation * Radioguided occult lesion localisation * Surgery

Purpose Magnetic Occult Lesion Localization Instrument (MOLLI) is a wireless, non-radioactive alternative for non-palpable breast lesion localization. The primary objective of this first-in-human study was to evaluate the clinical feasibility of using MOLLI for intraoperative localization of non-palpable breast lesions. Methods Twenty women with non-palpable breast lesions at a single institution received a lumpectomy using the MOLLI guidance system. Patients were co-localized with magnetic and radioactive markers up to 7 days before excision by a dedicated breast radiologist under sonographic guidance. Both markers were localized intraoperatively using dedicated hand-held probes. The primary outcome was successful excision of the magnetic marker, confirmed radiographically and pathologically. Demographic data, margin positivity, and re-excision rates were collected. Surgical oncologists, radiologists, and pathology staff were surveyed for user satisfaction. Results Post-radiological analysis: Post-implant mammograms verified that 17/20 markers were placed directly in the lesion center. Radiologists reported that all marker implantations procedures were \"easy\" or \"very easy\" following a single training session. Post-surgical analysis: All MOLLI markers were successfully removed with the specimen during surgical excision. In all cases, surgeons ranked the MOLLI guidance system as \"very easy\" for lesion localization. Pathologic analysis: All patients had negative margins. All anatomic pathology staff ranked the MOLLI system as \"very easy\" to localize markers. Conclusions The MOLLI guidance system is a reliable and accurate method for intraoperative localization of non-palpable breast lesions. Further evaluation of the MOLLI system in studies against current standards of care is required to demonstrate system cost-effectiveness and improved patient-reported outcomes.

Purpose To assess the effects of contemporary treatment of ductal carcinoma in situ (DCIS) on the risk of developing an ipsilateral invasive breast cancer (iIBC) in the Dutch female population. Methods Clinical data was obtained from the Netherlands Cancer Registry (NCR), a nationwide registry of all primary malignancies in the Netherlands integrated with the data from PALGA, the Dutch nationwide network and registry of histo- and cytopathology in the Netherlands, on all women in the Netherlands treated for primary DCIS from 2005 to 2015, resulting in a population-based cohort of 14.419 women. Cumulative iIBC incidence was assessed and associations of DCIS treatment type with subsequent iIBC risk were evaluated by multivariable Cox regression analyses. Results Ten years after DCIS diagnosis, the cumulative incidence of iIBC was 3.1% (95% CI: 2.6-3.5%) in patients treated by breast conserving surgery (BCS) plus radiotherapy (RT), 7.1% (95% CI: 5.5-9.1) in patients treated by BCS alone, and 1.6% (95% CI: 1.3-2.1) in patients treated by mastectomy. BCS was associated with a significantly higher risk for iIBC compared to BCS + RT during the first 5 years after treatment (HR 2.80, 95% CI: 1.91-4.10%). After 5 years of follow-up, the iIBC risk declined in the BCS alone group but remained higher than the iIBC risk in the BCS + RT group (HR 1.73, 95% CI: 1.15-2.61). Conclusions Although absolute risks of iIBC were low in patients treated for DCIS with either BCS or BCS + RT, risks remained higher in the BCS alone group compared to patients treated with BCS + RT for at least 10 years after DCIS diagnosis.

Background and AimsRegional anaesthesia for breast surgery has traditionally been used for perioperative pain control and to reduce opioid consumption, but not as primary anaesthesia. To date, there are few published data on awake breast surgery, and these usually involve moderate sedation with propofol.MethodsWe report our case series of 3 patients who successfully underwent a combination of interfascial blocks as the sole anaesthetic technique for outpatient partial mastectomy via a hemi-periareolar incision. The ultrasound-guided blocks were performed with a mixture of lidocaine/epinephrine 9/0.01 mg/ml and consisted of a pecto-intercostal fascial plane block (PIFP) at the level of the fourth costal cartilage and a two-level deep serratus anterior plane block (SAP) over the third and fifth ribs to take advantage of better spread and wider anaesthetic coverage. Doses didn’t exceed the recommended maximum of 7 mg/kg. Prior to surgery, a pinprick test was performed in the mammary area to confirm the efficacy of the block. Anxiolysis was achieved through intermittent intravenous midazolam boluses, with the patients remaining cooperative and relaxed throughout the entire procedure.ResultsTwo of the three patients underwent surgery without incident, but patient 3 experienced mild pain during the incision, which was relieved with a single bolus of 50 micrograms of fentanyl and a local infiltration of 25 milligrams of bupivacaine. The remainder of the procedure was uneventful. Post-operative pain was minimal at all times.Abstract P240 Table 1Outcomes of patients undergoing awake partial mastectomy with interfascial blocksConclusionsAwake breast cancer surgery is feasible and has emerged as a less risky alternative to general anaesthesia with the potential to reduce time to discharge.

Background and AimsGiven the rising global demand for breast cancer surgery, Hospital del Mar is testing a new care circuit for breast-conserving surgery using local or regional anaesthesia with sedation as an alternative to general anaesthesia. If successful, this approach may reduce time in the operating theatre and the post-anaesthetic care unit (PACU). This case series aims to describe our initial experience and assess patient and professional tolerance and satisfaction.MethodsWe report a prospective case series of five patients undergoing lumpectomy under regional or local anaesthesia with minimal to moderate sedation. Three received deep serratus anterior plane block (d-SAPB) and pecto-intercostal fascial plane block (PIFP), one received d-SAPB plus local infiltration, and one underwent local infiltration only.ResultsIn this case series, no patients required conversion to general anesthesia, and none reported postoperative pain above 3 on the visual numeric scale. Eighty percent were discharged the same day; the rest were admitted for social reasons. At the two-month follow-up, four out of five reported high satisfaction (measured by the EVAN-LR questionnaire) and expressed willingness to repeat the procedure under the same conditions. One patient did not, due to vomiting that was resolved with medication. The surgical team rated the experience positively, with no technical issues or complications.Abstract P129 Table 1Outcome of patients undergoing lumpectomy under locoregional anaesthesia.ConclusionsThis five-case series demonstrates the safety, efficacy, and patient tolerance of a locoregional anaesthesia-sedation circuit for breast-conserving surgery. Its use may improve resource efficiency, enhance the patient‘s experience, and has been positively evaluated by the medical team.

Background: Surgical options for breast cancer have evolved significantly over the past decades. Lumpectomy with radiation remains the preferred approach for early-stage cancers, while unilateral mastectomy rates have declined. However, bilateral mastectomy rates have increased. We aimed to determine contemporary trends and predictors of contralateral prophylactic mastectomy (CPM) and its impact on oncological outcomes among women with breast cancer. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) 17 database between 2000 and 2019 among women with non-metastatic breast cancer who had undergone lumpectomy, unilateral mastectomy, or CPM. We collected demographic, clinicopathologic, and treatment data to analyze trends in surgical management and identify predictors for CPM using a multinomial logistic regression model. Survival outcomes between surgical options were compared using the Kaplan-Meier curve. Results: A total of 1130455 women who had undergone lumpectomy (60.8%), unilateral mastectomy (34.0%), or bilateral mastectomy (5.2%) were included. The proportion of women undergoing lumpectomy and bilateral mastectomy increased from 4.3% to 5.8% and 2.2% to 5.6%, respectively, between 2000 and 2019, while the rate of unilateral mastectomy decreased from 5.4% to 4.8%. Contralateral prophylactic mastectomy was associated with younger age, later diagnostic year, White race, marital status (married, divorced), advanced cancer stage, and node positivity, while lumpectomy was linked to older age, higher income, urban/metropolitan living, early-stage cancer, and smaller tumour. Overall survival was higher for lumpectomy and CPM than unilateral mastectomy (p < 0.0001). However, breast cancer-specific mortality was lowest for lumpectomy (p < 0.0001). Conclusion: Contralateral prophylactic mastectomy is influenced by various demographic and clinicopathological factors but offers limited long-term survival and oncological benefits.

Introduction/BackgroundThe status of the surgical margins of lumpectomy specimens is one of the most important determinants of local recurrence during breast cancer management.The usefulness of practicing systematic cavity shaving is still subject to debate but could avoid surgical re-excision and allow diagnosis of multifocality.MethodologyThis is a retrospective, analytical, single-center study carried out in the Gynecology and Obstetrics department at Charles Nicolle University Hospital in Tunis, Tunisia, over a period of 5 years between January 2016 and December 2020, including patients who had conservative treatment associated with systematic cavity shaving as part of the management of breast cancer.ResultsWe included 93 patients. The median age was 48 years with extremes ranging from 25 to 95 years.The median radiological tumor size was 22 mm with extremes of 9 to 40 mm.The volume of the lumpectomy specimen had a median of 134.5 cm3 (from 9 to 660 cm3).A positive shave was noted in 20 patients (21.5%).Among patients with tumor-free lumpectomy margins, 4 had a positive shave (4.3%).Cavity shaving avoided the need for re-excision in 10.8% of cases and contributed to the diagnosis of multifocality in 4.3% of cases.There was no correlation between the volume resected and the usefulness of the shaving.In the multivariate study, we did not find any predictive factors of positivity or usefulness of the shaving.ConclusionIn our study, a useful cavity shaving rate of 10.8% allows us to recommend this procedure: for one out of 10 patients, it avoids surgical re-excision.And since there is no specific population for whom shaving is most useful, we recommend practicing it systematically.DisclosuresAuthors have no conflict of interest to declare.

Background: Intraoperative in-room specimen radiography (IRSR) allows for immediate in-theatre mammographic determination of specimen margin status in breast-conserving surgery (BCS) for breast cancer. It has been demonstrated to be equivalent or superior to the traditional specimen radiography (SR) in detecting margin positivity. This retrospective study aimed to examine the impact of replacing SR with IRSR at a tertiary institution on positive margin rates, reoperation rates, and excised volume of wire-localized BCS. Methods: Our study reviewed 794 consecutive BCS with wire-localization identified from a prospectively maintained database at a breast centre in Canada from January 2017 to December 2019. The effect of IRSR compared with SR on positive margin and reoperation rates were evaluated using univariate regression, while excised tissue volumes were evaluated using linear regression. Results: The analysis demonstrated no statistically significant reduction in overall positive margin rates, reoperation rates, and excised tissue volume in wire-localized BCS after the introduction of IRSR. However, there was a trend toward reduction in close (< 2 mm) or positive margin rates (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.33-1.12, p = 0.11), and reoperation rates (OR 0.61, 95% CI 0.32-1.14, p = 0.12) in patients whose lumpectomy showed pure ductal carcinoma in situ (DCIS). A statistically significant reduction in reoperation rates (OR 0.45, 95% CI 0.23-0.86, p = 0.019) in patients who underwent preoperative stereotactic biopsy was also noted. Statistically significant increased excised tissue volume with IRSR was found in patients with invasive cancers. Conclusion: Our study revealed that IRSR at our centre correlated with a trend toward decreased margin positivity and reoperations in the DCIS subgroup, with corresponding statistically significant reduction in reoperations of breast cancers confirmed on stereotactic biopsy, the modality often used for sampling of calcifications most common in DCIS. Further study is needed to elucidate the increase in excised tissue volume.

Breast cancer is the most commonly diagnosed cancer and the leading cause of death among female patients, which seriously threatens the health of women in the whole world. The treatments of breast cancer require the cooperation of a multidisciplinary setting and taking tumor load and molecular makers into account. For early breast cancer, breast-conserving surgery with radiotherapy or mastectomy alone remains the standard management, and the administration of adjuvant systemic therapy is decided by the status of lymph nodes, hormone receptors, and human epidermal growth factor receptor-2. For metastatic breast cancer, the goal of treatments is to prolong survival and maintain quality of life. This review will present the current advances and controversies of surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy, immunotherapy, gene therapy, and other innovative treatment strategies in early-stage and metastatic breast cancer. Keywords: breast cancer, surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy, immunotherapy, gene therapy