{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:47:30Z","timestamp":1778219250147,"version":"3.51.4"},"reference-count":61,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T00:00:00Z","timestamp":1692576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons\u2019 expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. Methods: Patients (stage I\u2013III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed. Results: A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896\u20138.724 was predictive for BCS, 8.725\u20139.375 for OPS, and 9.376\u201314.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5\u201314.7%; p = 0.010), a better locoregional disease-free survival (98.8\u201388.9%; p &lt; 0.001) and a better overall survival (96.1\u201386.5%; p = 0.017), and a better satisfaction with breasts (39.8\u201327.5%; p = 0.017) and physical wellbeing (93.5\u201373.6%; p = 0.001). Conclusion: A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.<\/jats:p>","DOI":"10.3390\/jpm13081280","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T01:33:11Z","timestamp":1692581591000},"page":"1280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6773-3848","authenticated-orcid":false,"given":"Antonio","family":"Franco","sequence":"first","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8219-5336","authenticated-orcid":false,"given":"Alba","family":"Di Leone","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8260-4753","authenticated-orcid":false,"given":"Marco","family":"Conti","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6320-2609","authenticated-orcid":false,"given":"Alessandra","family":"Fabi","sequence":"additional","affiliation":[{"name":"Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa","family":"Carbognin","sequence":"additional","affiliation":[{"name":"Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreina Daniela","family":"Terribile","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-2466","authenticated-orcid":false,"given":"Paolo","family":"Belli","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5253-4678","authenticated-orcid":false,"given":"Armando","family":"Orlandi","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-507X","authenticated-orcid":false,"given":"Martin Alejandro","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Moschella","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0152-049X","authenticated-orcid":false,"given":"Elena Jane","family":"Mason","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-1477","authenticated-orcid":false,"given":"Giovanni","family":"Cimino","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"De Filippis","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Marazzi","sequence":"additional","affiliation":[{"name":"Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7445-3366","authenticated-orcid":false,"given":"Ida","family":"Paris","sequence":"additional","affiliation":[{"name":"Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Visconti","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana","family":"Barone Adesi","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5828-2851","authenticated-orcid":false,"given":"Lorenzo","family":"Scardina","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0223-9635","authenticated-orcid":false,"given":"Sabatino","family":"D\u2019Archi","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzia","family":"Salgarello","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6085-1195","authenticated-orcid":false,"given":"Diana","family":"Giannarelli","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Masetti","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2950-3395","authenticated-orcid":false,"given":"Gianluca","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ofri, A., Elstner, K., Mann, G., Kumar, S., and Warrier, S. (2023). Neoadjuvant chemotherapy in non-metastatic breast cancer: The surgeon\u2019s perspective. 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