To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer

Ebner, Florian; Gregorio, Nikolaus de; Rempen, A; Möhr, Peter; Gregorio, Amelie de; Wöckel, Achim; Janni, Wolfgang; Witucki, Gerlo

doi:10.4274/jtgga.2016.0222

Cited by 8 publications

(9 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is also supported by a study from another tertiary cancer center [28], which reported the large burden and impact in low-resource settings of the detrimental effect of inadequate or incomplete breast or axillary surgery for breast cancer when procedures were performed by non-oncological surgeons. In addition, revision breast surgery gives an opportunity to mark the tumor cavity with clips to guide subsequent radiotherapy [29]. Immune histochemical status of breast cancer patients in this cohort shows low HER 2 receptor positivity (8.5%).…”

Section: Discussionmentioning

confidence: 89%

Sentinel Lymph Node Biopsy After Initial Lumpectomy (SNAIL Study)—a Prospective Validation Study

Agrawal

Bansawal

Arun

et al. 2018

Indian J Surg Oncol

View full text Add to dashboard Cite

Tertiary oncology center clinicians are commonly faced with the problem of managing patients with a diagnosis of breast cancer made after lumpectomy in the Primary Health Care (PHC) setting. There are no studies or guidelines that address the further surgical management in this group of patients regarding sentinel lymph node biopsy (SLNB) and need for breast post-operative cavity excision. Prospective observational study was planned to evaluate the feasibility of SLNB and defining the need for definitive breast surgery in patients diagnosed with breast cancer after lumpectomy in PHC. The study was carried out from January 2015 to August 2017 in Tata Medical Center, India, approved by institutional review board (EC/TMC/36/14). Seventy patients who underwent lumpectomy with a definitive histological analysis of breast cancer were included in this study. Each patient had definitive breast surgery and SLNB using subareoral blue dye injection followed by validation axillary dissection. The identification rate (IR) for SLNB was 92% (64/70). The median number of SLNs removed was 2 (IQR 1, 3). There were 2 patients with false negative results resulting in false negative rate (FNR) of 11%. Overall, SLNB procedure has the sensitivity of 89%, NPV of 96%, and accuracy was 97%. Peri-areoral incision of initial surgery was associated with low IR (84%) and high FNR (33%). Final histopathology showed residual invasive cancer in 43% and ductal carcinoma in situ in 14% of patients. Among 21 patients where initial lumpectomy histopathology margin was free of cancer, residual malignancy was found in 57% of patients. Prior excision of lumps for breast cancer does not affect the accuracy of SLNB. Peri-areoral scar may be associated with high FNR and low IR, although further studies are needed to validate this statement. Definitive breast surgery is required for all patients, irrespective of initial lumpectomy histopathological margin status.

show abstract

Section: Discussionmentioning

confidence: 89%

Sentinel Lymph Node Biopsy After Initial Lumpectomy (SNAIL Study)—a Prospective Validation Study

Agrawal

Bansawal

Arun

et al. 2018

Indian J Surg Oncol

View full text Add to dashboard Cite

show abstract

“…Several studies have demonstrated that traditional clinical planning techniques tend to underdose the tbd, to increase radiation to normal surrounding tissue, and to result in low interobserver reliability in target delineation 1,[4][5][6] . A 2016 U.K. Royal College of Radiologists consensus statement unanimously supports the use of tbd clips as the standard of care in bcs to improve the planning and administration of adjuvant boost radiation 3 .…”

Section: Practice Guideline Recommendationmentioning

confidence: 99%

“…Breast-conserving surgery consists of lumpectomy or partial mastectomy and, when combined with postoperative adjuvant radiotherapy, has been shown to be comparable to mastectomy in terms of overall survival 1,2 . Oncoplastic surgery combines bcs with plastic surgery tissue displacement techniques to immediately reshape the breast, with the aim of improving cosmetic outcomes while treating the breast cancer [3][4][5][6] . Oncoplastic surgery has allowed for larger tumours or tumours in a challenging location where volume loss could affect overall cosmesis to be resected while oncologic principles and cosmetic outcomes are both maintained 5,7,8 .…”

Section: Introductionmentioning

confidence: 99%

Consensus Statement on Tumour Bed Localization for Radiation after Oncoplastic Breast Surgery

et al. 2020

View full text Add to dashboard Cite

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery. OPS has led to some challenges with adjuvant radiation, particularly when accurate tumour bed (TB) delineation is needed for focused radiation (i.e. accelerated partial breast radiation or boost radiation). Currently, there on no guidelines on tumour bed localization for adjuvant targeted radiation after OPS. Methods: A modified-Delphi method was used to establish consensus amongst a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus (LABCNC) Group and in subsequent online surveys. Results: The main recommendations are as follows: 1) Surgical clips are necessary and should, at a minimum, be placed along the four side walls of the cavity plus one to four clips at the posterior margin if necessary; 2) Operative reports should include pertinent information to help guide the radiation oncologists; 3) Breast surgeons and radiation oncologists should have a basic understanding of OPS techniques and work on “speaking a common language”; and 4) Careful consideration is needed when determining the value of targeted radiation, like boost, in higher level OPS procedures with extensive tissue rearrangement. Conclusion: The panel developed a total of six recommendations on TB delineation for more focused radiation therapy after OPS, with over 80% agreement on each statement. These are summarized along with the corresponding evidence and/or expert opinion.

show abstract

“…They are generally available in most ORs, but inconsistently utilized in breast surgery cases (11,20). Despite being a standard in tumor bed marking, Yang et al (9) report the accuracy of clips representing the original tumor site is debatable as they: may be displaced with full thickness closure of the surrounding tissue, thus not correlate with the true extent of the cavity; may not be easily visualized on portal images and only provide a single point of reference for a margin, leading observers to interpolate the border of the cavity (2,12,(21)(22)(23)(24)(25)(26)(27)(28), potentially contributing to inaccuracy in target delineation for XRT. Radiation oncologists report alterations in delivered therapy secondary to clip placement (11,24,27,29).…”

Section: Surgical Clipsmentioning

confidence: 99%

“…The exact recommended placement and number of surgical clips for tumor bed identification with radiation planning varies (2,18,(21)(22)(23)(24)28,29). Clips have been reported to move or 'migrate' from their initial placement location (9,24,25,(30)(31)(32).…”

Section: Surgical Clipsmentioning

confidence: 99%

A novel, adaptable, radiographically opaque, multi-plane continuous filament marker for optimizing tissue identification, radiation planning, and radiographic follow-up

Mitchell¹,

Lee²,

Dupree³

et al. 2019

Gland Surg

View full text Add to dashboard Cite

Background: In breast cancer treatment, marking the tumor bed is an important aspect of the surgical component of therapy. Clear delineation of the tumor bed allows radiation oncologists a defined target for planning and delivering postoperative radiation therapy (XRT). Tumor bed marking also allows radiographic follow-up of the tumor bed on subsequent breast imaging. The aim of this assessment is to evaluate the ease and feasibility of utilizing a tumor bed filament marker (VeraForm  , Videra Surgical inc., USA) as a marker in post-operative benign surgical sites and malignant breast surgical tumor beds in breast cancer surgery. Methods:The filament marker is a novel radiopaque surgical filament that in lieu of clips and other markers is implanted in the surgical tumor bed during breast surgery. Following development of the filament marker, the researchers used breast phantoms and radiographic images to develop a series of geometric patterns of placement options that optimize comprehensive multi-plane radiographic interpretation of the exact tumor bed or surgical margin. Three breast surgeons at 3 separate institutions then used this filament as a continuous multi-plane marker in 20 patients during breast conservation surgery. In these patients, the filament marker was thus used to mark the tumor bed (breast cancer surgery) or surgical site (benign breast disease) instead of the more traditional devices such as clips or other metallic open framework devices.We then assessed 2 important factors related to this device; (I) the ease, feasibility, and accuracy of in vivo placement with oncoplastic and non-oncoplastic breast conservation surgery techniques; (II) the radiographic footprint this device left on standard imaging protocols of post-operative mammogram (MMG), computed tomography (CT) scan, breast magnetic resonance imaging (MRI) examinations, and ultrasounds (USs) for both routine follow-up imaging and for standard radiation planning.Results: There were no adverse events reported with the use of this device. The cases were then reviewed by a multidisciplinary team that included the original surgeon, a breast radiologist, and radiation oncologist.Their unanimous evaluation was that the filament marker clearly delineated all sides and planes of the tumor bed (cancer surgery) or surgical site (benign disease). Regardless of surgical technique utilized, this information provided precise 3D guidance for radiation planning and delivery as well as radiographic followup. The surgeons involved reported that delineating the bed with the filament marker was a quick and easy procedure and did not interfere with performing the planned surgical technique. Radiologists, surgeons, 610 Mitchell et al. Continuous radiopaque filament marker

show abstract

To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer

Cited by 8 publications

References 22 publications

Sentinel Lymph Node Biopsy After Initial Lumpectomy (SNAIL Study)—a Prospective Validation Study

Sentinel Lymph Node Biopsy After Initial Lumpectomy (SNAIL Study)—a Prospective Validation Study

Consensus Statement on Tumour Bed Localization for Radiation after Oncoplastic Breast Surgery

A novel, adaptable, radiographically opaque, multi-plane continuous filament marker for optimizing tissue identification, radiation planning, and radiographic follow-up

Contact Info

Product

Resources

About