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Warwar S, Kulkarni S. From Input to Impact: Clinical Significance of Data Quality in the National Cancer Database. Ann Surg Oncol 2024; 31:5489-5490. [PMID: 38909117 DOI: 10.1245/s10434-024-15604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/24/2024]
Affiliation(s)
- Samantha Warwar
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Swati Kulkarni
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Guergan S, Boeer B, Fugunt R, Helms G, Roehm C, Solomianik A, Neugebauer A, Nuessle D, Schuermann M, Brunecker K, Jurjut O, Boehme KA, Dammeier S, Enderle MD, Bettio S, Gonzalez-Menendez I, Staebler A, Brucker SY, Kraemer B, Wallwiener D, Fend F, Hahn M. Optical Emission Spectroscopy for the Real-Time Identification of Malignant Breast Tissue. Diagnostics (Basel) 2024; 14:338. [PMID: 38337854 PMCID: PMC10855719 DOI: 10.3390/diagnostics14030338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Breast conserving resection with free margins is the gold standard treatment for early breast cancer recommended by guidelines worldwide. Therefore, reliable discrimination between normal and malignant tissue at the resection margins is essential. In this study, normal and abnormal tissue samples from breast cancer patients were characterized ex vivo by optical emission spectroscopy (OES) based on ionized atoms and molecules generated during electrosurgical treatment. The aim of the study was to determine spectroscopic features which are typical for healthy and neoplastic breast tissue allowing for future real-time tissue differentiation and margin assessment during breast cancer surgery. A total of 972 spectra generated by electrosurgical sparking on normal and abnormal tissue were used for support vector classifier (SVC) training. Specific spectroscopic features were selected for the classification of tissues in the included breast cancer patients. The average classification accuracy for all patients was 96.9%. Normal and abnormal breast tissue could be differentiated with a mean sensitivity of 94.8%, a specificity of 99.0%, a positive predictive value (PPV) of 99.1% and a negative predictive value (NPV) of 96.1%. For 66.6% patients all classifications reached 100%. Based on this convincing data, a future clinical application of OES-based tissue differentiation in breast cancer surgery seems to be feasible.
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Affiliation(s)
- Selin Guergan
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Bettina Boeer
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Regina Fugunt
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Gisela Helms
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Carmen Roehm
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Anna Solomianik
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Alexander Neugebauer
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Daniela Nuessle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Mirjam Schuermann
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Ovidiu Jurjut
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Karen A. Boehme
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Sascha Dammeier
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Markus D. Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Sabrina Bettio
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Irene Gonzalez-Menendez
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Annette Staebler
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Sara Y. Brucker
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Bernhard Kraemer
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Diethelm Wallwiener
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Falko Fend
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
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The Development of Investigator-Initiated Clinical Trials in Surgical Oncology. Surg Oncol Clin N Am 2023; 32:13-25. [PMID: 36410913 DOI: 10.1016/j.soc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Investigator-initiated trials (IITs) are designed by principal investigators who identify important, unaddressed clinical gaps and opportunities to answer these questions through clinical trials. Surgical oncologists are poised to lead IITs due to their multidisciplinary clinical practice and substantial research background. The process of developing, organizing, and implementing IITs is multifaceted and involves important steps including (but not limited to) navigating regulatory requirements, obtaining funding, and meeting enrollment targets. Here, the authors explore the steps, methodology, and barriers of IIT development by surgical oncologists and highlight the importance of IITs in oncology.
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Karadeniz Cakmak G. Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty. Breast Care (Basel) 2022; 16:559-573. [PMID: 35087359 DOI: 10.1159/000518992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. SUMMARY The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. KEY MESSAGES The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient's satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.
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Wang T, Bredbeck BC, Sinco B, Shubeck S, Baskin AS, Skolarus T, Dossett LA. Variations in Persistent Use of Low-Value Breast Cancer Surgery. JAMA Surg 2021; 156:353-362. [PMID: 33533894 PMCID: PMC7859877 DOI: 10.1001/jamasurg.2020.6942] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022]
Abstract
Importance Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continued overuse. However, little information exists about facility-level variation or determinants of differential deimplementation. Objective To identify variation and determinants of persistent use of low-value breast cancer surgical care. Design, Setting, and Participants Retrospective cohort study in which reliability-adjusted facility rates of each procedure were calculated using random-intercept hierarchical logistic regression before and after evidence demonstrated that each procedure was unnecessary. The National Cancer Database is a prospective cancer registry of patients encompassing approximately 70% of all new cancer diagnoses from more than 1500 facilities in the United States. Data were analyzed from November 2019 to August 2020. The registry included women 18 years and older diagnosed as having breast cancer between 2004 and 2016 and meeting inclusion criteria for each Choosing Wisely recommendation. Main Outcomes and Measures Rate of each low-value breast cancer procedure based on facility type and breast cancer volume categories before and after the release of data supporting each procedure's omission. Results The total cohort included 920 256 women with a median age of 63 years. Overall, 86% self-identified as White, 10% as Black, 3% as Asian, and 4.5% as Hispanic. Most women in this cohort were insured (51% private and 47% public), were living in a metropolitan or urban area (88% and 11%, respectively), and originated from the top half of income-earning households (65.5%). While there was significant deimplementation of axillary lymph node dissection and lumpectomy reoperation in response to guidelines supporting omission of these procedures, rates of contralateral prophylactic mastectomy and sentinel lymph node biopsy in older women increased during the study period. Academic research programs and high-volume facilities overall demonstrated the greatest reduction in use of these low-value procedures. There was significant interfacility variation for each low-value procedure. Facility-level axillary lymph node dissection rates ranged from 7% to 47%, lumpectomy reoperation rates ranged from 3% to 62%, contralateral prophylactic mastectomy rates ranged from 9% to 67%, and sentinel lymph node biopsy rates ranged from 25% to 97%. Pearson correlation coefficient for each combination of 2 of the 4 procedures was less than 0.11, suggesting that hospitals were not consistent in their deimplementation performance across all 4 procedures. Many were high outliers in one procedure but low outliers in another. Conclusions and Relevance Interfacility variation demonstrates a performance gap and an opportunity for formal deimplementation efforts targeting each procedure. Several facility-level characteristics were associated with differential deimplementation and performance.
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Affiliation(s)
- Ton Wang
- Department of Surgery, Michigan Medicine, Ann Arbor
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Brooke C. Bredbeck
- Department of Surgery, Michigan Medicine, Ann Arbor
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Brandy Sinco
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Sarah Shubeck
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison S. Baskin
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
- University of Michigan School of Medicine, Ann Arbor
| | - Ted Skolarus
- Department of Urology, Michigan Medicine, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lesly A. Dossett
- Department of Surgery, Michigan Medicine, Ann Arbor
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
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Tamirisa N, Lei X, Caudle AS, Giordano SH, Zhao H, Chavez-MacGregor M. Impact of SSO-ASTRO "No Ink on Tumor" Guidelines on Reexcision Rates among Older Breast Cancer Patients. Ann Surg Oncol 2020; 28:3703-3713. [PMID: 33225394 DOI: 10.1245/s10434-020-09370-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The SSO-ASTRO consensus guideline on invasive breast cancer defined negative margin as no ink on tumor, obviating the need for reexcision in some patients. We evaluated the impact of these recommendations on the rates of reexcision in older breast cancer patients undergoing breast-conserving surgery (BCS). PATIENTS AND METHODS Women age ≥ 66 years with stage I-II breast cancer who underwent BCS and radiation were identified in the SEER-Medicare linked database (2012-2015). We divided patients into three cohorts: pre-guideline (January 2012 to September 2013), peri-guideline (October 2013 to March 2014), and post-guideline (April 2014 to September 2016). Descriptive statistics were used, and the relative change in reexcision rate between the pre- and post-guideline periods was calculated. Multivariable logistic regression was used to evaluate factors associated with risk of reexcision. RESULTS A total of 11,639 patients were included (pre-guideline, N = 5211; peri-guideline, N = 1366; post-guideline, N = 5062); overall, 21.7% of patients underwent reexcision. The reexcision rates decreased after the guideline was published (23.5% vs. 19.3%, p < 0.001). In the multivariable model, BCS during the post-guideline period was associated with a statistically significant decreased risk of reexcision (RR = 0.84; 95% CI 0.78-0.90). Lobular histology was associated with a higher risk of reexcision (RR = 1.32; 95% CI 1.19-1.46), and greater surgeon volume was associated with lower risk of reexcision (RR = 0.92; 95% CI 0.85-1.0). CONCLUSIONS Among older breast cancer patients undergoing BCS for invasive cancer, reexcision rates decreased with the dissemination of the SSO-ASTRO consensus guideline. Identifying factors associated with higher rates of reexcision could improve guideline compliance and reduce the frequency of unnecessary interventions in older patients.
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Affiliation(s)
- Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Franceschini G. Performance of standardized tasks and evidence-based surgery may increase the chance of success in breast conserving treatment. Gland Surg 2020; 9:1069-1071. [PMID: 32953617 DOI: 10.21037/gs-20-523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Gianluca Franceschini
- Division of Breast Surgery, Department of Women's and Children's Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Lesniak DM, Clough KB, Killelea BK. Revisiting the modern toolkit to optimize breast conservation surgery. Gland Surg 2020; 9:478-480. [PMID: 32420278 DOI: 10.21037/gs.2020.01.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Elmore LC, Margenthaler JA. A tale of two operations: re-excision as a quality measure. Gland Surg 2019; 8:593-595. [PMID: 32042664 DOI: 10.21037/gs.2019.11.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Leisha C Elmore
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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