Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery

• Published in: European journal of surgical oncology Vol. 42; no. 4; pp. 481 - 488
• Main Authors: Shiina, N, Sakakibara, M, Fujisaki, K, Iwase, T, Nagashima, T, Sangai, T, Kubota, Y, Akita, S, Takishima, H, Miyazaki, M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2016
• Subjects: Breast cancer; Breast density; Breast Neoplasms - diagnosis; Breast Neoplasms - psychology; Breast Neoplasms - surgery; Breast-conserving surgery; Cosmetic outcome; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Mammography; Mastectomy, Segmental - methods; Mastectomy, Segmental - psychology; Middle Aged; Organ Size; Postoperative Period; Prognosis; Quality of Life; Retrospective Studies; ROC Curve; Surgery; Time Factors; Breast density; PBVE; ROC; Breast cancer; percent breast volume excised; volumetric breast density; BCT; percent of remnant breast volume; PRBV; VBD; Cosmetic outcome; breast-conserving therapy; receiver operating characteristic; Breast-conserving surgery
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.01.004

Abstract Background The critical issue related to breast-conserving therapy (BCT) is that cosmetic outcomes deteriorate with long-term follow-up. There is little research for breast density as a predictor of cosmetic outcomes at the late stage after BCT. To improve the long-term quality of life after BCT of breast cancer patients, the correlation of volumetric breast density (VBD) and cosmetic outcome at the late stage after BCT was evaluated. Study design Breast volume, fibroglandular tissue volume, adipose tissue volume, and VBD were calculated on mammography using image analysis software (Volpara® ) in 151 patients with BCT. Furthermore, the correlation of breast density and the change of breast volume over time was analyzed on mammography in 99 patients who were followed-up long-term after BCT. Results On multivariate analysis, VBD was a predictor of cosmetic outcome after BCT with percent breast volume excised (PBVE). Decreased adipose tissue volume and increased fibrosis were more common in patients with VBD < 15%. Furthermore, remnant breast volume continued to decrease over time in low breast density patients during long-term follow-up. 93% of patients with VBD ≥ 15% and PBVE < 10% had a better cosmetic outcome, while 60% of patients with VBD < 15% and PBVE ≥ 10% had a worse cosmetic outcome after BCT. Conclusions While PBVE was involved in cosmetic outcome at the early stage after BCT, VBD was associated with cosmetic outcome at the late stage after BCT. Thus, a combination of VBD and PBVE could predict cosmetic outcome after BCT and contribute to the selection for the appropriate BCT.