title: How to compare the oncological safety of oncoplastic breast conservation surgery - To wide local excision or mastectomy?
abstract: BACKGROUND
  Comparative studies suggest that patients treated with oncoplastic breast conservation surgery (OBCS) have similar pathology to patients treated with wide local excision (WLE). However, patients treated with OBCS have never been compared to patients treated with mastectomy. The aim of this study was to identify which control group was comparable to patients undergoing OBCS.
  
  
  METHODS
  Commonly reported histopathological variables of patients treated with OBCS, WLE or mastectomy ± immediate reconstruction (Ms ± IR) were compared using Fisher Exact or Chi squared tests.
  
  
  RESULTS
  1000 patients' data were analysed (OBCS: n = 119; WLE: n = 600; Ms ± IR: n = 281). Tumour size was significantly bigger after OBCS than WLE (p < 0.001), but similar to Ms ± IR (p = 0.138). Tumour grade was higher after OBCS than WLE (p < 0.001), but similar to Ms ± IR (p = 0.497). More axillary nodes were involved in patients with OBCS than WLE (p < 0.001), but comparable to Ms ± IR (p = 0.175). ER and PR expressions were lower after OBCS compared to WLE (p = 0.007, p = 0.009), but identical to Ms ± IR (p = 1, p = 0.904 respectively). Differences in application of systemic (neo)adjuvant therapy followed the above trend.
  
  
  CONCLUSIONS
  Striking similarities found between OBCS and mastectomy patients' histopathological results are in sharp contrast with previously published data. This study suggests that oncological outcomes following OBCS should be compared to mastectomy besides WLE.
authors.affiliation: Department of Surgery, Victoria Infirmary Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mansell
authors.affiliation: Department of Surgery, Glasgow Royal Infirmary, UK.
authors.forename: E
authors.initials: E
authors.lastname: Weiler-Mithoff
authors.affiliation: Department of Surgery, Victoria Infirmary Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: Martin
authors.affiliation: Department of Surgery, Victoria Infirmary Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Surgery, Western Infirmary Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: Stallard
authors.affiliation: Department of Surgery, Western Infirmary Glasgow, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Doughty
authors.affiliation: Department of Surgery, Victoria Infirmary Glasgow, UK. Electronic address: laszlo.romics@nhs.net.
authors.forename: L
authors.initials: L
authors.lastname: Romics
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D016462:Mammaplasty / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000379:methods / Q000706:statistics & numerical data*; D015413:Mastectomy, Simple / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Mastectomy; Oncoplastic breast conservation; Pathology; Recurrence; Therapeutic mammoplasty; Wide excision