A Randomized Prospective Study of Lumpectomy Margin Assessment with Use of MarginProbe in Patients with Nonpalpable Breast Malignancies

Schnabel, Freya; Boolbol, Susan K.; Gittleman, Mark; Karni, Tami; Tafra, Lorraine; Feldman, Sheldon; Police, Alice; Friedman, Neil B.; Karlan, Scott; Holmes, Dennis R.; Willey, Shawna C.; Carmon, Moshe; Fernandez, Kristen; Akbari, Stephanie; Harness, Jay K.; Guerra, Lisa; Frazier, Thomas G.; Lane, Karen; Simmons, Rache M.; Estabrook, Alison; Allweis, Tanir

doi:10.1245/s10434-014-3602-0

Cited by 156 publications

(113 citation statements)

References 22 publications

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“…Recently, the St Gallen panel2 recommended a minimal acceptable surgical margin of ‘no ink on invasive tumour or DCIS’. Other interventions significantly reducing intraoperative tumour margin positivity have been described: digital specimen radiology ( P = 0·012 for digital versus conventional mammography)59, tumour margin cavity shaves60 and real‐time cancer margin assessments61 62. Ataseven and colleagues22 reported that neoadjuvant chemotherapy‐induced pathological complete cancer response rates increased the surgical options for BCS without compromising clinical outcomes, an approach requiring future investigation.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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“…The use of MarginProbe® reduced the need for a second operation from 29.9% to 14.1%. A similar trial by Schnabel et al [2] yielded excision rates of 62% for positive margins vs 22% without the probe. In summary, the total number of re-operations was reduced by 6%.…”

Section: Discussionmentioning

confidence: 91%

“…The success of local treatment depends on having clear resection margins. Residual cancer in resection margins can be found in as many as 20-46% of patients treated by BCT [2][3][4] which significantly increases the risk of recurrence, with ductal carcinoma in situ (DCIS) being particularly difficult to excise [5]. It is therefore vital to evaluate the clearance of excision margins.…”

Section: Introductionmentioning

confidence: 99%

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Dielectric-technique-assisted breast cancer surgery

Rząca¹,

Orzechowski²,

Wolny³

et al. 2017

Nowotwory. Journal of Oncology

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Introduction. In conservative breast cancer surgery, removing all carcinogenic lesions is a sound basis for achieving therapeutic success. The cleanness of the cutting margin is usually assessed after surgery and any residual cancerous tissue that are found, require further surgery. A simple and cheap assessment method is presented which can be used during surgery, the dielectric cancer probe (DCP), which allows the surgeon to take fast decisions on whether to extend incisions. Method. The DCP method consists of measuring and then differentiating between the electrical properties (permeability and conductivity) of healthy and cancerous breast tissue. A polyethylene strip is used to separate the examined tissue from the instrument probe and the procedure is carried out by the operating surgeon. Results. This method was found to allow correct identification of cancerous breast tissue based on taking 189 samples from 70 patients using the intraoperative hand probe. The sensitivity and specificity were respectively 87% and 99%. Conclusions. The DCP is a high sensitivity method and is totally safe for the patient and can be used intraoperatively. The device is an aid to the surgeon for differentiating between healthy and cancerous breast tissue. Its widespread use should reduce the number of reoperations in the conservative surgical management of breast cancer patients. NOWOTWORY J Oncol 2017; 67, 2: 108-114

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“…In addition to intraoperative frozen section, mastectomy specimen radiology and devices to detect margin involvement [10] are used more widely in the USA but in the UK, there has been a lack of pathology consensus on the need to assess all mastectomy margins. A national quality assurance initiative in Holland that started in 2003, mandated that all Dutch breast surgeons register their mastectomy pathology and for 23,121 patients undergoing mastectomy the rate of involvement of margins fell and correlated with subsequent local recurrence.…”

Section: Introductionmentioning

confidence: 99%

Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after paterson

Bundred¹,

Thomas

Dixon

2017

Breast Cancer Res Treat

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Purpose The Kennedy report into the actions of the disgraced Breast Surgeon, Paterson focussed on issues of informed consent for mastectomy, management of surgical margins and raised concerns about local recurrence rates and the increasing emphasis on cosmesis after mastectomy for breast cancer. This article assesses whether Kennedy's recommendations apply to the UK as a whole and how to address these issues. New GMC advice on consent and newer nonevidenced innovations in immediate reconstruction have altered the level of informed consent required. Patients deserve a better understanding of the issues of oncological versus cosmetic outcomes on which to base their decisions. Involvement of the whole multidisciplinary team including Oncologists is necessary in surgical planning. Failure to obtain clear microscopic margins at mastectomy leads to an increased local recurrence, yet has received little attention in the UK. Whereas, other countries have used surgical quality assurance audits to reduce local recurrence; local recurrence rates are not available and the extent of variation across the UK in margin involvement after surgery, its management and relationship to local recurrence needs auditing prospectively to reduce unnecessary morbidity. To reassure public, patients and the NHS management, an accreditation system with more rigour than NHSBSP QA and peer review is now required. Resource and efforts to support its introduction will be necessary from the Royal College of Surgeons and the Association of Breast Surgeons. New innovations require careful evaluation before their backdoor introduction to the NHS. Private Hospitals need to have the same standards imposed.

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A Randomized Prospective Study of Lumpectomy Margin Assessment with Use of MarginProbe in Patients with Nonpalpable Breast Malignancies

Cited by 156 publications

References 22 publications

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Dielectric-technique-assisted breast cancer surgery

Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after paterson

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