Reexcision Surgery for Breast Cancer: An Analysis of the American Society of Breast Surgeons (ASBrS) MasterySM Database Following the SSO-ASTRO “No Ink on Tumor” Guidelines

Schulman, Amanda; Mirrielees, Jennifer A.; Leverson, Glen; Landercasper, Jeffrey; Greenberg, Caprice C.; Wilke, Lee G.

doi:10.1245/s10434-016-5516-5

Cited by 70 publications

(70 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the agreement on these recommendations is different between centers and the choice of optimal margins depends mainly on the surgeons' practice and methods of margin assessment by pathologists which was supported by the current National Institute for Health and Care Excellence (NICE) guidelines . Accepting closer margins of excision is a means of reducing re‐operation rates, as has been shown in invasive disease . However, planning a wider macroscopic margin in higher risk cases or tailoring the scrutiny of margin assessment to the risk factors are other strategies.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

et al. 2019

View full text Add to dashboard Cite

Background Management of breast ductal carcinoma in situ (DCIS) has various approaches with distinct institutional specific practice. Here, we review DCIS management in a single institution with emphasize on re‐operation rates and outcome. Methods Breast ductal carcinoma in situ cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n = 1249). Clinicopathological data were collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re‐excision, presence of residual tumor in the re‐excision specimens, use of radiotherapy and ipsilateral recurrences were analyzed. Results 34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumor grade, size >40 mm, and associated with comedo necrosis and Paget's disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumor tissue was detected in 53% of the re‐excision specimens. Re‐excision rates of patients treated with breast‐conserving surgery (BCS) were reduced from approximately 70% to 23%, and the final mastectomy rates decreased from 60% to 20%. Changes in surgical practice with acceptance of smaller excision margins and more frequent use of local radiotherapy have led to a significant decrease not only in the re‐excision rate but also in the final mastectomy rate together with non‐significant reduction in 5‐ and 10‐year local recurrence rates. Conclusion Although BCS is increasingly the preferred primary surgical option for DCIS management, a proportion of low‐risk DCIS patients continue to undergo re‐excision surgery or completion mastectomy. Despite acceptance of smaller margins, recurrence rate is decreasing.

show abstract

Section: Discussionsupporting

confidence: 89%

“…42 Accepting closer margins of excision is a means of reducing re-operation rates, as has been shown in invasive disease. 43 However, planning a wider macroscopic margin in higher risk cases or tailoring the scrutiny of margin assessment to the risk factors are other strategies.…”

Section: Oncology-american Society For Radiation Oncology Has Publishedmentioning

confidence: 99%

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

et al. 2019

View full text Add to dashboard Cite

show abstract

“…This is based on the results from a meta-analysis that demonstrated an increase of 2.44 in the odds ratio of local recurrence for positive margins (tumour on ink) but with no significant benefits demonstrated for wider margins [8]. Interestingly, only relatively small further reductions in re-operation rates from 20.2% to 16.5% [52] and from 21.4% to 15.1% [53] have been observed following acceptance of the 2014 SSO-ASTRO guidelines and these reduced rates could still be considered excessive. Extrapolation of re-operative rates of 15% combined with the annual incidence of breast cancer and the increasing popularity of breast conserving surgery, amounts to many thousands of women undergoing potentially unnecessary operations with a significant health and economic cost to the patient and healthcare provider [13].…”

Section: Discussionmentioning

confidence: 99%

Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery

et al. 2017

View full text Add to dashboard Cite

BackgroundRe-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20–25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment.MethodsElectrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos.ResultsA classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data acquisition and analysis was possible within a mean of 1.80 seconds (SD ±0.40).ConclusionsThe REIMS method has been optimised for real-time iKnife analysis of heterogeneous breast tissues based on subtle changes in lipid metabolism, and the results suggest spectral analysis is both accurate and rapid. Proof-of-concept data demonstrate the iKnife method is capable of online intraoperative data collection and analysis. Further validation studies are required to determine the accuracy of intra-operative REIMS for oncological margin assessment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-017-0845-2) contains supplementary material, which is available to authorized users.

show abstract

“…For all, adoption of these guidelines has the potential to reduce re-excision rates with, more importantly, a decrease in patient’s anxiety, morbidity, cost, adverse effect on cosmesis, and a delayed start to systemic therapy. The consensus panels recognised that anyhow there are circumstances in which margins wider than no ink on the tumour may be indicated for patients with invasive cancer and in which margins less than 2mm may be acceptable for patients with DCIS [13, 14, 15]. …”

Section: Pathologymentioning

confidence: 99%

Highlights from the 15th St Gallen International Breast Cancer Conference 15–18 March, 2017, Vienna: tailored treatments for patients with early breast cancer

Morigi¹

2017

ecancer

View full text Add to dashboard Cite

The 15th St Gallen International Breast Cancer Conference was held in Vienna for the second time, from 15th–18th March 2017. 4000 people from 105 countries all over the world were invited to take part in the event. The real highlight of the conference was the last day with the International Consensus Session which was chaired by around 50 experts on breast cancer worldwide. With reference to data from scientific research, the consensus panel tried to offer guidelines for the management of breast cancer with the aim of providing patients with optimal treatment. The topics covered focused on the treatment of breast cancer, consideration of surgery, radiotherapy, neo-adjuvant, and adjuvant systemic therapy for breast cancer, as well as genetics and prevention of breast cancer.In particular, in terms of precision medicine, an important topic of the conference was ‘is it possible to think that it could become routine in clinical practice to use immunotherapy and targeted therapy based on genetic signatures?’In view of personalised therapy, it is important to take into consideration women’s treatment preferences. It is also important not only to offer guidelines which help breast cancer experts all over the world to choose the proper treatment for women with breast cancer but also to discuss the pros and cons of the therapy with the patient. This allows for a better understanding of the disease.‘From the maximum tolerable to the minimum effective treatment: it is essential to escalate treatment when necessary and to de-escalate when unnecessary’. These few words could summarise the meaning of the 15th St Gallen International Breast Cancer Conference. Prof Martine Piccart-Gebhart was awarded with the St Gallen International Breast Cancer Award 2017 for her fundamental clinical research contribution and Prof Giuseppe Curigliano with the Umberto Veronesi Memorial Award which aims to recognise a physician’s leading role in advancing the science and care of breast cancer patients. Curigliano, in his lecture, spoke about the revolutionary immunotherapy in the clinical management of breast cancer (BC). For the development of these therapies, it is necessary to identify the genetic determinants of BC immune phenotypes in which The Cancer Genome Atlas (TCGA) has contributed towards this.For example, the T helper (Th-1) phenotype (ICR4), which also exhibits upregulation of immune-regulatory transcripts (eg. PDL1, PD1, FOXP3, IDO1, and CTLA4), was associated with prolonged patients’ survival. Chromosome segment 4q21, which includes genes encoding the Th-1 chemokines CXCL9-11, was significantly amplified only in the immune favourable phenotype (ICR4). The mutation and neo-antigen load progressively decreased from ICR4 to ICR1 but could not explain immune phenotypic differences. Mutations of TP53 were enriched in the immune favourable phenotype (ICR4). Instead, the presence of MAP3K1 and MAP2K4 mutations were closely associated with an immune unfavourable phenotype (ICR1). Using both the TCGA and the validation dataset, the degree ...

show abstract

Reexcision Surgery for Breast Cancer: An Analysis of the American Society of Breast Surgeons (ASBrS) MasterySM Database Following the SSO-ASTRO “No Ink on Tumor” Guidelines

Cited by 70 publications

References 31 publications

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery

Highlights from the 15th St Gallen International Breast Cancer Conference 15–18 March, 2017, Vienna: tailored treatments for patients with early breast cancer

Contact Info

Product

Resources

About