scholarly journals Effect of LigaSure™, Monopolar Cautery, and Bipolar Cautery on Surgical Margins in Breast-Conserving Surgery

Breast Care ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 194-199 ◽  
Author(s):  
Ahmet Türkan ◽  
Gökhan Akkurt ◽  
Metin Yalaza ◽  
Gürkan Değirmencioğlu ◽  
Mehmet Tolga Kafadar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Thermal Damage ◽  
False Negative ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Bipolar Cautery ◽  
Tissue Sections ◽  
Significant Difference ◽  
Lumpectomy Specimen

Background: We compared the differences in thermal damage at the surgical margin between monopolar cautery, bipolar cautery, and LigaSure™ in breast cancer lumpectomy specimens and assessed the effect of these techniques on the evaluation of the surgical margins. Methods: 30 patients scheduled for breast-conserving surgery for breast cancer were included in this study. During lumpectomy, each of the superior, inferior, lateral, and medial borders of the tumour was excised using one of the following: a scalpel, monopolar cautery, bipolar cautery, and LigaSure technology. The surgical margins of frozen and paraffin-embedded tissue sections of the lumpectomy specimen were evaluated. Thermal damage was defined as the maximum depth of thermal damage (in mm) from the surgical margin, and the level was categorized as none, low (≤1 mm), or high (>1 mm). Results: There was no statistically significant difference between monopolar cautery, bipolar cautery, and LigaSure in terms of thermal damage. There was no thermal damage at the surgical margin in tissues dissected by scalpel. Conclusion: Thermal damage due to the excision method may cause false-negative and false-positive results in the surgical margin evaluation of lumpectomy specimens. More research is needed on the effects of different energy modalities on surgical margin evaluation in breast-conserving surgery.

The effect of margin status on local recurrence following breast conservation and radiation therapy for DCIS

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 597-597
Author(s):  
M. R. Kell ◽  
C. Dunne ◽  
C. Canning ◽  
M. Morrow
Keyword(s):  
Local Recurrence ◽  
Randomized Trials ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Surgical Margins ◽  
Significant Difference

597 Background: There is no consensus on what constitutes an adequate surgical margin in patients receiving breast conserving surgery (BCS) and postoperative irradiation (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncological benefit. Methods: A comprehensive search for published trials which examined outcomes after adjuvant RT following BCS for DCIS was performed using medline and cross referencing available data. Reviews of each study were conducted, and data were extracted. Fixed and random effects methods were used to combine data. Primary outcomes were in breast tumour recurrence (IBTR) related to surgical margins. Results: Analysis of 3,606 patients from randomized trials confirms that patients with negative margins are significantly less likely to recur than those with positive margins after RT (RR 0.53, 95% CI= 0.42 to 0.66, p<0.01). Combined data from randomized and non randomized trials, of 5,500 patients, demonstrates that where the margin status is close or unknown there is significant risk of IBTR compared to a negative margin (RR=1.68, 95% CI= 1.22–2.33, p<0.01). When specific margin thresholds are examined a 2 mm margin is superior to less than 2 mm (OR=0.67, 95% CI 0.51 -0.89, p<0.01), however we saw no significant difference in the rate of IBTR between a 2 mm margin and >5 mm (OR=1.49, 95% CI 0.54 to 4.9, p>0.05). Conclusions: Surgical margins negative for DCIS should be obtained following BCS for DCIS. A margin threshold of 2mm appears be as good as a larger margin when BCS for DCIS is combined with RT. No significant financial relationships to disclose.

scholarly journals “Unplanned breast-conserving surgery after systemic therapy in locally advanced breast cancer: the results of level II oncoplastic techniques”

2021 ◽  
Author(s):  
mehmet gulcelik ◽  
Lütfi Doğan
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Axillary Recurrence ◽  
Free Survival ◽  
Level Ii ◽  
Significant Difference

BACKGROUND: In patients with breast cancer for whom neoadjuvant chemotherapy (NAC) is planned, it is recommended to mark the primary tumor before treatment (planned surgery). However, surgeons may have to perform breast-conserving surgery on patients whose tumors are not marked (unplanned surgery). This study focused on the results obtained with planned and unplanned level II oncoplastic surgery (OPS) techniques applied to patients after NAC. METHODS: Patient groups who underwent planned, unplanned OPS and mastectomy after NAC were compared. Surgical margin status, re-operation and re-excision requirements, ipsilateral breast tumor recurrence (IBTR) and axillary recurrence rates recorded. Long-term local recurrence-free survival (LRFS), disease-free survival and overall survival were evaluated. RESULTS: There was no significant difference between the planned and unplanned OPS groups in terms of surgical margin status, re-excision requirement, and mastectomy rates. During an average follow-up period of 43 months, 5.3% and 4% of the patients in the planned OPS group developed IBTR and axillary recurrence, respectively, whereas these rates were 6.6% and 5.3% in the unplanned OPS group. In the mastectomy group, the rates of IBTR and axillary recurrence were found to be 4.1% and 3.8%, respectively. There was no significant difference between the three groups in terms of IBTR (p: 0.06) and axillary recurrence (p: 0.08) rates. CONCLUSION: Breast conserving surgery can be applied using level II OPS techniques with the post-NAC radiological examination and marking even if primary tumor marking is not done in the pre-NAC period.

scholarly journals Risk factors for positive resection margins of breast cancer tumorectomy specimen following breast-conserving surgery

2017 ◽  
Vol 32 (2) ◽  
Author(s):  
Niko Heiss ◽  
Valentin Rousson ◽  
Assia Ifticene-Treboux ◽  
Hans-Anton Lehr ◽  
Jean-François Delaloye
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Invasive Cancer ◽  
Surgical Experience ◽  
Positive Surgical Margins ◽  
Positive Margins ◽  
Significant Difference ◽  
Excision Rate

AbstractBackgroundThe aim of the study was to identify risk factors for positive surgical margins in breast-conserving surgery for breast cancer and to evaluate the influence of surgical experience in obtaining complete resection.MethodsAll lumpectomies for invasive breast carcinoma and ductal carcinoma in situ (DCIS) between April 2008 and March 2010 were selected from the database of a single institution. Re-excision rates for positive margins as well as patient and histopathologic tumor characteristics were analyzed. Surgical experience was staged by pairs made of Resident plus Specialist or Consultant. Two periods were defined. During period A, the majority of operations were performed by Residents under supervision of Specialist or Consultant. During period B, only palpable tumors were operated by Residents.ResultsThe global re-excision rate was 27% (50 of 183 patients). The presence of DCIS increased the risk for positive margins: 60% (nine of 15 patients) in the case of sole DCIS compared to 26% (41 of 160 patients) for invasive cancer (p = 0.005) and 35% (42 of 120 patients) in the case of peritumoral DCIS compared to 11% (seven of 62 patients) in the case of sole invasive cancer (p = 0.001). Re-excision rate decreased from 36% (23 of 64 patients) during period A to 23% (27 of 119 patients) during period B (p = 0.055). There was no significant difference between the surgical pairs.ConclusionIn our study, DCIS was the only risk factor for positive surgical margins. Breast-conserving surgery for non-palpable tumors should be performed by Specialists, however, palpable tumors can be safely operated by Residents under supervision.

scholarly journals THE MODERN ASPECTS OF THE BREAST CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH BREAST CANCER CT1-3N0-3M0

2020 ◽  
Vol 66 (4) ◽  
pp. 376-380
Author(s):  
Nadezhda Volchenko ◽  
A. Bosieva ◽  
A. Zikiryakhodzhayev ◽  
M. Ermoshchenkova
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Breast Conserving Surgery ◽  
Point Of View ◽  
Medical Documentation ◽  
Oncological Safety ◽  
Lobular Cancer ◽  
Significant Difference ◽  
Disease Free

Introduction. While the “no tumor on ink” approach is generally accepted for breast-conserving surgery (BCS) in patient with breast cancer, it remains unclear whether it is oncologically safe for BCS after neoadjuvant chemotherapy therapy (NACT). The aim of the study is to investigate the optimal width of the resection edges in BCS after NALT and the influence on disease-free and overall survival in patients with breast cancer. Materials and methods. Retrospectively, the medical documentation of 76 patients with breast cancer, who were performed BCS after NACT, was studied. The distribution by stage of breast cancer was as follows: I St. -5 patients, II St. - 55, III St. - 16 (excluded IIIB St.). Invasive cancer of non-specific type was diagnosed in 81.6% of cases, in 6.5% - lobular cancer, in 1.3% - combined breast cancer. Radical breast resections in the classic version were performed in 28 cases, and oncoplastic resections in various modifications were performed in 48 Cases. Results. We present the retrospective data of 76 patients with breast cancer who underwent OSA after NALT in the Department of breast and skin cancer OF the Moscow Institute of medical research. P. A. Herzen. The results of our study demonstrated the oncological safety of OSO with respect to new sizes of tumor nodes after NALT followed by remote radiotherapy. The method of “absence of tumor cells” at the edges of resection demonstrated a high percentage of 1, 3, 5-year relapse - free and overall survival, the frequency of relapse was 2.6%. There was no statistically significant difference in 1, 3, 5-year relapse-free and overall survival when the width of the resection edges was more or less than 1 mm. Conclusion. The results of numerous studies have demonstrated that the breast- conserving surgery is the safe method of surgical treatment from an oncological point of view and is an alternative for radical mastectomies for patients with the breast cancer after neoadjuvant chemotherapy.

No long-term increase in cardiac-related mortality after breast-conserving surgery and radiation therapy using modern techniques.

1998 ◽  
Vol 16 (4) ◽  
pp. 1374-1379 ◽  
Author(s):  
A J Nixon ◽  
J Manola ◽  
R Gelman ◽  
B Bornstein ◽  
A Abner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Conservative Surgery ◽  
Breast Conserving Surgery ◽  
Breast Irradiation ◽  
Breast Radiotherapy ◽  
Treatment Characteristics ◽  
Increased Risk ◽  
Significant Difference ◽  
Related Mortality

PURPOSE To determine whether left-breast irradiation using modern techniques after breast-conserving surgery leads to an increased risk of cardiac-related mortality. METHODS Between 1968 and 1986, 1,624 patients were treated for unilateral stage I or II breast cancer at the Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA, with conservative surgery and breast irradiation. Seven hundred forty-five patients with a potential follow-up of at least 12 years were analyzed. Clinical, pathologic, and treatment characteristics were compared between the 365 patients (49%) who received left-sided irradiation and the 380 patients (51%) who received right-sided irradiation. The relationship between left-sided breast irradiation and the risk of nonbreast cancer- and cardiac-related mortality was examined. RESULTS There was no significant difference in the distribution of clinical, pathologic, or treatment characteristics between the two groups, with the exception of a small difference in pathologic tumor size (medians, left, 2.0 cm, right, 1.5 cm; P = .007). At 12 years, a majority of patients still were alive. Slightly more patients with left-sided tumors had died of breast cancer (31% v 27%; P = NS). Equivalent proportions from each group died of nonbreast cancer causes (11%), including nine patients (2%) from each group who died from cardiac causes. The risk of cardiac mortality did not increase as time after treatment increased for patients who received left-sided irradiation compared with right-sided irradiation. A model that controlled for clinical, pathologic, and treatment differences showed no significant increase in any category of cause of death (breast, cardiac, or other) for patients who received left-sided irradiation. CONCLUSION These results suggest that modern breast radiotherapy is not associated with an increased risk of cardiac-related mortality within at least the first 12 years after treatment.

Multicentric Breast Cancer: A New Indication for Sentinel Node Biopsy—A Multi-Institutional Validation Study

2006 ◽  
Vol 24 (21) ◽  
pp. 3374-3380 ◽  
Author(s):  
Michael Knauer ◽  
Peter Konstantiniuk ◽  
Anton Haid ◽  
Etienne Wenzl ◽  
Michaela Riegler-Keil ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
False Negative ◽  
False Negative Rate ◽  
Breast Conserving Surgery ◽  
Axillary Lymph ◽  
Identification Rate ◽  
Multicentric Breast Cancer ◽  
Adequate Quality

Purpose Multicentric breast cancer has been considered to be a contraindication for sentinel node (SN) biopsy (SNB). In this prospective multi-institutional trial, SNB-feasibility and accuracy was evaluated in 142 patients with multicentric cancer from the Austrian Sentinel Node Study Group (ASNSG) and compared with data from 3,216 patients with unicentric cancer. Patients and Methods Between 1996 and 2004, 3,730 patients underwent SNB at 15 ASNSG-affiliated hospitals. Patient data were entered in a multicenter database. One hundred forty-two patients presented with multicentric invasive breast cancer and underwent SNB. Results Intraoperatively, a mean number of 1.67 SNs were excised (identification-rate, 91.5%). The incidence of SN metastases was 60.8% (79 of 130). This was confirmed by axillary lymph node dissection (ALND) in 125 patients. Of patients with positive SNs, 60.8% (48 of 79) showed involvement of nonsentinel nodes (NSNs), as did three patients with negative SNs (false-negative rate, 4.0). Sensitivity, negative predictive value, and overall accuracy were 96.0%, 93.3%, and 97.3%, respectively. Ninety-one percent of the patients underwent mastectomy, and 9% were treated with breast conserving surgery. None of the patients have shown axillary recurrence so far (mean follow-up, 28.8 months). Compared with 3,216 patients with unicentric cancer, there was a significantly higher rate of SN metastases as well as in NSNs, whereas there was no difference in detection and false-negative rates. Conclusion Multicentric breast cancer is a new indication for SNB without routine ALND in controlled trials. Given adequate quality control and an interdisciplinary teamwork of surgical, nuclear medicine, and pathology units, SNB is both feasible and accurate in this disease entity.

Optimizing Clinical Management of Surgical Margins in Breast-Conserving Therapy for Breast Cancer

2013 ◽  
pp. 66-71
Author(s):  
Stephen R. Grobmyer ◽  
Michael S. Cowher ◽  
Joseph P. Crowe
Keyword(s):  
Breast Cancer ◽  
Retrospective Studies ◽  
Tumor Biology ◽  
Surgical Margin ◽  
Breast Conserving Therapy ◽  
Surgical Margins ◽  
Margin Assessment ◽  
Margin Width ◽  
Definition Of ◽  
Made In

There has been, and continues to be, significant controversy over the definition of an “optimal” surgical margin in breast-conserving therapy (BCT). The historic basis of this controversy stems from the original trials documenting the safety of BCT and many conflicting retrospective studies that have sought to define the association between surgical margin width and outcomes over the last 20 years. It is important to understand that margin assessment is an inexact science, and current laboratory approaches to surgical-margin assessment represent only a sampling of the surgical margin. Currently available evidence suggests that decisions regarding surgical margins in BCT should be made in the context of what is known about the biology of breast cancer, as well the interactions of tumor biology, adjuvant treatment for breast cancer, and outcomes. Achieving consensus on management of surgical margins in BCT should be a clinical priority as it offers the opportunity to reduce the burden of breast cancer treatment on patients without compromising cancer-related outcomes.

Incidence of local recurrence in patients after breast-conserving surgery and postoperative radiotherapy with or without a supplementary radiation.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 159-159
Author(s):  
Danijela D. Scepanovic ◽  
Andrea Hurakova ◽  
Martina Lukacovicova ◽  
Zuzana Dolinska ◽  
Andrea Masarykova ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Significant Influence ◽  
Postoperative Radiotherapy ◽  
Local Treatment ◽  
Breast Conserving Surgery ◽  
Low Risk ◽  
Surgical Margins ◽  
Complete Excision ◽  
Incomplete Excision ◽  
Significant Difference

159 Background: We evaluated the incidence of local recurrence (LR) among patients (pts) who received radiotherapy with/without a supplementary dose of radiation (boost) to the tumor bed after breast-conserving surgery (BCS) for early breast cancer (BC). Methods: In our retrospective analysis (from 2000-2004) 449 pts with stage I/II BC received 50Gy of radiation to the whole breast in 2Gy fractions over a five-week period after BCS. There were 328 pts (73%) with microscopically complete excision (>5mm margins) and 121 pts (27%) with a microscopically incomplete excision (≤5mm margins). Patients with a microscopically complete or incomplete excision were randomly assigned to receive either no further local treatment (190) or an additional localized dose (309) of 10-16Gy, usually given in 5-8 fractions (fr) by electrons/15Gy in 3 fr by HDR interstitial brachytherapy. Results: During a median follow-up period of 79 months (min 20, max 120), the cumulative incidence of LR was 3% for all group of pts (449). The LR was observed in 1 of 190 pts in group without boost and 13 of 309 pts in group with boost. There was statistically significant difference between two groups of pts regarding local recurrence rate (LRR) (p= 0.0218).The 5 year actuarial rates of LR were 1% in group of pts with negative surgical margins versus 8% in group of pts with positive margins [95% CI, 6% (1%-26%)] (p<0.001). Multivariate analysis showed that pts with negative surgical margins had strongly statistically significant influence (p<0.001) and pts with negative lymph/angioinvasion had statistically significant influence on low risk of LR (p = 0.007). The 5 year DFS was 90% and OS was 98% in all group of pts (449). There was no statistical significant difference between two groups of pts regarding DFS and OS. Conclusions: In our analysis, the incidence of LR is low. However, there was better result in no boost group of pts regarding LRR. The cause was in more frequent selection among worse group of pts with positive surgical margins for application of boost (73% vs 52%, p<0.0001). The strong criteria for identifying low risk group of pts for LR were: negative surgical margins and absence of lymph/angioinvasion.

Ten-Year Multi-Institutional Results of Breast-Conserving Surgery and Radiotherapy in BRCA1/2-Associated Stage I/II Breast Cancer

2006 ◽  
Vol 24 (16) ◽  
pp. 2437-2443 ◽  
Author(s):  
Lori J. Pierce ◽  
Albert M. Levin ◽  
Timothy R. Rebbeck ◽  
Merav A. Ben-David ◽  
Eitan Friedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Breast Conservation Surgery ◽  
Breast Cancers ◽  
Mutation Status ◽  
High Risk Women ◽  
Mutation Carriers ◽  
Significant Difference

Purpose We compared the outcome of breast-conserving surgery and radiotherapy in BRCA1/2 mutation carriers with breast cancer versus that of matched sporadic controls. Methods A total of 160 BRCA1/2 mutation carriers with breast cancer were matched with 445 controls with sporadic breast cancer. Primary end points were rates of in-breast tumor recurrence (IBTR) and contralateral breast cancers (CBCs). Median follow-up was 7.9 years for mutation carriers and 6.7 years for controls. Results There was no significant difference in IBTR overall between carriers and controls; 10- and 15-year estimates were 12% and 24% for carriers and 9% and 17% for controls, respectively (hazard ratio [HR], 1.37; P = .19). Multivariate analyses for IBTR found BRCA1/2 mutation status to be an independent predictor of IBTR when carriers who had undergone oophorectomy were removed from analysis (HR, 1.99; P = .04); the incidence of IBTR in carriers who had undergone oophorectomy was not significantly different from that in sporadic controls (P = .37). CBCs were significantly greater in carriers versus controls, with 10- and 15-year estimates of 26% and 39% for carriers and 3% and 7% for controls, respectively (HR, 10.43; P < .0001). Tamoxifen use significantly reduced risk of CBCs in mutation carriers (HR, 0.31; P = .05). Conclusion IBTR risk at 10 years is similar in BRCA1/2 carriers treated with breast conservation surgery who undergo oophorectomy versus sporadic controls. As expected, CBCs are significantly increased in carriers. Although the incidence of CBCs was significantly reduced in mutation carriers who received tamoxifen, this rate remained significantly greater than in controls. Additional strategies are needed to reduce contralateral cancers in these high-risk women.

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