S E Tevis1, H B Neuman2, E A Mittendorf1,3, H M Kuerer1, I Bedrosian1, S M DeSnyder1, A M Thompson1, D M Black1, M E Scoggins1, A A Sahin1, K K Hunt1, A S Caudle4. 1. Department of Breast Surgical Oncology, University of Texas- MD Anderson Cancer Center, Houston, TX, USA. 2. University of Wisconsin, Madison, WI, USA. 3. Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. 4. Department of Breast Surgical Oncology, University of Texas- MD Anderson Cancer Center, Houston, TX, USA. ascaudle@mdanderson.org.
Abstract
BACKGROUND: Successful breast-conserving surgery requires achieving negative margins. At our institution, the whole surgical specimen is imaged and then serially sectioned with repeat imaging. A multidisciplinary discussion then determines need for excision of additional margins. The goal of this study was to determine the benefit of each component of this approach in reducing the number of positive margin. METHODS: This single-institution, prospective study included ten breast surgical oncologists who were surveyed to ascertain whether they would have taken additional margins based their review of whole specimen images (WSI) and review of serially sectioned images (SSI). These results were compared with the multidisciplinary decisions (MDD) and pathology results. Margin status was defined using consensus guidelines. RESULTS: One hundred surveys were completed. Margins on the original specimen were positive or close in 21%. After WSI, surgeons reported that they would have taken additional margins in 26 cases, reducing the number of positive/close margins from 21 to 13% (p < 0.001). After SSI, 52 would have taken additional margins; however, the number of positive/close margins remained 13%. MDD resulted in additional margins taken in 56 cases, reducing the number of positive/close margins to 7% (p < 0.001 compared with SSI). CONCLUSIONS: While surgeon review of specimen radiographs can decrease the number of positive or close margins from 21 to 13%, more rigorous multidisciplinary, intraoperative margin assessment reduces the number of close or positive margins to 7%.
BACKGROUND: Successful breast-conserving surgery requires achieving negative margins. At our institution, the whole surgical specimen is imaged and then serially sectioned with repeat imaging. A multidisciplinary discussion then determines need for excision of additional margins. The goal of this study was to determine the benefit of each component of this approach in reducing the number of positive margin. METHODS: This single-institution, prospective study included ten breast surgical oncologists who were surveyed to ascertain whether they would have taken additional margins based their review of whole specimen images (WSI) and review of serially sectioned images (SSI). These results were compared with the multidisciplinary decisions (MDD) and pathology results. Margin status was defined using consensus guidelines. RESULTS: One hundred surveys were completed. Margins on the original specimen were positive or close in 21%. After WSI, surgeons reported that they would have taken additional margins in 26 cases, reducing the number of positive/close margins from 21 to 13% (p < 0.001). After SSI, 52 would have taken additional margins; however, the number of positive/close margins remained 13%. MDD resulted in additional margins taken in 56 cases, reducing the number of positive/close margins to 7% (p < 0.001 compared with SSI). CONCLUSIONS: While surgeon review of specimen radiographs can decrease the number of positive or close margins from 21 to 13%, more rigorous multidisciplinary, intraoperative margin assessment reduces the number of close or positive margins to 7%.
Authors: G Ciccarelli; M R Di Virgilio; S Menna; L Garretti; A Ala; R Giani; R Bussone; G Canavese; E Berardengo Journal: Radiol Med Date: 2007-04-20 Impact factor: 3.469
Authors: Sarah L Blair; Kari Thompson; Joseph Rococco; Vanessa Malcarne; Peter D Beitsch; David W Ollila Journal: J Am Coll Surg Date: 2009-09-11 Impact factor: 6.113
Authors: Amanda M Schulman; Jennifer A Mirrielees; Glen Leverson; Jeffrey Landercasper; Caprice Greenberg; Lee G Wilke Journal: Ann Surg Oncol Date: 2016-08-31 Impact factor: 5.344
Authors: Laurence E McCahill; Richard M Single; Erin J Aiello Bowles; Heather S Feigelson; Ted A James; Tom Barney; Jessica M Engel; Adedayo A Onitilo Journal: JAMA Date: 2012-02-01 Impact factor: 56.272
Authors: Neslihan Cabioglu; Kelly K Hunt; Aysegul A Sahin; Henry M Kuerer; Gildy V Babiera; S Eva Singletary; Gary J Whitman; Merrick I Ross; Frederick C Ames; Barry W Feig; Thomas A Buchholz; Funda Meric-Bernstam Journal: Ann Surg Oncol Date: 2007-01-28 Impact factor: 5.344
Authors: Monica Morrow; Paul Abrahamse; Timothy P Hofer; Kevin C Ward; Ann S Hamilton; Allison W Kurian; Steven J Katz; Reshma Jagsi Journal: JAMA Oncol Date: 2017-10-01 Impact factor: 31.777
Authors: Mansher Singh; Gayatri Singh; Kevin T Hogan; Kristen A Atkins; Anneke T Schroen Journal: World J Surg Oncol Date: 2010-01-18 Impact factor: 2.754
Authors: Puneet Singh; Marion E Scoggins; Aysegul A Sahin; Rosa F Hwang; Henry M Kuerer; Abigail S Caudle; Elizabeth A Mittendorf; Alastair M Thompson; Isabelle Bedrosian; Mediget Teshome; Sarah M DeSnyder; Funda Meric-Bernstam; Kelly K Hunt Journal: Ann Surg Open Date: 2020-12