Cavity Shaving Reduces Involved Margins and Reinterventions Without Increasing Costs in Breast-Conserving Surgery: A Propensity Score-Matched Study

Corsi, Fabio; Sorrentino, Luca; Bonzini, Matteo; Bossi, Daniela; Truffi, Marta; Amadori, Rosella; Nebuloni, Manuela; Brillat, Barbara; Mazzucchelli, Serena

doi:10.1245/s10434-017-5774-x

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…It has not been shown to adversely affect cosmetic outcomes. Corsi et al found that avoiding cavity shaved margins expose patients to 6.2-fold higher risk of positive margin and 5.46-fold higher risk of reintervention (76). The cost effectiveness has been looked at, and there has been no increase in cost doing cavity shaves due to significantly fewer reoperations (77).…”

Section: Updatementioning

confidence: 99%

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

et al. 2018

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In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool. The original ten tools were updated with the latest evidence from the literature and our strength of recommendation. We added an additional section looking at new tools and techniques that may provide more accurate intraoperative assessment of margins.The updates on the CALLER Toolbox for lumpectomy will help guide surgeons to various resources to aid in the removal of breast cancer, while being aware of cosmesis and decreasing re excision rates.

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Section: Updatementioning

confidence: 99%

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

et al. 2018

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“…Oncologic surgeons typically approach this by excising a volume of tissue slightly larger than that of the target tumor to obtain an outer layer of presumably healthy tissue known as the tumor margin. The surgeon may also take additional margin of tissue shaved from the walls of the cavity created by the tumor [4][5][6]. If, on postoperative analysis, the pathologist determines the margins to be free of cancerous cells to a depth of 2 mm or more from the main tumor for DCIS, and no ink on tumor for invasive cancer, then the chances of local disease recurrence are relatively low.…”

Section: Introductionmentioning

confidence: 99%

Potential Utility of Adjunct Imaging with Wide-Field Optical Coherence Tomography for Gross and Microscopic Evaluation of Breast Specimens in Real-Time in the Operating Suite

et al. 2021

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One challenge in the surgical management of breast cancer is maximizing the preservation of healthy tissue while achieving acceptable negative margins. Tools capable of assessing disease-margin involvement intraoperatively and in real-time could provide clinically useful guidance regarding the adequacy of margin resection before the surgery is over. Here we report the intraoperative use of optical coherence tomography (OCT) in 3 patients with DCIS. In all 3 cases, additional lesions identified by OCT during surgery were also noted in histopathology reports 3 to 5 days post-surgery, suggesting that intraoperative use of OCT is a valuable tool for margin determination in real-time.

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“…Only direct medical costs were reported; indirect costs (not directly accountable to the operation) and intangible costs (unquantifiable cost relating to an identifiable source) were not estimated in any of the reviewed literature. The source of cost estimates was hospital records in four studies and Centers for Medicare and Medicaid Services reimbursement data in three. Initial BCS and reoperation costs were in the range US $1234–11786 and $655–9136 respectively ( Table S2, supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…The present health economic review highlights the heterogeneity and paucity of high‐quality studies reporting cost estimates of reoperations in breast surgery. Only nine studies have commented on reported costs of re‐excision in BCS, with two employing a predictive model to hypothesize the cost impact of re‐excision following BCS in the USA and Canada. Several studies contained minimal cost information, whereas others reported a range of costs for numerous variables that could not be collated accurately.…”

Section: Discussionmentioning

confidence: 99%

Patient-level costs in margin re-excision for breast-conserving surgery

Grant

Al-Khudairi

John

et al. 2019

Journal of British Surgery

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Background: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS. Methods: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0⋅75, £1 = €1⋅14 and US $1 = €0⋅85. Results: The median QHES score was 47 (i.q.r. 32⋅5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752-18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0⋅001). Conclusion: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.

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Cavity Shaving Reduces Involved Margins and Reinterventions Without Increasing Costs in Breast-Conserving Surgery: A Propensity Score-Matched Study

Abstract: CSM reduces reexcisions, mainly in luminal breast cancers, without increasing costs.

Cited by 21 publications

References 28 publications

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

Potential Utility of Adjunct Imaging with Wide-Field Optical Coherence Tomography for Gross and Microscopic Evaluation of Breast Specimens in Real-Time in the Operating Suite

Patient-level costs in margin re-excision for breast-conserving surgery

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