Breast-Conserving Surgery

Aka: Breast-Conserving Surgery, Conservative Breast Surgery, Breast Lumpectomy with Radiation, Breast Lumpectomy

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II. Indications: Localized Breast Cancer

  1. Considered optimal therapy for early Breast Cancer
  2. Stage I or Stage II Breast Cancer (localized tumor)
    1. Tumor not fixed to overlying skin
    2. Tumor not fixed to underlying Muscle
    3. Negative surgical margins
    4. No diffuse, inflammatory or multicentric cancer
    5. No malignant appearing mammographic abnormalities after surgery
    6. No previous radiation to the Breast or chest wall (prevents further Breast Radiation Therapy)
  3. Lymph Node involvement is not a contraindication
    1. Lymph Nodes must not be fixed to other Lymph Nodes
    2. Lymph Nodes must not be fixed to surrounding tissue
  4. Invasive ductal and lobular cancer not contraindication
    1. Tumor must not be diffuse
    2. Requires that negative surgical margins are achieved
  5. References
    1. Morrow (2002) CA Cancer J Clin 52(5): 277-300 [PubMed]

III. Contraindications

  1. Absolute
    1. Two or more primary tumors in different quadrants
    2. Associated diffuse suspicious microcalcifications
    3. Previous Breast irradiation
    4. Pregnancy (unless near estimated delivery date)
  2. Relative (due to resulting cosmetic result)
    1. Collagen vascular disease (poor vascular supply)
    2. Large tumor in small Breast

IV. Protocol: Breast Cancer

  1. Tumor localization
    1. Biopsy of suspected tumor site
      1. Stereotactic needle biopsy or
      2. Needle localization Excisional Biopsy
    2. Axillary node examination
      1. Sentinel Lymph Node biopsy or
      2. Axillary node dissection
  2. Conservative Breast Surgery
    1. Complete tumor excision with negative margins
  3. Breast Radiation Therapy
    1. Follows all cases of Conservative Breast Surgery
    2. Radiation Therapy starts 2-4 weeks after surgery
    3. Timing: 5 days per week for 6 weeks
    4. Radiation exposure
      1. Entire Breast: 5000 cGy
      2. Tumor site: 1500 cGy (in addition to 5000 cGy)

V. Efficacy

  1. Survival outcomes same as for Mastectomy in early cases
  2. High recurrence rate unless radiation follows surgery
  3. References
    1. Fisher (2002) N Engl J Med 347:1233-41 [PubMed]
    2. Fisher (1995) N Engl J Med 333:1456-61 [PubMed]
    3. Winchester (1998) CA Cancer J Clin 48:83-107 [PubMed]

VI. Advantages: Breast conserving surgery over Mastectomy

  1. Improved body image and higher treatment satisfaction
  2. No greater fear of recurrence compared with Mastectomy
  3. Lower rates of Major Depression, anxiety and Insomnia
  4. References
    1. Curran (1998) Eur J Cancer 34:307-14 [PubMed]

VII. Complications

  1. Positive tissue margins after conservative surgery
    1. Requires modified radical Mastectomy
  2. Local recurrence (5-12% of cases)
    1. Treated with Mastectomy
  3. Breast radiation changes (e.g. skin thickening)
  4. Wound Infection, seroma or Hematoma (<5% of cases)

VIII. References

  1. Abeloff (2000) Clinical Oncology, p. 2094-5
  2. Townsend (2001) Sabiston Surgery, p. 576-7
  3. Apantaku (2002) Am Fam Physician 66(12):2271-81 [PubMed]
  4. Chung (2002) Obstet Gynecol Clin North Am 29(1):173-88 [PubMed]

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Related Studies

Ontology: Lumpectomy of breast (C0851238)

Definition (NCI_NCI-GLOSS) Surgery to remove abnormal tissue or cancer from the breast and a small amount of normal tissue around it. It is a type of breast-sparing surgery.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D015412
SnomedCT 71222002, 150299008, 392022002, 392021009, 72258006
CPT 19301
English Excision Mastectomies, Local, Excision Mastectomy, Local, Limited Resection Mastectomies, Local Excision Mastectomies, Local Excision Mastectomy, Lumpectomy, Mastectomies, Limited Resection, Mastectomies, Local Excision, Mastectomy, Limited Resection, Mastectomy, Local Excision, Resection Mastectomies, Limited, Resection Mastectomy, Limited, Excision of lesion of breast, Lumpectomy of breast, Lumpectomy of Breast, breast surgery lumpectomy, lumpectomy, lumpectomy (treatment), Breast lump removal NOS, excision of breast lump, tylectomy, breast lumpectomy, partial mastectomy, breast lump removal, Breast lump removal, Tylectomy, Tylectomy of breast, Breast lumpectomy, Excision of breast lump, Lumpectomy of breast (procedure), Tylectomy (procedure), Tylectomy, NOS, Lumpectomy, NOS, Limited Resection Mastectomy
Italian Asportazione di nodulo mammario, Asportazione di nodulo mammario NAS, Lumpectomia, Resezione mammaria limitata
Dutch borstknobbelverwijdering NAO, lumpectomie, borstknobbelverwijdering, Lumpectomie
French Ablation d'une tumeur mammaire SAI, Ablation d'une tumeur, Biopsie excisionnelle, Tumorectomie, Lumpectomie, Ablation d'une tumeur mammaire
German Brustknotenentfernung NNB, Lumpektomie, Brustknotenentfernung
Portuguese Remoção de nódulo mamário NE, Remoção de nódulo mamário, Lumpectomia
Spanish Extirpación de nódulo mamario NEOM, Nodulectomía, nodulectomía, tumorectomía de la mama, tumorectomía, nodulectomía de mama (procedimiento), nodulectomía de mama, tilectomía (procedimiento), tilectomía, Extirpación de nódulo mamario, Lumpectomía
Japanese 乳房腫瘤摘除, 乳房腫瘤摘除ＮＯＳ, ﾆｭｳﾎﾞｳｼｭﾘｭｳﾃｷｼﾞｮNOS, ﾆｭｳﾎﾞｳｼｭﾘｭｳﾃｷｼﾞｮ
Czech Odstranění bulky prsu NOS, Lumpektomie, Odstranění bulky prsu
Hungarian Lumpectomia, Emlődaganat eltávolítás, Emlődaganat eltávolítás k.m.n.
Norwegian Lumpektomi, Mastektomi, begrenset reseksjon
Derived from the NIH UMLS (Unified Medical Language System)

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