Breast density and the risk for positive lumpectomy margins.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 50-50 ◽  
Author(s):  
Freya Ruth Schnabel ◽  
Tanir Allweis
Keyword(s):  
Breast Density ◽  
Odds Ratio ◽  
Positive Margin ◽  
Mammographic Breast Density ◽  
Mri Imaging ◽  
Positive Margins ◽  
Positive Margin Rate ◽  
Device Use ◽  
Lumpectomy Specimen ◽  
Lumpectomy Margins

50 Background: Current methods for intraoperative assessment of lumpectomy margins are limited, and a meaningful proportion of patients require re-excision to achieve acceptable margins. There is little available information regarding the relationship of mammographic breast density (BD) and positive margin rate. Methods: The MarginProbe device uses radiofrequency spectroscopy to evaluate the margins of lumpectomy specimens. The current study utilized data from the MarginProbe Pivotal Trial (Dune Medical Devices, Israel, NCT00749931). This randomized clinical trial compared adjunctive intraoperative use of the MarginProbe device with surgeons’ standard approach to lumpectomy surgery. For the current analysis, data was compiled from the period prior to patient randomization and device use. Variables of interest included BD, patient and tumor characteristics, and the margin status of the main lumpectomy specimen (prior to device use in the device arm). For the purpose of this analysis, a positive margin was considered tumor on ink. Statistical analysis was performed with univariate and multivariate analysis, and linear/logistic regression. Results: A total of 664 patients were enrolled in the trial. 450 patients had preoperative breast density information available, and formed the basis for this analysis. As expected, higher BD was associated with younger age, lower BMI and smaller breast and specimen volume. Increased BD was also associated with increased use of preoperative MRI imaging (odds ratio 2.2, p<0.0001). Higher BD was also associated with a significant increase in main lumpectomy specimen positive margin rate (Table). The odds ratio was 1.46 per change in density category (p=0.011). BD remained significantly associated with positive margins after controlling for age, BMI and breast volume. Conclusions: Higher BD is an independent risk factor for positive margins in main lumpectomy specimens, suggesting that adjunctive methods for intraoperative margin assessment may be particularly helpful in these patients. [Table: see text]

scholarly journals Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

2020 ◽  
Vol 13 (6) ◽  
pp. 419-424
Author(s):  
T Ellul ◽  
P Grice ◽  
A Mainwaring ◽  
N Bullock ◽  
A Shanahan ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Penile Cancer ◽  
Frozen Section ◽  
Surgical Margin ◽  
Positive Margin ◽  
Surgical Excision ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Positive Margins ◽  
Positive Margin Rate

Introduction and objectives: The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis. Materials and methods: We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates. Results: A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%). Conclusions: In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer. Level of evidence: Not applicable for this multicentre audit.

Margins in Laryngeal Squamous Cell Carcinoma Treated with Transoral Laser Microsurgery: A National Database Study

2019 ◽  
Vol 161 (6) ◽  
pp. 986-992 ◽  
Author(s):  
Jonathan Hanna ◽  
Philip R. Brauer ◽  
Elliot Morse ◽  
Saral Mehra
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Positive Margin ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Positive Margins ◽  
Factors Associated ◽  
Positive Margin Rate

Objectives To determine national positive margin rates in transoral laser microsurgery, to compare patients with positive and negative margins, and to identify factors associated with positive margins. Study Design Retrospective review of the National Cancer Database. Setting Population based. Subjects/Methods Patients included those with TIS-T3 laryngeal squamous cell carcinoma (2004-2014). Univariable and multivariable logistic regression were used to identify predictors. Results A total of 1959 patients met inclusion criteria. The national positive margin rate was 22.3%. Sixty-five percent of patients had T1 disease; 94.3% were N-negative; and 74.0% had glottic tumors. Fifty-eight percent of patients were treated at academic centers, and 60.6% were treated at facilities performing <2 cases per year. On multivariable analysis, factors associated with margin status included facility volume (odds ratio [95% CI]; in cases per year: 0.93 [0.89-0.97], P = .001), academic status (vs nonacademic; academic: 0.70 [0.54-0.90], P = .008), T-stage (vs T1; T2: 2.74 [2.05-3.65], T3: 5.53 [3.55-8.63], TIS: 0.59 [0.38-0.92], P < .001), and N-stage (vs N0; N1: 3.42 [1.79-6.54], N2: 2.01 [1.09-3.69], P < .001). Tumor subsite was not associated with margin status. Conclusion The national positive margin rate for laryngeal laser surgery is 22%, which is concerning given the equivalent survival benefit offered by surgery and primary radiation and the increased likelihood of bimodal therapy in the situation of positive margins. Cases treated at nonacademic centers and those with lower caseloads had a higher likelihood of positive margins. There was a linear association between T-stage and likelihood of positive margins, with T3 tumors being 5 times as likely as T1 to yield positive margins. This study highlights the importance of proper patient selection for transoral laser microsurgery resections.

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

2019 ◽  
Vol 161 (4) ◽  
pp. 620-628 ◽  
Author(s):  
Liliya Benchetrit ◽  
Elliot Morse ◽  
Benjamin L. Judson ◽  
Saral Mehra
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Proportional Hazards ◽  
Positive Margin ◽  
Cox Proportional Hazards ◽  
Surgical Margins ◽  
Multivariable Logistic Regression Analysis ◽  
Positive Surgical Margins ◽  
Positive Margins ◽  
Positive Margin Rate

Objectives Identify positive margin rate in a national cohort of patients with submandibular carcinoma, identify predictors of positive margins, and associate margins with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer–accredited hospitals. Subjects and Methods We included patients in the National Cancer Database from 2004 to 2014 who were diagnosed with submandibular carcinoma and underwent primary surgical resection. We determined the rate of positive surgical margins and associated patient, tumor, and treatment factors with positive margins via univariable and multivariable logistic regression analysis. We associated margin status with overall survival by Kaplan-Meier curve and Cox proportional hazards regression. Results We identified 1150 patients with submandibular malignancy undergoing surgical resection. Positive margin rate was 41.0%. Increased odds of positive margins were seen in patients with advanced T stage (vs T1, T3: odds ratio [OR] = 3.04, P < .001; T4a: OR = 2.89, P < .001), adenoid cystic carcinoma histology (OR = 1.54, P = .020), and those treated at nonacademic facilities (OR = 1.41, P = .008). Patients who underwent a preoperative diagnostic biopsy had decreased odds of positive margins (OR = 0.72, P = .014). Positive margins were associated with reduced overall survival (58% vs 69% 5-year overall survival, P < .001; hazard ratio = 1.49, P = .001) when controlling for patient, tumor, and management factors. Conclusions The national positive margin rate of submandibular carcinoma is 41.0%. Preoperative biopsy and treatment at academic institutions independently decreased the risk of positive margins, and positive margins were independently associated with diminished overall survival. Positive margin rate for submandibular carcinoma may be considered a benchmark for quality of care.

Intraoperative margin assessment with the MarginProbe at different mammographic breast densities.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 47-47 ◽  
Author(s):  
Alice Police ◽  
Erin Lin ◽  
Karen Lane
Keyword(s):  
Breast Density ◽  
Clinical Benefit ◽  
Breast Imaging ◽  
Assessment Tool ◽  
Univariate Analysis ◽  
Breast Conserving Surgery ◽  
Mammographic Breast Density ◽  
Margin Assessment ◽  
Positive Margins ◽  
Intraoperative Margin Assessment

47 Background: Mammographic breast density (BD) is known to affect breast imaging. MarginProbe is an RF Spectroscopy intraoperative margin assessment tool. We looked at the effect of mammographic breast density (BD) on the performance of the device. Mammographic density was assigned by Breast Imaging-Reporting and Data System (BI-RADS) classification prior to breast conserving surgery with the MarginProbe. Methods: For the current study we analyzed MarginProbe device arm data from the MarginProbe Pivotal Trial for which BD data was available. Clear margins of the main specimen, which is where the MarginProbe was applied, were defined as no tumor on ink. Clinical benefit was defined as clearing positive main specimen margins or cancer in the shaving. Analysis was performed based on logistic and linear regression, with univariate analysis. Results: The dataset for the analysis included 196 patients for which preoperative BD data was available. With higher BD, there was an increase in the rate of main lumpectomy specimen with positive margins (OR 1.65 per change in density category, p=0.025). The rate of shavings with clinical benefit showed an upward trend, with increasing BD. The number of shavings per patient increased with BD, however the overall volume of shavings did not increase. There was an increase in the per patient relative clinical benefit as BD increased (OR 1.6 per change in density category, p=0.024). Conclusions: With higher breast density patients and surgeons face an increase in risk for main specimen positive margins. With the increased BD and main specimen positivity more shavings were removed, but shavings volume did not increase as average shaving volume decreased with higher BD. Higher level of patient clinical benefit was observed with higher BD.

scholarly journals Relationship of mammographic densities to breast cancer risk

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Engy A. Ali ◽  
Mariam Raafat
Keyword(s):  
Breast Cancer ◽  
Breast Density ◽  
Statistical Significance ◽  
Significant Risk ◽  
Close Relation ◽  
Mammographic Screening ◽  
Mammographic Breast Density ◽  
Study Results ◽  
Relationship Of ◽  
Mammographic Densities

Abstract Background Our goal was to find out the relation between mammographic densities and cancer of the breast according to the recent ACR classification. From the medical records of Kasereliny Hospital, 49,409 women were subjected to digital mammography for screening, of which 1500 breast cancer cases were collected. The mammographic categories of breast density were ACR-A, B, C, and D, which were detected by two senior radiologists. All radiological classifications were made using both standard mammographic views bilaterally. Two-sided tests of statistical significance were represented by all the P values. Results From 2014 to 2019, 49,409 women came for digital mammographic screening, their age ranges between 40 and 65, and all of them are included in the study. One thousand cases of breast cancer cases were radiologically and pathologically diagnosed. Different densities were arranged in descending pattern depending on the frequency of positive cases: D (13.7%), C (3.3%), B (2.7%), A (2.2%). There is positive significant risk ratio among every higher mammographic density in comparison to the lower density. Conclusion Our study results show that the risk of breast cancer is in close relation to the mammographic breast density.

scholarly journals Subjective Versus Quantitative Methods of Assessing Breast Density

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 331 ◽  
Author(s):  
Wijdan Alomaim ◽  
Desiree O’Leary ◽  
John Ryan ◽  
Louise Rainford ◽  
Michael Evanoff ◽  
...  
Keyword(s):  
Breast Density ◽  
Quantitative Methods ◽  
Weighted Kappa ◽  
Subjective Assessment ◽  
Evidence Base ◽  
Assessment Methods ◽  
Digital Data ◽  
Mammographic Breast Density ◽  
National Breast ◽  
Busy Clinical Setting

In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.

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