Reducing The Need For Second Surgery After Lumpectomy: Why Isn't Everybody Doing This?

Reducing The Need For Second Surgery After Lumpectomy: Why Isn't Everybody Doing This?

Cancer-News

3 weeks
2 Views
Share
Want to watch this again later?
Sign in to add this video to a playlist. Login
0 0
Category:
Description:

Gregory Senofsky, MD of UCLA Health answers a question often asked by colleagues.

______

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.

Read here: https://www.oncologytube.com/video/intraoperative-teamwork-of-breast-cancer-surgeon-and-pathologist-greatly-reduces-need-for-second-surgery-after-lumpectomy

Up Next Autoplay
New Technology to Streamline Drug Discovery
New Technology to Streamline Drug Discovery
Category: Other
2 Views
Cancer-News 9 hours
Using Technology to Better Understand What Goes Wrong in Cancer
Using Technology to Better Understand What Goes Wrong in Cancer
Category: Breast Cancer
0 Views
Cancer-News 9 hours
How Does This Affect Clinicians Today?
How Does This Affect Clinicians Today?
Category: Breast Cancer
1 Views
Cancer-News 10 hours
Measuring Chromatin Accessibility: How Reliable is This Data?
Measuring Chromatin Accessibility: How Reliable is This Data?
Category: Breast Cancer
0 Views
Cancer-News 10 hours
Dual-function Virus Designed For Killing Tumor Cells and Helping Immune Cells
Dual-function Virus Designed For Killing Tumor Cells and Helping Immune Cells
Category: Melanoma and Skin Cancer
3 Views
Cancer-News 11 hours
Mapping the usual breast development to recognize cancer better
Mapping the usual breast development to recognize cancer better
Category: Breast Cancer
2 Views
Cancer-News 12 hours
Metformin: How Does This Affect Treatment?
Metformin: How Does This Affect Treatment?
Category: Ovarian Cancer
3 Views
Cancer-News 12 hours
New Frontier Possibility for Preventing Ovarian Cancer
New Frontier Possibility for Preventing Ovarian Cancer
Category: Ovarian Cancer
2 Views
Cancer-News 12 hours
"Wild idea" opens possible new boundaries to ovarian cancer prevention
Category: Ovarian Cancer
5 Views
Cancer-News 12 hours
Personalized Algorithms: How is this different?
Personalized Algorithms: How is this different?
Category: Immunotherapy
4 Views
Cancer-News 1 day