1
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Joel C, Ciampa M, O'Hara T, Bandera BC, Mangieri CW. Effect of three-dimensional intraoperative imaging on surgical outcomes with breast conservation therapy. Am J Surg 2022; 225:1009-1012. [PMID: 36621358 DOI: 10.1016/j.amjsurg.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/04/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Breast conservation therapy (BCT) is frequently performed for breast cancer and associated with a significant risk for positive margins. Intraoperative three-dimensional (3-D) tomosynthesis potentially could limit the risk of positive margins. METHODS Retrospective review of an institutional breast cancer registry. Evaluated BCT cases for a two year time period prior to and after the introduction of intraoperative 3-D tomosynthesis. Primary outcome was the effect of 3-D tomosynthesis on margin positivity rates. Secondary measures were the impact of 3-D tomosynthesis on additional margin procurements at the index surgery and operative time. RESULTS A total of 228 cases were evaluated with 106 cases utilizing 3-D tomosynthesis and 122 cases with standard imaging. No significant difference in margin positivity rates between the cohorts at 23.9% versus 15.8% for 3-D tomosynthesis and standard imaging respectively (OR 1.53, CI 0.772-3.032, P = 0.221). 3-D tomosynthesis was associated with increased margin procurement rates (OR 2.34, 95%CI 1.303-4.190, P = 0.004) and longer operative times (P < 0.001). CONCLUSION Intraoperative 3-D tomosynthesis was not found to limit margin positivity rates or improve the performance of the procedure.
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Affiliation(s)
- Constance Joel
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Maeghan Ciampa
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Thomas O'Hara
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Bradley C Bandera
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Christopher W Mangieri
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
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2
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Akrami M, Hosseinpour H, Ghoddusi Johari M, Shariat M, Zangouri V, Tahmasebi S, Keumarsi Z, Hosseinpour A, Talei A. Occurrence of residual disease in specimens of re-excision surgery in patients with positive margins of primary quadrantectomy. Breast J 2021; 27:797-803. [PMID: 34402559 DOI: 10.1111/tbj.14281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
Performing a re-intervention following a positive margin after primary lumpectomy in patients with breast cancer entails several disadvantages such as additional costs and postponing the follow-up treatments. In the present study, we sought to measure the incidence rate of residual disease in specimens taken from breast cancer patients who had positive margins after quadrantectomy and also compare the clinical and pathological factors between patients with and without a residual disease after the secondary surgery. All of the medical records of patients undergoing quadrantectomy from December 1994 to December 2019 were collected from Shiraz Breast Cancer Registry (SBCR). Patients were divided into two subgroups of patients with and without residual disease from the secondary surgery and also with and without positive margin from the first operation. Two groups were compared in terms of all clinicopathological factors. The records of 4843 patients undergoing quadrantectomy were reviewed, of which 132 (2.3%) had involved margins. Of these, 112 patients underwent a secondary surgery and 28 had residual disease (25%). No clinicopathological factor was correlated with presence of residual cancer. Also, bigger tumor size (p < 0.001) and the presence of in situ component (p < 0.001) were associated with positive margin and hence the need for a re-excision surgery. These results revealed that the significant rate of residual disease in the specimens of the secondary surgery indicates that a re-operation (either re-excision or simple mastectomy) cannot be omitted after obtaining a positive margin from the primary quadrantectomy.
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Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Mehdi Shariat
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Keumarsi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Hosseinpour
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Madheswaran S, Mungra N, Biteghe FAN, De la Croix Ndong J, Arowolo AT, Adeola HA, Ramamurthy D, Naran K, Khumalo NP, Barth S. Antibody-Based Targeted Interventions for the Diagnosis and Treatment of Skin Cancers. Anticancer Agents Med Chem 2021; 21:162-186. [PMID: 32723261 DOI: 10.2174/1871520620666200728123006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/19/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cutaneous malignancies most commonly arise from skin epidermal cells. These cancers may rapidly progress from benign to a metastatic phase. Surgical resection represents the gold standard therapeutic treatment of non-metastatic skin cancer while chemo- and/or radiotherapy are often used against metastatic tumors. However, these therapeutic treatments are limited by the development of resistance and toxic side effects, resulting from the passive accumulation of cytotoxic drugs within healthy cells. OBJECTIVE This review aims to elucidate how the use of monoclonal Antibodies (mAbs) targeting specific Tumor Associated Antigens (TAAs) is paving the way to improved treatment. These mAbs are used as therapeutic or diagnostic carriers that can specifically deliver cytotoxic molecules, fluorophores or radiolabels to cancer cells that overexpress specific target antigens. RESULTS mAbs raised against TAAs are widely in use for e.g. differential diagnosis, prognosis and therapy of skin cancers. Antibody-Drug Conjugates (ADCs) particularly show remarkable potential. The safest ADCs reported to date use non-toxic photo-activatable Photosensitizers (PSs), allowing targeted Photodynamic Therapy (PDT) resulting in targeted delivery of PS into cancer cells and selective killing after light activation without harming the normal cell population. The use of near-infrared-emitting PSs enables both diagnostic and therapeutic applications upon light activation at the specific wavelengths. CONCLUSION Antibody-based approaches are presenting an array of opportunities to complement and improve current methods employed for skin cancer diagnosis and treatment.
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Affiliation(s)
- Suresh Madheswaran
- Medical Biotechnology & Immunotherapy Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Neelakshi Mungra
- Medical Biotechnology & Immunotherapy Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fleury A N Biteghe
- Department of Radiation Oncology and Biomedical Sciences, Cedars-Sinai Medical, 8700 Beverly Blvd, Los Angeles, CA, United States
| | - Jean De la Croix Ndong
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, United States
| | - Afolake T Arowolo
- The Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Henry A Adeola
- The Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Dharanidharan Ramamurthy
- Medical Biotechnology & Immunotherapy Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Krupa Naran
- Medical Biotechnology & Immunotherapy Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- The Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Stefan Barth
- Medical Biotechnology & Immunotherapy Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Göker M, Marcinkowski R, Van Bockstal M, Keereman V, Van Holen R, Van Dorpe J, Vandenberghe S, Brans B, Depypere H, Van den Broecke R. 18F-FDG micro-PET/CT for intra-operative margin assessment during breast-conserving surgery. Acta Chir Belg 2020; 120:366-374. [PMID: 32452298 DOI: 10.1080/00015458.2020.1774163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rationale: Positive surgical margins for invasive breast cancer (BC) treated with breast-conserving surgery (BCS) are defined as ink on tumor. The rate of positive margins is approximately 20%, since a time- and cost-effective method for margin assessment is lacking. In this study, we investigated margin status by intra-operative imaging using high-resolution 18 F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) and X-ray computed tomography (CT).Methods: Twenty patients were enrolled and received 4 MBq/kg of FDG prior to surgery. Intra-operative imaging of the specimens was performed by the MOLECUBES β-CUBE (PET) and X-CUBE (CT). Margin status was assessed by three surgeons and compared with an algorithm. The sensitivity and specificity were calculated by using histopathological assessment as a gold standard.Results: A region with high FDG uptake was visualized in all specimens. Automated analysis showed a sensitivity of 90%, a specificity of 60%, and an area under the curve (AUC) of 0.86 after ROC analysis. Margin assessment by the surgeons resulted in a mean sensitivity and specificity of 79% and 72%, respectively.Conclusions: This proof-of-concept study demonstrates that high-resolution FDG-PET/CT can facilitate intra-operative margin assessment during BCS. This technique achieves good sensitivity and specificity and may therefore reduce re-operation rates in the future.
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Affiliation(s)
- Menekse Göker
- Department of Gynecology, Ghent University Hospital, Ghent, Belgium
| | | | - Mieke Van Bockstal
- Department of Pathological Anatomy, Ghent University Hospital, Ghent, Belgium
- Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vincent Keereman
- MOLECUBES NV, MeetDistrict – Ghelamco Arena, Ghent, Belgium
- Department of Electronics and Information Systems, MEDISIP, Ghent University, Ghent, Belgium
| | - Roel Van Holen
- MOLECUBES NV, MeetDistrict – Ghelamco Arena, Ghent, Belgium
- Department of Electronics and Information Systems, MEDISIP, Ghent University, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathological Anatomy, Ghent University Hospital, Ghent, Belgium
| | - Stefaan Vandenberghe
- Department of Electronics and Information Systems, MEDISIP, Ghent University, Ghent, Belgium
| | - Boudewijn Brans
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Herman Depypere
- Department of Gynecology, Ghent University Hospital, Ghent, Belgium
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5
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Tran-Harding K, Shi Q, Gibbs R, Szabunio M, Wang X. Evaluation of Margin Status of a Breast Lumpectomy Specimen: What the Radiologist Should Know. Curr Probl Diagn Radiol 2019; 48:599-604. [DOI: 10.1067/j.cpradiol.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 11/22/2022]
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6
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Gu J, Delisle M, Engler-Stringer R, Groot G. Mastectomy versus breast-conservation therapy: an examination of how individual, clinicopathologic, and physician factors influence decision-making. ACTA ACUST UNITED AC 2019; 26:e522-e534. [PMID: 31548821 DOI: 10.3747/co.26.5079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The choice of mastectomy compared with breast-conservation therapy (bct) in early-stage breast cancer (esbca) is a complicated decision-making process. Interprovincially, Canada's mastectomy rates vary from 25% to 68%, with Saskatchewan reporting the nation's second-highest mastectomy rate at 63%. The aim of our research was to better understand why women with esbca choose mastectomy rather than bct in Saskatchewan. Methods We created a survey based on a previously developed framework that organizes influencing factors into 3 constructs: clinicopathologic, physician, and individual belief factors. Results Treatment choice was found to be influenced by disease stage and multiple individual belief factors. Compared with their counterparts having stage i disease, women with stage ii disease were significantly more likely to undergo mastectomy [odds ratio (or): 7.48]. Patients rating "worry about cancer recurrence" and "total treatment time" as more influential in their choice were also more likely to undergo mastectomy (or: 3.4 and 1.8 respectively). Conversely, women rating "wanting to keep own breast tissue," "tumour size," and "surgeon's opinion" as influential in their choice were more likely to undergo bct (or: 0.17, 0.66, and 0.69 respectively). Conclusions Our study demonstrates that treatment choices for Saskatchewan women with esbca are influenced primarily by disease stage and individual belief factors. Those findings suggest that women are making their treatment choices predominantly based on individual values and preferences. The use of rates of mastectomy and bct as indicators of quality of care might be misleading. Instead, a shift in attention toward patient-centred care might be more appropriate.
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Affiliation(s)
- J Gu
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK
| | - M Delisle
- Department of Surgery, University of Manitoba, Winnipeg, MB
| | - R Engler-Stringer
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK
| | - G Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK
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Duraes M, Crochet P, Pagès E, Grauby E, Lasch L, Rebel L, Van Meer F, Rathat G. Surgery of nonpalpable breast cancer: First step to a virtual per‐operative localization? First step to virtual breast cancer localization. Breast J 2019; 25:874-879. [DOI: 10.1111/tbj.13379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Martha Duraes
- Department of gynaecological surgery Montpellier University Hospital Montpellier France
| | - Patrice Crochet
- Department of gynaecological surgery Montpellier University Hospital Montpellier France
| | - Emmanuelle Pagès
- Department of radiology Montpellier University Hospital Montpellier France
| | - Elsa Grauby
- Department of gynaecological surgery Montpellier University Hospital Montpellier France
| | - Lidia Lasch
- Department of gynaecological surgery Montpellier University Hospital Montpellier France
| | - Lucie Rebel
- Department of gynaecological surgery Montpellier University Hospital Montpellier France
| | | | - Gauthier Rathat
- Department of gynaecological surgery Montpellier University Hospital Montpellier France
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8
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Gu J, Groot G, Boden C, Busch A, Holtslander L, Lim H. Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review. Clin Breast Cancer 2018; 18:e539-e554. [DOI: 10.1016/j.clbc.2017.12.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/22/2017] [Indexed: 01/11/2023]
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9
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Gu J, Groot G. Creation of a new clinical framework - why women choose mastectomy versus breast conserving therapy. BMC Med Res Methodol 2018; 18:77. [PMID: 29986654 PMCID: PMC6038174 DOI: 10.1186/s12874-018-0533-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/27/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clinical medicine has lagged behind other fields in understanding and utilizing frameworks to guide research. In this article, we introduce a new framework to examine why women choose mastectomy versus breast conserving therapy in early stage breast cancer, and highlight the importance of utilizing a conceptual framework to guide clinical research. METHODS The framework we present was developed through integrating previous literature, frameworks, theories, models, and the author's past research. RESULTS We present a conceptual framework that illustrates the central domains that influence women's choice between mastectomy versus breast conserving therapy. These have been organized into three broad constructs: clinicopathological factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and individual belief factors. The aim of this framework is to provide a comprehensive basis to describe, examine, and explain the factors that influence women's choice of mastectomy versus breast conserving therapy at the individual level. CONCLUSION We have developed a framework with the purpose of helping health care workers and policy makers better understand the multitude of factors that influence a patient's choice of therapy at an individual level. We hope this framework is useful for future scholars to utilize, challenge, and build upon in their own work on decision-making in the setting of breast cancer. For clinician-researchers who have limited experience with frameworks, this paper will highlight the importance of utilizing a conceptual framework to guide future research and provide an example.
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Affiliation(s)
- Jeffrey Gu
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7, Health Science Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada.
| | - Gary Groot
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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10
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Valero MG, Mallory MA, Losk K, Tukenmez M, Hwang J, Camuso K, Bunnell C, King T, Golshan M. Surgeon Variability and Factors Predicting for Reoperation Following Breast-Conserving Surgery. Ann Surg Oncol 2018; 25:2573-2578. [PMID: 29786129 DOI: 10.1245/s10434-018-6526-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reoperation after breast-conserving surgery (BCS) is common and has been partially associated with the lack of consensus on margin definition. We sought to investigate factors associated with reoperations and variation in reoperation rates across breast surgeons at our cancer center. METHODS Retrospective analyses of patients with clinical stage I-II breast cancer who underwent BCS between January and December 2014 were conducted prior to the recommendation of 'no ink on tumor' margin. Patient demographics and tumor and surgical data were extracted from medical records. A multivariate regression model was used to identify factors associated with reoperation. RESULTS Overall, 490 patients with stage I (n = 408) and stage II (n = 89) breast cancer underwent BCS; seven patients had bilateral breast cancer and underwent bilateral BCS procedures. Median invasive tumor size was 1.1 cm, reoperation rate was 22.9% (n = 114) and varied among surgeons (range 15-40%), and, in 100 (88%) patients, the second procedure was re-excision, followed by unilateral mastectomy (n = 7, 6%) and bilateral mastectomy (n = 7, 6%). Intraoperative margin techniques (global cavity or targeted shaves) were utilized in 50.1% of cases, while no specific margin technique was utilized in 49.9% of cases. Median total specimen size was 65.8 cm3 (range 24.5-156.0). In the adjusted model, patients with multifocal disease were more likely to undergo reoperation [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.17-15.42]. In addition, two surgeons were found to have significantly higher reoperation rates (OR 6.41, 95% CI 1.94-21.22; OR 3.41, 95% CI 1.07-10.85). CONCLUSIONS Examination of BCS demonstrated variability in reoperation rates and margin practices among our breast surgeons. Future trials should look at surgeon-specific factors that may predict for reoperations.
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Affiliation(s)
- Monica G Valero
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Melissa Anne Mallory
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Katya Losk
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mustafa Tukenmez
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Kristen Camuso
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Craig Bunnell
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Richey WL, Luo M, Goodale SE, Clements LW, Meszoely IM, Miga MI. A system for automatic monitoring of surgical instruments and dynamic, non-rigid surface deformations in breast cancer surgery. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10576:105761H. [PMID: 31130766 PMCID: PMC6530568 DOI: 10.1117/12.2295221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When negative tumor margins are achieved at the time of resection, breast conserving therapy (lumpectomy followed with radiation therapy) offers patients improved cosmetic outcomes and quality of life with equivalent survival outcomes to mastectomy. However, high reoperation rates ranging 10-59% continue to challenge adoption and suggest that improved intraoperative tumor localization is a pressing need. We propose to couple an optical tracker and stereo camera system for automated monitoring of surgical instruments and non-rigid breast surface deformations. A bracket was designed to rigidly pair an optical tracker with a stereo camera, optimizing overlap volume. Utilizing both devices allowed for precise instrument tracking of multiple objects with reliable, workflow friendly tracking of dynamic breast movements. Computer vision techniques were employed to automatically track fiducials, requiring one-time initialization with bounding boxes in stereo camera images. Point based rigid registration was performed between fiducial locations triangulated from stereo camera images and fiducial locations recorded with an optically tracked stylus. We measured fiducial registration error (FRE) and target registration error (TRE) with two different stereo camera devices using a phantom breast with five fiducials. Average FREs of 2.7 ± 0.4 mm and 2.4 ± 0.6 mm with each stereo-camera device demonstrate considerable promise for this approach in monitoring the surgical field. Automated tracking was shown to reduce error when compared to manually selected fiducial locations in stereo camera image-based localization. The proposed instrumentation framework demonstrated potential for the continuous measurement of surgical instruments in relation to the dynamic deformations of a breast during lumpectomy.
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Affiliation(s)
- Winona L Richey
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN USA
| | - Ma Luo
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN USA
| | - Sarah E Goodale
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN USA
| | - Logan W Clements
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN USA
| | - Ingrid M Meszoely
- Vanderbilt University Medical Center, Division of Surgical Oncology, Nashville, TN USA
| | - Michael I Miga
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN USA
- Vanderbilt University Department of Radiology and Radiological Sciences, Nashville, TN USA
- Vanderbilt Institute for Surgery and Engineering, Nashville, TN USA
- Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, TN USA
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Kalinathan L, Kathavarayan RS, Nagendram D, Vij M, Rela M. Segmentation of hepatocellular carcinoma and dysplastic liver tumors in histopathology images using area based adaptive expectation maximization. MULTIMEDIA TOOLS AND APPLICATIONS 2018; 77:1761-1782. [DOI: 10.1007/s11042-016-4260-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
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13
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Zhang Z, Pei J, Wang D, Gan Q, Ye J, Yue J, Wang B, Povoski SP, Martin EW, Hitchcock CL, Yilmaz A, Tweedle MF, Shao P, Xu RX. A Wearable Goggle Navigation System for Dual-Mode Optical and Ultrasound Localization of Suspicious Lesions: Validation Studies Using Tissue-Simulating Phantoms and an Ex Vivo Human Breast Tissue Model. PLoS One 2016; 11:e0157854. [PMID: 27367051 PMCID: PMC4930179 DOI: 10.1371/journal.pone.0157854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/02/2016] [Indexed: 12/02/2022] Open
Abstract
Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer. The development of intraoperative guidance systems for identifying all sites of disease and improving the likelihood of complete surgical resection is an area of active ongoing research, as this can lead to a decrease in the need of subsequent additional surgical procedures. We develop a wearable goggle navigation system for dual-mode optical and ultrasound imaging of suspicious lesions. The system consists of a light source module, a monochromatic CCD camera, an ultrasound system, a Google Glass, and a host computer. It is tested in tissue-simulating phantoms and an ex vivo human breast tissue model. Our experiments demonstrate that the surgical navigation system provides useful guidance for localization and core needle biopsy of simulated tumor within the tissue-simulating phantom, as well as a core needle biopsy and subsequent excision of Indocyanine Green (ICG)—fluorescing sentinel lymph nodes. Our experiments support the contention that this wearable goggle navigation system can be potentially very useful and fully integrated by the surgeon for optimizing many aspects of oncologic surgery. Further engineering optimization and additional in vivo clinical validation work is necessary before such a surgical navigation system can be fully realized in the everyday clinical setting.
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Affiliation(s)
- Zeshu Zhang
- School of Engineering Science, University of Science and Technology of China, Hefei, China
| | - Jing Pei
- Department of Surgery, Anhui Medical University, Hefei, China
| | - Dong Wang
- School of Engineering Science, University of Science and Technology of China, Hefei, China
- College of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Qi Gan
- School of Engineering Science, University of Science and Technology of China, Hefei, China
| | - Jian Ye
- School of Engineering Science, University of Science and Technology of China, Hefei, China
| | - Jian Yue
- Department of Surgery, Anhui Medical University, Hefei, China
| | - Benzhong Wang
- Department of Surgery, Anhui Medical University, Hefei, China
| | - Stephen P. Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail: (SP); (PS); (RX)
| | - Edward W. Martin
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Charles L. Hitchcock
- Pathology Department, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Alper Yilmaz
- College of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Michael F. Tweedle
- Radiology Department, Wright Center for Innovation, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Pengfei Shao
- School of Engineering Science, University of Science and Technology of China, Hefei, China
- * E-mail: (SP); (PS); (RX)
| | - Ronald X. Xu
- School of Engineering Science, University of Science and Technology of China, Hefei, China
- College of Engineering, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail: (SP); (PS); (RX)
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14
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Ballal H, Taylor DB, Bourke AG, Latham B, Saunders CM. Predictors of re-excision in wire-guided wide local excision for early breast cancer: a Western Australian multi-centre experience. ANZ J Surg 2015; 85:540-5. [PMID: 25879775 DOI: 10.1111/ans.13067] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND A significant proportion of breast cancers present as impalpable lesions requiring radiological guidance prior to surgical excision, commonly by hook-wire placement. Complete lesion excision is an essential part of treatment, and re-excision may be needed to ensure this and minimize local recurrence. We explore a 1-year audit of re-excision of hook-wire-guided excisions in two large public breast units in Western Australia and define factors associated with the requirement for re-excision. METHODS A retrospective review of wire-localized wide local excisions for early breast cancer in 2009 at two tertiary breast centres in Western Australia. RESULTS Of 148 localized lesions, 44 (30%) underwent re-excision. The only significant preoperative finding was the location of tumour in the breast. The intra-operative specimen radiograph provided useful information that influenced re-excision. Smaller (≤5 mm) and larger (>20 mm) tumours on final pathological size were more likely to undergo re-excision as well as a larger difference in actual size to predicted size. The presence of ductal carcinoma in situ (DCIS) increased re-operation, as did multifocality. CONCLUSION This study highlights factors that should make the surgeon more cautious for re-excision. Suspicion of DCIS, especially at the periphery of tumours, and a central tumour location increase risk. Lesion localization techniques play an important role in minimizing risk while maintaining cosmesis.
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Affiliation(s)
- Helen Ballal
- Breast Centre, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Donna B Taylor
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Anita G Bourke
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Bruce Latham
- Department of Pathology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Christobel M Saunders
- School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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15
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Affiliation(s)
- David Azria
- Department of Radiation Oncology and INSERM U896, Institut du Cancer Montpellier, 34298 Montpellier, France.
| | - Claire Lemanski
- Department of Radiation Oncology and INSERM U896, Institut du Cancer Montpellier, 34298 Montpellier, France
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16
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Soot L, Weerasinghe R, Wang L, Nelson HD. Rates and indications for surgical breast biopsies in a community-based health system. Am J Surg 2013; 207:499-503. [PMID: 24315378 DOI: 10.1016/j.amjsurg.2013.07.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND High rates of surgical breast biopsies in community hospitals have been reported but may misrepresent actual practice. METHODS Patient-level data from 5,757 women who underwent breast biopsies in a large integrated health system were evaluated to determine biopsy types, rates, indications, and diagnoses. RESULTS Between 2008 and 2010, 6,047 breast biopsies were performed on 5,757 women. Surgical biopsy was the initial diagnostic procedure in 16% (n = 942) of women overall and in 6% (72 of 1,236) of women with newly diagnosed invasive breast cancer. Invasive breast cancer was diagnosed in 72 women (8%) undergoing surgical biopsy compared with 1,164 (24%) undergoing core needle biopsy (P < .001, age adjusted). Main indications for surgical biopsies included symptomatic abnormalities, technical challenges, and patient choice. CONCLUSIONS Surgical biopsy was the initial diagnostic procedure in 16% of women with breast abnormalities, comparable with rates at academic centers. Rates could be improved by more careful consideration of indications.
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Affiliation(s)
- Laurel Soot
- Providence Cancer Center, Providence Health and Services Oregon, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Roshanthi Weerasinghe
- Providence Cancer Center, Providence Health and Services Oregon, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Lian Wang
- Medical Data Research Center, Providence Health and Services Oregon, Portland, OR, USA
| | - Heidi D Nelson
- Providence Cancer Center, Providence Health and Services Oregon, 4805 NE Glisan Street, Portland, OR 97213, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
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17
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Los márgenes de resección en la cirugía conservadora del cáncer de mama. Cir Esp 2013; 91:404-12. [DOI: 10.1016/j.ciresp.2013.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 02/07/2013] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
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18
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Morrow M, Winograd JM, Freer PE, Eichhorn JH. Case records of the Massachusetts General Hospital. Case 8-2013. A 48-year-old woman with carcinoma in situ of the breast. N Engl J Med 2013; 368:1046-53. [PMID: 23484832 DOI: 10.1056/nejmcpc1214221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
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19
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Yu CC, Chiang KC, Kuo WL, Shen SC, Lo YF, Chen SC. Low re-excision rate for positive margins in patients treated with ultrasound-guided breast-conserving surgery. Breast 2013; 22:698-702. [PMID: 23333255 DOI: 10.1016/j.breast.2012.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/28/2012] [Accepted: 12/26/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Re-excision is a necessary procedure in obtaining clean margins for breast-conserving surgery (BCS)-treated patients. Re-excision rates vary widely among different breast cancer management procedures. The aim of this study was to evaluate the efficacy of ultrasound (US)-guided BCS to decrease the re-excision rate in patients with US-detectable breast cancer, as well as the relationship between positive margins and ultrasonographic characteristics of tumor. METHODS Between 2008 and 2009, we identified consecutive patients who underwent initial US-guided BCS for breast in situ or invasive carcinoma, which was preoperatively detected using US examination and on the basis of image-guided biopsy findings. The margins achieved after BCS were separately assessed by performing frozen section analysis of shaved margins. The negative margin and positive margin groups were compared for clinicopathological features and ultrasonographic findings. RESULTS Of 381 patients undergoing US-guided BCS, 126 (33.1%) had palpable tumors and 255 (66.9%) had nonpalpable tumors. Positive margins were noted in 35 patients (9.2%). These patients underwent re-excision and were margin-free; no further surgery was required for these patients. There were no significant intergroup differences in clinicopathological features and ultrasonographic findings. CONCLUSION Breast US is an effective modality for intraoperative tumor localization and can thus help obtain clean margins and reduce the re-excision rate in cases in which breast-conserving therapy has been performed. Furthermore, frozen section analysis of cavity shaved margins is a feasible method for minimizing the need for further surgery.
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Affiliation(s)
- Chi-Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan
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20
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Jung W, Kang E, Kim SM, Kim D, Hwang Y, Sun Y, Yom CK, Kim SW. Factors Associated with Re-excision after Breast-Conserving Surgery for Early-Stage Breast Cancer. J Breast Cancer 2012; 15:412-9. [PMID: 23346170 PMCID: PMC3542849 DOI: 10.4048/jbc.2012.15.4.412] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 10/12/2012] [Indexed: 11/30/2022] Open
Abstract
Purpose Re-excisions after breast-conserving surgery (BCS) for breast cancer cause delays in the adjuvant treatment, increased morbidity, and leads to poor aesthetic results. Thus, efforts to reduce the re-excision rate are essential. This study aimed to conclusively determine the re-excision rate and the factors associated with re-excision after BCS. Methods We retrospectively reviewed the medical records and pathological reports of 711 cases that underwent BCS for early-stage breast cancer. Univariate and multivariate analyses were performed. Results Of the 711 cases of BCS, 71 (10.0%) required re-excision. Patients in the re-excision group were younger than those in the no re-excision group. Non-palpable lesions, the presence of non-mass-like enhancement at magnetic resonance imaging, multifocality, the presence of a ductal carcinoma in situ (DCIS) component, and an infiltrative tumor border were also significantly associated with re-excision. Multivariate analysis indicated that younger age, non-palpable lesions, multifocal lesions, and the presence of a DCIS component were factors which were independently associated with re-excision. Tumors located in the lower inner quadrant had a relatively high involved resection margin rate as well as a narrow resection margin width, especially at the superior and medial margins. Lateral margins showed a tendency toward a wider resection margin width. Conclusion At our institution, the rate of re-excision was low despite the lack of an intraoperative frozen section. Patients with non-palpable or multifocal tumors, a DCIS component, or those who were younger than 50 years were more likely to require re-excision after BCS. These factors should be considered when planning surgical management of early-stage breast cancer. Positive resection margin rates and margin widths differed on a directional basis based on tumor location, and these differences were considerable.
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Affiliation(s)
- Woohyun Jung
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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21
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Predictors of margin status after breast-conserving operations in an underscreened population. Langenbecks Arch Surg 2012. [DOI: 10.1007/s00423-012-1023-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Rua C, Lebas P, Michenet P, Ouldamer L. Evaluation of lumpectomy surgical specimen radiographs in subclinical, in situ and invasive breast cancer, and factors predicting positive margins. Diagn Interv Imaging 2012; 93:871-7. [PMID: 23021868 DOI: 10.1016/j.diii.2012.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the diagnostic performance of radiological evaluation of the margins of surgical specimens from lumpectomies for subclinical malignant breast lesions. MATERIALS AND METHODS Retrospective study in two French hospitals including all patients who had a non-palpable in situ (ISDC) or invasive (IDC) ductal carcinoma treated by lumpectomy after radiological localisation. For the analysis, the lesions were divided into two groups depending on the majority component in the definitive histological examination: ISDC or IDC. The radiological margin considered was 10mm. RESULTS For the 178 lumpectomies studied, the sensitivity of the radiographs of the surgical specimen was 33.3% for ISDC and 50% for IDC. The surgical revision rate was 27.41% for ISDC and 12.64% for IDC. The significant predictive factors for positive margins were the radiological size of the lesions (>10mm) for ISDC (P=0.02) and radiologically positive margins for IDC (P=0.01). Correlation was found between the histological and radiological sizes of the lesion for IDC, but not for ISDC. CONCLUSION Radiological examination of surgical specimens does not provide a satisfactory evaluation of the histological margins, in particular for ISDC, even with a radiological threshold of 10mm.
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Affiliation(s)
- C Rua
- Gynaecology Department, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnelé, Tours cedex, France.
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23
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Bricou A, Héquet D, Tengher-Barna I, Ziol M, Barranger E. [Realizing systematic cavity margins in conservative breast cancer surgery]. ACTA ACUST UNITED AC 2012; 40:715-9. [PMID: 22995051 DOI: 10.1016/j.gyobfe.2012.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
Abstract
The quality of surgical margins in lumpectomy are strong criteria to define risk of locoregional recurrence when conservative treatment is undertaken. Intraoperatively, the limits of adequate resection are sometimes difficult to define. This is why some teams propose the realization of systematic cavity margins during the excision of lumpectomy during the same operation. We expose the potential benefits of this type of practice using data from the literature.
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Affiliation(s)
- A Bricou
- Service de gynécologie obstétrique, université Paris-13, hôpital Jean-Verdier, Paris-Seine-Saint-Denis, AP-HP, avenue du 14-Juillet, 931430 Bondy, France
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24
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Reedijk M, Hodgson N, Gohla G, Boylan C, Goldsmith CH, Foster G, Cornacchi SD, McCready D, Lovrics PJ. A prospective study of tumor and technical factors associated with positive margins in breast-conservation therapy for nonpalpable malignancy. Am J Surg 2012; 204:263-8. [DOI: 10.1016/j.amjsurg.2012.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 11/29/2022]
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25
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Li Y, Li Z, Wang X, Liu F, Cheng Y, Zhang B, Shi D. In vivo cancer targeting and imaging-guided surgery with near infrared-emitting quantum dot bioconjugates. Theranostics 2012; 2:769-76. [PMID: 22916076 PMCID: PMC3425123 DOI: 10.7150/thno.4690] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/02/2012] [Indexed: 01/06/2023] Open
Abstract
Early detection and subsequent complete surgical resection are among the most efficient methods for treating cancer. However, low detection sensitivity and incomplete tumor resection are two challenging issues. Nanoparticle-based imaging-guided surgery has proven promising for cancer-targeted imaging and subsequent debulking surgery. Particularly, the use of near infrared (NIR) fluorescent probes such as NIR quantum dots (QDs) allows deep penetration and high sensitivity for tumor detection. In this study, NIR-emitting CdTe QDs (maximum fluorescence emission peak at 728 nm) were synthesized with a high quantum yield (QY) of 38%. The tumor-specific QD bioconjugates were obtained by attaching cyclic Arg-Gly-Asp peptide (cRGD) to the surface of synthesized QDs, and then injected into U87 MG tumor-bearing mice via tail veins for tumor-targeted imaging. The tumor and its margins were visualized and distinguished by NIR QD bioconjugates, and tumor resection was successfully accomplished via NIR guidance using a Fluobeam-700 NIR imaging system. Our work indicates that the synthesized tumor-specific NIR QDs hold great promise as a potential fluorescent indicator for intraoperative tumor imaging.
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26
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Atalay C, Irkkan C. Predictive factors for residual disease in re-excision specimens after breast-conserving surgery. Breast J 2012; 18:339-44. [PMID: 22616572 DOI: 10.1111/j.1524-4741.2012.01249.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Local recurrence is an issue of concern after breast-conserving therapy and removing the primary tumor with negative surgical margins is the most important determinant of local recurrence. However, some patients with positive margins after initial surgery will have no residual tumor in the re-excision specimen. To avoid unnecessary re-excisions, factors predicting residual disease in re-excision material should be determined. This study aimed to determine the predictive factors for residual disease in the re-excision material in a homogeneous group of patients with positive margins and only invasive ductal carcinoma. Breast cancer patients treated between 2005 and 2008 with breast-conserving surgery and subsequent re-excisions due to positive surgical margins after initial surgery were included in the study. Patients were divided into two groups as those with and without residual disease in the re-excision material. One hundred and four breast cancer patients were included in the study. Forty-seven patients (45.2%) had residual tumor in re-excision specimen. Patient characteristics such as age (p = 0.42) and physical findings (p = 1.0) and specimen volume (p = 0.24), tumor grade (p = 0.33), estrogen (p = 1.0), and progesterone (p = 0.37) receptor status, axillary lymph node metastases (p = 0.16), extensive intraductal component (p = 0.8), and lymphovascular invasion (p = 0.064) were found as insignificant factors for predicting residual tumor. Large tumor size (>3 cm) (p = 0.026), human epidermal growth factor receptor2 (HER2) positivity (p = 0.013), and tumor to specimen volume ratio of >70% (p = 0.002) significantly increased the probability of finding residual disease after re-excision. In multivariate analysis, HER2 positivity (p = 0.046) and tumor to specimen volume ratio of >70% (p = 0.006) independently predicted the presence of residual disease. As a result, in patients with HER2 positive tumors larger than 3 cm, larger volume of breast tissue around the tumor should be removed to decrease the number of re-excisions due to positive surgical margins.
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Affiliation(s)
- Can Atalay
- Department of General Surgery, Ankara Oncology Hospital Department of Pathology, Ankara Oncology Hospital, Ankara, Turkey.
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27
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Coopey SB, Buckley JM, Smith BL, Hughes KS, Gadd MA, Specht MC. Lumpectomy cavity shaved margins do not impact re-excision rates in breast cancer patients. Ann Surg Oncol 2011; 18:3036-40. [PMID: 21947583 DOI: 10.1245/s10434-011-1909-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The benefits of taking shaved cavity margins (SCM) at the time of lumpectomy are unclear. We sought to determine if taking SCM decreases re-excision rates by increasing the total breast tissue volume excised. METHODS We undertook a retrospective review of breast cancer patients who underwent lumpectomy from 2004 to 2006. Patients were divided into three groups. Group 1 had lumpectomy alone, group 2 had lumpectomy plus select (1-3) SCM, and group 3 had lumpectomy plus complete (≥4) SCM. Pathologic findings and surgical outcomes were compared between groups. RESULTS 773 cancers treated by lumpectomy were included in this study; 197 were in group 1, 130 were in group 2, and 446 were in group 3. The mean total volume of breast tissue excised in group 1 (106.6 cm(3)) was significantly larger than the volume excised in groups 2 (79.3 cm(3)) and 3 (76.3 cm(3)). Rates of re-excision and successful breast-conservation therapy (BCT) were not significantly different between groups. Despite a lower total volume of breast tissue excised in groups 2 and 3, there was no significant increase in locoregional recurrence rates (LRR) at median follow-up of 54 months. CONCLUSIONS Taking additional SCM during lumpectomy resulted in a significantly lower overall volume of breast tissue excised, with no increase in LRR. Contrary to prior studies, we found that SCM did not decrease re-excision rates or impact the success of BCT. Therefore, the main advantage of taking SCM appears to be that less breast tissue is excised, which could potentially improve cosmetic outcomes.
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Affiliation(s)
- Suzanne B Coopey
- Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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28
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Coopey S, Smith BL, Hanson S, Buckley J, Hughes KS, Gadd M, Specht MC. The Safety of Multiple Re-excisions after Lumpectomy for Breast Cancer. Ann Surg Oncol 2011; 18:3797-801. [DOI: 10.1245/s10434-011-1802-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 11/18/2022]
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Davis KM, Hsu CH, Bouton ME, Wilhelmson KL, Komenaka IK. Intraoperative Ultrasound Can Decrease the Re-excision Lumpectomy Rate in Patients with Palpable Breast Cancers. Am Surg 2011. [DOI: 10.1177/000313481107700627] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Positive margins occur in 15 to 69 per cent of patients undergoing lumpectomy. The current study was performed to evaluate intraoperative ultrasound in patients undergoing lumpectomy for palpable breast cancer. A retrospective chart review was performed of patients with palpable cancer who underwent lumpectomy with intraoperative ultrasound from 2004 to 2009. Each patient was matched with two patients who underwent lumpectomy alone over the same time period. Matching criteria included tumor size, clinical stage, body mass index, age at diagnosis, and lymphovascular invasion or extensive intraductal component. Twenty-two consecutive patients who underwent lumpectomy with intraoperative ultrasound were matched with 44 patients who underwent lumpectomy without intraoperative ultrasound. In addition to matching criteria, the patients were similar with respect to ethnicity, insurance status, weight, predominant histology, estrogen receptor, progesterone receptor, and Her2 status. Patients who underwent lumpectomy with intraoperative ultrasound were significantly less likely to have an involved margin (41 vs 9%, P = 0.01) and less likely to require a re-excision (34 vs 9%, P = 0.04). The lumpectomy volumes in the intraoperative ultrasound group were smaller than the volumes in the lumpectomy alone group. Intraoperative ultrasound can decrease the rate of positive margins and re-excision lumpectomy in patients with palpable breast cancers.
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Affiliation(s)
- Karole M. Davis
- Department of Surgery, Maricopa Medical Center, Phoenix, Arizona
| | - Chiu-Hsieh Hsu
- Arizona Cancer Center, University of Arizona, Tucson, Arizona
- Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, Arizona
| | - Marcia E. Bouton
- Department of Surgery, Maricopa Medical Center, Phoenix, Arizona
| | | | - Ian K. Komenaka
- Department of Surgery, Maricopa Medical Center, Phoenix, Arizona
- Arizona Cancer Center, University of Arizona, Tucson, Arizona
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Holmes DR. Ongoing consideration of cavity evaluation devices in the treatment of breast cancer. Ann Surg Oncol 2011; 18:1809-11. [PMID: 21519919 DOI: 10.1245/s10434-011-1684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Londero V, Zuiani C, Panozzo M, Linda A, Girometti R, Bazzocchi M. Surgical specimen ultrasound: Is it able to predict the status of resection margins after breast-conserving surgery? Breast 2010; 19:532-7. [DOI: 10.1016/j.breast.2010.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 05/19/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022] Open
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An appraisal of pre-operative MRI in breast cancer: More effective staging of the breast or much ado about nothing? Maturitas 2010; 67:291-3. [DOI: 10.1016/j.maturitas.2010.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 08/20/2010] [Indexed: 11/22/2022]
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33
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Gioux S, Choi HS, Frangioni JV. Image-Guided Surgery Using Invisible Near-Infrared Light: Fundamentals of Clinical Translation. Mol Imaging 2010. [DOI: 10.2310/7290.2010.00034] [Citation(s) in RCA: 382] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sylvain Gioux
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, and CEA-LETI-MINATEC, Grenoble, France
| | - Hak Soo Choi
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, and CEA-LETI-MINATEC, Grenoble, France
| | - John V. Frangioni
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, and CEA-LETI-MINATEC, Grenoble, France
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34
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Badruddoja M. Lumpectomy and cavity shaving. J Am Coll Surg 2010; 210:1015-6. [PMID: 20510817 DOI: 10.1016/j.jamcollsurg.2010.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Morrow M. Magnetic resonance imaging for screening, diagnosis, and eligibility for breast-conserving surgery: promises and pitfalls. Surg Oncol Clin N Am 2010; 19:475-92. [PMID: 20620922 DOI: 10.1016/j.soc.2010.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Magnetic resonance imaging (MRI) is able to visualize small tumor deposits that previously could only be identified on pathologic examination. MRI is most valuable in areas in which patient management has been problematic, including screening women with known or suspected BRCA 1 and 2 mutations, and identification of the primary tumor site in patients presenting with axillary adenopathy. The role of MRI in the patient with newly diagnosed breast cancer remains controversial. Success rates for patients selected for breast-conserving therapy without MRI are high, and rates of ipsilateral breast tumor recurrence are low. Future efforts to improve the local therapy for breast cancer must acknowledge the heterogeneity of the disease and tailor approaches to the biology of individual subsets. This goal can only be accomplished through a multidisciplinary approach that examines the applications of newer diagnostic modalities such as MRI.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street, New York, NY 10065, USA.
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36
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Bloom S, Morrow M. A Clinical Oncologic Perspective on Breast Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2010; 18:277-94, ix. [DOI: 10.1016/j.mric.2010.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hodgson NC, Lytwyn A, Bacopulos S, Elavathil L. Adenoid cystic breast carcinoma: high rates of margin positivity after breast conserving surgery. Am J Clin Oncol 2010; 33:28-31. [PMID: 19730354 DOI: 10.1097/coc.0b013e31819fdfc8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Adenoid cystic carcinoma of the breast (ACCB) is a rare malignancy with favorable prognosis: axillary lymph node involvement, distant metastases, and death due to disease are uncommon. ACCB may recur locally many years after primary surgical excision and may be substantially higher if primary procedure is lumpectomy rather than mastectomy. METHODS Pathology database searched to identify patients diagnosed with ACCB between 1988 and 2007 at Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.Two pathologists independently reviewed histology to confirm diagnosis of ACCB, and documented surgical procedure, tumor size, tumor grade, surgical margin, and lymph node status. Immunohistochemistry was performed on representative blocks and independently reviewed by 2 pathologists. Clinical and radiologic data were retrospectively reviewed. RESULTS Fifteen cases of ACCB were identified and pathology slides were available for 12. The median age was 62 years. Seven patients presented with a palpable mass and breast pain was described in 3. Positive surgical margins were identified in 5 patients (42%). Only 3 patients had postoperative radiation therapy. CONCLUSIONS Our series shows frequent resection margin involvement in ACCB. Neither clinical nor mammographic examination consistently delineated full tumor extent preoperatively. Future use of magnetic resonance imaging in preoperative assessment may prevent high positive margin rate when lumpectomy is planned. Histologic assessment of tumor extent may be difficult, but immunohistochemistry may be helpful in this regard.
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Affiliation(s)
- Nicole C Hodgson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Fadare O, Clement NF, Ghofrani M. High and intermediate grade ductal carcinoma in-situ of the breast: a comparison of pathologic features in core biopsies and excisions and an evaluation of core biopsy features that may predict a close or positive margin in the excision. Diagn Pathol 2009; 4:26. [PMID: 19691836 PMCID: PMC2740842 DOI: 10.1186/1746-1596-4-26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 08/19/2009] [Indexed: 11/10/2022] Open
Abstract
Low and high-grade ductal carcinoma in-situ (DCIS) are known to be highly disparate by a multitude of parameters, including progression potential, immunophenotype, gene expression profile and DNA ploidy. In this study, we analyzed a group of intermediate and high-grade DCIS cases to determine how well the core biopsy predicts the maximal pathology in the associated excisions, and to determine if there are any core biopsy morphologic features that may predict a close (≤ 0.2 cm) or positive margin in the subsequent excision. Forty-nine consecutive paired specimens [core biopsies with a maximal diagnosis of DCIS, and their corresponding excisions, which included 20 and 29 specimens from mastectomies and breast conserving surgeries respectively] were evaluated in detail. In 5 (10%) of 49 cases, no residual carcinoma was found in the excision. In another 4 cases, the changes were diagnostic only of atypical ductal hyperplasia. There were 4 and 3 respective cases of invasive and microinvasive carcinoma out of the 49 excision specimens, for an overall invasion frequency of 14%. In 28 cases where a sentinel lymph node evaluation was performed, only 1 was found to be positive. Among the 40 cases with at least residual DCIS in the excision, there were 5 cases in which comedo-pattern DCIS was present in the excision but not in the core biopsy, attributed to the lower maximal nuclear grade in the biopsy proliferation in 4 cases and the absence of central necrosis in the 5th. For the other main histologic patterns, in 8 (20%) of 40 cases, there were more patterns identified in the core biopsy than in the corresponding excision. For the other 32 cases, 100%, 66%, 50%, 33% and 25% of the number of histologic patterns in the excisions were captured in 35%, 5%, 17.5%, 15% and 7.5% of the preceding core biopsies respectively. Therefore, the core biopsy reflected at least half of the non-comedo histologic patterns in 77.5% of cases. In 6(15%) of the 40 cases, the maximum nuclear grade of the excision (grade 3) was higher than that seen in the core biopsy (grade 2). Overall, however, the maximum nuclear grade in the excision was significantly predicted by maximum nuclear grade in the core biopsy (p = 0.028), with a Phi of 0.347, indicating a moderately strong association. At a size threshold of 2.7 cm, there was no significant association between lesional size and core biopsy features. Furthermore, the clear margin width of the cases with lesional size ≤ 2.7 cm (mean 0.69 cm) was not significantly different (p = 0.4) from the cases with lesional size > 2.7 cm (mean 0.56 cm). Finally, among a variety of core biopsy features that were evaluated, including maximum nuclear grade, necrosis, cancerization of lobules, number of tissue cores with DCIS, number of DCIS ducts per tissue core, total DCIS ducts, or comedo-pattern, only necrosis was significantly associated with a positive or close (≤ 0.2 cm) margin on multivariate analysis (Phi of 0.350). It is concluded that a significant change [to invasive disease (14%) or to no residual disease (10%)] is seen in approximately 24% of excisions that follow a core biopsy diagnosis of intermediate or high-grade DCIS. Core biopsy features are of limited value in predicting a close or positive margin in these lesions.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA.
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Povoski SP, Jimenez RE, Wang WP, Xu RX. Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer. BMC Cancer 2009; 9:254. [PMID: 19635166 PMCID: PMC2724549 DOI: 10.1186/1471-2407-9-254] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 07/27/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve "adequate" or "negative" surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS. METHODS Retrospective analysis of 204 BCS procedures performed for invasive breast cancer from August 2003 to June 2007, in which patients underwent a standard BCS resection and systematic sampling of nine standardized re-resection margins (superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, and deep-posterior). Multiple variables (including patient, tumor, specimen, and follow-up variables) were evaluated. RESULTS 6.4% (13/204) of patients had positive BCS specimen margins (defined as tumor at inked edge of BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor within 1 mm or less of inked edge but not at inked edge of BCS specimen). 11.8% (24/204) of patients had at least one re-resection margin containing additional disease, independent of the status of the BCS specimen margins. 7.1% (13/182) of patients with negative BCS specimen margins (defined as no tumor cells seen within 1 mm or less of inked edge of BCS specimen) had at least one re-resection margin containing additional disease. Thus, 54.2% (13/24) of patients with additional disease in a re-resection margin would not have been recognized by a standard BCS procedure alone (P < 0.001). The nine standardized resection margins represented only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen. CONCLUSION Our methodology accurately assesses the adequacy of surgical resection margins for determination of which individuals may need further resection to the affected breast in order to minimize the potential risk of local recurrence while attempting to limit the volume of additional breast tissue excised, as well as to determine which individuals are not realistically amendable to BCS and instead need a completion mastectomy to successfully remove multifocal disease.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Rafael E Jimenez
- Department of Pathology, The Ohio State University, Columbus, Ohio, 43210, USA
- Current address : Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Wenle P Wang
- Department of Pathology, The Ohio State University, Columbus, Ohio, 43210, USA
- Current address : Department of Pathology, VA Medical Center at Baltimore, Baltimore, Maryland, 21201, USA
| | - Ronald X Xu
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, 43210, USA
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Hwang N, Schiller DE, Crystal P, Maki E, McCready DR. Magnetic Resonance Imaging in the Planning of Initial Lumpectomy for Invasive Breast Carcinoma: Its Effect on Ipsilateral Breast Tumor Recurrence After Breast-Conservation Therapy. Ann Surg Oncol 2009; 16:3000-9. [DOI: 10.1245/s10434-009-0607-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/13/2009] [Accepted: 04/13/2009] [Indexed: 11/18/2022]
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McCready D, Schiller D. Author Reply: Partial Breast Intraoperative Radiation. Ann Surg Oncol 2008. [DOI: 10.1245/s10434-008-9945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ziogas D, Ignatiadou E, Fatouros M. Lumpectomy and partial breast irradiation--risks and benefits for early breast cancer. Ann Surg Oncol 2008; 15:2352-3; authopr reply 2354. [PMID: 18239967 DOI: 10.1245/s10434-008-9825-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 01/18/2023]
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