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Abstract: Background: We evaluated the usefulness of axillary ultrasound (US) in patients with core biopsy–proven ductal carcinoma in situ (DCIS). Methods: Preoperative axillary US, fine-needle aspiration (FNA), and sentinel lymph node (SLN) data from women with DCIS were reviewed. Results: Eighty-two women with DCIS underwent axillary US. In 16 women (19.5%) US was abnormal; however, FNA was negative in all cases. Sixty-one women (74%) underwent SLN surgery; 2 were positive for macrometastasis (3%) and 1 had isolated tumor cells. None of them had an abnormal US. Axillary US did not change the management in any of the cases. Conclusions: Axillary US and FNA did not change the management in any of the 82 cases. In women with a core biopsy diagnosis of DCIS, positive nodes are uncommon and unlikely to be detected by axillary US. Routine preoperative axillary US is not recommended for pure DCIS on core biopsy. [Copyright &y& Elsevier]

Background: Optimal surgical management of patients with invasive lobular carcinoma (ILC) who undergo neoadjuvant chemotherapy (NAC) is unknown. We evaluated optimal margin distance and local recurrence (LR) rates for these patients. Methods: Ninety-three (30%) of 311 patients with ILC received NAC. We examined margin status, residual disease after re-excision, and clinical outcomes. Results: Margin positivity rates after the final operative procedure were similar between the NAC and surgery-first group (P > .05). The proportion of patients, stratified by margin status, who were taken back for re-excision was not different between the 2 groups, and, similarly, there were no differences in frequency of residual disease (all P > .05). At a median follow-up of 3.1 years, 1 patient in the NAC group and 2 in the surgery-first group developed LR (P = 1.0). Conclusions: Patients with ILC who have undergone NAC and have margins >1 mm have a low probability of residual disease and LR. [Copyright &y& Elsevier]

Abstract: Background: Molecular breast imaging (MBI) depicts functional uptake of targeted radiotracers in the breast using dedicated gamma cameras. Methods: MBI studies were performed under several institutional protocols evaluating the use of MBI in screening and diagnosis. Results: By using a single-head system, sensitivity for breast cancer detection was 85% (57 of 67) overall and 29% for tumors 5 mm or less in diameter. Sensitivity improved to 91% (117 of 128) overall and 69% for tumors 5 mm or less using a dual-head system. In 650 high-risk patients undergoing breast cancer screening, MBI detected 7 cancers, 5 of which were missed on mammography. In 24 of 149 (16%) breast cancer patients MBI detected additional disease not seen on mammography. The sensitivity of MBI was 88% (83 of 94) for invasive ductal carcinoma, 79% (23 of 29) for invasive lobular carcinoma, and 89% (25 of 28) for ductal carcinoma in situ. Conclusions: MBI can detect invasive ductal carcinoma, ductal carcinoma in situ, and invasive lobular carcinoma. It has a promising role in evaluating the extent of disease and multifocal disease in the breast for surgical treatment planning. [Copyright &y& Elsevier]

Background: The unique growth pattern of invasive lobular carcinoma (ILC) poses a challenge for preoperative assessment of disease extent within the breast. Whether it similarly limits lymph node staging by ultrasound (US) and fine-needle aspiration (FNA) biopsy was the subject of the current study. Methods: A total of 217 patients with ILC who underwent axillary US were reviewed. FNA biopsy was performed when US findings were suspicious or indeterminate. Findings were compared to literature reports of US in invasive ductal carcinoma (IDC) patients. Results: Axillary US was negative in 137 patients (63%) and suspicious or indeterminate in 80 patients (37%). FNA biopsy was positive in 62% (47/76 patients). Preoperative US and FNA biopsy identified 43 of 111 (39%) node-positive patients. Sensitivity of US with FNA biopsy correlated with primary tumor and nodal metastasis size. Similar results were seen in IDC populations. Conclusion: US with FNA biopsy appears to be similarly useful in axillary staging of ILC and IDC patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: We hypothesized that even in the face of a positive intramammary lymph node (IMLN) a negative axillary sentinel lymph node (SLN) reliably stages the axilla and complete axillary lymph node dissection (CALND) can be avoided. Methods: A literature search identified 386 publications that included IMLNs and SLN biopsies. Patients with a positive IMLN and negative axillary SLN who underwent a CALND were included. A review of our database was also performed. Results: Twenty-one cases in the literature met our criteria. A review of our database resulted in 2 additional cases. Twenty-three patients were identified who had a positive IMLN, negative axillary SLN biopsy, and underwent a CALND. In all cases, the CALND was negative. Conclusions: An axillary SLN biopsy accurately represents the disease status of the axilla in cases with a positive IMLN. CALND can be avoided in the setting of a positive IMLN and a negative axillary SLN biopsy. [Copyright &y& Elsevier]

Abstract: Background: Although blue dye is routinely used for lymphatic mapping, it is not used for lymphatic mapping in pregnancy-associated breast cancer, because of concern of fetal risk. Methods: To investigate the safety of blue dye for lymphatic mapping in pregnant women, the pharmacokinetics of methylene blue dye were examined in 10 nonpregnant women, and the results were extrapolated to estimate maximal fetal exposure to the dye. Results: Plasma and urine measurements indicated that the dye quickly distributed from the breast injection site to the circulation, with 32% of the total dose excreted in urine within 48 hours. Combined with existing data on organ distribution of methylene blue, the estimated maximal dose to the fetus is 0.25 mg (5% of the administered dose), likely further reduced by other physiologic factors related to pregnancy. Conclusions: The analysis suggests that methylene blue dye can be used for lymphatic mapping in pregnancy-associated breast cancer with minimal fetal risk. [Copyright &y& Elsevier]

Abstract: Background: Wire-localized breast biopsy (WLBB) remains the standard method for the surgical excision of nonpalpable breast lesions. Because of many of its shortcomings, most important a high microscopic positive margin rate, alternative approaches have been described, including radioactive seed localization (RSL). This review highlights the literature regarding RSL, including safety, the ease of the procedure, billing, and oncologic outcomes. Methods: Medline and PubMed were searched using the terms “radioactive seed” and “breast.” All peer-reviewed studies were included in this review. Conclusions: RSL is a promising approach for the resection of nonpalpable breast lesions. It is a reliable and safe alternative to WLBB. RSL is at least equivalent compared with WLBB in terms of the ease of the procedure, removing the target lesion, the volume of breast tissue excised, obtaining negative margins, avoiding a second operative intervention, and allowing for simultaneous axillary staging. [Copyright &y& Elsevier]

Background: The goal of the current study was to evaluate the effect of regional anesthesia using paravertebral block (PVB) on postoperative pain after breast surgery.Methods: Patients undergoing unilateral breast surgery without reconstruction were randomized to general anesthesia (GA) only or PVB with GA and pain scores assessed.Results: Eighty patients were randomized (41 to GA and 39 to PVB with GA). Operative times were not significantly different between groups. Pain scores were lower after PVB compared to GA at 1 hour (1 vs 3, P = .006) and 3 hours (0 vs 2, P = .001) but not at later time points. The overall worst pain experienced was lower with PVB (3 vs 5, P = .02). More patients were pain-free in the PVB group at 1 hour (44% vs 17%, P = .014) and 3 hours (54% vs 17%, P = .005) postoperatively.Conclusions: PVB significantly decreases postoperative pain up to 3 hours after breast cancer surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background: Evidence supports single-dose preoperative antibiotic (ABX) prophylaxis for breast surgery; however, limited data exist regarding the incidence and type of antibiotic complications postoperatively. Methods: Breast/axillary surgeries between July 2004 and June 2006 were reviewed. Complications were analyzed by antibiotic group: preoperative prophylaxis, postoperative prophylaxis, and therapeutic intent. The Fisher exact test was used to compare complication rates. Results: A total of 389 patients underwent breast/axillary surgeries during the study period. A total of 363 (93%) patients received ABX: 353 (91%) received a single preoperative dose, 91 (23%) received postoperative ABX prophylaxis, and 76 (201%) received ABX for therapeutic intent. Among patients receiving ABX, 15 (4%) had an ABX-related complication. The ABX-related complication rate was significantly higher among those receiving postoperative prophylaxis (5.5%; 5 of 91) compared with those receiving preoperative ABX alone (0%; 0 of 214) (P = .002). Conclusions: Drug-related complications were uncommon with preoperative ABX prophylaxis. Considering the potential complications of ABX after breast surgery, the use of postoperative prophylaxis should be reexamined. [Copyright &y& Elsevier]

Abstract: Background: Seroma is a common complication after mastectomy. We review our experience with sclerotherapy for postmastectomy seroma management. Methods: Patients who underwent outpatient sclerotherapy for postmastectomy seroma were reviewed. Ninety-five percent ethyl alcohol or povidone iodine, which was administered by way of percutaneous catheter, was the initial sclerosant, and dwell time was 20 to 30 minutes. Povidone iodine solution was instilled 2 to 3 times daily. Catheters were removed when output reached <30 mL/d or when cavity size was <20 ml by sinogram. Results: Sixteen patients (18 seromas) had sclerotherapy initiated at median of 34 days after surgery. Mean number of treatment days was 3 (median duration 16). Seven patients (44%) developed infection during treatment, which was associated with increased duration. Three seromas recurred and were successfully treated with single aspiration. Comments: Sclerotherapy is a feasible treatment for chronic seroma after mastectomy. Longer treatment duration was associated with infection; antibiotic prophylaxis should be considered. Research is necessary to determine optimal regimens and superiority over other approaches. [Copyright &y& Elsevier]

Background: While nipple-sparing mastectomy (NSM) is gaining acceptance for risk reduction and for treatment of early stage breast cancer, node-positive disease remains a relative contraindication. Our aim was to evaluate the use and outcomes of NSM in node-positive breast cancer patients., Methods: We identified 240 cancers in 226 patients (14 bilateral) scheduled for NSM and operated on between 1/2009 and 6/2014. We compared outcomes for 58 node-positive vs 182 node-negative patients., Results: Intraoperative conversion to skin-sparing mastectomy was similar for node-positive and node-negative patients, 10% and 7%, as was 1-year success of NSM, 84% and 90%, respectively. Five-year locoregional disease-free estimates were 82% (95% CI 68%-99%) for node-positive and 99% (95% CI 96%-100%) for node-negative patients, P = .004; however, there were no nipple-areolar recurrences among node-positive patients., Conclusions: With careful consideration of biologic and anatomic risk factors for recurrence, these data suggest that NSM is a reasonable option for selected node-positive breast cancer patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)