Evaluating the Effect of Margin Consensus Guideline Publication on Operative Patterns and Financial Impact of Breast Cancer Operation

Bhutiani, Neal; Mercer, Megan; Bachman, Katelynn C.; Heidrich, Samantha R.; Martin, Robert C.G.; Scoggins, Charles R.; McMasters, Kelly M.; Ajkay, Nicolás

doi:10.1016/j.jamcollsurg.2018.01.050

Cited by 34 publications

(31 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The work, encompassing two national studies, as well as five institutional ones, documents what would be the logical outcome-that when one changes the definition of what is a positive margin requiring re-excision to become more narrow, the re-excision rates decline. [2][3][4][5][6][7][8] Problematic, however, is that they could not actually document why re-excisions decreased. Was it really the change in definition?…”

mentioning

confidence: 99%

Defining Why the Re-excision Rate Dropped

Chagpar

2019

Ann Surg Oncol

View full text Add to dashboard Cite

mentioning

confidence: 99%

Defining Why the Re-excision Rate Dropped

Chagpar

2019

Ann Surg Oncol

View full text Add to dashboard Cite

“…In 2014 and 2016 the Society of Surgical Oncology (SSO), the American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO) recognized “no ink on tumor” as the standard for an adequate margin for invasive breast cancer and a 2 mm margin as the standard for DCIS [ 22 , 23 ]. Several studies reported a reduction of RBS rates by comparing series before and after the release of these guidelines ( Table 4 ) [ [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ], which was confirmed by a recently published meta-analysis [from 22% to 14%; Odds Ratio (OR) 0.65; 95% Confidence Interval (CI) 0.54–0.78; p < 0.0001) [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Reoperation rate after breast conserving surgery as quality indicator in breast cancer treatment: A reappraisal

et al. 2020

View full text Add to dashboard Cite

Aim To analyse the role of repeated breast surgery (RBS) after breast conserving surgery (BCS) as a quality indicator in a consecutive series of breast cancer patients. Methods Data from 1233 breast cancer patients submitted to BCS from 2015 to 2019 were reviewed. The influence of several variables on RBS rate (182/1232; 14.8%) was examined. Univariate and multivariate analyses were conducted to look for significant associations with the risk of RBS. Results Surgical workload, BCS rate and clinicopathological variables were consistent over the study period, while RBS rate decreased after the introduction of shaving of cavity margins (from 17.9% to 9.5%). Tumor persistence at RBS was higher for mastectomy vs. re-excision (87.3% vs. 37.8%; p = 0.05), inconclusive vs. positive diagnostic biopsy (48.2% vs. 69.4%; p = 0.003), ductal carcinoma in situ vs. invasive carcinoma (69.0% vs. 51.3%; p = 0.046) and lower after neoadjuvant therapy (14.3% vs. 57.8%; p = 0.044). Several clinicopathological variables were associated with the risk of RBS, but only multifocality [Odds Ratio (OR): 1.8; p = 0.009], microcalcifications (OR: 2.0, p = 0.000), neoadjuvant therapy (OR: 0.4; p = 0.014), pathological intraoperative assessment (OR: 0.6; p = 0.010) and shaving of cavity margins (OR: 0.3; p = 0.000) retained independent value at multivariate analysis. Conclusions RBS rate can be reduced by shaving of cavity margins. Current standards for RBS should not be made more stringent due to the existence of non-actionable risk factors. The value of RBS as a quality indicator should be scrutinzed.

show abstract

“…Reported re‐excision rates generally vary widely, ranging as high as 30% to 60% . This leaves the patient exposed to the potential complications of reoperation, poor cosmetic outcomes, increased psychological stress, and increased healthcare costs . This constellation of factors has prompted a search for methods of intraoperative assessment of surgical margins to assist in the intraoperative determination of margin adequacy.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the relationship between ductal carcinoma in situ, calcifications, and margin status in patients undergoing breast conserving surgery

Bruenderman

Bhutiani

Mercer

et al. 2019

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background Microcalcifications associated with ductal carcinoma in situ (DCIS‐AMC) close to lumpectomy margins could be used as a surrogate for margin involvement and aid in decreasing margin re‐excision. We sought to evaluate the histologic factors of DCIS‐AMC near lumpectomy margins. Methods Women with DCIS treated with breast‐conserving surgery (BCS) who had DCIS‐AMC on surgical specimens were identified. Pathology slides were reviewed to determine the distance of DCIS‐AMC from each margin (six per specimen) and the distance of DCIS from each margin (ie, margin status). Results Of 35 patients (210 margins), 24 had close/positive margins (39 margins [18%]). DCIS‐AMC≤10 mm from a margin was associated with a greater incidence of DCIS≤2 mm from the margin (31.7% DCIS‐AMC≤10 mm vs 13.3% no DCIS‐AMC≤10 mm, P = 0.003). On multivariable analysis, DCIS≤2 mm from the margin was independently associated with DCIS‐AMC≤10 mm from the margin (odds ratio 2.95, 95% confidence interval 1.48‐5.86, P = 0.002). Conclusions DCIS‐AMC≤10 mm from the inked margin is associated with DCIS at or close to the margin (≤2 mm). Using this knowledge, intraoperative techniques like specimen radiography could be utilized to detect microcalcifications≤10 mm from a margin and guide selective margin re‐excision in BCS.

show abstract

Evaluating the Effect of Margin Consensus Guideline Publication on Operative Patterns and Financial Impact of Breast Cancer Operation

Cited by 34 publications

References 15 publications

Defining Why the Re-excision Rate Dropped

Defining Why the Re-excision Rate Dropped

Reoperation rate after breast conserving surgery as quality indicator in breast cancer treatment: A reappraisal

Evaluating the relationship between ductal carcinoma in situ, calcifications, and margin status in patients undergoing breast conserving surgery

Contact Info

Product

Resources

About