Skip to main content

Advertisement

SpringerLink
Log in

The lobar approach to breast ultrasound imaging and surgery

  • Review Article
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Breast cancer is a lobar disease in the sense that, at the earliest stages, the cancer is structurally confined to a single sick lobe. The subgross morphology of breast carcinoma is often complex, as multiple invasive foci are frequently present and the ductal system often contains an extensive in situ component. Adequate preoperative visualization of all of the malignant structures within the affected breast and preoperative mapping of the lesions in relation to the surrounding normal structures are essential for successful image-guided breast surgery and therefore are key factors in assuring adequate local control of the disease. We advocate use of the lobar approach in ultrasound imaging (ducto-radial echography) and breast-conserving surgery based on the lobar anatomy of the breast, the sick lobe theory, our extensive clinical experience with the approach, and favorable long-term patient outcomes. Despite abundant evidence demonstrating the advantages of the lobar approach, the number of breast centers using it in practice is still limited. In this review, we aim to call attention to the advantages of the lobar approach from the theoretical, imaging, and surgical points of view.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Cooper AP. On the anatomy of the breast. London: Longman, Orme, Green, Bown, and Longmans; 1840.

    Google Scholar 

  2. Townsend CM. Breast lumps. Clin Symp. 1980;32:1–30.

    PubMed  Google Scholar 

  3. Durante EL, Cavazzini L. Surgical echography as diagnostic and staging tool in breast pathology. In: Montorsi M, Granelli P, editors. Thoracic Surgery. Bologna: Monduzzi Publisher; 1988. p. 301–8.

    Google Scholar 

  4. Durante E, Cavallesco NG, Pampolini M, et al. Echography of the breast. Indications, criteria and diagnostic possibilities. Minerva Chir. 1989;44:405–17 (Article in Italian).

  5. Ueno E, Tohno E, Soeda S, et al. Dynamic tests in real-time breast echography. Ultrasound Med Biol. 1988;14:53–7.

    Article  PubMed  Google Scholar 

  6. Ueno E. Real-time two dimensional Doppler imaging in the breast diseases. Proceedings of the 55th annual scientific meeting of Japan Society of Ultrasonics in Medicine 1990;73–74.

  7. Teboul M, Halliwell M. Atlas of ultrasound and ductal echography of the breast. Oxford: Wiley; 1995.

    Google Scholar 

  8. Amy D. Echographie mammaire: echoanatomie. JL mensuel d’echographie LUS. 2000;10:654–62.

    Google Scholar 

  9. Gallager S, Martin J. Early phases in the development of breast cancer. Cancer. 1969;24:1170–8.

    Article  CAS  PubMed  Google Scholar 

  10. Holland R, Veling SHJ, Mravunac M, et al. Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56:979–90.

    Article  CAS  PubMed  Google Scholar 

  11. Nakama S, Yokoi H. Shimatani Y, et al. Comparative studies on ultrasonogram with histological structure of the breast cancer: an examination in the invasive process of breast cancer and the fixation to the skin. In: Kasumi F, Ueno E, editors. Topics in breast Ultrasound. Tokyo (Japan): Shinohara Publishers; 1991. pp. 90–91.

  12. Tot T. DCIS, cytokeratins, and the theory of the sick lobe. Virchows Arch. 2005;447:1–8.

    Article  PubMed  Google Scholar 

  13. Villadsen R. In search of stem cell hierarchy in the human breast and its relevance in breast cancer evolution. APMIS. 2005;113:903–21.

    Article  PubMed  Google Scholar 

  14. Agelopoulos K, Buerger H, Brandt B. Allelic imbalance of the egfr gene as key event in breast cancer progression: the concept of committed progenitor cells. Current Cancer Drug Target. 2008;8:431–45.

    Article  CAS  Google Scholar 

  15. Tot T. The role of large-format histopathology in assessing subgross morphological prognostic parameters: a single institution report of 1000 consecutive breast cancer cases. Int J Breast Cancer. 2012;2012:1–8. Art ID 395415. doi:10.1155/2012/395415

    Google Scholar 

  16. Tot T. The Sick Lobe Concept. In: Francescatti DS, Silverstein MJ, editors. Breast cancer: a new era in management. New York: Springer; 2014. p. 79–94.

    Chapter  Google Scholar 

  17. Teboul M. Practical ductal echography, guide to intelligent and intelligible ultrasonic breast imaging. Madrid: Medgen SA; 2004. p. 240–340.

    Google Scholar 

  18. Teboul M. Advantages of ductal echography (DE) over conventional breast investigation: the requirement for an anatomically led breast ultrasonography. Med Ultrason. 2010;12:32–42.

    PubMed  Google Scholar 

  19. Amy D. Lobar ultrasound of the breast. In: Tot T, editor. Breast cancer, a lobar disease. New York: Springer; 2011. p. 153–62.

    Google Scholar 

  20. Teboul M. A new concept in breast investigation: echohistological acino-ductal analysis or analytic echography. Biomed Pharmacother. 1988;42:289–96.

    CAS  PubMed  Google Scholar 

  21. Tot T. Breast cancer subgross morphological parameters and their relation to molecular phenotypes and prognosis. J OncoPath. 2014;2:69–76.

    Article  Google Scholar 

  22. Dolphin G. The surgical approach to the “sick lobe”. In: Francescatti DS, Silverstein MJ, editors. Breast cancer: a new era in management. New York: Springer; 2014. p. 113–32.

    Chapter  Google Scholar 

  23. Curigliano G, Viale G, Bagnardi V, et al. Clinical relevance of HER2 overexpression/amplification in patients with small tumor size and node negative cancer. J Clin Oncol. 2009;27:5693–9.

    Article  PubMed  Google Scholar 

  24. Tot T, Gere M, Pekár G, et al. Breast cancer multifocality, disease extent, and survival. Hum Pathol. 2011;42:1761–9.

    Article  PubMed  Google Scholar 

  25. Chung AP, Huynh K, Kidner T, et al. Comparison of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer. J Am Coll Surg. 2012;215:137–46.

    Article  PubMed  Google Scholar 

  26. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology: American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;8:553–64.

    Article  Google Scholar 

  27. O’Sullivan MJ, Li T, Freedman G, et al. The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery. Ann Surg Oncol. 2007;14:3133–40.

    Article  PubMed  Google Scholar 

  28. Mullenix PS, Cuadrado DG, Steele SR, et al. Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy. Am J Surg. 2004;187:643–6.

    Article  PubMed  Google Scholar 

  29. Durante E, Pellegrini F, Carbonell Luna MI. Preoperative local staging of invasive cancer by US. In: Badulescu F, Bondari A, Enachescu V, editors. Syllabus of Euroson School Course Breast Ultrasound (ISBN 973-7757-23-8). Craiova (Romania): Editura Medicala Universitara Craiova; 2004. pp. 77–80.

  30. Durante E, Pellegrini F, Carbonell Luna MI. US breast conservative surgery and sentinel node. In: Badulescu F, Bondari A, Enachescu V, editors. Syllabus of Euroson School Course Breast Ultrasound (ISBN 973-7757-23-8). Craiova (Romania): Editura Medicala Universitara Craiova; 2004. pp. 90–94.

  31. Aziz D, Rawlinson E, Narod SA, et al. The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer. Breast J. 2006;12:331–7.

    Article  PubMed  Google Scholar 

  32. Bani MR, Lux MP, Heusinger K, et al. Factors correlating with reexcision after breast-conserving therapy. Eur J Surg Oncol. 2009;35:32–7.

    Article  CAS  PubMed  Google Scholar 

  33. Rath MG, Heil J, Domschke C, et al. Predictors of respectability in breast-conserving therapy. Arch Gynecol Obstet. 2012;286:1023–31.

    Article  PubMed  Google Scholar 

  34. Jung W, Kang E, Kim SM, et al. Factors associated with re-excision after breast-conserving surgery for early-stage breast cancer. J Breast Cancer. 2012;15:412–9.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Eck DL, Koonce SL, Goldberg RF, et al. Breast surgery outcomes as a quality measures according to the NSQIP database. Ann Surg Oncol. 2012;19:3212–7.

    Article  PubMed  Google Scholar 

  36. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307:467–75.

    Article  PubMed  Google Scholar 

  37. Meier-Meitinger M, Rauth C, Adamietz B, et al. Accuracy of radiological tumour size assessment and the risk for re-excision in a cohort of primary breast cancer patients. Eur J Surg Oncol. 2012;38:44–51.

    Article  CAS  PubMed  Google Scholar 

  38. Wilke LG, Czechura T, Waang C, et al. Repeat surgery after breast conservation for the treatment of Stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004–2010. JAMA. 2014. doi:10.1001/jamasurg.2014.926.

    Google Scholar 

  39. M De Camargo Cancela, Comber H, Sharp L. Hospital and surgeon caseload are associated with risk of re-operation following breast-conserving surgery. Breast Cancer Res Treat. 2014;140:535–44.

    Google Scholar 

  40. Hunt KK, Sahin AA. Too much, too little, or just right? Tumors margins in women undergoing breast-conserving surgery. J Clin Oncol. 2014;32:1401–6.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Dr. Amy, Dr. Durante, and Dr. Tot have no financial interest or other relationship with any manufacturer of any product or provider of any service mentioned in this article.

Ethical standard

Additional informed consent was obtained from all the patients for whom identifying information is included in this article.

Author information

Authors and Affiliations

  1. Breast Center, 21 Avenue Victor Hugo, Aix-en-Provence, 13100, France

    Dominique Amy

  2. Institute of General Surgery, University of Ferrara, via C.Contini n° 19, 44123, Ferrara, Italy

    Enzo Durante

  3. Department of Clinical Pathology and Cytology, Central Hospital Falun, 79182, Falun, Sweden

    Tibor Tot

Authors
  1. Dominique Amy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enzo Durante
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tibor Tot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dominique Amy.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amy, D., Durante, E. & Tot, T. The lobar approach to breast ultrasound imaging and surgery. J Med Ultrasonics 42, 331–339 (2015). https://doi.org/10.1007/s10396-015-0625-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-015-0625-5

Keywords

Search

Navigation