European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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To compare the surgical outcomes of women diagnosed with invasive ductal and lobular carcinoma of the breast. ⋯ We observed similar success rates and trends in both the ILC and IDC groups where BCS was attempted. Patients selected for BCS with ILC were statistically more likely to have successful surgery compared with IDC as tumour size increased. There however was no statistical difference in a pooled analysis of successful treatment across all tumour sizes in comparing the two groups. We conclude that BCS is an appropriate and acceptable treatment option for women diagnosed with ILC.
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The diagnosis and surgical management of screen-detected Ductal Carcinoma In Situ (DCIS) remains controversial including a range of axillary approaches and consequent morbidity. This study examined the management of the axilla in all patients with DCIS presenting through the United Kingdom National Health Service Breast Screening Programme (UK NHS BSP). Retrospective analysis of the UK NHS BSP identified 26,696 women initially diagnosed with DCIS over the 8 years 1 April 2003-31 March 2011. ⋯ Overall, 12.0% of women with invasive cancer, 1.7% with micro-invasion, and 0.2% with DCIS alone, were ultimately node positive. Improved pre-operative sampling of DCIS, axillary assessment by ultrasound with needle biopsy for suspected metastases, risk stratification for sentinel node biopsy (for high grade or extensive DCIS) and avoiding axillary clearance for a pre-operative diagnosis of DCIS alone should reduce unnecessary axillary surgery. Standards using such criteria for axillary surgery in screen-detected DCIS should be integrated into the NHS BSP.
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The use of acellular dermal matrix (ADM) has transformed the technique of implant-based breast reconstruction. It offers the option of a one-stage procedure and is felt to have benefits in cosmetic outcome but the medium and long-term outcomes are unknown. ⋯ While offering potential cosmetic and financial benefits, the use of ADM with implant-based reconstructions has a significant rate of implant loss, further surgery and potential delay in adjuvant therapy. These must be considered when planning treatment and consenting patients.