Should oncoplastic breast conserving surgery be used for the treatment of early stage breast cancer? Using the GRADE approach for development of clinical recommendations
Nicola Rocco,
Giuseppe Catanuto, MD, PhD,
Michela Cinquini,
Werner Audretsch,
John Benson,
Carmen Criscitiello, MD, PhD,
Rosa Di Micco,
Tibor Kovacs,
Henry Kuerer,
Laura Lozza,
Giacomo Montagna,
Ivan Moschetti,
Nahid Nafissi,
Rachel L. O’Connell,
Serena Oliveri,
Loredana Pau,
Gianfranco Scaperrotta,
Achilles Thoma,
Zoe Winters, MD, PhD,
Maurizio Bruno Nava
Affiliations
Nicola Rocco
G.RE.T.A. Group for Reconstructive and Therapeutic Advancements, Milan, Naples, Catania, Italy; Corresponding author.
Giuseppe Catanuto, MD, PhD
G.RE.T.A. Group for Reconstructive and Therapeutic Advancements, Milan, Naples, Catania, Italy; Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
Michela Cinquini
Unit of Systematic Reviews Methodology and Guidelines Production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
Werner Audretsch
Department of Senology and Breast Surgery, Marien Hospital VKKD, Dusseldorf, Germany
John Benson
Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
Carmen Criscitiello, MD, PhD
IEO, European Institute of Oncology IRCCS, Milan, Italy
Rosa Di Micco
Breast Surgery Unit, San Raffaele University Hospital, Milan, Italy; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
Tibor Kovacs
Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; Breast Institute, Jiahui International Hospital, Shanghai, China
Henry Kuerer
Division of Surgery, Department of Breast Surgical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
Laura Lozza
Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
Giacomo Montagna
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Breast Center, University Hospital of Basel, Basel, Switzerland
Ivan Moschetti
Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
Nahid Nafissi
Iran University of Medical Sciences, Teheran, Iran
Rachel L. O’Connell
Department of Breast Surgery Royal Marsden NHS Foundation Trust, Sutton, UK
Serena Oliveri
Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
Loredana Pau
Europa Donna Italia, Milan, Italy
Gianfranco Scaperrotta
Radiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
Achilles Thoma
Division of Plastic Surgery, Department of Surgery, McMaster University & Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
Zoe Winters, MD, PhD
Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
Maurizio Bruno Nava
G.RE.T.A. Group for Reconstructive and Therapeutic Advancements, Milan, Naples, Catania, Italy
Introduction: The potential advantages of oncoplastic breast conserving surgery (BCS) have not been validated in robust studies that constitute high levels of evidence, despite oncoplastic techniques being widely adopted around the globe. There is hence the need to define the precise role of oncoplastic BCS in the treatment of early breast cancer, with consensual recommendations for clinical practice. Methods: A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints and establish recommendations for the use of oncoplastic BCS as primary treatment of unifocal early stage breast cancers using the GRADE approach. Results: According to the results of the systematic review of literature, the panelists were asked to comment on the recommendation for use of oncoplastic BCS for treatment of operable breast cancer that is suitable for breast conserving surgery, with the GRADE approach. Based on the voting outcome, the following recommendation emerged as a consensus statement: Oncoplastic breast conserving surgery should be recommended versus standard breast conserving surgery for the treatment of operable breast cancer in adult women who are suitable candidates for breast conserving surgery (with very low certainty of evidence). Discussion: This review has revealed a low level of evidence for most of the important outcomes in oncoplastic surgery with lack of any randomized data and absence of standard tools for evaluation of clinical outcomes and especially patients’ values.Despite areas of controversy, about one-third (36%) of panel members expressed a strong recommendation in support of oncoplastic BCS. Presumably, this reflects a synthesis of views on the relative complexity of these techniques, associated complications, impact on quality of life and costs.
