Relationship between initial margin status and residual carcinoma after re-excision for invasive duct breast carcinoma

Kotwall, Cyrus A.; Ranson, M.; Stiles, Anquonette; Hamann, Mary Sue; Hall, Tana; Brinker, Carda C.; Weiss, Anna

doi:10.1007/bf02524100

Cited by 12 publications

(14 citation statements)

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“…Nearly half of reexcision specimens do not harbor residual cancer. 6,11,22 In our study, we found that 47.9% of patients with clear but less than 1.0-mm margins underwent reexcision, and 20.2% of patients with margins between 1.0 and 1.9 mm underwent reexcision.…”

Section: Variability In Reexcision Following Breast Conservation Surgerymentioning

confidence: 86%

“…Failure to achieve appropriate margins at the initial operation will require additional surgery with reexcision rate estimates ranging from 30% to 60%. [6][7][8][9] These additional operations can produce considerable psychological, physical, and economic stress for patients and delay use of recommended adjuvant therapies. A high percentage (10%-36%) of women requiring reexcision undergo total mastectomy.…”

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confidence: 99%

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Variability in Reexcision Following Breast Conservation Surgery

McCahill

Single²,

Bowles³

et al. 2012

JAMA

463

329

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Context Health care reform calls for increasing physician accountability and transparency of outcomes. Partial mastectomy is the most commonly performed procedure for invasive breast cancer and often requires reexcision. Variability in reexcision might be reflective of the quality of care.Objective To assess hospital and surgeon-specific variation in reexcision rates following partial mastectomy. Design, Setting, and Patients An observational study of breast surgery performed between 2003 and 2008 intended to evaluate variability in breast cancer surgical care outcomes and evaluate potential quality measures of breast cancer surgery. Women with invasive breast cancer undergoing partial mastectomy from 4 institutions were studied (1 university hospital [University of Vermont] and 3 large health plans [Kaiser Permanente Colorado, Group Health, and Marshfield Clinic]). Data were obtained from electronic medical records and chart abstraction of surgical, pathology, radiology, and outpatient records, including detailed surgical margin status. Logistic regression including surgeon-level random effects was used to identify predictors of reexcision. Main Outcome Measure Incidence of reexcision.Results A total of 2206 women with 2220 invasive breast cancers underwent partial mastectomy and 509 patients (22.9%; 95% CI, 21.2%-24.7%) underwent reexcision (454 patients [89.2%; 95% CI, 86.5%-91.9%] had 1 reexcision, 48 [9.4%; 95% CI, 6.9%-12.0%] had 2 reexcisions, and 7 [1.4%; 95% CI, 0.4%-2.4%] had 3 reexcisions). Among all patients undergoing initial partial mastectomy, total mastectomy was performed in 190 patients (8.5%; 95% CI, 7.2%-9.5%). Reexcision rates for margin status following initial surgery were 85.9% (95% CI, 82.0%-89.8%) for initial positive margins, 47.9% (95% CI, 42.0%-53.9%) for less than 1.0 mm margins, 20.2% (95% CI, 15.3%-25.0%) for 1.0 to 1.9 mm margins, and 6.3% (95% CI, 3.2%-9.3%) for 2.0 to 2.9 mm margins. For patients with negative margins, reexcision rates varied widely among surgeons (range, 0%-70%; P=.003) and institutions (range, 1.7%-20.9%; PϽ.001). Reexcision rates were not associated with surgeon procedure volume after adjusting for case mix (P=.92). ConclusionSubstantial surgeon and institutional variation were observed in reexcision following partial mastectomy in women with invasive breast cancer.

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Section: Variability In Reexcision Following Breast Conservation Surgerymentioning

confidence: 86%

mentioning

confidence: 99%

Variability in Reexcision Following Breast Conservation Surgery

McCahill

Single²,

Bowles³

et al. 2012

JAMA

463

329

View full text Add to dashboard Cite

show abstract

“…There is much debate in the literature regarding margin size [4][5][6][7], however, over 50% of surveyed surgeons consider no tumor present within 1-2 mm of the surface to be sufficient for a clear margin [8,9]. As 30% to 60% of patients undergo reexcision, there remains a significant need for a real-time evaluation of the tumor margin [10][11][12][13]. Unfortunately, existing methods for intraoperative tumor margin evaluation are limited and considered inadequate.…”

Section: Introductionmentioning

confidence: 99%

Differentiation of ex vivo human breast tissue using polarization-sensitive optical coherence tomography

South¹,

Chaney²,

Marjanović³

et al. 2014

Biomed. Opt. Express

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Successful treatment of breast cancer typically requires surgical removal of the tumor. Optical coherence tomography (OCT) has been previously developed for real-time imaging of the surgical margin. However, it can be difficult to distinguish between normal stromal tissue and cancer tissue based on scattering intensity and structure alone. Polarization-sensitive optical coherence tomography (PS-OCT) is sensitive to form birefringence of biological tissue. We report on the development of a high-speed PS-OCT system and imaging of ex vivo human breast tissue, showing enhanced contrast between healthy and cancerous tissues based upon collagen content confirmed with corresponding histology. These results demonstrate the feasibility of using PS-OCT to supplement structural OCT as a possible method for intraoperative tumor margin evaluation. References and links 1. American Cancer Society, Breast Cancer Facts & Figs. 2013 (American Cancer Society, Atlanta, GA, 2013. 2. B. Fisher, S. Anderson, J. Bryant, R. G. Margolese, M. Deutsch, E. R. Fisher, J.-H. Jeong, and N. Wolmark, "Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer," N. Engl. J. Med. 347(16), 1233-1241 (2002). 3. U. Veronesi, N. Cascinelli, L. Mariani, M. Greco, R. Saccozzi, A. Luini, M. Aguilar, and E. Marubini, "Twentyyear follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer," N. Engl. J. Med. 347(16), 1227-1232 (2002). 4. P. Ananthakrishnan, F. L. Balci, and J. P. Crowe, "Optimizing surgical margins in breast conservation," Int. J. Surg. Oncol. 2012, 585670 (2012 J. Keely, "Aligned collagen is a prognostic signature for survival in human breast carcinoma," Am. ©2014 Optical Society of America

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“…A 2-mm margin of normal tissue is an accepted criterion for clear margins [1]. Unfortunately, between 20 and 70% of patients who undergo BCS require additional surgery due to incomplete removal of the disease during the first operation [2][3][4][5][6][7][8][9][10][11]. The heterogeneous appearance of breast cancer to the naked eye creates a challenge for surgeons to intraoperatively identify tumor regions to ensure complete removal of the disease [12].…”

Section: Introductionmentioning

confidence: 99%

A low-cost, portable, and quantitative spectral imaging system for application to biological tissues

Fu¹,

Yu²,

Lo³

et al. 2010

Opt. Express

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Abstract:The ability of diffuse reflectance spectroscopy to extract quantitative biological composition of tissues has been used to discern tissue types in both pre-clinical and clinical cancer studies. Typically, diffuse reflectance spectroscopy systems are designed for single-point measurements. Clinically, an imaging system would provide valuable spatial information on tissue composition. While it is feasible to build a multiplexed fiber-optic probe based spectral imaging system, these systems suffer from drawbacks with respect to cost and size. To address these we developed a compact and low cost system using a broadband light source with an 8-slot filter wheel for illumination and silicon photodiodes for detection. The spectral imaging system was tested on a set of tissue mimicking liquid phantoms which yielded an optical property extraction accuracy of 6.40 ± 7.78% for the absorption coefficient (µ a ) and 11.37 ± 19.62% for the wavelength-averaged reduced scattering coefficient (µ s '). ©2010 Optical Society of America

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Relationship between initial margin status and residual carcinoma after re-excision for invasive duct breast carcinoma

Cited by 12 publications

References 0 publications

Variability in Reexcision Following Breast Conservation Surgery

Variability in Reexcision Following Breast Conservation Surgery

Differentiation of ex vivo human breast tissue using polarization-sensitive optical coherence tomography

A low-cost, portable, and quantitative spectral imaging system for application to biological tissues

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