Skip to main content

Advertisement

SpringerLink
Log in

The Value of Repeated Breast Surgery as a Quality Indicator in Breast Cancer Care

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Breast-conserving surgery, a major achievement in surgical oncology, has allowed an increasing number of breast cancer patients to avoid the mutilation of mastectomy. However, mastectomy still is performed in certain circumstances although breast-conserving surgery would be equally safe. Many reasons, including patients’ and surgeons’ personal motivations, influence the decision-making process before the final choice between breast preservation and mastectomy. The importance of quality measurement and reporting in medicine is increasingly recognized, and breast surgery is no exception. The substantial variability of re-excision rates for positive surgical margins after a first attempt at breast-conserving surgery suggests that improvement is possible. Therefore, the re-excision rate has been proposed as a quality metric for assessing and comparing the performance of different institutions. Indeed, re-excision rates can be reduced by actionable factors such as accurate preoperative local staging, localization of occult lesions, and intraoperative assessment of the oriented specimen. However, equally important non-actionable risk factors pertaining the biology, detectability, and resectability of the tumor also should be taken into account. Therefore, if the re-excision rate has to be used as a performance indicator of breast surgical care, critical interpretation of results with accurate case-mix adjustment are mandatory, and reasonable targets must be appropriately set so that surgeons treating patients at higher risk of positive margins are not unduly penalized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41. https://doi.org/10.1056/nejmoa022152.

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32. https://doi.org/10.1056/nejmoa020989.

    Article  PubMed  Google Scholar 

  3. Showalter SL, Grover S, Sharma S, Lin L, Czerniecki BJ. Factors influencing surgical and adjuvant therapy in stage I breast cancer: a SEER 18 database analysis. Ann Surg Oncol. 2013;20:1287–94. https://doi.org/10.1245/s10434-012-2693-8.

    Article  PubMed  Google Scholar 

  4. Mahmood U, Hanlon AL, Koshy M, et al. Increasing national mastectomy rates for the treatment of early-stage breast cancer. Ann Surg Oncol. 2013;20:1436–43. https://doi.org/10.1245/s10434-012-2732-5.

    Article  PubMed  Google Scholar 

  5. Houssami N, Turner R, Morrow M. Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg. 2013;257:249–55. https://doi.org/10.1097/sla.0b013e31827a8d17.

    Article  PubMed  Google Scholar 

  6. Chiba A, Hoskin TL, Hallberg EJ, et al. Impact that timing of genetic mutation diagnosis has on surgical decision making and outcome for BRCA1/BRCA2 mutation carriers with breast cancer. Ann Surg Oncol. 2016;23:3232–8. https://doi.org/10.1245/s10434-016-5328-7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM. Breast reconstruction after mastectomy: a 10-year analysis of trends and immediate postoperative outcomes. Breast. 2017;32:7–12. https://doi.org/10.1016/j.breast.2016.11.023.

    Article  PubMed  Google Scholar 

  8. van Maaren MC, Strobbe LJA, Koppert LB, Poortmans PMP, Siesling S. Nationwide population-based study of trends and regional variation in breast-conserving treatment for breast cancer. Br J Surg. 2018;105:1768–77. https://doi.org/10.1002/bjs.10951.

    Article  PubMed  Google Scholar 

  9. Riedel F, Heil J, Golatta M, et al. Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet. 2019;299:1043–53. https://doi.org/10.1007/s00404-018-4982-3.

    Article  CAS  PubMed  Google Scholar 

  10. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150:9–16. https://doi.org/10.1001/jamasurg.2014.2895.

    Article  PubMed  Google Scholar 

  11. Garcia-Etienne CA, Tomatis M, Heil J, et al. Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer. 2012;48:1947–56. https://doi.org/10.1016/j.ejca.2012.03.008.

    Article  PubMed  Google Scholar 

  12. Mamtani A, Morrow M. Why are there so many mastectomies in the United States? Annu Rev Med. 2017;68:229–41. https://doi.org/10.1146/annurev-med-043015-075227.

    Article  CAS  PubMed  Google Scholar 

  13. Boero IJ, Paravati AJ, Hou J, et al. The impact of surgeons on the likelihood of mastectomy in breast cancer. Ann Surg. 2019;269:951–8. https://doi.org/10.1097/sla.0000000000002698.

    Article  PubMed  Google Scholar 

  14. Jonczyk MM, Jean J, Graham R, Chatterjee A. Surgical trends in breast cancer: a rise in novel operative treatment options over a 12-year analysis. Breast Cancer Res Treat. 2019;173:267–74. https://doi.org/10.1007/s10549-018-5018-1.

    Article  PubMed  Google Scholar 

  15. Morrow M, Abrahamse P, Hofer TP, et al. Trends in reoperation after initial lumpectomy for breast cancer: addressing overtreatment in surgical management. JAMA Oncol. 2017;3:1352–7. https://doi.org/10.1001/jamaoncol.2017.0774.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kantor O, Pesce C, Kopkash K, et al. Impact of the Society of Surgical Oncology–American Society for Radiation Oncology margin guidelines on breast-conserving surgery and mastectomy trends. J Am Coll Surg. 2019;229:104–14. https://doi.org/10.1016/j.jamcollsurg.2019.02.051.

    Article  PubMed  Google Scholar 

  17. Morrow M, Katz SJ. The challenge of developing quality measures for breast cancer surgery. JAMA. 2012;307:509–10. https://doi.org/10.1001/jama.2012.74.

    Article  PubMed  Google Scholar 

  18. van Deurzen CH. Predictors of surgical margin following breast-conserving surgery: a large population-based cohort study. Ann Surg Oncol. 2016;23:627–33. https://doi.org/10.1245/s10434-016-5532-5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pilewskie M, Morrow M. Margins in breast cancer: how much is enough?. Cancer. 2018;124:1335–41. https://doi.org/10.1002/cncr.31221.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Brouwer de Koning SG, Vrancken Peeters MTFD, Jóźwiak K, Bhairosing PA, Ruers TJM. Tumor resection margin definitions in breast-conserving surgery: systematic review and meta-analysis of the current literature. Clin Breast Cancer. 2018;18:e595–600. https://doi.org/10.1016/j.clbc.2018.04.004.

    Article  PubMed  Google Scholar 

  21. Haloua MH, Volders JH, Krekel NM, et al. A nationwide pathology study on surgical margins and excision volumes after breast-conserving surgery: there is still much to be gained. Breast. 2016;25:14–21. https://doi.org/10.1016/j.breast.2015.11.003.

    Article  CAS  PubMed  Google Scholar 

  22. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;21:704–16. https://doi.org/10.1200/jco.2013.53.3935.

    Article  Google Scholar 

  23. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21:717–30. https://doi.org/10.1245/s10434-014-3480-5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Toss MS, Pinder SE, Green AR, et al. Breast conservation in ductal carcinoma in situ (DCIS): what defines optimal margins?. Histopathology. 2017;70:681–92. https://doi.org/10.1111/his.13116.

    Article  PubMed  Google Scholar 

  25. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol. 2016;34:4040–6. https://doi.org/10.1200/jco.2016.68.3573.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Marinovich ML, Azizi L, Macaskill P, et al. The association of surgical margins and local recurrence in women with ductal carcinoma in situ treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2016;23:3811–21. https://doi.org/10.1245/s10434-016-5446-2.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Telli ML, Gradishar WJ, Ward JH. NCCN guidelines updates: breast cancer. J Natl Compr Cancer Netw. 2019;14:641–4. https://doi.org/10.6004/jnccn.2019.5006.

    Article  Google Scholar 

  28. Biganzoli L, Marotti L, Hart CD, et al. Quality indicators in breast cancer care: an update from the EUSOMA working group. Eur J Cancer. 2017;86:59–81. https://doi.org/10.1016/j.ejca.2017.08.017.

    Article  PubMed  Google Scholar 

  29. ABS Consensus Margin Width in Breast Conservation Surgery. https://associationofbreastsurgery.org.uk/media/1418/abs-consensus-on-margin-width-in-breast-conservation-surgery.pdf. Accessed 25 Mar 2020.

  30. National Breast Cancer Organization of the Netherlands. Guideline breast cancer. http://www.oncoline.nl. Accessed 25 Mar 2020.

  31. McCahill LE, Privette A, James T, et al. Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons. Arch Surg. 2009;144:455–62. https://doi.org/10.1001/archsurg.2009.56.

    Article  PubMed  Google Scholar 

  32. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in re-excision following breast conservation surgery. JAMA. 2012;307:467–75. https://doi.org/10.1001/jama.2012.43.

    Article  PubMed  Google Scholar 

  33. Wilke LG, Czechura T, Wang C, et al. Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004–2010. JAMA Surg. 2014;149:1296–305. https://doi.org/10.1001/jamasurg.2014.926.

    Article  PubMed  Google Scholar 

  34. Landercasper J, Whitacre E, Degnim AC, Al-Hamadani M. Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery (SM) database. Ann Surg Oncol. 2014;21:3185–91. https://doi.org/10.1245/s10434-014-3905-1.

    Article  PubMed  Google Scholar 

  35. Landercasper J, Bennie B, Parsons BM, et al. Fewer reoperations after lumpectomy for breast cancer with neoadjuvant rather than adjuvant chemotherapy: a report from the National Cancer Database. Ann Surg Oncol. 2017;24:1507–15. https://doi.org/10.1245/s10434-016-5760-8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Isaacs AJ, Gemignani ML, Pusic A, Sedrakyan A. Association of breast conservation surgery for cancer with 90-day reoperation rates in New York state. JAMA Surg. 2016;151:648–55. https://doi.org/10.1001/jamasurg.2015.5535.

    Article  PubMed  Google Scholar 

  37. Landercasper J, Borgert AJ, Fayanju OM, et al. Factors associated with reoperation in breast-conserving surgery for cancer: a prospective study of American Society of Breast Surgeon members. Ann Surg Oncol. 2019;26:3321–36. https://doi.org/10.1245/s10434-019-07547-w.

    Article  PubMed  PubMed Central  Google Scholar 

  38. van Leeuwen MT, Falster MO, Vajdic CM, et al. Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. BMJ Open. 2018;8:e020858. https://doi.org/10.1136/bmjopen-2017-020858.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Talsma AK, Reedijk AM, Damhuis RA, Westenend PJ, Vles WJ. Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals. Eur J Surg Oncol. 2011;37:357–63. https://doi.org/10.1016/j.ejso.2011.01.008.

    Article  CAS  PubMed  Google Scholar 

  40. Vos EL, Siesling S, Baaijens MHA, et al. Omitting re-excision for focally positive margins after breast-conserving surgery does not impair disease-free and overall survival. Breast Cancer Res Treat. 2017;164:157–67. https://doi.org/10.1007/s10549-017-4232-6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Jeevan R, Cromwell DA, Trivella M, et al. Reoperation rates after breast-conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ. 2012;345:e4505. https://doi.org/10.1136/bmj.e4505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Tang SS, Kaptanis S, Haddow JB, et al. Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland. Eur J Cancer. 2017;84:315–24. https://doi.org/10.1016/j.ejca.2017.07.032.

    Article  PubMed  Google Scholar 

  43. Kryh CG, Pietersen CA, Rahr HB, Christensen RD, Wamberg P, Lautrup MD. Re-resection rates and risk characteristics following breast-conserving surgery for breast cancer and carcinoma in situ: a single-centre study of 1575 consecutive cases. Breast. 2014;23:784–9. https://doi.org/10.1016/j.breast.2014.08.011.

    Article  CAS  PubMed  Google Scholar 

  44. Langhans L, Jensen MB, Talman MM, Vejborg I, Kroman N, Tvedskov TF. Reoperation rates in ductal carcinoma in situ versus invasive breast cancer after wire-guided breast-conserving surgery. JAMA Surg. 2017;152:378–84. https://doi.org/10.1001/jamasurg.2016.4751.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Schulman AM, Mirrielees JA, Leverson G, Landercasper J, Greenberg C, Wilke LG. Re-excision surgery for breast cancer: an analysis of the American Society of Breast Surgeons (ASBrS) MasterySM database following the SSO-ASTRO “no ink on tumor” guidelines. Ann Surg Oncol. 2017;24:52–8. https://doi.org/10.1245/s10434-016-5516-5.

    Article  PubMed  Google Scholar 

  46. Monaghan A, Chapinal N, Hughes L, Baliski C. Impact of SSO-ASTRO margin guidelines on reoperation rates following breast-conserving surgery. Am J Surg. 2019;217:862–7. https://doi.org/10.1016/j.amjsurg.2019.01.007.

    Article  PubMed  Google Scholar 

  47. Rosenberger LH, Mamtani A, Fuzesi S, et al. Early adoption of the SSO-ASTRO consensus guidelines on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer: initial experience from Memorial Sloan Kettering Cancer Center. Ann Surg Oncol. 2016;23:3239–46. https://doi.org/10.1245/s10434-016-5397-7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Patten CR, Walsh K, Sarantou T, et al. Changes in margin re-excision rates: experience incorporating the “no ink on tumor” guideline into practice. J Surg Oncol. 2017;116:1040–5. https://doi.org/10.1002/jso.24770.

    Article  PubMed  Google Scholar 

  49. Chung A, Gangi A, Amersi F, Bose S, Zhang X, Giuliano A. Impact of consensus guidelines by the Society of Surgical Oncology and the American Society for Radiation Oncology on margins for breast-conserving surgery in stages 1 and 2 invasive breast cancer. Ann Surg Oncol. 2015;22:422–7. https://doi.org/10.1245/s10434-015-4829-0.

    Article  Google Scholar 

  50. Heelan Gladden AA, Sams S, Gleisner A, et al. Re-excision rates after breast-conserving surgery following the 2014 SSO-ASTRO guidelines. Am J Surg. 2017;214:1104–9. https://doi.org/10.1016/j.amjsurg.2017.08.023.

    Article  PubMed  Google Scholar 

  51. Merrill AL, Coopey SB, Tang R, et al. Implications of new lumpectomy margin guidelines for breast-conserving surgery: changes in re-excision rates and predicted rates of residual tumor. Ann Surg Oncol. 2016;23:729–34. https://doi.org/10.1245/s10434-015-4916-2.

    Article  PubMed  Google Scholar 

  52. Mamtani A, Zabor EC, Rosenberger LH, Stempel M, Gemignani ML, Morrow M. Was reexcision less frequent for patients with lobular breast cancer after publication of the SSO-ASTRO margin guidelines?. Ann Surg Oncol. 2019;26:3856–62. https://doi.org/10.1245/s10434-019-07751-8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Piper ML, Wong J, Fahrner-Scott K, et al. Success rates of re-excision after positive margins for invasive lobular carcinoma of the breast. NPJ Breast Cancer. 2019;5:1–5. https://doi.org/10.1038/s41523-019-0125-7.

    Article  CAS  Google Scholar 

  54. Havel L, Naik H, Ramirez L, Morrow M, Landercasper J. Impact of the SSO-ASTRO margin guideline on rates of re-excision after lumpectomy for breast cancer: a meta-analysis. Ann Surg Oncol. 2019;26:1238–44. https://doi.org/10.1245/s10434-019-07247-5.

    Article  PubMed  Google Scholar 

  55. Houvenaeghel G, Lambaudie E, Bannier M, et al. Positive or close margins: reoperation rate and second conservative resection or total mastectomy? Cancer Manag Res. 2019;11:2507. https://doi.org/10.2147/cmar.s190852.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Balleyguier C, Dunant A, Ceugnart L, et al. Preoperative breast magnetic resonance imaging in women with local ductal carcinoma in situ to optimize surgical outcomes: results from the randomized phase III trial IRCIS. J Clin Oncol. 2019;37:885–92. https://doi.org/10.1200/jco.18.00595.

    Article  PubMed  Google Scholar 

  57. Cowppli-Bony A, Trétarre B, Marrer E, et al. Compliance with clinical guidelines for breast cancer management: a population-based study of quality-of-care indicators in France. PLoS ONE. 2019;14:e0224275. https://doi.org/10.1371/journal.pone.0224275.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Meier-Meitinger M, Rauh C, Adamietz B, et al. Accuracy of radiological tumour size assessment and the risk for re-excision in a cohort of primary breast cancer patients. Eur J Surg Oncol. 2012;38:44–51. https://doi.org/10.1016/j.ejso.2011.10.008.

    Article  CAS  PubMed  Google Scholar 

  59. Rosato R, Sacerdote C, Pagano E, et al. Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population-based study in Northern Italy. Breast Cancer Res Treat. 2009;117:349–56. https://doi.org/10.1007/s10549-008-0252-6.

    Article  CAS  PubMed  Google Scholar 

  60. Sacerdote C, Bordon R, Pitarella S, et al. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy. BMC Health Serv Res. 2013;13:28. https://doi.org/10.1186/1472-6963-13-28.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Escribà JM, Esteban L, Gálvez J, et al. Reoperations after primary breast-conserving surgery in women with invasive breast cancer in Catalonia, Spain: a retrospective study. Clin Transl Oncol. 2017;19:448–56. https://doi.org/10.1007/s12094-016-1546-5.

    Article  PubMed  Google Scholar 

  62. Funk A, Heil J, Harcos A, et al. Efficacy of intraoperative specimen radiography as margin assessment tool in breast-conserving surgery. Breast Cancer Res Treat. 2020;179:425–33. https://doi.org/10.1007/s10549-019-05476-6.

    Article  PubMed  Google Scholar 

  63. Fisher S, Yasui Y, Dabbs K, Winget M. Re-excision and survival following breast-conserving surgery in early-stage breast cancer patients: a population-based study. BMC Health Serv Res. 2018;18:94. https://doi.org/10.1186/s12913-018-2882-7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Bodilsen A, Bjerre K, Offersen BV, et al. The influence of repeat surgery and residual disease on recurrence after breast-conserving surgery: a Danish Breast Cancer Cooperative Group study. Ann Surg Oncol. 2015;22:476–85. https://doi.org/10.1245/s10434-015-4707-9.

    Article  Google Scholar 

  65. Kahlert S, Kolben TM, Schmoeckel E, et al. Prognostic impact of residual disease in simultaneous additional excision specimens after one-step breast-conserving therapy with negative final margin status in primary breast cancer. Eur J Surg Oncol. 2018;44:1318–23. https://doi.org/10.1016/j.ejso.2018.06.014.

    Article  PubMed  Google Scholar 

  66. Sorrentino L, Agozzino M, Albasini S, et al. Involved margins after lumpectomy for breast cancer: always to be re-excised?. Surg Oncol. 2019;30:141–6. https://doi.org/10.1016/j.suronc.2019.08.002.

    Article  PubMed  Google Scholar 

  67. Boundouki G, Wong Sik Hee JR, Croghan N, et al. Comparing long-term local recurrence rates of surgical and non-surgical management of close anterior margins in breast-conserving surgery. Breast Cancer Res Treat. 2019;176:311–9. https://doi.org/10.1007/s10549-019-05242-8.

    Article  PubMed  Google Scholar 

  68. Landercasper J, Attai D, Atisha D, et al. Toolbox to reduce lumpectomy reoperations and improve cosmetic outcome in breast cancer patients: the American Society of Breast Surgeons Consensus Conference. Ann Surg Oncol. 2015;22:3174–83. https://doi.org/10.1245/s10434-015-4759-x.

    Article  PubMed  PubMed Central  Google Scholar 

  69. McEvoy MP, Landercasper J, Naik HR, Feldman S. Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic. Gland Surg. 2018;7:536. https://doi.org/10.21037/gs.2018.11.03.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Gray RJ, Pockaj BA, Garvey E, Blair S. Intraoperative margin management in breast-conserving surgery: a systematic review of the literature. Ann Surg Oncol. 2018;25:18–27. https://doi.org/10.1245/s10434-016-5756-4.

    Article  PubMed  Google Scholar 

  71. Versteegden DPA, Keizer LGG, Schlooz-Vries MS, Duijm LEM, Wauters CAP, Strobbe LJA. Performance characteristics of specimen radiography for margin assessment for ductal carcinoma in situ: a systematic review. Breast Cancer Res Treat. 2017;166:669–79. https://doi.org/10.1007/s10549-017-4475-2.

    Article  CAS  PubMed  Google Scholar 

  72. Rhee D, Pockaj B, Wasif N, et al. Operative outcomes of conventional specimen radiography versus in-operating room specimen radiography in radioactive seed-localized segmental mastectomies. Am J Surg. 2018;215:151–4. https://doi.org/10.1016/j.amjsurg.2017.07.019.

    Article  PubMed  Google Scholar 

  73. St John ER, Al-Khudairi R, Ashrafian H, et al. Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis. Ann Surg. 2017;265:300–10. https://doi.org/10.1097/sla.0000000000001897.

    Article  PubMed  Google Scholar 

  74. Chagpar AB, Killelea BK, Tsangaris TN, et al. A randomized, controlled trial of cavity-shave margins in breast cancer. N Engl J Med. 2015;373:503–10. https://doi.org/10.1056/nejmoa1504473.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Wang K, Ren Y, He J. Cavity-shaving plus lumpectomy versus lumpectomy alone for patients with breast cancer undergoing breast-conserving surgery: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0168705. https://doi.org/10.1371/journal.pone.0168705.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Clough KB, Meredith I. The oncoplastic frenzy: beware the swing of the pendulum. Ann Surg Oncol. 2019;26:3792–3. https://doi.org/10.1245/s10434-019-07755-4.

    Article  PubMed  Google Scholar 

  77. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91. https://doi.org/10.1245/s10434-009-0792-y.

    Article  PubMed  Google Scholar 

  78. Chatterjee A, Gass J, Patel K, et al. A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26:3436–44. https://doi.org/10.1245/s10434-019-07345-4.

    Article  PubMed  Google Scholar 

  79. De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol. 2016;23:3247–58. https://doi.org/10.1245/s10434-016-5313-1.

    Article  Google Scholar 

  80. Kosasih S, Tayeh S, Mokbel K, Kasem A. Is oncoplastic breast-conserving surgery oncologically safe? A meta-analysis of 18,103 patients. Am J Surg. 2020. https://doi.org/10.1016/j.amjsurg.2019.12.019.

    Article  PubMed  Google Scholar 

  81. Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72:145–9. https://doi.org/10.1097/sap.0b013e3182605598.

    Article  CAS  PubMed  Google Scholar 

  82. Chen JY, Huang YJ, Zhang LL, Yang CQ, Wang K. Comparison of oncoplastic breast-conserving surgery and breast-conserving surgery alone: a meta-analysis. J Breast Cancer. 2018;21:321–9. https://doi.org/10.4048/jbc.2018.21.e36.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Campbell EJ, Romics L. Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature. Breast Cancer (Dove Med Press). 2017;9:521. https://doi.org/10.2147/bctt.s113742.

    Article  Google Scholar 

  84. Volders JH, Haloua MH, Krekel NM, et al. Neoadjuvant chemotherapy in breast-conserving surgery: consequences on margin status and excision volumes: a nationwide pathology study. Eur J Surg Oncol. 2016;42:986–93. https://doi.org/10.1016/j.ejso.2016.02.252.

    Article  CAS  PubMed  Google Scholar 

  85. Spronk PER, Volders JH, van den Tol P, Smorenburg CH, Vrancken Peeters MTFD. Breast-conserving therapy after neoadjuvant chemotherapy: data from the Dutch Breast Cancer Audit. Eur J Surg Oncol. 2019;45:110–7. https://doi.org/10.1016/j.ejso.2018.09.027.

    Article  PubMed  Google Scholar 

  86. Devane LA, Baban CK, O’Doherty A, Quinn C, McDermott EW, Prichard RS. The impact of neoadjuvant chemotherapy on margin re-excision in breast-conserving surgery (published online ahead of print, 30 January 2020). World J Surg. 2020. https://doi.org/10.1007/s00268-020-05383-8.

  87. Loibl S, von Minckwitz G, Raab G, et al. Surgical procedures after neoadjuvant chemotherapy in operable breast cancer: results of the GEPARDUO trial. Ann Surg Oncol. 2006;13:1434–42. https://doi.org/10.1245/s10434-006-9011-2.

    Article  PubMed  Google Scholar 

  88. Volders JH, Negenborn VL, Spronk PE, et al. Breast-conserving surgery following neoadjuvant therapy: a systematic review on surgical outcomes. Breast Cancer Res Treat. 2018;168:1–12. https://doi.org/10.1007/s10549-017-4598-5.

    Article  PubMed  Google Scholar 

  89. Chagpar AB, Wilke LG. Should reexcision rates in breast cancer care be a quality measure? Ann Surg Oncol. 2018;25:2818–22. https://doi.org/10.1245/s10434-018-6576-5.

    Article  PubMed  Google Scholar 

  90. Dragun AE, Huang B, Tucker TC, Spanos WJ. Increasing mastectomy rates among all age groups for early-stage breast cancer: a 10-year study of surgical choice. Breast J. 2012;18:318–25. https://doi.org/10.1111/j.1524-4741.2012.01245.x.

    Article  PubMed  Google Scholar 

  91. Neuburger J, Macneill F, Jeevan R, van der Meulen JH, Cromwell DA. Trends in the use of bilateral mastectomy in England from 2002 to 2011: retrospective analysis of hospital episode statistics. BMJ Open. 2013;3:e003179. https://doi.org/10.1136/bmjopen-2013-003179.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Fisher CS, Martin-Dunlap T, Ruppel MB, Gao F, Atkins J, Margenthaler JA. Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast conservation therapy regardless of age. Ann Surg Oncol. 2012;19:3246–50. https://doi.org/10.1245/s10434-012-2525-x.

    Article  PubMed  Google Scholar 

  93. Tan M, Silva E. If not now, when? The case for a target rate of re-excision for breast-conserving surgery as a standard of care quality measure. Breast J. 2019;25:1306–7. https://doi.org/10.1111/tbj.13467.

    Article  PubMed  Google Scholar 

  94. Cellini C, Huston TL, Martins D, et al. Multiple re-excisions versus mastectomy in patients with persistent residual disease following breast conservation surgery. Am J Surg. 2005;189:662–6. https://doi.org/10.1016/j.amjsurg.2005.03.005.

    Article  PubMed  Google Scholar 

  95. Christiansen P, Carstensen SL, Ejlertsen B, et al. Breast-conserving surgery versus mastectomy: overall and relative survival: a population-based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol. 2018;57:19–25. https://doi.org/10.1080/0284186x.2017.1403042.

    Article  PubMed  Google Scholar 

  96. Lei X, Liu F, Luo S, et al. Evaluation of guidelines regarding surgical treatment of breast cancer using the AGREE Instrument: a systematic review. BMJ Open. 2017;7:e014883. https://doi.org/10.1136/bmjopen-2016-014883.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Hassett MJ, Hughes ME, Niland JC, et al. Selecting high-priority quality measures for breast cancer quality improvement. Med Care. 2008;46:762. https://doi.org/10.1097/mlr.0b013e318178ead3.

    Article  PubMed  PubMed Central  Google Scholar 

  98. van der Heiden-van der Loo M, de Munck L, Visser O, et al. Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands. Breast Cancer Res Treat. 2012;131:691–8. https://doi.org/10.1007/s10549-011-1809-3.

    Article  PubMed  Google Scholar 

  99. Gooiker GA, Veerbeek L, van der Geest LG, et al. De prestatie-indicator ‘irradicaliteit na borstsparende operatie’: geen zuiver zicht op goede zorg [The quality indicator “tumour-positive surgical margin following breast-conserving surgery” does not provide transparent insight into care]. Ned Tijdschr Geneeskd. 2010;154:A1142.

    PubMed  Google Scholar 

  100. Landercasper J, Bailey L, Buras R, et al. The American Society of Breast Surgeons and Quality Payment Programs: ranking, defining, and benchmarking more than 1 million patient quality measure encounters. Ann Surg Oncol. 2017;24:3093–106. https://doi.org/10.1245/s10434-017-5940-1.

    Article  PubMed  PubMed Central  Google Scholar 

  101. van Dam PA, Tomatis M, Marotti L, et al. Time trends (2006–2015) of quality indicators in EUSOMA-certified breast centres. Eur J Cancer. 2017;85:15–22. https://doi.org/10.1016/j.ejca.2017.07.040.

    Article  PubMed  Google Scholar 

  102. Guarneri V, Pronzato P, Bertetto O, et al. Use of electronic administrative databases to measure quality indicators of breast cancer care: experience of five regional oncology networks in Italy. JCO Oncol Pract. 2020;16:e211–20. https://doi.org/10.1200/jop.19.00466.

    Article  PubMed  Google Scholar 

  103. Hassett MJ. Quality improvement in the era of big data. J Clin Oncol. 2017. https://doi.org/10.1200/jco.2017.74.1181.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by Ministero della Salute Ricerca Corrente 2020, FPRC 5xmille Ministero della Salute 2015 (Strategy).

Author information

Authors and Affiliations

  1. Gynecological Oncology Unit, Candiolo Cancer Institute, FPO–IRCCS, Candiolo, Italy

    Francesca Tamburelli MD & Riccardo Ponzone MD, PhD

Authors
  1. Francesca Tamburelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Ponzone MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riccardo Ponzone MD, PhD.

Ethics declarations

Disclosures

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamburelli, F., Ponzone, R. The Value of Repeated Breast Surgery as a Quality Indicator in Breast Cancer Care. Ann Surg Oncol 28, 340–352 (2021). https://doi.org/10.1245/s10434-020-08704-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08704-2

Search

Navigation