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Annals of Surgical Oncology

, Volume 24, Issue 1, pp 52–58 | Cite as

Reexcision Surgery for Breast Cancer: An Analysis of the American Society of Breast Surgeons (ASBrS) MasterySM Database Following the SSO-ASTRO “No Ink on Tumor” Guidelines

  • Amanda M. Schulman
  • Jennifer A. Mirrielees
  • Glen Leverson
  • Jeffrey Landercasper
  • Caprice Greenberg
  • Lee G. WilkeEmail author
Breast Oncology

Abstract

Background

In February 2014 , the Society of Surgical Oncology and the American Society for Radiation Oncology released guidelines standardizing a negative margin after breast-conserving surgery (BCS) as “no ink on tumor” in patients with early-stage invasive cancer. We sought to determine whether reexcision rates after initial BCS decreased after guideline publication, using the ASBrS MasterySM of Breast Surgery Program.

Methods

Between January 2013 and June 2015, data from the ASBrS MasterySM database was analyzed to determine reexcision rates pre and post guideline publication. Reasons for reexcision were evaluated as were the associations with patient and provider characteristics. Chi square test, Fisher’s exact test, Student’s t test, ANOVA, and multivariable logistic regression were used as appropriate. All analyses were performed using Microsoft Excel and SPSS, with p value <0.05 as significant.

Results

Among 252 providers, the overall reexcision rate after initial BCS decreased by 3.7 % from 20.2 to 16.5 % (p < 0.001). Notable was a 13.8 % decrease (p < 0.001) in reexcisions being done for close margins. Of the analyzed physician and patient characteristics the majority of subgroups showed decreases between the two time periods; however, only “Percent Breast Surgery in Practice” was significant. On adjusted analysis, there were no specific patient factors associated with a reduction in reexcision rates.

Conclusions

Following the SSO-ASTRO “no ink on tumor” guideline publication, a reduction in overall reexcision rates and reexcision rates for close margins after initial BCS was observed in the ASBrS MasterySM database. More widespread implementation outside this group of early adopters is anticipated with ongoing dissemination.

Keywords

National Comprehensive Cancer Network Breast Surgery Breast Conservation Surgery Ipsilateral Breast Tumor Recurrence Breast Surgeon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Gomez SL, Glaser SL, McClure LA, et al. The California neighborhoods data system: a new resource for examining the impact of neighborhood characteristics on cancer incidence and outcomes in populations. Cancer Causes Control. 2011;22(4):631-47.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-41.CrossRefPubMedGoogle Scholar
  3. 3.
    Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early-stage invasive breast carcinoma. Cancer. 1999;86(4):628-37.Google Scholar
  4. 4.
    King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158-64.CrossRefPubMedGoogle Scholar
  5. 5.
    Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76(2):259-67.CrossRefPubMedGoogle Scholar
  6. 6.
    Tartter PI, Kaplan J, Bleiweiss I, et al. Lumpectomy margins, reexcision, and local recurrence of breast cancer. Am J Surg. 2000;179(2):81-5.CrossRefPubMedGoogle Scholar
  7. 7.
    Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24(13):2028-37.CrossRefPubMedGoogle Scholar
  8. 8.
    Amato B, Rispoli C, Iannone L, Testa S, Compagna R, Rocco N. Surgical margins of resection for breast cancer: current evidence. Minerva Chir. 2012;67(5):445-52.PubMedGoogle Scholar
  9. 9.
    Dillon MF, Hill AD, Quinn CM, McDermott EW, O’Higgins N. A pathologic assessment of adequate margin status in breast-conserving therapy. Ann Surg Oncol. 2006;13(3):333-9.CrossRefPubMedGoogle Scholar
  10. 10.
    Coopey S, Smith BL, Hanson S, et al. The safety of multiple re-excisions after lumpectomy for breast cancer. Ann Surg Oncol. 2011;18(13):3797-801.CrossRefPubMedGoogle Scholar
  11. 11.
    Revesz E, Khan SA. What are safe margins of resection for invasive and in situ breast cancer? Oncology (Williston Park). 2011;25(10):890-5.PubMedGoogle Scholar
  12. 12.
    Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717-30.CrossRefPubMedGoogle Scholar
  13. 13.
    Jagsi R, Smith BD, Sabel M, Pierce L. Individualized, patient-centered application of consensus guidelines to improve the quality of breast cancer care. Int J Radiat Oncol Biol Phys. 2014;88(3):535-6.CrossRefPubMedGoogle Scholar
  14. 14.
    McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467-75.CrossRefPubMedGoogle Scholar
  15. 15.
    Pleijhuis RG, Graafland M, de Vries J, Bart J, de Jong JS, van Dam GM. Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions. Ann Surg Oncol. 2009;16(10):2717-30.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21(3):704-16.CrossRefPubMedGoogle Scholar
  17. 17.
    American Society of Breast Surgeons MasterySM Program. http://masterybreastsurgeons.org/. Accessed 5 Apr 2014.
  18. 18.
    Kiefe CI, Weissman NW, Allison JJ, Farmer R, Weaver M, Williams OD. Identifying achievable benchmarks of care: concepts and methodology. Int J Qual Health Care. 1998;10(5):443-7.CrossRefPubMedGoogle Scholar
  19. 19.
    Hatfield MD, Ashton CM, Bass BL, Shirkey BA. Surgeon-specific reports in general surgery: establishing benchmarks for peer comparison within a single hospital. J Am Coll Surg. 2016;222(2):113-21.CrossRefPubMedGoogle Scholar
  20. 20.
    Buchholz TA, Somerfield MR, Griggs JJ, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32(14):1502-6.CrossRefPubMedGoogle Scholar
  21. 21.
    National Comprehensive Cancer Network: Endorsement of SSO-ASTRO Margin Status Guidelines. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
  22. 22.
    Wilke LG, Czechura T, Wang C, et al. Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004-2010. JAMA Surg. 2014;149(12):1296-305.CrossRefPubMedGoogle Scholar
  23. 23.
    Landercasper J, Whitacre E, Degnim AC, Al-Hamadani M. Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol. 2014;21(10):3185-91.CrossRefPubMedGoogle Scholar
  24. 24.
    Gupta A, Subhas G, Dubay L, et al. Review of re-excision for narrow or positive margins of invasive and intraductal carcinoma. Am Surg. 2010;76(7):731-4.PubMedGoogle Scholar
  25. 25.
    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(5):1297-303.CrossRefPubMedGoogle Scholar
  26. 26.
    Chung A, Gangi A, Amersi F, Bose S, Zhang X, Giuliano A. Impact of consensus guidelines by the Society of Surgical Oncology and the American Society for Radiation Oncology on margins for breast-conserving surgery in stages 1 and 2 invasive breast cancer. Ann Surg Oncol. 2015;22 Suppl 3:422-7.CrossRefGoogle Scholar
  27. 27.
    Merrill AL, Coopey SB, Tang R, et al. Implications of new lumpectomy margin guidelines for breast-conserving surgery: changes in reexcision rates and predicted rates of residual tumor. Ann Surg Oncol. 2016;23(3):729-34.CrossRefPubMedGoogle Scholar
  28. 28.
    Zork NM, Komenaka IK, Pennington RE, et al. The effect of dedicated breast surgeons on the short-term outcomes in breast cancer. Ann Surg. 2008;248(2):280-5.CrossRefPubMedGoogle Scholar
  29. 29.
    Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer. 2010;46(13):2344-56.CrossRefPubMedGoogle Scholar
  30. 30.
    Osborn JB, Keeney GL, Jakub JW, Degnim AC, Boughey JC. Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins. Ann Surg Oncol. 2011;18(11):3204-9.CrossRefPubMedGoogle Scholar
  31. 31.
    Schwartz T, Degnim AC, Landercasper J. Should re-excision lumpectomy rates be a quality measure in breast-conserving surgery? Ann Surg Oncol. 2013;20(10):3180-3.CrossRefPubMedGoogle Scholar
  32. 32.
    Boughey JC, Hieken TJ, Jakub JW, et al. Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: evaluation of the National Surgical Quality Improvement Program data. Surgery. 2014;156(1):190-7.CrossRefPubMedGoogle Scholar
  33. 33.
    Landercasper J, Attai D, Atisha D, et al. Toolbox to reduce lumpectomy reoperations and improve cosmetic outcome in breast cancer patients: the American Society of Breast Surgeons Consensus Conference. Ann Surg Oncol. 2015;22(10):3174-83.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Pass HA, Klimberg SV, Copeland EM. Are “breast-focused” surgeons more competent? Ann Surg Oncol. 2008;15(4):953-5.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    DeSnyder SM, Hunt KK, Smith BD, Moran MS, Klimberg S, Lucci A. Assessment of Practice Patterns Following Publication of the SSO-ASTRO Consensus guideline on margins for breast-conserving therapy in stage I and II invasive breast cancer. Ann Surg Oncol. 2015;22(10):3250-6.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Amanda M. Schulman
    • 1
  • Jennifer A. Mirrielees
    • 1
  • Glen Leverson
    • 1
  • Jeffrey Landercasper
    • 2
  • Caprice Greenberg
    • 1
  • Lee G. Wilke
    • 1
    Email author
  1. 1.Department of Surgery Administration MC: 7375, Clinical Science CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.The Norma J Vinger Center for Breast CareGundersen Medical FoundationLa CrosseUSA

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