Influence of Surgical Technique on Mastectomy and Reexcision Rates in Breast-Conserving Therapy for Cancer

Unzeitig, Alison; Kobbermann, Anne; Xie, Xian Jin; Yan, Jingsheng; Euhus, David M.; Peng, Yan; Sarode, Venetia; Moldrem, Amy; Leitch, A. Marilyn; Andrews, Valerie; Rao, Roshni

doi:10.1155/2012/725121

Cited by 25 publications

(20 citation statements)

References 38 publications

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“…There are publications in the literature reporting re-excision rates in the range of 9-50% following BCS (21,22). We think that the reason why the re-excision rate of 4% in our series was lower as compared to similar publications was that the number of our cases was low.…”

Section: Discussioncontrasting

confidence: 58%

The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

Ünsal

Dural

Çelik

et al. 2015

UCD

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Objective: Minimally invasive surgery is increasingly gaining importance in breast surgery parallel to other surgical branches. Sentinel lymph node biopsy (SLNB) is a method that has radically changed the approach to breast surgery in the last decade of the 20 th century. In this study, we aimed to evaluate the adaptation process to these alterations in breast surgery at our clinic. Material and Methods:Patients who underwent surgery with a diagnosis of breast cancer in our clinic between April 2010 and November 2013 were retrospectively evaluated in terms of demographic characteristics, the number of operations and type of surgical methods applied according to years, SLNB performance rate, and results of frozen section and histopathological analysis. The first year of SLNB practice was accepted as part of the learning curve, and 24 patients who were operated during that period underwent routine axillary dissection. Results:The median age of 198 patients who were included in the study was 55 years (25-89). It was detected that the number of cases who underwent surgery for breast cancer increased in years, that the SLNB application rate increased from 37% to 66% between 2010 and 2013 (p=0.01), and SLNB staining rates increased from 70% to 94% (p=0.03). When only results from the last four years were evaluated, the mean staining rate in patients with SLNB (n=105) was 88% (n=92), with positive histopathology in 32% of these cases (n=30). Despite a decreasing trend over the years, a metastatic axillary lymph node was detected in paraffin block evaluation in spite of negative frozen section examination of SLNB in five cases, and 5 patients (5%) out of 97 patients who underwent breast conserving surgery required re-excision. The histopathological diagnosis was invasive ductal carcinoma in 84% (n=167) of patients. Conclusion:It was observed that during the four-year period of adaptation, the application rate of breast conserving surgery and SLNB reached accepted standards, and that both the technical problems encountered in SLNB and the requirement for re-excision after breast conserving surgery significantly decreased with increasing case volume and experience.

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Section: Discussioncontrasting

confidence: 58%

The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

Ünsal

Dural

Çelik

et al. 2015

UCD

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“…The association of positive surgical margins after lumpectomy with lobular histology, multifocality, lymphovascular invasion (LVI), high grade DCIS, and an extensive intraductal component (EIC), is well reported in the literature . Others have begun to explore the role of surgical technique . This study was undertaken to further define modifiable risk factors for positive margins and residual disease following lumpectomy and to validate previous findings in our patient population.…”

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confidence: 57%

Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

et al. 2016

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Breast conservation therapy (BCT) has a reported incidence of positive margins ranging widely in the literature from 20% to 70%. Efforts have been made to refine standards for partial mastectomy and to predict which patients are at highest risk for incomplete excision. Most have focused on histology and demographics. We sought to further define modifiable risk factors for positive margins and residual disease. A retrospective study was conducted of 567 consecutive partial mastectomies by 21 breast and general surgeons from 2009 to 2012. Four hundred fourteen cases of neoplasm were reviewed for localization, intraoperative assessment, excision technique, rates, and results of re-excision/mastectomy. Histologic margins were positive in 23% of patients, 25% had margins 0.1-0.9 mm, and 7% had tumor within 1-1.9 mm. Residual tumor was identified at-in 61 cases: 38% (disease at margin), 21% (0.1-0.9 mm), and 14% (1-1.9 mm). Ductal carcinoma in situ (DCIS) was present in 85% of residual disease on re-excision and correlated to higher rates of re-excision (p = <0.001), residual disease, and subsequent mastectomy. The use of multiple needles to localize neoplasms was associated with 2-3 times the likelihood for positive margins than when a single needle was required. The removal of additional margins at initial surgery correlated with improved rates of complete excision when DCIS was present. Patients must have careful analysis of specimen margins at the time of surgery and may benefit from additional tissue excision or routine shaving of the cavity of resection. Surgeons should conduct careful patient selection for BCT, in the context of multifocal, and multicentric disease. Patients for whom tumor localization requires bracketing may be at higher risk for positive margins and residual disease and should be counseled accordingly.

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“…7 Unzeitig et al found that routine cavity shaving resulted in nearly half the reexcision rate associated with standard partial mastectomy (24% vs. 47%, P<0.001). 8 Similarly, Marudanayagam et al found that before the introduction of cavity shaving, 49 of 392 patients (12%) underwent reoperation for margin clearance, whereas afterward, only 22 of 394 patients (6%) who underwent cavity shaving required further surgery. 9 Cao et al found that 59% of 103 patients who had positive margins on their initial specimen had negative margins after cavity shaving.…”

Section: Discussionmentioning

confidence: 96%

A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer

et al. 2015

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BACKGROUND Routine resection of cavity shave margins (additional tissue circumferentially around the cavity left by partial mastectomy) may reduce the rates of positive margins (margins positive for tumor) and reexcision among patients undergoing partial mastectomy for breast cancer. METHODS In this randomized, controlled trial, we assigned, in a 1:1 ratio, 235 patients with breast cancer of stage 0 to III who were undergoing partial mastectomy, with or without resection of selective margins, to have further cavity shave margins resected (shave group) or not to have further cavity shave margins resected (no-shave group). Randomization occurred intraoperatively after surgeons had completed standard partial mastectomy. Positive margins were defined as tumor touching the edge of the specimen that was removed in the case of invasive cancer and tumor that was within 1 mm of the edge of the specimen removed in the case of ductal carcinoma in situ. The rate of positive margins was the primary outcome measure; secondary outcome measures included cosmesis and the volume of tissue resected. RESULTS The median age of the patients was 61 years (range, 33 to 94). On final pathological testing, 54 patients (23%) had invasive cancer, 45 (19%) had ductal carcinoma in situ, and 125 (53%) had both; 11 patients had no further disease. The median size of the tumor in the greatest diameter was 1.1 cm (range, 0 to 6.5) in patients with invasive carcinoma and 1.0 cm (range, 0 to 9.3) in patients with ductal carcinoma in situ. Groups were well matched at baseline with respect to demographic and clinicopathological characteristics. The rate of positive margins after partial mastectomy (before randomization) was similar in the shave group and the no-shave group (36% and 34%, respectively; P= 0.69). After randomization, patients in the shave group had a significantly lower rate of positive margins than did those in the no-shave group (19% vs. 34%, P= 0.01), as well as a lower rate of second surgery for margin clearance (10% vs. 21%, P= 0.02). There was no significant difference in complications between the two groups. CONCLUSIONS Cavity shaving halved the rates of positive margins and reexcision among patients with partial mastectomy. (Funded by the Yale Cancer Center; ClinicalTrials.gov number, NCT01452399.)

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Influence of Surgical Technique on Mastectomy and Reexcision Rates in Breast-Conserving Therapy for Cancer

Cited by 25 publications

References 38 publications

The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer

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