Practice patterns and perceptions of margin status for breast conserving surgery for breast carcinoma: National Survey of Canadian General Surgeons

Lovrics, Peter; Gordon, Maggie; Cornacchi, Sylvie D.; Farrokhyar, Forough; Ramsaroop, Amanda; Hodgson, Nicole; Quan, May Lynn; Wright, Francis; Porter, Geoffrey A.

doi:10.1016/j.breast.2012.07.017

Cited by 21 publications

(13 citation statements)

References 33 publications

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“…12,13 Moreover, some breast surgeons are not confident with the novel definition of clear margin, and often propose unnecessary re-excision in order to gain wider margins. 12,14,15 CSM could be an interesting solution, since it resolves doubts whenever a margin is found positive on lumpectomy specimen. Indeed CSM avoids false positive margins arising from misleading interpretation of the pathologist, or from technical pitfalls related to specimen handling(e.g.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Surgeons were asked to indicate if they did not perform breast surgery as part of their practice. The survey consisted of 27 questions on the following topics: frequency of use of diagnostic excisional biopsies and preoperative core biopsy; definitions of negative margins for ductal carcinoma in situ (DCIS) and invasive breast cancer; frequency of use of intraoperative margin assessment techniques; goals for gross surgical margins for DCIS and invasive cancer; frequency of skin resection, and dissection to chest wall; recommendations for re‐excision and referral to radiation oncology.…”

Section: Methodsmentioning

confidence: 99%

“…Our recent survey of Canadian (CDN) breast surgeons found marked variation in BCS practices (11). We found heterogeneity in the definition of negative and close margins, recommendations for re-excision and use of intraoperative techniques (11). Surveys of American (AM) breast surgeons have similarly shown variations in definitions of negative margins and use of intraoperative techniques for margin assessment (12,13).…”

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Survey of American and Canadian General Surgeons' Perceptions of Margin Status and Practice Patterns for Breast Conserving Surgery

et al. 2014

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Although breast conservation surgery (BCS) is commonly performed, several aspects of the procedure remain controversial. We undertook a cross-sectional survey to compare Canadian (CDN) and American (AM) general surgeons' reported BCS practice patterns to better understand the cross-border differences in early-stage breast cancer surgery care. A modified Dillman Method survey was mailed to 1,447 AM and 1,443 CDN surgeons. Factors evaluated included preoperative assessment, margin definition, surgical techniques, and re-excision practices. The response rate was 26% and 51% for AM and CDN surgeons, respectively. There was variation in use of preoperative core biopsies. American surgeons required wider margins for invasive cancer and ductal carcinoma in situ, and more often recommend re-excision for invasive cancer with 1 and 2 mm margins (p < 0.05). There was also variability in surgical techniques used for intraoperative margin assessment. Wide variation in BCS practice was observed, with some of this variability related to surgeon country.

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“…A similar pattern was seen for patients with DCIS. 3 Finally, in a survey of 702 North American radiation oncologists, 45.9% considered a margin negative when there was no tumor at the inked margin; margin widths of 1, 2, 3, 5, and 10 mm were considered negative by 7.4%, 21.8%, 10%, 10%, and 4.9% of respondents, respectively. 4 Lack of consistency among clinicians in defining an adequate negative margin has led to wide variation in the rate of re-excision following lumpectomy.…”

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The Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer: Perspectives for Pathologists

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et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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A variety of patient, treatment, and pathologic factors are associated with an increased risk of ipsilateral breast tumor recurrence (local recurrence) after breast conservation therapy for invasive breast cancer. Arguably, the most important of these has been the status of the microscopic margins of excision of the resected breast specimen. Among patients treated with breast-conserving surgery and radiation therapy, positive margins (ie, invasive carcinoma or ductal carcinoma in situ [DCIS] touching an inked tissue edge) are associated with a 2-fold increase in the risk of local recurrence when compared with negative margins.1 Therefore, obtaining negative margins prior to radiation therapy is the primary goal of breast-conserving surgery, and minimizing the microscopic residual tumor burden through removal of larger amounts of normal breast tissue has traditionally been considered a major factor for optimizing local control.Although it has been more than 20 years since 6 randomized clinical trials reported that treatment with breast-conserving surgery and radiation therapy results in equivalent survival to mastectomy for women with earlystage breast cancer, there is still no universal agreement on what constitutes an adequate negative margin for patients being managed with the breast-conserving approach. Surveys of surgeons and radiation oncologists have demonstrated that there is no single threshold margin width identified as adequate by more than 50% of respondents. When 318 surgeons were presented with a scenario involving a patient with a T1 invasive breast cancer with planned radiation therapy following lumpectomy, 11% indicated that tumor not touching ink was an adequate negative margin, 42% favored a margin of at least 1 to 2 mm, 28% favored a margin of 5 mm or more, and 19% preferred a margin of more than 10 mm.2 In a survey of 730 surgeons in Canada, 40% considered a margin negative for invasive breast cancer if there was no tumor at ink, 14% required at least a 1-mm margin, 29% at least a 2-mm margin, and 18% at least a 5-mm margin. A similar pattern was seen for patients with DCIS.3 Finally, in a survey of 702 North American radiation oncologists, 45.9% considered a margin negative when there was no tumor at the inked margin; margin widths of 1, 2, 3, 5, and 10 mm were considered negative by 7.4%, 21.8%, 10%, 10%, and 4.9% of respondents, respectively. 4 Lack of consistency among clinicians in defining an adequate negative margin has led to wide variation in the rate of re-excision following lumpectomy. In a study that included 54 surgeons, rates of re-excision ranged from 0% to 70%.5 Moreover, approximately half of these re-excisions were performed in patients with negative margins, apparently with the belief that a wider negative margin would further decrease the rate of local recurrence.In current clinical practice, 10-year local recurrence rates after breast-conserving surgery and radiation therapy are low, ranging from 5% to 10%. For the most common subgroup of breast cancer patients, that is,...

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Practice patterns and perceptions of margin status for breast conserving surgery for breast carcinoma: National Survey of Canadian General Surgeons

Abstract: Responses revealed significant variation in attitudes and practices. These findings likely reflect an absence of consensus in the literature and potential gaps between best evidence and practice.

Cited by 21 publications

References 33 publications

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

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

Survey of American and Canadian General Surgeons' Perceptions of Margin Status and Practice Patterns for Breast Conserving Surgery

The Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer: Perspectives for Pathologists

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