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Background: In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), also named "COVID-19", has produced a global pandemic and has seriously affected many health systems around the world. Since the World Health Organization (WHO) declared the novel COVID-19 outbreak as a global pandemic, many international societies and groups of experts have published clinical guidelines and recommendations for surgical management of breast cancer patients in this time of crisis and issued COVID guidelines to prioritize surgery where time is critical and it cannot be deferred. Methods: In this study, we review current recommendations for breast cancer surgery during the COVID-19 pandemic and propose a plan for future waves of the current pandemic while minimizing the risk of the contagious disease and oversaturating the health systems regarding the burden of accumulating untreated disease. Results: We create a critical and constructive vision from learnt lessons for similar future situations and propose a moving forward plan during and after the COVID-19 pandemic. Conclusion: Although in many parts of world, it would appear that now we are past the peak of the COVID-19 pandemic, we still face as uncertainty as to the future course of the pandemic and the challenges of the second wave. It is important to reappraise continuously the guidance and to emphasize the need for new protocols under new norms to continue to deliver breast cancer surgery safely. [ABSTRACT FROM AUTHOR]

A case study of a 44-year-old woman presented with a history of painless, growing of right breast mass causing postural changes. Topics include patient was presented in a multidisciplinary meeting (MDM) with input from sarcoma specialists as well as plastic surgeons that recommended right total mastectomy with immediate reconstruction; and thoracic computed tomography (CT) scan confirmed a large, irregular, solid right breast mass with dilated vasculature in its caudal portion.

Objective: The aim of this retrospective study was to assess the risk factors for developing ipsilateral breast tumor reappearance (IBTR) and de novo contralateral breast cancer (BC) after primary BC treatment. Methods: Retrospectively, 15,168 consecutive patients with primary monolateral BC were enrolled in this monocentric study (from June 1994 to December 2006). Clinicopathological features, follow-up, and survival at 15 years were considered for statistical analysis. Results: Significant associations of increased risk for IBTR were verified with metastatic axillary lymph nodes (HR 1.37 [1.15–1.62], p = 0.0004), high tumor grade G2 (HR 1.35 [1.05–1.74], p = 0.02) and G3 (HR 1.35 [1.01–1.79], p = 0.04), luminal B (HR 1.51 [1.25–1.82], p < 0.0001), and HER2-positive (HR1.66 [1.14–2.41], p = 0.008) and triple-negative subtype (HR 1.54 [1.07–2.21], p = 0.02). Older age (HR 1.44 [1.08–1.91], p = 0.01) and positive family history (HR 1.85 [1.47–2.32], p < 0.0001) were risk factors for contralateral BC. Significant protective factors for IBTR were hormonotherapy (HR 0.71 [0.59–0.85], p = 0.0003), chemotherapy (HR 0.72 [0.60–0.87], p = 0.001), and radiotherapy (HR 0.73 [0.61–0.87], p = 0.0005). Hormonotherapy was also confirmed as a protective factor for contralateral second BC (HR 0.43 [0.30–0.60], p < 0.0001). Conclusions: We classified factors for IBTR and contralateral BC in high- and low-risk groups. In the high-risk group, breast surgery still remains more important than in the low-risk group, which seems to benefit more from adjuvant treatments. [ABSTRACT FROM AUTHOR]

Simple Summary: Surgical management is currently the main standard of care procedure used in order to treat ductal carcinoma in situ (DCIS) of the breast. Nevertheless, the survival benefit of surgical resection in patients with such lesions appears to be low, especially for low-grade DCIS. Low-grade DCIS typically exhibit a slow growth pattern and, in many cases, never fully develop into a clinically significant disease: discerning harmless lesions from potentially invasive ones could lead to avoid overtreatment in many patients. Nonetheless, up to 26% of patients with biopsy-proven DCIS can reveal a synchronous invasive carcinoma in surgical specimens. Here, we aimed to create a model of radiological and pathological criteria able to reduce the underestimation of vacuum assisted breast biopsy in DCIS, identifying patients at very low risk (e.g., <2%) of diagnostic underestimation. Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: A total of 3100 VABBs were retrospectively reviewed, among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients' features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate and multivariate analysis. Finally, we developed a nomogram for predicting the upstage at surgery, according to the multivariate logistic regression model. Results: The overall upgrade rate to invasive carcinoma was 10.8%. At univariate analysis, the risk of upgrade was significantly lower in patients with greater age (p = 0.018), without post-biopsy residual lesion (p < 0.001), with a smaller post-biopsy residual lesion size (p < 0.001), and in the presence of low-grade DCIS only in specimens with microcalcifications (p = 0.002). According to the final multivariable model, the predicted probability of upstage at surgery was lower than 2% in 58 patients; among these 58 patients, only one (1.7%) upstage was observed, showing a good calibration of the model. Conclusions: An easy-to-use nomogram for predicting the upstage at surgery based on radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas. [ABSTRACT FROM AUTHOR]

Abstract: Although it has been shown that axillary dissection (AD) is unnecessary and without a rational basis in patients with pure ductal intraepithelial neoplasia (DIN), it is evident from the literature that AD (i.e., in the USA and in the UK) has been still recently performed. Furthermore sentinel lymph node biopsy (SLNB) is not usually required in all cases of DIN, but may be indicated in certain specific cases. Even if the SLNB is positive, AD should not be performed immediately but only in cases where an invasive component is found on definitive pathological examination of the DIN lesions. [Copyright &y& Elsevier]

Introduction: Patients who have undergone mantle radiotherapy for Hodgkin's disease (HD) are at increased risk of developing breast cancer. In such patients, breast conserving surgery (BCS) followed by breast irradiation is generally considered contraindicated owing to the high cumulative radiation dose. Mastectomy is therefore recommended as the first option treatment in these women., Methods: Six patients affected by early breast cancer previously treated with mantle radiation for HD underwent BCS associated with full-dose intraoperative radiotherapy with electrons (ELIOT)., Results: A total dose of 21 Gy (prescribed at 90% isodose) in five cases and 17 Gy (at 100% isodose) in one case were delivered directly to the mammary gland without acute complications and with good cosmetic results. After an average of 30.8 months of follow up, no late sequelae were observed and the patients are free of disease., Conclusion: In patients previously irradiated for HD, ELIOT can avoid repeat irradiation of the whole breast, permit BCS and decrease the number of avoidable mastectomies.