Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland

Tang, Sarah; Kaptanis, Sarantos; Haddow, J. B.; Mondani, Giuseppina; Elsberger, Beatrix; Tasoulis, Marios Konstantinos; Obondo, Christine; Johns, Neil; Ismail, Wesam W; Syed, Asim; Kissias, Panayioti; Venn, Mary L; Sundaramoorthy, Souganthy; Irwin, Gareth; Sami, Amtul; Elfadl, Dalia; Baggaley, Alice; Remoundos, Dionysios-Dennis; Langlands, Fiona; Charalampoudis, Petros; Barber, Zoe; Hamilton-Burke, Werbena; Khan, Ayesha; Sirianni, Chiara; Merker, Louise; Saha, Sunita; Lane, Risha; Chopra, Sharat; Dupré-Crochet, Sophie; Manning, Aidan; John, Edward St; Musbahi, Aya; Dlamini, Nokwanda; McArdle, Caitlin L; Wright, Chloe; Murphy, James O.; Aggarwal, Ravi; Dordea, Matei; Bosch, Karen; Egbeare, Donna; Osman, Hisham; Tayeh, Salim; Razi, Faraz; Iqbal, Javeria; Ledwidge, Serena; Albert, Vanessa; Masannat, Yazan

doi:10.1016/j.ejca.2017.07.032

Cited by 58 publications

(52 citation statements)

References 34 publications

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“…Re-excision is required when histopathology-based post-operative tests indicate that either the tumour is too close to the specimen margins or the tumour infiltrates the margins. Re-excision rates vary from centre to centre; a recent prospective study indicated a 0% to 41% (median 17.2%) re-excision rate across 76 individual centres in the UK (Tang et al 2017 ). Re-operation can cause patients additional stress and affect cosmetic outcome.…”

Section: Introductionmentioning

confidence: 99%

A compact system for intraoperative specimen imaging based on edge illumination x-ray phase contrast

et al. 2019

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A significant number of patients receiving breast-conserving surgery (BCS) for invasive carcinoma and ductal carcinoma in situ (DCIS) may need reoperation following tumor-positive margins from final histopathology tests. All current intraoperative margin assessment modalities have specific limitations. As a first step towards the development of a compact system for intraoperative specimen imaging based on edge illumination x-ray phase contrast, we prove that the system’s dimensions can be reduced without affecting imaging performance. We analysed the variation in noise and contrast to noise ratio (CNR) with decreasing system length using the edge illumination x-ray phase contrast imaging setup. Two-(planar) and three-(computed tomography (CT)) dimensional imaging acquisitions of custom phantoms and a breast tissue specimen were made. Dedicated phase retrieval algorithms were used to separate refraction and absorption signals. A ‘single-shot’ retrieval method was also used, to retrieve thickness map images, due to its simple acquisition procedure and reduced acquisition times. Experimental results were compared to numerical simulations where appropriate. The relative contribution of dark noise signal in integrating detectors is significant for low photon count statistics acquisitions. Under constant exposure factors and magnification, a more compact system provides an increase in CNR. Superior CNR results were obtained for refraction and thickness map images when compared to absorption images. Results indicate that the ‘single-shot’ acquisition method is preferable for a compact CT intraoperative specimen scanner; it allows for shorter acquisition times and its combination of the absorption and refraction signals ultimately leads to a higher contrast. The first CT images of a breast specimen acquired with the compact system provided promising results when compared to those of the longer length system.

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Section: Introductionmentioning

confidence: 99%

A compact system for intraoperative specimen imaging based on edge illumination x-ray phase contrast

et al. 2019

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“…In addition, up to 20% of patients may require additional surgery for re-excision of margins involved with tumour following histopathological assessment [10]. This has considerable impact on patient well-being and significant resource implications for the NHS [11] and although many international centres now accept the pathological definition of a clear margin as 'no tumour at the inked resection margin' [12], current practice continues to vary across the UK [13].…”

Section: Problems With Current Management Strategiesmentioning

confidence: 99%

The SMALL Trial: A Big Change for Small Breast Cancers

et al. 2019

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“…Definitive BCS is associated with similar survival rates to those achieved with mastectomy. Unfortunately, on average, 18 per cent of patients with ductal carcinoma in situ (DCIS) and 27 per cent of those with invasive disease undergoing BCS in the UK require reoperation for positive margins. Positive margins after BCS are associated with a twofold increased risk of ipsilateral breast tumour recurrence, which is not negated by radiotherapy, systemic therapy or endocrine therapy.…”

Section: Introductionmentioning

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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Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland

Cited by 58 publications

References 34 publications

A compact system for intraoperative specimen imaging based on edge illumination x-ray phase contrast

A compact system for intraoperative specimen imaging based on edge illumination x-ray phase contrast

The SMALL Trial: A Big Change for Small Breast Cancers

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

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