BALKAN MCO 2011 - J. Zgajnar and M. Margaritoni - Surgery (SLNB, management of non palpable lesions, specific problems of the Balkan region, oncoplastic surgery)

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

In all breast lesions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mammography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ultrasound ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MRI ,[object Object],[object Object],[object Object],[object Object],[object Object]

F INE N EEDLE A SPIRATION B IOPSY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Core biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object]

D ecision on first t reatment based on : ,[object Object],[object Object],[object Object]

Aim of the surgery in BC ,[object Object],[object Object],[object Object],[object Object]

Cancer has to be radically excised ,[object Object],[object Object],[object Object],[object Object]

Tumour size : breast size is crucial

What to do? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

margins dilemma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Internal mammary chain Rotter nodes intramammary Infraclavicular nodes axillary lnn.

Side effects od the ALND ,[object Object],[object Object],[object Object],[object Object]

SLNB indications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*van Deurzen et al, JNCI 2008 **Viale et al, Am Surg 2005 ***Staver et al, Ann Surg Oncol 2010 ****Katz et al, JCO 2008

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Bilimoria et al, JCO 2009

[object Object],[object Object],Author No. of patients No. of recurrences Median follow-up (months) Guenther (2003) 46 0 32 Fant (2003) 31 0 30 Naik (2004) 210 3 25 Langer (2005) 27 0 42 Jeruss (2005) 73 0 27 Hwang (2007) 196 0 30 Park (2007) 278 6 23 Zakaria (2008) 86 0 30 TOTAL 947 9 (1%) 27

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],*Khan et al, Ann Surg Oncol 2005 Newman et al, Ann Surg Oncol 2007

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Patients with up to two positive (macromets) SLNs RANDOMIZATION ALND NO ALND Patients with ITC or micromets in SLNs RANDOMIZATION ALND NO ALND Patients with positive SLNs RANDOMIZATION ALND RT of the axilla

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Bilimoria et al, JCO 2009 **Wasif et al, Ann Surg Oncol 2009

Acosog Z 11 Giuliano AE et al, JAMA, 2011

St. Gallen consensus 2011 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgery of screening detected cancers encompasses.. ,[object Object]

Screen-detected breast cancer surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical techniques to be used ,[object Object],[object Object],[object Object],[object Object],[object Object]

Some important facts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Localisation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What do we want? correct wrong

ROLL Radioguided Occult Lesion Localization (Luini A et al., BJS, 1999) ,[object Object],[object Object],[object Object]

Frozen section? ,[object Object]

EUSOMA GUIDELINES Perry N.M. on behalf of EUSOMA Eur J Cancer 200 1 ;37: 159 - 172 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

European guidelines ,[object Object],[object Object],[object Object]

BALKAN MCO 2011 - J. Zgajnar and M. Margaritoni - Surgery (SLNB, management of non palpable lesions, specific problems of the Balkan region, oncoplastic surgery)

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BALKAN MCO 2011 - J. Zgajnar and M. Margaritoni - Surgery (SLNB, management of non palpable lesions, specific problems of the Balkan region, oncoplastic surgery)