Surgeon Re-Excision Rates after Breast-Conserving Surgery: A Measure of Low-Value Care

Kaczmarski, Katerina; Wang, Peiqi; Gilmore, Richard; Overton, Heidi N.; Euhus, David M.; Jacobs, Lisa K.; Habibi, Mehran; Camp, Melissa; Weiss, Matthew J.; Makary, Martin A.

doi:10.1016/j.jamcollsurg.2018.12.043

Cited by 57 publications

(53 citation statements)

References 23 publications

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“…However, 15% to 35% of BCS patients require a second surgery due to incomplete initial excision (i.e., one or more positive margins) as determined by histopathological analysis. [3][4][5][6][7][8] Identification of cancer at the margin is a spatial detection problem, filtered visually by pathology technicians and pathologists performing labor-intensive searches of tissue sections. Several techniques have been proposed for improved BCS margin assessment, but significant limitations associated with each approach have prevented their widespread adoption.…”

Section: Introductionmentioning

confidence: 99%

Structured light imaging for breast-conserving surgery, part II: texture analysis and classification

et al. 2019

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Subdiffuse spatial frequency domain imaging (sd-SFDI) data of 42 freshly excised, bread-loafed tumor resections from breast-conserving surgery (BCS) were evaluated using texture analysis and a machine learning framework for tissue classification. Resections contained 56 regions of interest (RoIs) determined by expert histopathological analysis. RoIs were coregistered with sd-SFDI data and sampled into ∼4 × 4 mm 2 subimage samples of confirmed and homogeneous histological categories. Sd-SFDI reflectance textures were analyzed using gray-level co-occurrence matrix pixel statistics, image primitives, and power spectral density curve parameters. Texture metrics exhibited statistical significance (p-value < 0.05) between three benign and three malignant tissue subtypes. Pairs of benign and malignant subtypes underwent texture-based, binary classification with correlation-based feature selection. Classification performance was evaluated using fivefold cross-validation and feature grid searching. Classification using subdiffuse, monochromatic reflectance (illumination spatial frequency of f x ¼ 1.37 mm −1 , optical wavelength of λ ¼ 490 nm) achieved accuracies ranging from 0.55 (95% CI: 0.41 to 0.69) to 0.95 (95% CI: 0.90 to 1.00) depending on the benign-malignant diagnosis pair. Texture analysis of sd-SFDI data maintains the spatial context within images, is free of light transport model assumptions, and may provide an alternative, computationally efficient approach for wide field-of-view (cm 2) BCS tumor margin assessment relative to pixel-based optical scatter or color properties alone.

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Section: Introductionmentioning

confidence: 99%

Structured light imaging for breast-conserving surgery, part II: texture analysis and classification

et al. 2019

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“…Additionally, the pooled re‐excision rate for available literature comparing BCS alone with BCS and CSM was found to be 30.1% 1 . A recent paper reviewing national re‐excision rates showed an average re‐excision rate of 17.2% in the period after the 2014 “no ink on tumor” consensus guideline 5 . This paper defined outliers as physicians with re‐excision rates > 30%, which calls into question the applicability of these RCTs with regard to general practice.…”

Section: Introductionmentioning

confidence: 99%

Impact of systematic cavity shave margins in breast‐conserving surgery at a large community hospital with a low baseline re‐excision rate

et al. 2020

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Systematic cavity shave margins (CSM) can decrease rate of positive margins and re‐excision beyond that of selective CSM. The objective of this study was to determine whether systematic CSM decreased re‐excision rate in a population with a low baseline re‐excision rate. We conducted a retrospective chart review of patients who underwent breast‐conserving surgery (BCS) from November 2013 to November 2017. Primary end points were re‐excision rate and margin status. Secondary end points were total volume of tissue excised, operative time, and concordance of core needle biopsy (CNB) pathology with final surgical pathology. The re‐excision rates were 14.29% in the no shave margin group; 15.38% in the selective CSM; and 14.59% in the systematic CSM (P = .985). Odds of re‐excision with ductal carcinoma in situ (DCIS) was 5.04 times greater than with invasive cancer (INV) and 1.94 times higher than with INV and DCIS. There was no significant difference in positive margins between groups (P = .362). Mean specimen volume was lowest in the systematic CSM group (64.6 cm3), compared to no CSM and selective CSM (94.6 cm3 and 91.8 cm3, respectively). With inclusion of shave margin volumes, total volume removed was not significantly different between no shave margin group (94.6 cm3) and systematic CSM (89.7 cm3) (P = .949). For patients with invasive ductal carcinoma (IDC) alone on their initial biopsy pathology, 69% were discovered to also have DCIS upon final pathology. Re‐excision rate and specimen volume between all groups were not statistically different. There was a higher re‐excision rate when DCIS was present, especially when not identified on CNB. As systematic CSM is most impactful when DCIS is involved, it is important to establish its presence for proper surgical planning.

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“…Surgical resection, the main treatment for patients with advanced breast cancer, is divided into breast-conserving therapy and total mastectomy. Total mastectomy is performed for breast cancer patients who are not suitable for breast conserving surgery and has a great impact on the physical and psychological well-being of the patients (4,5). Since most surgical patients are already in advanced stage of breast cancer at the time of treatment, breast cancer is likely to metastasize even if the cancerous tissue is removed (6).…”

Section: Introductionmentioning

confidence: 99%

Expression of TRPC1 and SBEM protein in breast cancer tissue and its relationship with clinicopathological features and prognosis of patients

2020

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This study investigated the relationship of the expression of transient receptor potential channel 1 (TRPC1), small breast epithelial mucin (SBEM) in breast cancer tissues with clinical pathological features and prognosis of patients. Altogether 50 patients with breast cancer who were treated in Weifang People's hospital from April 2017 to November 2018 were selected, and the mRNA and protein differences of TRPC1 and SBEM in breast cancer patients and normal breast cancer tissues were detected by qRT-PCR and Western blot. Spearman test was used for correlation analysis. Logistic univariate and multivariate analysis were performed on the risk factors related to breast cancer metastasis in breast cancer patients. The expression of TRPC1 and SBEM in breast cancer tissues was significantly higher than that in normal breast tissues (P<0.001). The mRNA expression of TRPC1, SBEM and protein was not related to age, tumor size and tissue grade of breast cancer patients, but related to TNM stage, clinical stage and lymph node metastasis (P<0.001). The relative expression of TRPC1 was positively correlated with clinical stage of breast cancer (r=0.992, P<0.001). The relative expression of SBEM was positively correlated with the clinical stage of breast cancer (r=0.853, P<0.001). The relative expression of TRPC1 was positively correlated with TNM staging of breast cancer (r=0.860, P<0.001). The relative expression of SBEM was positively correlated with TNM staging of breast cancer (r=0.880, P<0.001). Multivariate conditional Logistic regression analysis showed that TNM staging, TRPC1, SBEM were independent risk factors for malignant breast cancer metastasis. On the contrary, expression of TRPC1 and SBEM in breast cancer tissues was up-regulated. TRPC1 and SBEM may be involved in the process of breast cancer occurrence, development and metastasis, and can be used as potential tissue biomarkers in diagnosis of breast cancer metastasis and disease assessment.

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Surgeon Re-Excision Rates after Breast-Conserving Surgery: A Measure of Low-Value Care

Cited by 57 publications

References 23 publications

Structured light imaging for breast-conserving surgery, part II: texture analysis and classification

Structured light imaging for breast-conserving surgery, part II: texture analysis and classification

Impact of systematic cavity shave margins in breast‐conserving surgery at a large community hospital with a low baseline re‐excision rate

Expression of TRPC1 and SBEM protein in breast cancer tissue and its relationship with clinicopathological features and prognosis of patients

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