A Review of Current Practices in Breast Conservation Surgery in the UK

Young, Oliver; Valassiadou, Kalliope; Dixon, Michael

doi:10.1308/003588407x155473

Cited by 27 publications

(26 citation statements)

References 30 publications

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“…The aim of breast conservative surgery is long-term disease control through excision of all of invasive and in situ cancer. Breast conservative surgery is as effective as mastectomy in terms of overall survival, ensures a good cosmetic result, and has many advantages in terms of psychological effects and quality of life (6,7). Surgical criteria for patient selection for breast conservative surgery include the following parameters: tumor extent, presence of unifocal tumors relative to the size of the breast ("tumor size to breast volume" ratio), tumor location, and patient preference (6,8).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore the data concerning the type of surgery do not always follow the radiological findings as the poor shift from mastectomy to breast conservative surgery after NACT is related to the surgeons' attitude for aggressive approach despite the response to NACT (6,8,37). Another limitation of the DCE-MRI examination is its relatively low specificity.…”

Section: Discussionmentioning

confidence: 99%

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MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

Zc²,

Plesinac-Karapandzic

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to prospectively assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the evaluation of predictive factors for breast conservative surgery during neoadjuvant chemotherapy. MATERIALS AND METHODSSixty-six patients were evaluated before the first treatment cycle, after the second cycle, and upon the completion of neoadjuvant chemotherapy according to largest tumor diameter, tumor volume, postcontrast enhancement, and tumor regression pattern. The patients were divided into responders (pathologic complete and near complete response) and nonresponders. Each subgroup was re-evaluated according to morphokinetic criteria for identification of candidates for breast conservative surgery. RESULTSIn responders (n=27), the lesion size upon the completion of neoadjuvant chemotherapy was significantly smaller compared to nonresponders (1.5±0.6 vs. 3.2±0.9 cm; P < 0.001), as was the volume (1.2 vs. 11.0 cm 3 ; P < 0.001). The measured lesion size did not differ from the histologic size (1.5±0.6 vs. 1.2±0.6 cm; P = 0.09) and had a high correlation (r=0.93). In responders, the following parameters were significantly different before and after neoadjuvant chemotherapy: size (3.6±1.4 to 1.5±0.6 cm; P < 0.001), volume (17.6 to 1.2 cm 3 ; P < 0.001), predominant concentric regression, plateau and continuous time-intensity curves (P < 0.001). DCE-MRI has the sensitivity of 87% and the accuracy of 77% to identify candidates for breast conservative surgery. CONCLUSION Selected morphokinetic DCE-MRI parameters may contribute to the multidisciplinary decision when considering the selection of candidates for breast conservative surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

Zc²,

Plesinac-Karapandzic

et al. 2013

Diagn Interv Radiol

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“…This difference between groups was found to be statistically significant and the same significant trend favoring not to reexcise was seen amongst surgeons participating in weekly tumor boards and those trained in surgical oncology. Another questionnaire study involving 200 breast surgeons in the United Kingdom showed less variation in surgeon practices with 91% of respondents favoring no further surgery if there was ADH at the margin of excision, but both invasive and in situ disease were 10 mm clear of the margin [20]. …”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, despite the high volume of studies investigating the question of adequate margin width, there is a paucity of studies that address the pathological characteristics of the cells within the margin. Not surprisingly, in the setting of no evidence-based guidelines, neither pathologists nor surgeons know what to do with the diagnosis of ADH involving a margin of a BCS specimen performed for early-stage breast cancer [18–20]. The purpose of this paper is to address the significance of a diagnosis of ADH at the margin and evaluate if there is evidence to guide the surgical decision for reexcision.…”

Section: Introductionmentioning

confidence: 99%

Atypical Ductal Hyperplasia at the Margin of Lumpectomy Performed for Early Stage Breast Cancer: Is there Enough Evidence to Formulate Guidelines?

Baker

Hasteh

Blair

2012

International Journal of Surgical Oncology

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Background. Negative margins are associated with a reduced risk of ipsilateral breast tumor recurrence (IBTR) in women with early stage breast cancer treated with breast conserving surgery (BCS). Not infrequently, atypical ductal hyperplasia (ADH) is reported as involving the margin of a BCS specimen, and there is no consensus among surgeons or pathologists on how to approach this diagnosis resulting in varied reexcision practices among breast surgeons. The purpose of this paper is to establish a reasonable approach to guide the treatment of ADH involving the margin after BCS for early stage breast cancer. Methods. the published literature was reviewed using the PubMed site from the US National Library of Medicine. Conclusions. ADH at the margin of a BCS specimen performed for early stage breast cancer is a controversial pathological diagnosis subject to large interobserver variability. There is not enough data evaluating this diagnosis to change current practice patterns; however, it is reasonable to consider reexcision for ADH involving a surgical margin, especially if it coexists with low grade DCIS. Further studies with longer followup and closer attention to ADH at the margin are needed to formulate treatment guidelines.

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“…Historically, the criteria for an adequate negative margin had relatively arbitrary thresholds ranging from “no tumor at inked margin” to 10mm or more [12,17]. Although absence of tumor at the inked margin is the current recommendation from national clinical consensus guidelines [15,16], there has been considerable variation in practice patterns among surgeons regarding the decision to re-excise or perform a mastectomy based on margin distance [2,18,19]. …”

Section: Introductionmentioning

confidence: 99%

Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?

et al. 2015

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Objectives Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates after BCS with negative margins. Materials and Methods We identified 1,423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model. Results Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level. Conclusion Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS.

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A Review of Current Practices in Breast Conservation Surgery in the UK

Abstract: The results show a large variation in practice with many surgeons not treating patients in accordance with current guidelines and evidence.

Cited by 27 publications

References 30 publications

MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

Atypical Ductal Hyperplasia at the Margin of Lumpectomy Performed for Early Stage Breast Cancer: Is there Enough Evidence to Formulate Guidelines?

Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?

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