J Breast Cancer.  2011 Mar;14(1):52-57. 10.4048/jbc.2011.14.1.52.

The Feasibility of Endoscopy-Assisted Breast Conservation Surgery for Patients with Early Breast Cancer

• Park HS
• Lee JS
• Lee JS
• Park S
• Kim SI
• Park BW

• KMID: 2175643
• DOI: http://doi.org/10.4048/jbc.2011.14.1.52

Abstract

PURPOSE
Breast conservation surgery (BCS) has become a standard treatment method for patients with early breast cancer. Endoscopy-assisted BCS (EABCS) can be performed through an inconspicuous periareolar and a small axillary incision for sentinel node biopsy, which may give better cosmetic outcomes than conventional BCS skin incisions. This study was designed to evaluate the feasibility of EABCS for patients with early breast cancer.
METHODS
Forty-three patients were candidates for EABCS, and EABCS was performed in 40 patients with breast cancer between January 2008 and July 2010. Their clinicopathological features were retrospectively analyzed. Operative time, margin status, complications, and relapse-free survival were compared with those of patients treated by conventional BCS and who were treated at the same institute during the same period.
RESULTS
The most common lesion site of the EABCS and conventional BCS groups was the upper area of the breast. Tumor size in all patients was less than 4 cm (range, 0.4-3.7 cm), and nodal involvement was found in eight (20%) patients in the BCS group. The mean operative time was 110 minutes for the EABCS group and 107 minutes for the conventional BCS group, and those were not significantly different. No significant difference in frozen or final margin status was observed between the EABCS and conventional BCS groups. Relapse-free survival was statistically equivalent between the groups with a median follow-up of 12 months. Postoperative complications occurred in five cases in four patients with EABCS, which was not significantly different from conventional BCS.
CONCLUSION
Performing EABCS in patients with early breast cancer seems to be feasible and safe. Further study with a longer-term follow-up may be needed to confirm the clinical value of EABCS.

Keyword

Breast; Breast neoplasms; Carcinoma; Endoscopy; Segmental mastectomy; Survival rate

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Cosmetics
Endoscopy
Follow-Up Studies
Humans
Mastectomy, Segmental
Nitriles
Operative Time
Postoperative Complications
Pyrethrins
Retrospective Studies
Skin
Survival Rate
Cosmetics
Nitriles
Pyrethrins

Figure

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  Figure 1 Study enrollment scheme. BCS=breast conservation surgery; EABCS=endoscopy-assisted breast conservation surgery.

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  Figure 2 Illustrations of the surgical technique. (A) Sentinel lymph node biopsy using technitium-99m was performed in the same manner as a routine sentinel lymph node biopsy. (B) The dissection was carried deep over the lateral edge of the pectoralis major muscle, and then the retromammary space was identified and dissected using Endosector LE under the view of an endoscopic video system. (C) Sufficient dissection of the retromammary space of the quadrant to be resected at the beginning of the quadrantectomy is important because it can mobilize the remaining breast parenchyma and provides easy handling of the resection and re-modeling of the remaining tissue. (D) The resection margin was marked using an injection of gentian-violet dye along the margin 1 cm distant from the tumor. (E) The lump containing the main lesion was excised using a knife after making a periareolar incision and constructing the subcutaneous flaps. Note that surgical clips were applied at the margins to inform the radiation oncologist of the exact location of the main lesion. (F) The breast parenchyma and skin wound were approximated.

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  Figure 3 Endoscopic findings of the retromammary space and insertion of surgical clips. (A) Note that the Endosector LE was placed just above the pectoralis major muscle and was slid over the retromammary space. (B) Arrow indicates a surgical clip in the remaining breast parenchyma. We usually inserted the surgical clips in four directions: nipple, inner and/or outer, and upper and/or lower areas of margins.

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  Figure 4 Postoperative scars from endoscopic-assisted breast conservation surgery and conventional breast conservation surgery. (A) Postoperative scar after conventional breast conservation surgery (BCS). (B) Postoperative scar after endoscopic-assisted breast conservation surgery (EABCS). Note that the periareolar scar of the patient who underwent EABCS is more inconspicuous than the incision scar of the patient who underwent conventional BCS.

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  Figure 5 Relapse-free survival (RFS) between endoscopic-assisted breast conservation surgery (EABCS) and conventional breast conservation surgery (BCS).

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