SP46. Incidental Breast Carcinoma In Reduction Mammoplasty: A Systematic Review
Bibliographic record
Abstract
Purpose: An estimated 534,284 breast reductions were performed worldwide in 2018. Occult histopathological findings of breast cancer in reduction mammoplasty specimens are rare but well documented in the literature. It has been a conventional practice for surgeons to obtain imaging studies prior to the reduction mammoplasty procedure. This practice aims to establish a radiological baseline of the breasts and detect occult pathological lesions before surgical intervention. Recent studies, however, have shown that preoperative imaging leads to an increasing number of false positive results and unnecessary diagnostic workups for the patient.The goal of this study was to conduct a systematic review to summarize the available literature on the incidence of occult breast carcinoma identified in patients undergoing non-oncologic reduction mammoplasty. Methods: A systematic review of all studies on the incidence of breast carcinoma in patients undergoing breast reduction was performed using PRISMA guidelines. Two databases were queried for randomized clinical trials, cohort studies, and retrospective studies. Two reviewers completed screening, data collection, and quality assessment. The Newcastle-Ottawa scale and JBI Critical Appraisal Checklist were used to assess methodological quality. Data extracted included the presence or absence of preoperative screening for breast cancer, sample size, age, pre-operative or intraoperative findings, and study recommendations. Results: A total of 328 articles were identified through a literature search. After the removal of duplicates, a total of 206 studies were screened. A final tally of 20 studies met our inclusion criteria, reporting on the incidence of breast carcinoma in reduction mammoplasty specimens. 18 studies were retrospective and 2 were prospective. All 20 studies used a routine intraoperative histopathologic examination of breast reduction specimens. 12 studies had patients undergo pre-operative imaging prior to reduction, 6 studies had only higher-risk patients undergo preoperative imaging (e.g. higher age, positive family history), and 2 studies had no pre-operative imaging. On histopathological evaluation, the incidence of breast carcinoma ranged from 0% to 1.6%. Most studies (19/20) found no correlation between preoperative imaging and histopathological diagnosis of breast carcinoma. One multicenter study of 5781 patients recommended preoperative imaging to be routinely performed in patients scheduled for non-oncologic reduction mammoplasty. They found a rate of 12.7% radiologically suspect findings, of which 1.3% were biopsy-confirmed malignancies. All studies recommended histopathological evaluation of breast reduction specimens. Conclusion: Our review demonstrates that histopathological evaluation of breast reduction specimens is widely recommended and used despite the small incidence of occult breast carcinoma findings. The current literature remains non-unanimous regarding routine preoperative imaging in patients undergoing reduction mammaplasty. Further studies are needed to confirm the role of preoperative imaging in patients undergoing reduction mammaplasty.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".