TY - JOUR
T1 - Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines
T2 - a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland
AU - Tang, Sarah Shuk-Kay
AU - Kaptanis, Sarantos
AU - Haddow, James B
AU - Mondani, Giuseppina
AU - Elsberger, Beatrix
AU - Tasoulis, Marios Konstantinos
AU - Obondo, Christine
AU - Johns, Neil
AU - Ismail, Wisam
AU - Syed, Asim
AU - Kissias, Panayioti
AU - Venn, Mary
AU - Sundaramoorthy, Souganthy
AU - Irwin, Gareth
AU - Sami, Amtul S
AU - Elfadl, Dalia
AU - Baggaley, Alice
AU - Remoundos, Dionysios Dennis
AU - Langlands, Fiona
AU - Charalampoudis, Petros
AU - Barber, Zoe
AU - Hamilton-Burke, Werbena L S
AU - Khan, Ayesha
AU - Sirianni, Chiara
AU - Merker, Louise Anne-Marie Grant
AU - Saha, Sunita
AU - Lane, Risha Arun
AU - Chopra, Sharat
AU - Dupré, Sophie
AU - Manning, Aidan T
AU - St John, Edward R
AU - Musbahi, Aya
AU - Dlamini, Nokwanda
AU - McArdle, Caitlin L
AU - Wright, Chloe
AU - Murphy, James O
AU - Aggarwal, Ravi
AU - Dordea, Matei
AU - Bosch, Karen
AU - Egbeare, Donna
AU - Osman, Hisham
AU - Tayeh, Salim
AU - Razi, Faraz
AU - Iqbal, Javeria
AU - Ledwidge, Serena F C
AU - Albert, Vanessa
AU - Masannat, Yazan
N1 - The cost of setting up and maintaining the REDCap server was supported by the St George's University Hospital Breast Unit Research Fund.
PY - 2017/10
Y1 - 2017/10
N2 - INTRODUCTION: There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates.METHODS: A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies.RESULTS: A total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70-900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0-41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin.CONCLUSION: There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
AB - INTRODUCTION: There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates.METHODS: A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies.RESULTS: A total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70-900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0-41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin.CONCLUSION: There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
KW - Breast Neoplasms
KW - Carcinoma, Ductal, Breast
KW - Carcinoma, Intraductal, Noninfiltrating
KW - Consensus
KW - Female
KW - Guideline Adherence
KW - Healthcare Disparities
KW - Humans
KW - Ireland
KW - Margins of Excision
KW - Mastectomy, Segmental
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'
KW - Prospective Studies
KW - Quality Indicators, Health Care
KW - Reoperation
KW - Treatment Outcome
KW - United Kingdom
KW - Journal Article
KW - Multicenter Study
KW - Research Support, Non-U.S. Gov't
U2 - 10.1016/j.ejca.2017.07.032
DO - 10.1016/j.ejca.2017.07.032
M3 - Article
C2 - 28865259
SN - 0959-8049
VL - 84
SP - 315
EP - 324
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -
