Impact of SSO-ASTRO margin guidelines on reoperation rates following breast-conserving surgery

Monaghan, Alex I. C.; Chapinal, N.; Hughes, Lauren; Baliski, Christopher

doi:10.1016/j.amjsurg.2019.01.007

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…Therefore, different definitions of “positive margin” were used, and it is difficult to generalize the findings. The publication of the consensus guidelines appears to have markedly decreased the rate of re-excision for positive margins 27 – 30 , and has thereby somewhat decreased the necessity of an intraoperative margin assessment technique. However, a positive margin rate of 10–15% still represents a significant portion of patients who will require a second surgery.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines

Nunez

Jones

Schulz-Costello

et al. 2020

Sci Rep

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Gross intraoperative assessment can be used to ensure negative margins at the time of surgery. Previous studies of this technique were conducted before the introduction of consensus guidelines defining a “positive” margin. We performed a retrospective study examining the accuracy of this technique since these guidelines were published. We identified all specimens that were grossly examined at the time of breast conserving surgery from January 2014 to July 2020. Gross and final microscopic diagnoses were compared and the performance of intraoperative examination was assessed in terms of false positive and false negative rates. Logistic regression models were used to examine the effect of clinicopathologic covariates on discordance. 327 cases were reviewed. Gross exam prompted re-excision in 166 cases (61%). The rate of false negative discordance was 8.6%. In multivariate analysis, multifocality on final pathology was associated with discordance. We consider the false negative rate acceptable for routine clinical use; however, there is an ongoing need for more accurate methods for the intraoperative assessment of margins.

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Section: Discussionmentioning

confidence: 99%

Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines

Nunez

Jones

Schulz-Costello

et al. 2020

Sci Rep

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“…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

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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.

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“…Re-excision was performed in the presence of a positive surgical margin. Negative surgical margin width was accepted as ≥ 2 mm and no tumor on ink before and after SSO and ASTRO consensus guideline [23,24]. Subareolar margin was evaluated after subcutaneous mastectomy, and nipple-areola complex was excised if there was margin positivity.…”

Section: Peri-operative Histopathologic Evaluationmentioning

confidence: 99%

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

et al. 2020

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Purpose: The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. Patients and methods: The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively.

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Impact of SSO-ASTRO margin guidelines on reoperation rates following breast-conserving surgery

Cited by 14 publications

References 18 publications

Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines

Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines

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

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

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