Intraoperative Assessment of Breast Cancer Specimens Decreases Cost and Number of Reoperations

2011 ◽  
Vol 77 (3) ◽  
pp. 342-344 ◽  
Author(s):  
John M. Uecker ◽  
Eric H. Bui ◽  
Kelli H. Foulkrod ◽  
John P. Sabra
Keyword(s):  
Breast Cancer ◽  
Operating Room ◽  
Medical Center ◽  
Margin Assessment ◽  
Surgical Interventions ◽  
Intraoperative Assessment ◽  
Surgical Costs ◽  
Operative Costs ◽  
Intraoperative Margin Assessment

It is the aim of our study to determine if the assessment of intraoperative breast cancer margins leads to decreased incidence of repeat operations and decreased cost. We collected data prospectively from two hospitals in Austin, TX, University Medical Center at Brackenridge (UMCB) and Seton Northwest Hospital (SNW), over a 2-year period. Comparison was made to see if intraoperative margin assessment affected total surgical costs and need for reoperation. One hundred and seven cases met criteria for inclusion in the study (UMCB = 45, SNW = 62). Intraoperative margin assessment was used in zero cases at SNW (0%) and in 17 at UMCB (38%). Intraoperative assessment was used in 16 per cent of total cases. Sixty per cent of cases at SNW required subsequent return to the operating room. Twenty-four per cent of cases at UMCB required subsequent reoperation ( P < 0.05). The average number of surgical interventions required was 1 ± 0.3 with intraoperative assessment, 2 ± 0.6 without, ( P < 0.05). Total surgical costs were $15,341 ± $4,328 with intraoperative assessment and $22,013 ± $13,821 without ( P < 0.05). Use of intraoperative margin assessment for breast cancer operations leads to both a decrease in reoperations as well as a decrease in total operative costs.

Combined experience at three breast centers with routine use of an intraoperative margin assessment device including comparison to historical re-excision rates.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 79-79 ◽  
Author(s):  
Mary L. Sebastian ◽  
Alice Marie Police ◽  
Stephanie Akbari ◽  
Beth Anglin
Keyword(s):  
Assessment Tool ◽  
Local Therapy ◽  
The United States ◽  
High Rate ◽  
Breast Cancer Patients ◽  
Margin Assessment ◽  
Surgical Interventions ◽  
Breast Centers ◽  
Intraoperative Margin Assessment ◽  
The Impact

79 Background: Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. This study is the first compellation of data among three breast centers to assess the impact of an intraoperative margin assessment tool (MarginProbe) on re-excision rates. This device has been approved for clinical use in the United States since 2013. We present groups of consecutive patients in each of these breast centers – before and after the implementation of routine intraoperative use of the margin assessment device during lumpectomy procedures. Methods: Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. We established the historical re-excision rates of each surgeon on a consecutive set of patients in a corresponding period just before we began using the device. Results: In total, 165 patients were treated in three institutions up until April 2014. Sixteen patients (9.7%, 16/165) required re-excision. Historical re-excision rates corresponding to periods of use before the intraoperative margin assessment device was put into use were 25.8% (48/186). The re-excision rate was reduced by 62% (P<0.0001). Six re-excisions were due to a positive shaving which was not measured by the device. Conclusions: Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.

Advances in Intraoperative Margin Assessment for Breast Cancer

2016 ◽  
Vol 4 (4) ◽  
Author(s):  
Jane J. Keating ◽  
Carla Fisher ◽  
Rebecca Batiste ◽  
Sunil Singhal
Keyword(s):  
Breast Cancer ◽  
Margin Assessment ◽  
Intraoperative Margin Assessment

scholarly journals Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma

2021 ◽  
Vol 15 ◽  
pp. 117822342199345
Author(s):  
Caroline Koopmansch ◽  
Jean-Christophe Noël ◽  
Calliope Maris ◽  
Philippe Simon ◽  
Marième Sy ◽  
...  
Keyword(s):  
Invasive Carcinoma ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Resection Margins ◽  
Margin Assessment ◽  
Positive Margins ◽  
Intraoperative Assessment ◽  
Intraoperative Margin Assessment

Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment ( P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment ( P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.

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