“To clip or not to clip. That is no question!”

Aznar, Marianne C.; Meattini, Icro; Poortmans, Philip; Steyerová, Petra; Wyld, Lynda

doi:10.1016/j.ejso.2017.03.009

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…With the increasing use of surgical techniques that minimize clear visualization of the tumor bed, the consistent placement of surgical clips is becoming even more important for breast radiotherapy, particularly for PBI and boost. To address this issue, specific recommendations have included: the consistent placement of 4-6 clips in the walls of the surgical cavity at the level where the primary tumor was located representing the boundaries of the resection; insertion of clips prior to repositioning or rotation of breast tissue during oncoplastic procedures; detailed operative reports that include the number of clips used, clip placement and closure technique; and close multidisciplinary collaboration between surgeons and radiation oncologists to augment reliable and accurate localization of the tumor bed for breast radiotherapy planning [23,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…The optimal placement and number of surgical clips following breast-conserving surgery have also been described to assist in the delivery of external beam radiotherapy for WBI, PBI or boost [25][26][27]. These guidelines and basic principles regarding consistent marking of the tumor bed with clips are becoming increasingly important for breast radiotherapy due to the frequent use of oncoplastic procedures in contemporary breast conservation techniques, whereby the tumor bed is typically poorly visualized in the post-operative setting [28]. It is estimated that 32% (21,388/67,878) of women diagnosed with breast cancer in England between the years 2012-2016 were eligible for PBI [29]; therefore, clear visualization of the tumor bed after breastconserving surgery is essential to maximize local therapy options for a sizeable proportion of breast cancer patients with low-risk disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Koch

Corey

Liu

et al. 2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Koch

Corey

Liu

et al. 2021

Advances in Radiation Oncology

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“…The consensus panel recommends the intraoperative placement of a minimum of 4 clips in the breast parenchyma on the superior, inferior, medial, and lateral walls of the lumpectomy cavity at the depth of the tumour in the plane between skin and chest wall (anterior to posterior). The clips should be placed before any breast tissue rotation or movement is performed 1,7,15 . If the tumour cavity extends to the chest wall, the panel suggests that 1-4 additional clips be placed on the chest wall to indicate the most posterior aspect of the tumour resection.…”

Section: Recommendationmentioning

confidence: 99%

“…Clear communication between specialties is therefore crucial throughout the care of patients with breast cancer. An editorial published in the European Journal of Surgical Oncology acknowledged advances in breast radiation techniques, including pbi, but emphasized that the success of such targeted radiation strategies "may be jeopardised unless surgeons and radiation oncologists work closely together to ensure that the tumour bed can be reliably identified" 15 .…”

Section: Recommendationmentioning

confidence: 99%

Consensus Statement on Tumour Bed Localization for Radiation after Oncoplastic Breast Surgery

et al. 2020

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Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery. OPS has led to some challenges with adjuvant radiation, particularly when accurate tumour bed (TB) delineation is needed for focused radiation (i.e. accelerated partial breast radiation or boost radiation). Currently, there on no guidelines on tumour bed localization for adjuvant targeted radiation after OPS. Methods: A modified-Delphi method was used to establish consensus amongst a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus (LABCNC) Group and in subsequent online surveys. Results: The main recommendations are as follows: 1) Surgical clips are necessary and should, at a minimum, be placed along the four side walls of the cavity plus one to four clips at the posterior margin if necessary; 2) Operative reports should include pertinent information to help guide the radiation oncologists; 3) Breast surgeons and radiation oncologists should have a basic understanding of OPS techniques and work on “speaking a common language”; and 4) Careful consideration is needed when determining the value of targeted radiation, like boost, in higher level OPS procedures with extensive tissue rearrangement. Conclusion: The panel developed a total of six recommendations on TB delineation for more focused radiation therapy after OPS, with over 80% agreement on each statement. These are summarized along with the corresponding evidence and/or expert opinion.

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“…6–9 A recent editorial in the European Journal of Surgical Oncology states that using the scar or seroma to identify the TB is inaccurate. 10 Postoperative breast tissue changes and remodeling can also interfere with identification of the TB. 11 Uncertainty can lead to a larger volume being delineated, with the risk of additional side effects, 12–17 especially in terms of fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Interobserver variability (between radiation oncologist and radiation therapist) in tumor bed contouring after breast-conserving surgery

Rocca

Lici

Giandini

et al. 2019

Tumori

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Purpose: To examine interobserver variability between the radiation oncologist (RTO) and the radiation therapist (RTT) in delineating the tumor bed (TB) in early breast cancer (BC). Methods: We retrospectively analyzed patients who received a radiotherapy boost to the TB. In a first group, the clinical target volume (CTV) for the boost was the surgical bed, defined by using surgical clips. In a second group, the CTV was defined by identifying a seroma cavity or a metallic find on the scar. These contours were compared in terms of volume, number of slices, and Dice similarity coefficient (DSC). Results: Forty patients were assessed: 20 had surgical clips (group 1) while the other 20 had none (group 2). There was no difference in the number of slices contoured by the 2 operators for group 1, but a statistically significant difference emerged in the volumes: the RTT identified a TB that was a mean 45% smaller than the one identified by the RTO. Random differences were found between the 2 operators for group 2. The TBs delineated for this group were significantly larger ( P<0.05) than those identified by the RTT for group 1. The mean Dice value between the RTO’s and the RTT’s TBs was 0.69±0.07 (range 0.53–0.81) for group 1 and 0.37±0.18 (range 0–0.58) for group 2 ( P<0.05). Conclusions: This study showed that the use of clips coincided with less interoperator variability. With appropriate training, the RTT may play an important part in the multidisciplinary radiotherapy team.

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“To clip or not to clip. That is no question!”

Cited by 12 publications

References 15 publications

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Consensus Statement on Tumour Bed Localization for Radiation after Oncoplastic Breast Surgery

Interobserver variability (between radiation oncologist and radiation therapist) in tumor bed contouring after breast-conserving surgery

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