Surgical management
tumor
SENTINEL NODE, TUMOR, SENTINEL LYMPH NODE
All patients included in this trial were candidates for breast-conserving surgery (lumpectomy) based on triple assessment breast evaluation. In the intervention group according to MRI findings, the surgical management could change from lumpectomy to mastectomy. The Lumpectomy was considered when conservative breast surgery was performed according to the initial surgical plan or when small changes to the initial surgical plan were considered irrelevant. Mastectomy was performed when breast conservation was not possible due to MRI findings: (a) the breast does not support a conservative surgery due to aesthetical reasons, and the tumor was 50% larger than evaluated by mammography and ultrasound (Fig. MRI additional findings. The two criteria, 50% threshold or/and multifocality and breast patient volume evaluation not supporting a breast conservative surgery, were defined in a consensus meeting at our institution with input from members of our multidisciplinary team. According to the surgeon’s judgment, the surgery was modified to skin-sparing or nipple-sparing mastectomy after assessing the MRI and the distance between the lesions and the areolar complex. At least three surgeons were needed to confirm the decision to modify the surgical approach to mastectomy during the outpatient clinic visit. No mastectomy was performed if there was no unanimous agreement.When necessary, preoperative localization was performed in all conservative breast surgeries using radio-guided occult lesion localization or wire localization (Kopans needle). Sentinel lymph node biopsy was performed using radio colloid or blue dye techniques.Lumpectomy was considered adequate when clear margins were achieved on histopathological exams. On the other hand, if clear margins were not achieved, these patients were submitted to a new surgical procedure, either re-excision or conversion to mastectomy.All lumpectomies and sentinel node biopsies were sent for intraoperative frozen-section analysis. Axillary lymph node dissection was recommended for patients with lymph nodal macro-metastases in more than two sentinel lymph nodes according to Z011 criteria [The surgical management modification was correct if the histopathology showed that the index lesion’s size was at least 50% larger, as measured by MRI, or if there were multifocal or multicentric lesions. Postoperative adjuvant treatment was conducted according to local treatment guidelines [