The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer

Lovrics, Peter; Cornacchi, Sylvie D.; Farrokhyar, Forough; Garnett, Anna; Chen, Vicky; Franic, Slobodan; Šimunović, Marko

doi:10.1016/j.amjsurg.2008.03.007

Cited by 139 publications

(121 citation statements)

References 35 publications

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“…The essential purpose of BCS is to completely remove the cancer while maintaining the cosmetic appearance of the breast, which is important to the patients. Previous studies have reported that BCS followed by radiation had a similar outcome to that of mastectomy in terms of mortality rate (1)(2)(3)(4)(5). However, a positive margin and young age (<53-55) are significant risk factors for ipsilateral breast tumor recurrence (IBTR) (6)(7)(8).…”

Section: Introductionmentioning

confidence: 98%

Impact of intraoperative specimen mammography on margins in breast-conserving surgery

Hisada

Sawaki

Ishiguro

et al. 2016

Molecular and Clinical Oncology

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Abstract.A positive resection margin is one of the most significant risk factors for local breast cancer recurrence following breast-conserving surgery (BCS). Intraoperative specimen mammography (SMMG) is routinely used to evaluate the surgical margin at our institution. The aim of the present study was to assess the adequacy of SMMG for margin assessment. The patient cohort included 174 women who underwent BCS in 2006. The sensitivity and specificity of SMMG were assessed by comparing the margins assessed by histological and radiological methods. It was also examined whether the rate of positive histological margins was decreased by re-excision following SMMG evaluation. A total of 23 false-negatives and 6 false-positives were determined by SMMG. The sensitivity and specificity of SMMG margin assessment for patients with primary breast cancer were 20.6 and 94.6%, respectively. The positive predictive value was 50% and the negative predictive value was 82.2%. A subgroup analysis revealed that the sensitivity and specificity of SMMG in cases with ductal carcinoma in situ (DCIS) were higher compared with those in invasive ductal carcinoma. Furthermore, the positive histological margin rate was not affected by re-excision. Although the general usefulness of intraoperative SMMG was not proven, this procedure may be useful in specific cases, particularly those with DCIS and those diagnosed by stereotactic biopsy. A prospective study with exact criteria and a standard procedure is required. IntroductionThe standard surgical treatments for breast cancer are breast-conserving surgery (BCS) and mastectomy. The essential purpose of BCS is to completely remove the cancer while maintaining the cosmetic appearance of the breast, which is important to the patients. Previous studies have reported that BCS followed by radiation had a similar outcome to that of mastectomy in terms of mortality rate (1-5). However, a positive margin and young age (<53-55) are significant risk factors for ipsilateral breast tumor recurrence (IBTR) (6-8). Moreover, a meta-analysis by the Early Breast Cancer Trialists' Collaborative Group showed that local recurrence affected survival rate (9). Recently, Moran et al (10) reported that the American Society of Radiation Oncology consensus guideline uses the results of a meta-analysis of margin width and IBTR. This guideline also indicated the optimal criteria for determining margin width in BCS. However, despite numerous previous studies, the criteria for intraoperative margin assessment in BCS have yet to be established. At our institution, intraoperative specimen digital mammography (SMMG) is used to assess the resection margins in all cases of BCS. The aim of the present study was to evaluate the usefulness of SMMG for achieving margin-free resection of breast tumors. Patients and methods Patients.A retrospective study of the medical records, pathological diagnosis and re-evaluation by SMMG of 426 breast cancer patients who underwent BCS at the Aichi Cancer Center Hospital (Nagoya, Japan) between J...

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Section: Introductionmentioning

confidence: 98%

Impact of intraoperative specimen mammography on margins in breast-conserving surgery

Hisada

Sawaki

Ishiguro

et al. 2016

Molecular and Clinical Oncology

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“…These factors should be carefully considered when planning the extent of the cavity shave margin. 24 …”

Section: Demographic and Clinical Patients' Data (Table)mentioning

confidence: 99%

Cavity shave margins for breast conservative surgery

2017

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Background: 20-40% of patients have positive margins after partial mastectomy. Taking additional tissue circumferentially around the cavity left by partial mastectomy "cavity shave margins" may reduce the rate of positive margins. This review aims to evaluate the effect of routine excision of circumferential cavity shave margins after breast-conserving surgery.Methods: This randomized controlled trial had been conducted in General Surgery Department, Sohag Faculty of Medicine from January 2015 to April 2017. 40 patients with early breast cancer were candidates for partial mastectomy and randomly assigned in a 1:1 ratio to have either additional circumferential cavity shave margins or not.Results: The mean age of both groups were around 39 years (range 30-50 years). More than half of the cases fell in stage I, with a little more than 20% of them were in stage 0 and the rest in stage II at time of operation. Although cavity shave group had longer operative time, longer hospital stay, and higher amount of blood loss; all these showed non-significant difference between the two groups. The mean amount of resected volume was significantly higher among cavity shave group compared to non-cavity shave group. The percentage of positive margin reduced from 40% before shave to only 10% after shave margin.Conclusions: Cavity shaving resulted in significant reduction of the rates of positive margins and re-operation among patients undergoing breast-conserving surgery.

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“…74 However no extant method balances the accuracy, speed and ease of use required to achieve an ideal method of intraoperative analysis, and all present methods still result in 20-55% of removals requiring a secondary surgery. [75][76][77] The ability of SHG F/B to readily distinguish tumor from healthy tissue 61,63 coupled with the fact that it is a quantitative, intrinsic signal, suggests that it may provide useful information to assist with margin assessment. Implementing F/B SHG techniques to detect different collagen profiles between healthy and tumor tissue along the border of the removed tissue would allow for the immediate analysis of the biopsy upon removal from the patient without the extensive staining and sectioning required for traditional pathological analysis.…”

Section: Role Of Shg Imaging In Tumor Margin Evaluationmentioning

confidence: 99%

The Use of Second Harmonic Generation to Image the Extracellular Matrix During Tumor Progression

Burke¹,

Brown

2014

IntraVital

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The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer

Cited by 139 publications

References 35 publications

Impact of intraoperative specimen mammography on margins in breast-conserving surgery

Impact of intraoperative specimen mammography on margins in breast-conserving surgery

Cavity shave margins for breast conservative surgery

The Use of Second Harmonic Generation to Image the Extracellular Matrix During Tumor Progression

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