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Struik GM, Schermers B, Mares I, Lont HE, Bradshaw JW, Ten Haken B, Ruers TJM, Mourik JEM, Birnie E, Klem TMAL. Randomized controlled trial comparing magnetic marker localization (MaMaLoc) with wire-guided localization in the treatment of early-stage breast cancer. Breast J 2021; 27:638-650. [PMID: 34142409 DOI: 10.1111/tbj.14262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Wire-guided localization (WGL) is the standard of care in the surgical treatment of nonpalpable breast tumors. In this study, we compare the use of a new magnetic marker localization (MaMaLoc) technique to WGL in the treatment of early-stage breast cancer patients. Open-label, single-center, randomized controlled trial comparing MaMaLoc (intervention) to WGL (control) in women with early-stage breast cancer. Primary outcome was surgical usability measured using the System Usability Scale (SUS, 0-100 score). Secondary outcomes were patient reported, clinical, and pathological outcomes such as retrieval rate, operative time, resected specimen weight, margin status, and reoperation rate. Thirty-two patients were analyzed in the MaMaLoc group and 35 in the WGL group. Patient and tumor characteristics were comparable between groups. No in situ complications occurred. Retrieval rate was 100% in both groups. Surgical usability was higher for MaMaLoc: 70.2 ± 8.9 vs. 58.1 ± 9.1, p < 0.001. Patients reported higher overall satisfaction with MaMaLoc (median score 5/5) versus WGL (score 4/5), p < 0.001. The use of magnetic marker localization (MaMaLoc) for early-stage breast cancer is effective and has higher surgical usability than standard WGL.
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Affiliation(s)
- Gerson M Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Bram Schermers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ingeborg Mares
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Harold E Lont
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Jennifer W Bradshaw
- Department of Radiology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Bernard Ten Haken
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jurgen E M Mourik
- Department of Medical Physics, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands.,Department of Genetics, University Medical Centre Groningen, University of Groningen, Amsterdam, The Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
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Peng Y, Luo ZY, Ni J, Cui HD, Lu B, Xiang AZ, Zhou J, Ding JW, Chen WH, Zhao J, Fang JH, Zhao P. Precision biopsy of breast microcalcifications: An improvement in surgical excision. Oncol Lett 2018; 16:1212-1218. [PMID: 30061943 DOI: 10.3892/ol.2018.8787] [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: 10/26/2016] [Accepted: 02/23/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to improve the conventional wire-guided localization biopsy (WGLB) of breast microcalcifications to overcome disadvantages associated with the procedure, including inaccurate localization and large specimen volume. The novel approach described in the present study was termed double wire-guided localization and rotary cutting biopsy (DWGLB). Prior to surgery, the precise localization of the lesions was assessed using two wires under the assistance of mammography X-ray and ultrasound, followed by complete excision of the lesions using a novel rotary cutting tool. The cylindrical specimen was placed on a scaled specimen holder for pathological examination. DWGLB was performed in 108 patients with the classification of as Breast Imaging Reporting and Data System score 4A. Percutaneous localization of the lesions guided by a mammography X-ray and ultrasound were successful in all 108 lesions (100%) with one puncture attempt. The lesions were precisely excised in all of 108 patients, and included 13 malignant lesions (DCIS of breast in 7 cases, DCIS with focal invasive carcinoma in 3 cases and invasive ductal carcinoma in 3 cases). The average distance of the BARD Dualok to the lesion was 4.1 mm; the average weight of specimens was 8.5 g. Compared with WGLB, DWGLB offers several advantages, including more accurate localization of lesions, a more standardized biopsy method and a smaller specimen volume. DWGLB can also provide the precise position of lesions in the specimen for further pathological examination.
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Affiliation(s)
- You Peng
- Department of Oncological Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhong-Yao Luo
- Department of Oncological Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Jie Ni
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Hai-Dong Cui
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Bei Lu
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Ai-Zhai Xiang
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Jun Zhou
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Jin-Wang Ding
- Department of Oncological Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Wen-Hui Chen
- Department of Radiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Jing Zhao
- Department of Radiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Jian-Hua Fang
- Department of Ultrasound, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Pan Zhao
- Department of Pathology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
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Breast cancer recurrence following radioguided seed localization and standard wire localization of nonpalpable invasive and in situ breast cancers: 5-Year follow-up from a randomized controlled trial. Am J Surg 2017; 213:798-804. [DOI: 10.1016/j.amjsurg.2016.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/13/2016] [Accepted: 06/18/2016] [Indexed: 11/18/2022]
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Moschetta M, Telegrafo M, Introna T, Coi L, Rella L, Ranieri V, Cirili A, Stabile Ianora AA, Angelelli G. Role of specimen US for predicting resection margin status in breast conserving therapy. G Chir 2016; 36:201-4. [PMID: 26712255 DOI: 10.11138/gchir/2015.36.5.201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. PATIENTS AND METHODS A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. RESULTS The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. CONCLUSIONS Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Italy/epidemiology
- Mastectomy, Segmental/methods
- Middle Aged
- Predictive Value of Tests
- Sensitivity and Specificity
- Treatment Outcome
- Ultrasonography
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Imaging Factors That Influence Surgical Margins After Preoperative 125I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization. AJR Am J Roentgenol 2016; 206:1112-8. [PMID: 27007608 DOI: 10.2214/ajr.15.14715] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to compare the potential influence of imaging variables on surgical margins after preoperative radioactive seed localization (RSL) and wire localization (WL) techniques. MATERIALS AND METHODS A total of 565 women with 660 breast lesions underwent RSL or WL between May 16, 2012, and May 30, 2013. Patient age, lesion type (mass, calcifications, mass with associated calcifications, other), lesion size, number of seeds or wires used, surgical margin status (close positive or negative margins), and reexcision and mastectomy rates were recorded. RESULTS Of 660 lesions, 127 (19%) underwent RSL and 533 (81%) underwent WL preoperatively. Mean lesion size was 1.8 cm in the RSL group and 1.8 cm in the WL group (p = 0.35). No difference in lesion type was identified in the RSL and WL groups (p = 0.63). RSL with a single seed was used in 105 of 127 (83%) RSLs compared with WL with a single wire in 349 of 533 (65%) WLs (p = 0.0003). The number of cases with a close positive margin was similar for RSLs (26/127, 20%) and WLs (104/533, 20%) (p = 0.81). There was no difference between the RSL group and the WL group in close positive margin status (20% each, p = 0.81), reexcision rates (20% vs 16%, respectively; p = 0.36), or mastectomy rates (6% each, p = 0.96). Lesions containing calcifications were more likely to require more than one wire (odds ratio [OR], 4.44; 95% CI, 2.8-7.0) or more than one seed (OR, 7.03; 95% CI, 1.6-30.0) when compared with masses alone (p < 0.0001). Increasing lesion size and the presence of calcifications were significant predictors of positive margins, whereas the use of more than one wire or seed was not (OR, 0.9; 95% CI, 0.5-1.5) (p = 0.75). CONCLUSION Close positive margin, reexcision, and mastectomy rates remained similar in the WL group and RSL group. The presence of calcifications and increasing lesion size increased the odds of a close positive margin in both the WL and RSL groups, whereas the use of one versus more than one seed or wire did not.
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Parvez E, Cornacchi SD, Hodgson N, Thoma A, Kong I, Foster G, Cheng J, Goldsmith CH, Dao D, Lovrics PJ. A cosmesis outcome substudy in a prospective, randomized trial comparing radioguided seed localization with standard wire localization for nonpalpable, invasive, and in situ breast carcinomas. Am J Surg 2014; 208:711-718. [PMID: 25201587 DOI: 10.1016/j.amjsurg.2014.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/30/2014] [Accepted: 05/31/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The primary study objective was to compare the cosmetic result of radioguided seed localization (RSL) with wire localization (WL). METHODS A subgroup of patients enrolled in a multicentered, randomized trial comparing WL with RSL participated. Frontal photographs were taken 1 and 3 years postsurgery. The European Organization for Research and Treatment of Cancer Cosmetic Rating System was used to evaluate cosmesis outcomes by the patient and a panel of 5 raters. RESULTS The study enrolled 73 patients (WL, n = 38; RSL, n = 35). Most patients rated their overall cosmesis as "excellent" or "good" (76% WL, 80% RSL). Patient and panel ratings on all cosmetic outcomes were similar between groups. Multivariable regression for overall cosmesis found larger specimen volume and reoperation to be predictors of worse ratings. CONCLUSIONS All cosmetic outcomes assessed were similar after WL and RSL. The comparable outcomes may reflect similar reoperation rates and volumes of excision between groups.
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Affiliation(s)
- Elena Parvez
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - Achilleas Thoma
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Iwa Kong
- Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - Gary Foster
- Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ji Cheng
- Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Charlie H Goldsmith
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Dyda Dao
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Peter J Lovrics
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
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Kim SHH, Cornacchi SD, Heller B, Farrokhyar F, Babra M, Lovrics PJ. An evaluation of intraoperative digital specimen mammography versus conventional specimen radiography for the excision of nonpalpable breast lesions. Am J Surg 2013; 205:703-10. [DOI: 10.1016/j.amjsurg.2012.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/28/2012] [Accepted: 08/28/2012] [Indexed: 11/17/2022]
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Mazeh H, Sagiv I, Katz D, Freund HR, Peretz T, Allweis TM. Association between patient age, volume of breast tissue excised, and local recurrence. J Surg Res 2013; 181:187-92. [DOI: 10.1016/j.jss.2012.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 06/13/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
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Koca B, Kuru B, Yuruker S, Gokgul B, Ozen N. Factors affecting surgical margin positivity in invasive ductal breast cancer patients who underwent breast-conserving surgery after preoperative core biopsy diagnosis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:154-9. [PMID: 23487000 PMCID: PMC3594642 DOI: 10.4174/jkss.2013.84.3.154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/03/2012] [Accepted: 12/18/2012] [Indexed: 11/30/2022]
Abstract
Purpose The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy. Methods Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity. Results Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LVI; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (EIC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity. Conclusion Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.
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Affiliation(s)
- Bulent Koca
- Department of General Surgery, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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10
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Lovrics PJ, Gordon M, Cornacchi SD, Farrokhyar F, Ramsaroop A, Hodgson N, Quan ML, Wright F, Porter G. Practice patterns and perceptions of margin status for breast conserving surgery for breast carcinoma: National Survey of Canadian General Surgeons. Breast 2012; 21:730-4. [DOI: 10.1016/j.breast.2012.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/16/2012] [Accepted: 07/29/2012] [Indexed: 11/26/2022] Open
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Showalter SL, Grover S, Sharma S, Lin L, Czerniecki BJ. Factors Influencing Surgical and Adjuvant Therapy in Stage I Breast Cancer: A SEER 18 Database Analysis. Ann Surg Oncol 2012; 20:1287-94. [DOI: 10.1245/s10434-012-2693-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Indexed: 11/18/2022]
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Lovrics PJ, Goldsmith CH, Hodgson N, McCready D, Gohla G, Boylan C, Cornacchi S, Reedijk M. A Multicentered, Randomized, Controlled Trial Comparing Radioguided Seed Localization to Standard Wire Localization for Nonpalpable, Invasive and in situ Breast Carcinomas. Ann Surg Oncol 2011; 18:3407-14. [DOI: 10.1245/s10434-011-1699-y] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Indexed: 11/18/2022]
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Lovrics PJ, Cornacchi SD, Vora R, Goldsmith CH, Kahnamoui K. Systematic review of radioguided surgery for non-palpable breast cancer. Eur J Surg Oncol 2011; 37:388-97. [PMID: 21333482 DOI: 10.1016/j.ejso.2011.01.018] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/06/2011] [Accepted: 01/17/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This systematic review examines whether radioguided localization surgery (RGL) (radioguided occult lesion localization - ROLL and radioguided seed localization - RSL) for non-palpable breast cancer lesions produces lower positive margin rates than standard wire-guided localization surgery. METHODS We performed a comprehensive literature review to identify clinical studies using either ROLL or RSL. Included studies examined invasive or in situ BC and reported pathologically assessed margin status or specimen volume/weight. Two reviewers independently assessed study eligibility and quality and abstracted relevant data on patient and surgical outcomes. Quantitative data analyses were performed. RESULTS Fifty-two clinical studies on ROLL (n = 46) and RSL (n = 6) were identified. Twenty-seven met our inclusion criteria: 12 studies compared RGL to WGL and 15 studies were single cohorts using RGL. Ten studies were included in the quantitative analyses. Data for margin status and re-operation rates from 4 randomized controlled trials (RCT; n = 238) and 6 cohort studies were combined giving a combined odds ratio (OR) of 0.367 and 95% confidence interval (CI): 0.277 to 0.487 (p < 0.001) for margins status and OR 0.347, 95% CI: 0.250 to 0.481 (p < 0.001) for re-operation rates. CONCLUSIONS The results of this systematic review of RGL versus WGL demonstrate that RGL technique produces lower positive margins rates and fewer re-operations. While this review is limited by the small size and quality of RCTs, the odds ratios suggest that RGL may be a superior technique to guide surgical resection of non-palpable breast cancers. These results should be confirmed by larger, multi-centered RCTs.
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Affiliation(s)
- P J Lovrics
- Department of Surgery, McMaster University, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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Abstract
The role of the breast cancer surgeon has changed from one with performance of one operation, to a position in which the surgeon is the patient's initial contact, leader of a multidisciplinary team, the clinical leader who ensures that the patient receives the most appropriate breast cancer treatment and then also receives follow up and surveillance services. Breast conservation rates, patient satisfaction rates, clear margins, use of oncoplastic surgical techniques, appropriate referral to other consultants, clinical trial referral, and survival rates are all higher when patients are cared for by breast-focused surgeons. This new role requires greater time both before and after surgery to provide the proper planning and care for these patients. Women with breast cancer should have access to these dedicated breast-focused surgeons. Recognition of this expanding responsibility and reimbursement for this time and expertise is needed so that women with breast cancer can be offered the highest quality of care.
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15
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The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer. Am J Surg 2009; 197:740-6. [DOI: 10.1016/j.amjsurg.2008.03.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 03/21/2008] [Accepted: 03/21/2008] [Indexed: 01/10/2023]
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Moyer HR, Carlson GW, Styblo TM, Losken A. Three-Dimensional Digital Evaluation of Breast Symmetry after Breast Conservation Therapy. J Am Coll Surg 2008; 207:227-32. [DOI: 10.1016/j.jamcollsurg.2008.02.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/12/2008] [Accepted: 02/12/2008] [Indexed: 11/25/2022]
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Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of Re-excision among Women Undergoing Breast-Conserving Surgery for Cancer. Ann Surg Oncol 2008; 15:1297-303. [DOI: 10.1245/s10434-007-9777-x] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 09/17/2007] [Accepted: 09/18/2007] [Indexed: 02/02/2023]
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Chirikos TN, French DD, Luther SL. Potential economic effects of volume-outcome relationships in the treatment of three common cancers. Cancer Control 2007; 11:258-64. [PMID: 15284717 DOI: 10.1177/107327480401100409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Thomas N Chirikos
- Department of Cancer Prevention and Control, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Abstract
MR imaging of the breast detects additional carcinoma in as many as 30% of women thought to have localized disease by clinical examination and mammography. This has led some to advocate its routine use in the preoperative evaluation of breast cancer patients. However, local failure rates in patients selected for breast conservation by conventional methods are less than 5% at 10 years, suggesting that he majority of this disease is controlled with radiotherapy. The potential role of MR in the preoperative evaluation and postoperative follow-up of patients with early-stage breast cancer is discussed.
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Affiliation(s)
- Monica Morrow
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Suite C302, Philadelphia, PA 19111, USA.
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Mesurolle B, El-Khoury M, Hori D, Phancao JP, Kary S, Kao E, Fleiszer D. Sonography of Postexcision Specimens of Nonpalpable Breast Lesions: Value, Limitations, and Description of a Method. AJR Am J Roentgenol 2006; 186:1014-24. [PMID: 16554572 DOI: 10.2214/ajr.05.0002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to retrospectively review our experience regarding the value of sonography in identifying a nonpalpable mass within a surgically excised specimen and in assessing the surgical margins in cases of malignancy. MATERIALS AND METHODS One hundred four lumpectomies were performed in 99 consecutive patients with 131 nonpalpable breast lesions after sonographically guided needle localization. All 104 surgical specimens were scanned on sonography, and 86 specimen radiographs were obtained. Visualization of the lesion on sonography was compared with specimen radiographs and histologic findings. Sonographic margin status was classified as negative (shortest distance between tumor and specimen margin, > 0.2 cm) or positive (shortest distance between tumor and specimen margin, 0.2 cm) and was compared with pathology results. RESULTS Specimen sonography showed 95.4% (125/131) of the excised abnormalities; nonfatty background and a lesion size of greater than 0.5 cm contributed significantly to the success of specimen sonography. Four of six lesions missed on sonography were identified on specimen radiography. Among 81 malignant specimens, sonography identified 38 specimens with positive margins and 43 with negative margins. Pathologic examination revealed eight false-positive and 10 false-negative results (21% false-positive rate and 23.2% false-negative rate). CONCLUSION Specimen sonography is an effective procedure for identifying the presence of the lesion within the specimen; however, it is of limited value in cases of small hypoechoic lesions against a fatty background. Assessment of margins is limited by both false-positive and false-negative results.
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Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave. West, Montreal, QC H3G 1A4, Canada
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Al-Refaie W, Kuerer HM, Khuwaja A, Perry A, Hunt KK, Feig B, Ames F, Ross M, Singletary SE, Meric-Bernstam F, Babiera GV. Determinants of mastectomy in breast conservation therapy candidates. Am J Surg 2005; 190:602-5. [PMID: 16164931 DOI: 10.1016/j.amjsurg.2005.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Revised: 06/10/2005] [Accepted: 06/10/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although underused, breast conservation therapy (BCT) is an accepted method for treatment of noninvasive and early breast cancer. The purpose of this analysis was to identify factors associated with receiving mastectomy when eligible for BCT. METHODS From a recent experience, 397 patients at the University of Texas M. D. Anderson Cancer Center presented with clinical stage 0, I, or II breast cancer. Demographics and tumor characteristics of patients who underwent BCT versus mastectomy were compared. RESULTS Of 293 BCT candidates, 203 patients (69%) underwent BCT and 90 patients (31%) received a mastectomy. Of those 90 patients, 66 patients (73%) had documented concerns about receiving BCT. Multivariate analyses showed that widow status was a factor associated with receiving mastectomy at presentation (P = .04). CONCLUSIONS The majority of BCT candidates with early stage breast cancer undergo BCT. In our study, widow status was a predictive factor of mastectomy in BCT candidates.
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Affiliation(s)
- Waddah Al-Refaie
- Department of Surgical Oncology, Unit 444, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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22
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Spilsbury K, Semmens JB, Saunders CM, Hall SE, Holman CDJ. Subsequent surgery after initial breast conserving surgery: a population based study. ANZ J Surg 2005; 75:260-4. [PMID: 15932433 DOI: 10.1111/j.1445-2197.2005.03352.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In line with current Australian early breast cancer management guidelines, more women are having breast conserving surgery to treat breast cancer when appropriate. Some women will undergo further surgery because of involved margins, early local relapse, or other factors including patient choice. The aim of this study was to investigate whether socio-economic, demographic or hospital factors were associated with the risk of re-excision or subsequent mastectomy. METHODS A record linkage population-based study on 12 711 women diagnosed with breast cancer in Western Australia from 1982 to 2000 who underwent breast surgery within 12 months of diagnosis was performed. Logistic regression was used to identify social, demographic and hospital factors associated with the risk of undergoing further surgery following initial breast conserving surgery. RESULTS The proportion of women undergoing initial breast conserving surgery doubled from 33% in 1982-1985 to 72% in 1998-2000. The proportion of women who underwent further surgery following initial breast conserving surgery decreased from 50 to 30% over the same period. The risk of re-excision or subsequent mastectomy was between 2.4 (95% CI 1.7-3.4) and 5.0 (95% CI 3.4-7.4) times greater if initial surgery was performed in a non-metropolitan hospital compared to Perth hospitals. Younger women were between 1.7 (95% CI 1.4-2.0) and 2.1 (95% CI 1.5-3.0) times more likely to undergo re-excisions compared to women aged 50-64 years of age. CONCLUSIONS Young women and women initially treated in non-metropolitan hospitals were at an increased risk of re-excision or a subsequent mastectomy following initial breast conserving surgery to treat breast cancer. Efforts need to be directed towards improving specialist health services outside of Perth if women continue to be treated for breast cancer in non-metropolitan hospitals.
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Affiliation(s)
- Katrina Spilsbury
- Western Australian Safety and Quality of Surgical Care Project, Centre for Health Services Research, School of Population Health, University of Western Australia, Western Australia, Australia.
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Abstract
A significant effect of hospital case volume on perioperative mortality has been documented for a variety of malignancies that require technically challenging operative procedures and complex perioperative management. The effect of case volume on outcome is less clear for the more common cancers, such as breast and colon cancers, that are less technically challenging and require little in the way of specialized care in the postoperative period. For these cancers perioperative mortality is minimal and one must look at other end points such as long-term survival and functional results. The literature demonstrating improved outcomes in terms of mammographical sensitivity, breast-conservation rates, specimen to tumour volume ratios in breast-conserving surgery, sentinel node biopsy success rates, and 5-year survival is reviewed.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/drug therapy
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Chemotherapy, Adjuvant
- Databases, Factual
- Female
- Genes, BRCA1/physiology
- Humans
- Magnetic Resonance Imaging
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/statistics & numerical data
- Mastectomy, Segmental/trends
- Mutation
- Neoplasm Recurrence, Local/prevention & control
- Randomized Controlled Trials as Topic
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Affiliation(s)
- Lisa A Newman
- Department of Surgery, Breast Care Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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25
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Abstract
BACKGROUND Despite the National Institutes of Health consensus statement in 1991 that breast-conserving surgery (BCS) followed by radiotherapy is an appropriate approach to the treatment of early-stage breast carcinoma, studies have shown a relatively low rate of BCS in the United States. The current study investigated predictors of breast conservation therapy in a large, diverse patient population. METHODS Between 1990 and 1998, 43,111 patients underwent surgery for breast carcinoma and were entered into the Cancer Surveillance Program database for Los Angeles County. Of these, 29,666 (68.3%) had complete data on patient demographics, staging, surgeon, type of surgery, and hospital. Data were collected regarding extent of disease, lymph node status, tumor size, age, race, socioeconomic status (SES), surgeon specialization, surgeon volume, hospital specialization, and hospital volume. Univariate and multivariate analyses were performed. RESULTS Univariate analysis showed that extent of disease, lymph node status, tumor size, age, race, SES, surgeon and hospital specialization, and surgeon and hospital volume all were significantly associated with surgery type (P <0.0001). Multivariate analysis showed that not only did extent of disease impact choice of surgery, but so did race, SES, hospital volume, surgeon volume, and surgeon specialization (P <0.0001). CONCLUSIONS These results suggest that not only does the extent of locoregional disease play a role in the likelihood of a woman undergoing breast conservation therapy, but patient age, socioeconomic status, racial/ethnic factors, and the experience of both the surgeon and hospital have an effect.
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Affiliation(s)
- Karen Hiotis
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, New York 10016, USA.
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26
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Burak WE, Agnese DM, Povoski SP. Advances in the surgical management of early stage invasive breast cancer. Curr Probl Surg 2004. [DOI: 10.1067/j.cpsurg.2004.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kim JA, Crowe JP, Woletz J, Dinunzio A, Kelly T, Dietz JR. Prospective study of intraoperative mammary ductoscopy in patients undergoing partial mastectomy for breast cancer. Am J Surg 2004; 188:411-4. [PMID: 15474437 DOI: 10.1016/j.amjsurg.2004.06.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 06/06/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to critically evaluate the added benefit of intraoperative mammary ductoscopy on margin assessment and identification of occult intraductal pathology in patients undergoing therapeutic partial mastectomy for in-situ and invasive breast carcinoma. METHODS Eligible patients underwent intraoperative mammary ductoscopy before partial mastectomy. In patients where an intraductal abnormality was identified and the mammary ductoscope was not within the partial mastectomy cavity, an additional ductoscopy-directed margin of tissue was analyzed. RESULTS Nineteen of 30 (63%) patients yielded nipple aspirate fluid and were able to undergo mammary ductoscopy; an intraductal abnormality was identified in 15 of 19 (79%) patients. Only 1 patient had an occult infiltrating carcinoma, which was outside of the resection cavity and identified by ductoscopy. CONCLUSIONS Although mammary ductoscopy can identify intraductal abnormalities during partial mastectomy in a significant number of patients, many of these findings may be either benign or within the standard field of resection, thus adding no benefit to the patient.
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Affiliation(s)
- Julian A Kim
- Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave., Desk A80, Cleveland, OH 44195, USA.
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Neuner JM, Gilligan MA, Sparapani R, Laud PW, Haggstrom D, Nattinger AB. Decentralization of breast cancer surgery in the United States. Cancer 2004; 101:1323-9. [PMID: 15368323 DOI: 10.1002/cncr.20490] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Physician volume of at least 15-30 annual breast cancer operations has been associated with higher 5-year survival rates. The authors sought to determine whether surgical volumes for breast cancer in the United States frequently reach this threshold. METHODS The authors conducted a retrospective cohort study of 987 surgeons who operated on 8105 Medicare patients with breast cancer during 1994-1995 in 6 areas in the Surveillance, Epidemiology and End Results tumor registry. The 2-year physician volume of breast cancer operations was estimated among Medicare patients (approximating the on-average annual volumes for patients of all ages) and its association was examined with physician characteristics and with 3 measures of surgical care. RESULTS The median 2-year Medicare volume for breast cancer surgeons was 6, and 79% of physicians performed < or = 12 operations. Approximately 50% of patients were cared for by physicians who performed < or = 12 operations over 2 years, and 10% of patients were cared for by physicians who performed > or = 30 operations. Surgeon characteristics of age, female gender, general surgery board certification, and academic affiliation were associated with modestly higher volumes of breast cancer surgery. Higher surgeon volumes were associated with higher patient receipt of breast-conserving surgery, testing for hormone receptors, and lymph node dissection during mastectomy. CONCLUSIONS Most physicians who perform breast cancer surgery perform few annual operations in Medicare patients, and lower volumes are associated with differences in surgical processes of care. Because patients in the Medicare age group comprise almost 50% of all incident breast cancer cases, surgical volumes for patients of all ages also are likely to be low. It is likely that only approximately 10% of patients in the United States are treated by surgeons who performing at least 30 annual operations.
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Affiliation(s)
- Joan M Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
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Abstract
Breast cancer detection and management have undergone dramatic changes over the past three decades. Women are increasingly diagnosed with early stage disease, and leaving them with breast conserving options versus mastectomy. Furthermore, advances in the chemoprevention arena offer the promise of reduced overall breast cancer burden in the future.
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Affiliation(s)
- Lisa A Newman
- University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive, 3308 Cancer Center, Ann Arbor, MI 48109-0932, USA.
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