Catanuto, G. (Giuseppe)

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    European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO
    (Elsevier, 2024) Zambon, M. (Marzia); Camps, J. (J.); Sardanelli, F. (Francesco); Marotti, L. (Lorenza); Schoones, J.W. (Jan W.); Catanuto, G. (Giuseppe); Smidt, M. (Marjolein); Dietz, J. (Jill); Sharma, N. (Nisha); Shaaban, A.M. (Abeer M.); Regitnig, P. (Peter); Athanasiou, A. (Alexandra); Santini, D. (Donatella); Gilbert, F. (Fiona); Varga, Z. (Zsuzsanna); Wyld, L. (Lynda); Rubio, I.T. (Isabel T.)
    Introduction Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. Methods These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. Results Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. Conclusions These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.
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    Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy
    (Springer, 2018) Blohmer, J.U. (Jens Uwe); Allweis, T.M. (Tanir M.); Fehr, M.K. (Mathias K.); Reitsamer, R. (Roland); Cardoso, M.J. (Maria Joao); Gouveia, P.F. (Pedro F.); Landin, J. (Julia); Olsha, O. (Oded); Urban, C. (Cicero); Ritter, M. (Mathilde); Hoffmann, J. (Jürgen); Brenelli, F. (Frabicio); Fulco, I. (Ilario); Paulinelli, R.R. (Regis Resende); Pusic, A.L. (Andrea L.); Kurzeder, C. (Christian); Catanuto, G. (Giuseppe); Bjelic-Radisic, V. (Vesna); Romics, L. (Lazslo); Farhadi, J. (Jian); Heil, J. (Jörg); Günthert, A. (Andreas); Tausch, C. (Cristoph); Tansley, A. (Anne); Galimberti, V. (Viviana); Weber, W.P. (Walter); Hadar, T. (Tal); Harder, Y. (Yves); Svensjö, T. (Tor); Hauser, N. (Nik); Biazus, J. (Jorge); Knauer, M. (Michael); Ganz-Blättler, U. (Ursula); Matrai, Z. (Zoltan); Bucher, S. (Sussane); Mechera, R. (Robert); Steffens, D. (Daniel); Kovacs, T. (Tibor); Meani, F. (Francesco); Lohsiriwat, V. (Visnu); Koller, R. (Rupert); Saccilotto, R. (Ramon); Kappos, E.A. (Elisabeth A.); Fitzal, F. (Florian); Sacchini, V. (Virgilio); Dubsky, P. (Peter); Barry, M. (Mitchel); Montagna, G. (Giacomo); Gentilini, O. (Oreste); Schwab, F.D. (Fabianne D.); Boniface, J. (Jana) de; Gnant, M. (Michael); Soysal, S.D. (Savas D.); El‑Tamer, M. (Mahmoud); Zeindler, J. (Jasmin); Haug, M. (Martin); Wyld, L. (Lynda); Rubio, I.T. (Isabel T.)
    Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.