Intraoperative Teamwork of Breast Cancer Surgeon and Pathologist Greatly Reduces Need for Second Surgery After Lumpectomy

FINDINGS

Breast cancer surgeons performing lumpectomies seek to spare healthy breast tissue while removing all cancerous cells, but determining appropriate margins and avoiding follow-up surgeries are ongoing challenges. This retrospective, single-institution review found that intraoperative teamwork between a breast cancer surgeon and a dedicated breast pathologist – utilizing tissue-marking ink and gross examination with magnification to evaluate margins – is an accurate, rapid and cost-effective means of significantly reducing the need for second-surgery margin re-excisions or mastectomies.

 

BACKGROUND

Several studies have shown significantly increased local breast cancer recurrence rates in patients with low-stage breast carcinoma in whom margins were positive for cancer cells or the margins were close – less than 1 millimeter – and the margins were not re-excised. Current acceptable re-excision rates for margins after lumpectomy using the “no tumor at ink” criteria are 14% for invasive breast cancer, and conversion rates to mastectomy are 4%.

 

METHOD

A UCLA Health surgical oncologist with oncoplastic training and a dedicated breast pathologist led this retrospective study reviewing results of lumpectomies performed in 250 patients between 2017 and 2018. Unlike standard practice, the pathologist was involved in the intraoperative ink and gross specimen assessment of the lumpectomy to assist in real time for margin clearance. She also read the final pathology results after overnight fixation.

 

Their margin requirement for the ink and gross assessment was 5.0 mm, and immediate re-excision at the time of the initial surgery was performed to achieve this result. Final margins of 2.0 mm were deemed acceptable for both invasive and pure ductal carcinoma in situ (DCIS) tumors.

 

RESULTS

In comparison to the current “acceptable” re-excision rate of 14% to achieve a tiny margin of clearance for invasive breast cancer, the authors report an 8.8% rate (22/250) with a 2 mm margin. The re-excision rate for pure DCIS was 5.6% (14/250). Their conversion rate from lumpectomy to mastectomy was 2% (5/250), compared to the standard 4%.

 

IMPACT

The intraoperative collaboration between a breast cancer surgeon and breast pathologist is a cost-effective way to ensure that breast-cancer margins are appropriate during initial lumpectomies, greatly reducing the need for second-surgery margin excisions or mastectomies.

 

AUTHORS

Dr. Gregory Senofsky, a surgical oncologist with UCLA Health Hematology Oncology, conducted this study with Dr. Rashidi Soni, a breast pathologist and medical director of pathology and laboratory at Henry Mayo Newhall Hospital in Valencia, California. The review included results from 250 patients treated at the hospital.

 

CONFERENCE PRESENTATION

Senofsky will present the abstract “Improved re-excision rates for lumpectomy for invasive breast cancer utilizing intraoperative ink and gross pathology” at the Euro Cancer Research Conference 2019 in Rome, Italy, Sept. 12-14, 2019.

 

About UCLA Health

UCLA Health includes four hospitals on two campuses — Ronald Reagan UCLA Medical Center; UCLA Medical Center, Santa Monica; Mattel Children’s Hospital UCLA; and Resnick Neuropsychiatric Hospital at UCLA — and more than 180 primary care and specialty offices throughout Southern California. UCLA Health ranks #1 in California and Los Angeles, and #6 in the nation in U.S. News & World Report’s Best Hospitals survey. Click here for more information.

Intraoperative Teamwork of Breast Cancer Surgeon and Pathologist Greatly Reduces Need for Second Surgery After Lumpectomy

Intraoperative Teamwork of Breast Cancer Surgeon and Pathologist Greatly Reduces Need for Second Surgery After Lumpectomy

Cancer-News

4 months
31 Views
Share
Want to watch this again later?
Sign in to add this video to a playlist. Login
0 0
Up Next Autoplay
National Brain Tumor Society to Provide Funding for ONC201 Trial in EGFR-Independent High-Grade Gliomas
National Brain Tumor Society to Provide Funding for ONC201 Trial in EGFR-Independent High-Grade Gliomas
Category: Acute Lymphoblastic Leukemia
2 Views
alexvarney 19 hours
Statement on New ASH Clinical Practice Guidelines on Sickle Cell Disease-Related Transfusion Support
Statement on New ASH Clinical Practice Guidelines on Sickle Cell Disease-Related Transfusion Support
Category: News
1 Views
Cancer-News 20 hours
GRACE Supportive Care Series:   Chemobrain with Guest, Lysa Buonnano
GRACE Supportive Care Series: Chemobrain with Guest, Lysa Buonnano
Category: Supportive Care
1 Views
cancergrace 4 days
ArcherDX Personalized Cancer Monitoring (PCM) Technology Designated by FDA as Breakthrough Device
ArcherDX Personalized Cancer Monitoring (PCM) Technology Designated by FDA as Breakthrough Device
Category: General
3 Views
Cancer-News 4 days
TOURMALINE-MM4: What's Next in Research?
TOURMALINE-MM4: What's Next in Research?
Category: Multiple Myeloma
2 Views
Cancer-News 4 days
TOURMALINE-MM4: Are There Safety Concerns?
TOURMALINE-MM4: Are There Safety Concerns?
Category: Multiple Myeloma
3 Views
Cancer-News 4 days
Minority Hematology Scholars to Study New Methods for Improving Blood Disease Treatments
Minority Hematology Scholars to Study New Methods for Improving Blood Disease Treatments
Category: News
0 Views
ash 4 days
What should clinicians know about patients with the H3 K27M mutation?
What should clinicians know about patients with the H3 K27M mutation?
Category: Brain Cancer
4 Views
Massachusetts General Hospital 4 days
TOURMALINE-MM4: Regulatory Pathway
TOURMALINE-MM4: Regulatory Pathway
Category: Multiple Myeloma
2 Views
Cancer-News 4 days
What Data Has Come Out of ONC201 in Adult Recurrent Glioblastoma?
What Data Has Come Out of ONC201 in Adult Recurrent Glioblastoma?
Category: Brain Cancer
1 Views
Massachusetts General Hospital 4 days