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International Journal of Breast Cancer
Volume 2011, Article ID 726384, 4 pages
http://dx.doi.org/10.4061/2011/726384
Research Article

Redefining Lumpectomy Using a Modification of the “Sick Lobe” Hypothesis and Ductal Anatomy

Department of Surgery, The University of Oklahoma Breast Institute and Division of Surgical Oncology, The University of Oklahoma Health Sciences Center, Oklahoma, OK 73104, USA

Received 8 February 2011; Revised 21 April 2011; Accepted 11 May 2011

Academic Editor: Tibor Tot

Copyright © 2011 W. Dooley et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. The “Sick Lobe” hypothesis states that breast cancers evolve from entire lobes or portions of lobes of the breast where initiation events have occurred early in development. The implication is that some cancers are isolated events and others are truly multi-focal but limited to single lobar-ductal units. Methods. This is a single surgeon retrospective review of early stage breast cancer lumpectomy patients treated from 1/2000 to 2/2005. Ductal endoscopy was used direct lumpectomy surgical margins by defining ductal anatomy and mapping proliferative changes within the sick lobe for complete excision. Results. Breast conservation surgery for stage 0–2 breast cancer with an attempt to perform endoscopy in association with therapeutic lumpectomy was performed in 554 patients (successful endoscopy in 465 cases). With an average followup of >5 years for the entire group, annual hazard rate for local failure in traditional lumpectomy without ductal mapping was 0.97%/yr. and for lumpectomy with ductal mapping and excision of entire sick lobe was 0.18%/yr. With endoscopy, 42% of patients were found to have extensive disease within their “sick lobe.” Conclusions. Targeting breast cancer lumpectomy using endoscopy and excision of regional associated proliferation seems associated with lower recurrence in this non-randomized series.