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Background <p>ACOSOG Z11102 demonstrated that breast-conserving surgery (BCS) with radiation is safe for multiple ipsilateral breast cancers (MIBCs), with re-excision and mastectomy conversion rates of 32.4% and 7.1%, respectively. Our objective was to evaluate the applicability of ACOSOG Z11102 in real-world practice.</p> Methods <p>A retrospective review of MIBC patients was performed to collect clinical and demographic information. Pathology was re-reviewed by two breast pathologists assessing distance between foci and presence of significant pathology in intervening tissue (incidental invasive carcinoma, ductal carcinoma in situ [DCIS], atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], and flat epithelial atypia [FEA]).</p> Results <p>Overall, 116 evaluable patients (70 mastectomy, 46 BCS) were included. The median age was 64&#xa0;years (range 34–93), the median number of foci was 2 (range 1–3), and the median size of the largest focus was 1.7&#xa0;cm (range 0.4–6.5). Most patients were cT1 (84, 72.4%) and cN0 (111, 95.7%). Of the 46 BCS patients, 23 (50%) needed re-excisions. Eleven of these 23 (47.8%) patients had successful re-excisions, while 12 (52.2%) underwent mastectomy. The successful BCS rate was 73.9%, with conversion to mastectomy in 26.1%. On review of intervening tissue, 26 (22.4%) patients had no pathologic findings, 57 (49.1%) had DCIS, 19 (16.4%) had ALH, 13 (11.2%) had ADH, 11 (9.5%) had LCIS, 6 (5.2%) had additional incidental invasive carcinoma, and 1 (0.9%) had FEA. Factoring in intervening findings and Z11102 criteria, 15/70 (21.4%) patients who underwent mastectomy could have been eligible for BCS.</p> Conclusions <p>Patient selection is critical when considering BCS for MIBC, as re-excision and mastectomy conversion rates may be higher in real-world practice.</p>

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Real-World Application of Alliance ACOSOG Z11102: How Many Patients Can be Spared Mastectomy?

  • 期刊论文

  • 发表日期：

    2025年9月16日

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  • Frances Phang,
  • Brian Finkelman,
  • Jessica Gooch,
  • Ann Olzinski-Kunze,
  • Kristin A. Skinner,
  • Daniel Kim,
  • Kimberly Gergelis,
  • Bradley Turner,
  • Anna Weiss

摘要

Background

ACOSOG Z11102 demonstrated that breast-conserving surgery (BCS) with radiation is safe for multiple ipsilateral breast cancers (MIBCs), with re-excision and mastectomy conversion rates of 32.4% and 7.1%, respectively. Our objective was to evaluate the applicability of ACOSOG Z11102 in real-world practice.

Methods

A retrospective review of MIBC patients was performed to collect clinical and demographic information. Pathology was re-reviewed by two breast pathologists assessing distance between foci and presence of significant pathology in intervening tissue (incidental invasive carcinoma, ductal carcinoma in situ [DCIS], atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], and flat epithelial atypia [FEA]).

Results

Overall, 116 evaluable patients (70 mastectomy, 46 BCS) were included. The median age was 64 years (range 34–93), the median number of foci was 2 (range 1–3), and the median size of the largest focus was 1.7 cm (range 0.4–6.5). Most patients were cT1 (84, 72.4%) and cN0 (111, 95.7%). Of the 46 BCS patients, 23 (50%) needed re-excisions. Eleven of these 23 (47.8%) patients had successful re-excisions, while 12 (52.2%) underwent mastectomy. The successful BCS rate was 73.9%, with conversion to mastectomy in 26.1%. On review of intervening tissue, 26 (22.4%) patients had no pathologic findings, 57 (49.1%) had DCIS, 19 (16.4%) had ALH, 13 (11.2%) had ADH, 11 (9.5%) had LCIS, 6 (5.2%) had additional incidental invasive carcinoma, and 1 (0.9%) had FEA. Factoring in intervening findings and Z11102 criteria, 15/70 (21.4%) patients who underwent mastectomy could have been eligible for BCS.

Conclusions

Patient selection is critical when considering BCS for MIBC, as re-excision and mastectomy conversion rates may be higher in real-world practice.