The adaptation process of a teaching and research hospital to changing trends in modern breast surgery
Mustafa Gökhan Ünsal1, Ahmet Cem Dural1, Muhammet Ferhat Çelik1, Cevher Akarsu1, İrfan Başoğlu1, M. Ece Dilege2, Selin Kapan1, Halil Alış1
1Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
2Department of General Surgery, Breast Health and Diseases Unit, V.K.V. American Hospital, İstanbul, Turkey
Objective: Minimally invasive surgery is increasingly gaining importance in breast surgery parallel to other surgical branches. Sentinel lymph node biopsy (SLNB) is a method that has radically changed the approach to breast surgery in the last decade of the 20th century. In this study, we aimed to evaluate the adaptation process to these alterations in breast surgery at our clinic.
Material and Methods: Patients who underwent surgery with a diagnosis of breast cancer in our clinic between April 2010 and November 2013 were retrospectively evaluated in terms of demographic characteristics, the number of operations and type of surgical methods applied according to years, SLNB performance rate, and results of frozen section and histopathological analysis. The first year of SLNB practice was accepted as part of the learning curve, and 24 patients who were operated during that period underwent routine axillary dissection.
Results: The median age of 198 patients who were included in the study was 55 years (25-89). It was detected that the number of cases who underwent surgery for breast cancer increased in years, that the SLNB application rate increased from 37% to 66% between 2010 and 2013 (p=0.01), and SLNB staining rates increased from 70% to 94% (p=0.03). When only results from the last four years were evaluated, the mean staining rate in patients with SLNB (n=105) was 88% (n=92), with positive histopathology in 32% of these cases (n=30). Despite a decreasing trend over the years, a metastatic axillary lymph node was detected in paraffin block evaluation in spite of negative frozen section examination of SLNB in five cases, and 5 patients (5%) out of 97 patients who underwent breast conserving surgery required re-excision. The histopathological diagnosis was invasive ductal carcinoma in 84% (n=167) of patients.
Conclusion: It was observed that during the four-year period of adaptation, the application rate of breast conserving surgery and SLNB reached accepted standards, and that both the technical problems encountered in SLNB and the requirement for re-excision after breast conserving surgery significantly decreased with increasing case volume and experience.
Keywords: Breast-conserving surgery, sentinel lymph node biopsy, lymph node dissection, mastectomy
Due to the retrospective design and anonymized data of patient charts, ethical approval has not been questioned.
Written informed consent was obtained from patients who participated in this study.
Concept - M.G.Ü., M.F.Ç., A.C.D.; Design - M.G.Ü., M.F.Ç., İ.B.; Supervision - H.A., M.E.D.; Data Collection and/or Processing - İ.B., A.C.D., C.A.; Analysis and/or Interpretation - H.A., M.E.D., S.K.; Literature Review - İ.B., A.C.D., C.A.; Writer - M.G.Ü., M.F.Ç., C.A.; / Critical Review - H.A., M.E.D., S.K.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.