Assistant Professor SMG-SNU Boramae Medical Center
Introduction: Central lumpectomy (CL) is a breast-conserving surgery (BCS) technique that excise nipple areolar complex with breast tumor for centrally located breast cancer. While several studies reported oncologic safety of CL compared to total mastectomy, few investigated local recurrence rate after CL.
Methods: Patient records who underwent BCS with clear resection margins for invasive breast cancer between 2004 and 2018 were retrospectively reviewed. Of the total 6,533 patients, 106 (1.6%) underwent CL. Median follow-up duration was 73.4 months. Ipsilateral breast tumor recurrence (IBTR) was compared with conventional BCS
Results: During the median follow-up period of 73.4 months, 7 and 132 IBTR events were observed in CL and conventional BCS groups, respectively. CL group showed significantly higher IBTR rate than the conventional BCS group (10-year IBTR rate: 5.8% vs. 3.1%, p=0.004) and also after adjusting other variables (HR 2.65; 95%CI: 1.07-6.60, p=0.048). However, regional recurrence, distant metastasis, and overall survival rate were not significantly different between the two groups. We conducted 1:3 propensity score matching (PSM) yielding 99 and 297 patients in CL and conventional BCS group, respectively. Still, CL showed significantly higher IBTR rate than conventional BCS group (HR 3.27; 95% CI: 0.94-11.36; p=0.048). Lastly, analyzing 2,213 patients whose tumor was located within 3cm of nipple, CL showed significantly higher IBTR rate than conventional BCS group before (p=0.032) and after PSM (p=0.025)
Conclusions: CL showed higher IBTR rate compared to conventional BCS while other survival outcomes were comparable. For centrally located tumors, CL can be an option for whom prefers to preserve breast. However, shared decision making with patients regarding potential IBTR risk and more careful surveillance would be needed.