Reviewing Best Practices in the Surgical Management of Breast Cancer: Key Advances

In this third episode of OncChats: Reviewing Best Practices in the Surgical Management of Breast Cancer, Gladys Giron, MD, FACS, and Cristina Lopez-Peñalver, MD, both of Baptist Health South Florida, discuss key advancements made in the surgical treatment of patients with breast cancer.

Lopez-Peñalver: As we’ve learned, advancements such as artificial intelligence and robotic surgery have transformed the landscape of the way we treat [patients with] cancer. Specific to breast cancer, Dr Giron, do you mind expanding on the key advancements in surgery for [these] patients?

Giron: Unfortunately, robotic surgery doesn’t play a role in our standard treatment for [patients with] breast cancer at this time. The use of artificial intelligence in the operating room for the surgical treatment of [these] patients is not quite a part of our standard of care. However, it certainly is part of and will expand its role in the radiologic diagnosis and detection of breast cancer and we do work very closely with our radiologists and our pathologists to work up our patients and eventually bring them to surgery.

[There are some] advancements that we have been able to witness during our time as medical students, residents, and then, in practice. In 1992, sentinel lymph node biopsies were performed and changed the landscape of axillary surgery—not just in [patients with] breast cancer, but in the management of other patients, such as those with melanoma. This procedure has allowed for less extensive axillary surgery in most [patients with] breast cancer. [Those with] stage III [disease] will often present with nodal metastatic disease, and therefore, move on to receive preoperative systemic therapy either chemotherapy or endocrine therapy. We want to be certain at the time of surgery that those lymph nodes are removed. One way to do that is to mark those lymph nodes, as you touched upon a bit earlier, Dr Lopez-Peñalver.

When we place radiologic clips, we cannot necessarily find those at the time of surgery and if we have the response that we desire, which is a decrease in the size of the lymph node, it may be difficult to find that particular lymph node at the time of our surgical intervention. So, the placement of markers that can later be tracked has really changed how we can manage those patients. We have the ability to use reflectors. We can use magnetic seeds or radioactive seeds that help us locate those lymph nodes to ensure that they are removed and that they are analyzed by the pathologist to give us an idea of what the response to treatment was, and therefore, guide treatment that is given by the medical oncologist and radiation oncologist after surgery.

Another area where we have seen a lot of advances that have had a great impact on the care of our patients is in that of oncoplastic techniques that can be used whether we operate on the patient up front or if we operate on them after neoadjuvant therapy. This allows for breast conservation in patients who, in the past, may not have been candidates for breast conservation; it improves cosmetic outcomes without compromising the care that the patient is receiving. Certainly, breast cancer reconstructive techniques have improved substantially for those who do require mastectomies.

Check back on Tuesday for the next episode in the series.