Outcome of oncoplastic breast-conserving surgery following bracketing wire localization for large breast cancer.
OBJECTIVE
The purpose of this study was to evaluate the outcome of breast conserving surgery comparing oncoplastic surgery (OS) and standard lumpectomy (SL) after preoperative bracketing wire localization of large neoplastic lesions.


METHODS
We retrospectively reviewed the medical records and the mammograms of patients operated on at the Institut Curie between May 2005 and September 2011 after bracketing wire localization under mammographic and/or sonographic guidance.


RESULTS
113 patients underwent surgery for a pre-operative diagnosis of DCIS (n = 80), micro-invasive carcinoma (n = 9) or invasive carcinoma (n = 24), by OS (n = 73) or SL (n = 40). In the OS group, radiological size (52 mm vs 39 mm, p < 0.001) and resection volumes (246 cc vs 88 cc, p < 0.00001) were significantly higher than in the SL group. Rates of clear histologic margins (60 vs 62%, NS), complete excision of microcalcifications (78% vs 72%, NS) and re-intervention rate (40% vs 42%, NS) were equivalent. The rate of local recurrence at 24 months was 3% [0-7.1] in patients with conservative treatment (n = 3). With a median follow-up of 40 months, 5 local relapses (two with axillary metastatic involvement), two distant metastatic evolution, one contralateral breast cancer and one death unrelated to cancer occurred.


CONCLUSIONS
Following bracketing wire localization, OS allowed the conserving management of significantly larger lesions with wider resection volumes, without significant increase in margin involvement or re-intervention rate, and equivalent rate of microcalcifications clearance compared to SL.
Department of Radiology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France. Electronic address: caroline.malhaire@curie.fr.
Caroline
C
Malhaire
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Delphine
D
Hequet
Department of Public Health, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Marie-Christine
MC
Falcou
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Jean-Guillaume
JG
Feron
Department of Radiology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Anne
A
Tardivon
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Alexandre
A
Leduey
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Eugénie
E
Guillot
Department of Public Health, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Véronique
V
Mosseri
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Roman
R
Rouzier
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Benoit
B
Couturaud
Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Fabien
F
Reyal
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D047368:Tumor Burden; D018084:Ultrasonography, Interventional