Postexcision Mammography Is Indicated After Resection of Ductal Carcinoma-In-Situ of the Breast

Waddell, Brad E.; Stomper, Paul C.; DeFazio, Jennifer L.; Hurd, Thelma C.; Edge, Stephen B.

doi:10.1007/s10434-000-0665-x

Cited by 32 publications

(15 citation statements)

References 19 publications

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“…Postlumpectomy mammograms to detect residual clinical disease in patients who had microcalcifications will do so in a significant number of patients and their routine use is recommended, even when negative surgical margins are obtained. 17,18 In some patients, we recommended reexcision for close (<2 mm) margins. This may represent a more aggressive approach at our institution; other surgeons may perceive close but negative surgical margins as margins that do not require reexcision.…”

Section: Discussionmentioning

confidence: 99%

Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board

Newman

Guest

Helvie

et al. 2006

Cancer

274

169

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BACKGROUNDThe treatment of breast cancer requires a multidisciplinary approach, and patients are often referred to a multidisciplinary cancer clinic. The purpose of the current study was to evaluate the impact of this approach on the surgical management of breast cancer.METHODSThe medical records of 149 consecutive patients referred to a multidisciplinary breast cancer clinic over a 1‐year period with a diagnosis of breast cancer were reviewed retrospectively for alterations in radiologic, pathologic, surgical, and medical interpretations and the effect that these alterations had on recommendations for surgical management.RESULTSA review of the imaging studies resulted in changes in interpretations in 67 of the 149 patients studied (45%). This resulted in a change in surgical management in 11% of patients. Review of the pathology resulted in changes in the interpretation for 43 of the 149 patients (29%). Thirteen patients (9%) had surgical management changes made solely as a result of pathologic reinterpretation. In 51 patients (34%), a change in surgical management was recommended after discussion with the surgeons, medical oncologists, and radiation oncologists that was not based on reinterpretation of the radiologic or pathologic findings. Overall, a second evaluation of patients referred to a multidisciplinary tumor board led to changes in the recommendations for surgical management in 77 of 149 of those patients studied (52%).CONCLUSIONSThe changes in management stemmed from differences in mammographic interpretation, pathologic interpretation, and evaluation by medical and radiation oncologists and surgical breast specialists. Multidisciplinary review can provide patients with useful additional information when making difficult treatment decisions. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board

Newman

Guest

Helvie

et al. 2006

Cancer

274

169

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“…It has been suggested that specimen radiography alone may not be a reliable way to determine the adequacy of excision for malignant microcalcifications, and that postoperative/pre-irradiation mammography should be performed 2-4 weeks after surgery [58,59]. Although we have not used this approach unless the specimen mammogram suggested a high likelihood of residual malignant calcifications remaining in the breast, some studies have indicated that this practice may reduce the incidence of IBTR [58,59].…”

Section: Strategies To Reduce the Need For Re-excisional Surgerymentioning

confidence: 85%

“…Although we have not used this approach unless the specimen mammogram suggested a high likelihood of residual malignant calcifications remaining in the breast, some studies have indicated that this practice may reduce the incidence of IBTR [58,59]. Postexcision mammography is generally an uncomfortable experience for patients, and no randomized trials indicate that this will decrease the chances of local recurrence.…”

Section: Strategies To Reduce the Need For Re-excisional Surgerymentioning

confidence: 90%

Appropriate Margin Width in Breast-Conserving Surgery

McKenzie-Johnson

Grover

Bear

2010

Curr Breast Cancer Rep

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Breast-conserving surgery (BCS) is an oncologically safe treatment for early-stage breast cancer. BCS refers to the excision of the primary tumor plus a margin of surrounding tissue with preservation of adequate breast tissue for acceptable cosmesis. Breast irradiation following BCS is considered "standard" therapy for most women, but the ideal or minimal acceptable margin has remained a point of controversy. Ideally, BCS should result in a low rate of ipsilateral breast tumor recurrence and excellent cosmetic results, and any potential benefits of re-excision must be balanced against the potential decrement in the cosmetic results. Critical review of the existing data addressing what constitutes adequate margins reveals that "close" margins may increase the risk of residual disease but does not clearly indicate that re-excision to achieve wider margins significantly decreases the risk of local recurrence.

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“…Postexcision preirradiation mammograms (PPMs) performed within a short time period after breast‐conserving surgery, but prior to adjuvant radiation, can be utilized to identify any radiographic evidence of residual disease. Previous attempts to ascertain the clinical benefit from a PPM have been hindered by small sample sizes and selection bias and have been retrospective in nature . Because only women considered to have a high risk of residual disease had postlumpectomy mammograms orders, many series likely overestimate the frequency of residual suspicious calcifications on PPM.…”

Section: Introductionmentioning

confidence: 99%

Development of a nomogram to predict the clinical impact of a postexcision preirradiation mammogram

et al. 2017

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We aimed to better quantify the impact of a postexcision preirradiation mammogram (PPM), first by identifying factors associated with abnormal results and then incorporating these findings into a nomogram. Beginning February 2011, our institution made a practice change to obtain a PPM on all patients with any calcifications identified. A total of 530 patients underwent a PPM. Suspicious abnormalities were reported in 61 patients (11.5%), with the PPM leading to a change in management in 47 instances (8.9%). A nomogram was created based on patient and tumor characteristics to identify patients most likely to have an abnormal PPM.

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Postexcision Mammography Is Indicated After Resection of Ductal Carcinoma-In-Situ of the Breast

Cited by 32 publications

References 19 publications

Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board

Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board

Appropriate Margin Width in Breast-Conserving Surgery

Development of a nomogram to predict the clinical impact of a postexcision preirradiation mammogram

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