title: Breast conservative surgery after neoadjuvant chemotherapy in breast cancer patients: comparison of two tumor localization methods.
abstract: OBJECTIVE
  The key to surgical planning for breast conservative treatment (BCT) after neoadjuvant chemotherapy (NAC) is tumor localization. Tumor marking can be performed using either skin tattoo or metallic marker. The objective of this study is to compare both types of tumor localization markers and to assess which techniques improve BCT in achieving a complete resection without compromise margins.
  
  
  METHODS
  149 patients between 1999 and 2009 were eligible for the study. The skin tattoo group (TG) included 118 patients and the metallic marker group (MG) included 31 patients. Both markers were placed before starting NAC.
  
  
  RESULTS
  Median clinical tumor volume was 10.3 cm(3) in the TG and 22.4 cm(3) in the MG (p = 0.051). After NAC treatment, there were no significant statistically differences in both groups regarding complete clinical response, partial clinical response, and complete and partial pathological response. Median pathological tumor volume was: 0.8 cm(3) in the TG and 0.69 cm(3) in the MG (p = 0.8). Lumpectomy volume was bigger in the TG (268 cm(3)) than MG (143 cm(3)); p < 0.004. There were no statistically significant differences when comparing margin status.
  
  
  CONCLUSIONS
  Lumpectomy guided with metallic marker after NAC allows lower excision of breast tissue without compromising margins. Having similar pathologic response between groups, skin tattoo leads to excise larger volume of tissue adding no benefits to the surgery. With the increasing pathologic complete responses to NAC, patients who are candidates for BCT after NAC will benefit from marking the tumor with metallic markers.
authors.affiliation: Breast Surgical Unit, Department of Gynecology, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron 119, Barcelona, Spain. maespino@vhebron.net
authors.forename: M
authors.initials: M
authors.lastname: Espinosa-Bravo
authors.forename: A
authors.initials: A
authors.lastname: Sao Avilés
authors.forename: A
authors.initials: A
authors.lastname: Esgueva
authors.forename: O
authors.initials: O
authors.lastname: Córdoba
authors.forename: J
authors.initials: J
authors.lastname: Rodriguez
authors.forename: T
authors.initials: T
authors.lastname: Cortadellas
authors.forename: C
authors.initials: C
authors.lastname: Mendoza
authors.forename: R
authors.initials: R
authors.lastname: Salvador
authors.forename: J
authors.initials: J
authors.lastname: Xercavins
authors.forename: I T
authors.initials: IT
authors.lastname: Rubio
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000601:surgery; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D013653:Tattooing; D016896:Treatment Outcome