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Shi XQ, Dong Y, Tan X, Yang P, Wang C, Feng W, Lin Y, Qian L. Accuracy of conventional ultrasound, contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging in assessing the size of breast cancer. Clin Hemorheol Microcirc 2022; 82:157-168. [PMID: 35723092 DOI: 10.3233/ch-221456] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was performed to investigate the accuracy of conventional ultrasound (US), contrast-enhanced US (CEUS), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing the size of breast cancer. METHODS In total, 49 breast cancer lesions of 48 patients were included in this study. The inclusion criteria were the performance of total mastectomy or breast-conserving surgery for treatment of breast cancer in our hospital from January 2017 to December 2020 with complete pathological results, as well as the performance of conventional US, CEUS, and DCE-MRI examinations with complete results. The exclusion criteria were non-mass breast cancer shown on conventional US or DCE-MRI, including that found on CEUS with no boundary with surrounding tissues and no confirmed tumor scope; a tumor too large to be completely displayed in the US section, thus affecting the measurement results; the presence of two nodules in the same breast that were too close to each other to be distinguished by any of the three imaging methods; and treatment with preoperative chemotherapy. Preoperative conventional US, CEUS, and DCE-MRI examinations were performed. The postoperative pathological results were taken as the gold standard. The lesion size was represented by its maximum diameter. The accuracy, overestimation, and underestimation rates of conventional US, CEUS, and DCE-MRI were compared. RESULTS The maximum lesion diameter on US, CEUS, DCE-MRI and pathology were 1.62±0.63 cm (range, 0.6-3.5 cm), 2.05±0.75 cm (range, 1.0-4.0 cm), 1.99±0.74 cm (range, 0.7-4.2 cm) and 1.92±0.83 cm (range, 0.5-4.0 cm), respectively. The lesion size on US was significantly smaller than that of postoperative pathological tissue (P < 0.05). However, there was no significant difference between the CEUS or DCE-MRI results and the pathological results. The underestimation rate of conventional US (55.1%, 27/49) was significantly higher than that of CEUS (20.4%, 10/49) and DCE-MRI (24.5%, 12/49) (P < 0.001 and P = 0.002, respectively). There was no significant difference in the accuracy of CEUS (36.7%, 18/49) and DCE-MRI (34.7%, 17/49) compared with conventional US (26.5%, 13/49); however, the accuracy of both groups tended to be higher than that of conventional US. The overestimation rate of CEUS (42.9%, 21/49) and DCE-MRI (40.8%, 20/49) was significantly higher than that of conventional US (18.4%, 9/49) (P = 0.001 and P = 0.015, respectively). CONCLUSIONS CEUS and DCE-MRI show similar performance when evaluating the size of breast cancer. However, CEUS is more convenient, has a shorter operation time, and has fewer restrictions on its use. Notably, conventional US is more prone to underestimate the size of lesions, whereas CEUS and DCE-MRI are more prone to overestimate the size.
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Affiliation(s)
- Xian-Quan Shi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yunyun Dong
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoqu Tan
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peipei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Feng
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuxuan Lin
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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2
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Simpson D, Allan J, McFall B. Radiological Underestimation of Tumor Size Influences the Success Rate of Re-Excision after Breast-conserving Surgery. Eur J Breast Health 2021; 17:363-370. [PMID: 34651116 DOI: 10.4274/ejbh.galenos.2021.2021-4-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022]
Abstract
Objective Failure to achieve adequate margins after breast-conserving surgery often leads to re-excision, either by repeat breast-conserving surgery (BCS) or by mastectomy. Despite the high frequency of this problem, the success rate of achieving adequate margins by repeat BCS is not well documented. The objective of this study was to determine the success rate of repeat BCS and identify the factors influencing that rate. Materials and Methods A retrospective review was performed of all women undergoing repeat BCS for inadequate margins after initial BCS in our breast unit between 2013 and 2019. Univariate and multivariate analyses were carried out to identify the factors influencing how often adequate margins were achieved after repeat BCS. Results One hundred fifty-four patients underwent repeat BCS after initially inadequate margins, of which adequate margins were achieved in 82%. Patients with successful repeat BCS had smaller tumors, had less underestimation of tumor size on imaging, and were less likely to have had cavity shaves taken at their initial BCS. A tumor size more than 50% larger than predicted by imaging was independently associated with failure of repeat BCS in multivariate analysis (odds ratio: 3.6, 95% CI: 1.41-9.20, p = 0.007). Underestimation of tumor size by imaging was commoner and more extensive in patients with larger tumors and those with ductal carcinoma in situ. Conclusion Re-excision by cavity shaves has a high success rate and should be offered to all patients who are deemed suitable for the procedure. Patients whose tumors are more than 50% larger than predicted by imaging should be counseled about the higher risk of failure.
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Affiliation(s)
- Duncan Simpson
- Breast Unit, Antrim Area Hospital, Bush Road, Antrim, Northern Ireland, United Kingdom
| | - Jennifer Allan
- Breast Unit, Antrim Area Hospital, Bush Road, Antrim, Northern Ireland, United Kingdom
| | - Brendan McFall
- Breast Unit, Antrim Area Hospital, Bush Road, Antrim, Northern Ireland, United Kingdom
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3
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Ghita A, Hubbard T, Matousek P, Stone N. Noninvasive Detection of Differential Water Content Inside Biological Samples Using Deep Raman Spectroscopy. Anal Chem 2020; 92:9449-9453. [PMID: 32603089 DOI: 10.1021/acs.analchem.0c01842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Here we conceptually demonstrate the capability of deep Raman spectroscopy to noninvasively monitor changes in the water content within biological tissues. Water was added by injection into an isolated tissue volume (a 20 mm diameter disk of 5 mm thickness) representing a 20% increase in the overall mass, which was equivalent to a 5% increase in the water/tissue content. The elevated water content was detected through a larger volume of tissue with a total thickness of approximately 12 mm and a spiked tissue segment located in its center using transmission Raman spectroscopy (TRS) by monitoring the change of the OH (∼3390 cm-1) Raman band area (3350-3550 cm-1 spectral region) after being normalized to the neighboring CH stretching band. The tissue sample was raster scanned with TRS to yield a spatial map of the water concentration within the sample encompassing the spiked tissue zone. The mapping revealed the presence and location of the spiked region. The results provide the first conceptual demonstration using a deep Raman-based architecture, which can be used noninvasively for the detection of an elevated water content deep within biological tissues. It is envisaged that this concept could play a role in rapid in vivo detection and localization of cancerous lesions (generally exhibiting a higher water content) beneath the tissue surface.
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Affiliation(s)
- Adrian Ghita
- Biomedical Spectroscopy Lab, School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Stoker Road, Exeter EX4 4QL, U.K
| | - Thomas Hubbard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX1 2LU, U.K.,Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, U.K
| | - Pavel Matousek
- Central Laser Facility, Research Complex at Harwell, STFC Rutherford Appleton Laboratory, UKRI, Harwell Campus, Oxfordshire OX11 0QX, U.K
| | - Nicholas Stone
- Biomedical Spectroscopy Lab, School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Stoker Road, Exeter EX4 4QL, U.K.,Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX1 2LU, U.K.,Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, U.K
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Miligy IM, Toss MS, Khout H, Whisker L, Burrell HC, Ellis IO, Green AR, Macmillan D, Rakha EA. Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution. Breast J 2019; 25:1143-1153. [PMID: 31318120 DOI: 10.1111/tbj.13425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Management of breast ductal carcinoma in situ (DCIS) has various approaches with distinct institutional specific practice. Here, we review DCIS management in a single institution with emphasize on re-operation rates and outcome. METHODS Breast ductal carcinoma in situ cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n = 1249). Clinicopathological data were collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re-excision, presence of residual tumor in the re-excision specimens, use of radiotherapy and ipsilateral recurrences were analyzed. RESULTS 34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumor grade, size >40 mm, and associated with comedo necrosis and Paget's disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumor tissue was detected in 53% of the re-excision specimens. Re-excision rates of patients treated with breast-conserving surgery (BCS) were reduced from approximately 70% to 23%, and the final mastectomy rates decreased from 60% to 20%. Changes in surgical practice with acceptance of smaller excision margins and more frequent use of local radiotherapy have led to a significant decrease not only in the re-excision rate but also in the final mastectomy rate together with non-significant reduction in 5- and 10-year local recurrence rates. CONCLUSION Although BCS is increasingly the preferred primary surgical option for DCIS management, a proportion of low-risk DCIS patients continue to undergo re-excision surgery or completion mastectomy. Despite acceptance of smaller margins, recurrence rate is decreasing.
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Affiliation(s)
- Islam M Miligy
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK
| | - Michael S Toss
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK
| | - Hazem Khout
- Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lisa Whisker
- Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helen C Burrell
- Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian O Ellis
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK.,Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Histopathology, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK
| | - Andrew R Green
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK
| | - Douglas Macmillan
- Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK.,Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Histopathology, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK
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5
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Tang SSK, Rapisarda F, Nerurkar A, Osin P, MacNeill F, Smith I, Johnston S, Ross G, Mohammed K, Gui GPH. Complete excision with narrow margins provides equivalent local control to wider excision in breast conservation for invasive cancer. BJS Open 2018; 3:161-168. [PMID: 30957062 PMCID: PMC6433318 DOI: 10.1002/bjs5.50121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/22/2018] [Indexed: 11/07/2022] Open
Abstract
Background Society of Surgical Oncology and American Society for Radiation Oncology guidelines define clear margins in breast-conserving therapy (BCT) as 'no ink on tumour', in contrast to the attainment of margins of at least 1 mm widely practised in the UK. The primary aim of this study was to explore clinical, surgical and tumour-related factors associated with local recurrence after BCT, with a secondary aim of assessing the impact of margin re-excision on the risk of local recurrence. Methods Patient demographics, surgical details, tumour characteristics and local recurrence were recorded for consecutive women with BCT undergoing surgery between January 1997 and January 2007. Margins were defined as clear (greater than 1 mm), close (less than 1 mm but no ink on tumour), reaches (ink on tumour) and clear after re-excision. Results A total of 1045 women of median age 54 (range 18-86) years were studied. Median follow-up was 89 (range 4-196) months. Local recurrence occurred in 52 patients (5·0 per cent). Ink on tumour was associated with local recurrence (hazard ratio (HR) 4·86, 95 per cent c.i. 1·49 to 15·79; P = 0·009). Risk of local recurrence was the same for close and clear margins (HR 1·03, 0·40 to 2·62; P = 0·954). In women with involved margins, re-excision was still associated with an increased local recurrence risk (HR 2·50, 1·32 to 4·72; P = 0·005). Oestrogen receptor negativity increased risk (HR 2·28, 1·28 to 4·06; P = 0·005). Conclusion Adequately excised margins, even when under 1 mm, provide equivalent outcomes to wider margins in BCT. Achieving complete excision at primary surgery achieves the lowest rates of local recurrence.
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Affiliation(s)
- S S K Tang
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - F Rapisarda
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - A Nerurkar
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - P Osin
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - F MacNeill
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - I Smith
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - S Johnston
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - G Ross
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - K Mohammed
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - G P H Gui
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
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6
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Bohte AE, Nelissen JL, Runge JH, Holub O, Lambert SA, de Graaf L, Kolkman S, van der Meij S, Stoker J, Strijkers GJ, Nederveen AJ, Sinkus R. Breast magnetic resonance elastography: a review of clinical work and future perspectives. NMR IN BIOMEDICINE 2018; 31:e3932. [PMID: 29846986 DOI: 10.1002/nbm.3932] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 06/08/2023]
Abstract
This review on magnetic resonance elastography (MRE) of the breast provides an overview of available literature and describes current developments in the field of breast MRE, including new transducer technology for data acquisition and multi-frequency-derived power-law behaviour of tissue. Moreover, we discuss the future potential of breast MRE, which goes beyond its original application as an additional tool in differentiating benign from malignant breast lesions. These areas of ongoing and future research include MRE for pre-operative tumour delineation, staging, monitoring and predicting response to treatment, as well as prediction of the metastatic potential of primary tumours.
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Affiliation(s)
- A E Bohte
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - J L Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - J H Runge
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Image Sciences and Biomedical Engineering, King's College London, London, UK
| | - O Holub
- Image Sciences and Biomedical Engineering, King's College London, London, UK
| | - S A Lambert
- Image Sciences and Biomedical Engineering, King's College London, London, UK
- Université Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM UMR 5220, U1206, Lyon, France
| | - L de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Kolkman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - S van der Meij
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - G J Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - R Sinkus
- Image Sciences and Biomedical Engineering, King's College London, London, UK
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Farrokh A, Maass N, Treu L, Heilmann T, Schäfer FK. Accuracy of tumor size measurement: comparison of B-mode ultrasound, strain elastography, and 2D and 3D shear wave elastography with histopathological lesion size. Acta Radiol 2018; 60:451-458. [PMID: 30043622 DOI: 10.1177/0284185118787354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting the exact extent of a breast tumor is of great importance for oncologic treatment strategies. Different types of elastography can be used as new tools for measuring lesion size. PURPOSE To provide evidence regarding the accuracy of tumor size measurement of strain elastography (SE), two-dimensional (2D) and three-dimensional (3D) shear wave elastography (SWE), and conventional B-image ultrasound. MATERIAL AND METHODS In this prospective study, the diameter of 105 malignant breast lesions was measured by SE, 2D and 3D SWE, and B-mode ultrasound. The histopathological lesion size was compared to all imaging-based measuring methods. RESULTS The mean lesion size of all breast carcinomas was 1.54 cm. B-mode ultrasound underestimates breast cancer size in 65.7 % of all cases in this study ( P < 0.0001). Mean lesion size was more accurately determined by SE, 2D and 3D SWE compared to B-mode ultrasound. Absolute differences between measured and actual lesion are smaller for B-mode ultrasound (0.26 cm) than for SE (0.41 cm) and 2D and 3D SWE (0.41 cm and 0.44 cm, respectively). CONCLUSION B-mode ultrasound allows more accurate lesion size measurement than SE and 2D or 3D SWE but has a significantly higher risk of underestimating tumor size which could lead to incomplete margins during surgery. 3D SWE was not superior to 2D SWE or SE but by trend more precise in predicting the size of invasive lobular carcinoma.
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Affiliation(s)
- André Farrokh
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicolai Maass
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Linn Treu
- 3 Department of Gynecology and Obstetrics, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Thorsten Heilmann
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fritz Kw Schäfer
- 2 Breast Imaging and Interventions, Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
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Ekatah GE, Turnbull AK, Arthur LM, Thomas J, Dodds C, Dixon JM. Margin width and local recurrence after breast conserving surgery for ductal carcinoma in situ. Eur J Surg Oncol 2017; 43:2029-2035. [PMID: 28917445 DOI: 10.1016/j.ejso.2017.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/25/2017] [Accepted: 08/04/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Ductal Carcinoma in situ (DCIS) represents 5% of symptomatic and 20-30% of screen detected cancers. Breast conserving surgery (BCS) ± radiotherapy is performed in over 70% of women with DCIS. What constitutes an adequate margin for BCS remains unclear. METHODS A single institution follow up study has been conducted of 466 patients with pure DCIS treated by BCS between 2000 and 2010 of whom 292 received whole breast radiotherapy and 167 did not. Patients were selected for radiotherapy based on perceived risk of in breast tumour recurrence (IBTR). Distance to nearest radial margin was measured; 10 patients had a margin width of <1 mm, 94 had widths of 1-2 mm and 362 had widths of >2 mm. There was no association of margin width and the use of radiotherapy. RESULTS At a median follow up of 7.2 years there were 44 IBTR (27 DCIS and 17 invasive). There was no evidence that margin widths >2 mm resulted in a lower rate of IBTR than margin widths of 1-2 mm. The actuarial IBTR rates at 5 and 10 years for margins of 1-2 mm were 9.0% (95% CI ± 5.9%) and 9.0% (95% CI ± 5.9%) respectively and for margins of >2 mm were 8.0% (95% CI ± 3.9%) and 13.0% (95% CI ± 3.9%) respectively. Odds Ratio for IBTR 1-2 mm vs >2 mm was 0.839 (95% CI 0.392-1.827) p = 0.846. In a multivariate analysis only DCIS size predicted for IBTR (HR 2.73 p < 0.0001). CONCLUSION 1 mm appears a sufficient margin width for BCS in DCIS irrespective of whether patients receive radiotherapy.
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Affiliation(s)
- Gregory E Ekatah
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Arran K Turnbull
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK; Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Laura M Arthur
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Jeremy Thomas
- Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Christine Dodds
- SE Scotland Cancer Network, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - J Michael Dixon
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK; Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK; Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, Edinburgh, UK.
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9
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Tang SSK, Kaptanis S, Haddow JB, Mondani G, Elsberger B, Tasoulis MK, Obondo C, Johns N, Ismail W, Syed A, Kissias P, Venn M, Sundaramoorthy S, Irwin G, Sami AS, Elfadl D, Baggaley A, Remoundos DD, Langlands F, Charalampoudis P, Barber Z, Hamilton-Burke WLS, Khan A, Sirianni C, Merker LAMG, Saha S, Lane RA, Chopra S, Dupré S, Manning AT, St John ER, Musbahi A, Dlamini N, McArdle CL, Wright C, Murphy JO, Aggarwal R, Dordea M, Bosch K, Egbeare D, Osman H, Tayeh S, Razi F, Iqbal J, Ledwidge SFC, Albert V, Masannat Y. 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. Eur J Cancer 2017; 84:315-324. [PMID: 28865259 DOI: 10.1016/j.ejca.2017.07.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates. METHODS A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies. RESULTS A total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70-900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0-41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin. CONCLUSION There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Consensus
- Female
- Guideline Adherence/standards
- Healthcare Disparities/standards
- Humans
- Ireland
- Margins of Excision
- Mastectomy, Segmental/adverse effects
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/standards
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Prospective Studies
- Quality Indicators, Health Care/standards
- Reoperation
- Treatment Outcome
- United Kingdom
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Affiliation(s)
- Sarah Shuk-Kay Tang
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England SW17 0QT, UK.
| | - Sarantos Kaptanis
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - James B Haddow
- Queen Mary University of London, Garrod Building, Turner Street, London, England E1 2AD, UK.
| | | | - Beatrix Elsberger
- Ninewells Hospital, James Arrott Drive, Dundee, Scotland DD1 9SY, UK.
| | | | - Christine Obondo
- Stobhill Hospital, 133 Balornock Road, Glasgow, Scotland G21 3UW, UK.
| | - Neil Johns
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh, Scotland EH42XU, UK.
| | - Wisam Ismail
- Bradford Royal Infirmary, Duckworth Lane, Bradford, England BD9 6RJ, UK.
| | - Asim Syed
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Mary Venn
- Ipswich Hospital, Heath Road, Ipswich, England IP4 5PD, UK.
| | | | - Gareth Irwin
- Ulster Hospital, Upper Newtownards Road, Belfast, Northern Ireland BT16 1RH, UK.
| | - Amtul S Sami
- Lincoln County Hospital, Greetwell Road, Lincoln, England LN2 5QY, UK.
| | - Dalia Elfadl
- Royal Marsden Hospital, Downs Road, Sutton, England SM2 5PT, UK.
| | - Alice Baggaley
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Fiona Langlands
- Castle Hill Hospital, Castle Road, Cottingham, Hull, England HU16 5JQ, UK.
| | | | - Zoe Barber
- Neville Hall Hospital, Brecon Road, Abergavenny, Wales NP7 7EG, UK.
| | | | - Ayesha Khan
- Royal Surrey County Hospital, Egerton Road, Guildford, England GU2 7XX, UK.
| | - Chiara Sirianni
- Betsi Cadwaladr University Local Health Board, Town Hall Newry Street, Holyhead, Wales LL65 1HN, UK.
| | | | - Sunita Saha
- Broomfield Hospital, Court Road, Chelmsford, England CM1 7ET, UK.
| | - Risha Arun Lane
- Darent Valley Hospital, Darenth Wood Road, Dartford, England DA2 8DA, UK.
| | - Sharat Chopra
- Abertawe Bro Morgannwg University Health Board, 1 Talbot Gateway, Port Talbot, Wales SA12 7BR, UK.
| | - Sophie Dupré
- Guy's Hospital, Great Maze Pond, London, England SE1 9RT, UK.
| | - Aidan T Manning
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Edward R St John
- Charing Cross Hospital, Fulham Palace Road, London, England W6 8RF, UK.
| | - Aya Musbahi
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Nokwanda Dlamini
- James Paget Hospital, Lowestoft Road, Great Yarmouth, England NR31 6LA, UK.
| | | | - Chloe Wright
- Bolton Breast Unit, Royal Bolton Hospital, Farnworth, Bolton, England BL4 0JR, UK.
| | - James O Murphy
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Ravi Aggarwal
- Hillingdon Hospital, Pield Heath Road, Uxbridge, England UB8 3NN, UK.
| | - Matei Dordea
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Karen Bosch
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Donna Egbeare
- Cardiff and Vale University Health Board, Heath Park, Cardiff, Wales CF14 4XW, UK.
| | - Hisham Osman
- Frimley Park Hospital, Portsmouth Road, Camberley, England GU16 7UJ, UK.
| | - Salim Tayeh
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - Faraz Razi
- North Hampshire Hospital, Aldermaston Road, Basingstoke, England RG24 9NA, UK.
| | - Javeria Iqbal
- Diana Princess of Wales Hospital, Scartho Road, Grimsby, England DN33 2BA, UK.
| | | | - Vanessa Albert
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK
| | - Yazan Masannat
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK; University of Aberdeen, Aberdeen, Scotland AB24 3FX, UK; University of East Anglia, Norwich, England NR4 7TJ, UK
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10
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Dixon JM, Renshaw L, Young O, Kulkarni D, Saleem T, Sarfaty M, Sreenivasan R, Kusnick C, Thomas J, Williams LJ. Intra-operative assessment of excised breast tumour margins using ClearEdge imaging device. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1834-1840. [PMID: 27591938 DOI: 10.1016/j.ejso.2016.07.141] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/04/2016] [Accepted: 07/14/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast conserving surgery (BCS) aims to remove a breast cancer completely and obtain clear margins. Complete excision is essential to reduce the risk of local recurrence. The ClearEdge™ (CE) imaging device examines margins of excised breast tissue intra-operatively. The aim of this study was to investigate the potential of the device in detecting margin involvement in patients having BCS. METHODS In Phase-1 58 patients underwent BCS and had 334 margins assessed by the device. In Phase-2 the device was used in 63 patients having BCS and 335 margins were assessed. Patients with margins considered close or involved by the CE device were re-excised. RESULTS The margin assessment accuracies in Phase-1 and Phase-2 compared to permanent section pathology were very similar: sensitivity (84.3% and 87.3%), specificity (81.9% and 75.6%), positive predictive value (67.2% and 63.6%), and negative predictive value (92.2% and 92.4%). The false positive rate (18.1% and 24.4%) and false negative rate (15.7% and 12.7%) were low in both phases. In Phase-2 re-excision rate was 37%, but in the 54 where the CE device was used appropriately the re-excision rate was 17%. Had all surgeons interpreted all images appropriately and re-excised margins detected as abnormal by the device in Phase-2 then the re-excision rate would have been 7%. CONCLUSION This study shows that the CE device has potential to reduce re-excision after BCS and further randomized studies of its value are warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/complications
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/surgery
- Dielectric Spectroscopy/instrumentation
- Dielectric Spectroscopy/methods
- Female
- Humans
- Intraoperative Period
- Male
- Margins of Excision
- Mastectomy, Segmental
- Middle Aged
- Neoplasm, Residual
- Predictive Value of Tests
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Affiliation(s)
- J M Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK; University of Edinburgh, Medical School, Scotland, UK.
| | - L Renshaw
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - O Young
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - D Kulkarni
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - T Saleem
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | | | | | | | - J Thomas
- Pathology Department, Western General Hospital, Edinburgh, Scotland, UK
| | - L J Williams
- University of Edinburgh, Medical School, Scotland, UK
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