Abstract
BACKGROUND: There is marked variability of re-excision rates after initial lumpectomy for breast cancer. Reasons for re-excision and variability across surgeons have not been well documented. We hypothesized the American Society of Breast Surgeons (ASBrS) Mastery(SM) Program can identify reasons for re-excision.
METHODS: Data from January 1 to 7 November 2013 were evaluated in the ASBrS Mastery(SM) Program to determine re-excision lumpectomy rate (RELR). On 1 June 2013, a tool to track reasons for re-excision was developed. Variation in re-excision rate by surgeon and patient characteristics was performed by Chi square test and Fisher's test for univariate analysis, then logistic regression with backwards elimination method for multivariate analysis.
RESULTS: For 6,725 patients undergoing initial lumpectomy for cancer, 328 surgeons reported 1,451 (21.6 %) patients had one or more re-excisions. The most common reasons for re-excision were ink positive margins in 783 (49.7 %), margin <1 mm (34.3 %), and margin 1-2 mm (7.2 %). By multivariate analysis, re-excision rates were lower in patients aged less than 35 years, with White (non-) Hispanic ethnicity, and, among surgeons in solo practice, more years in practice and higher-volume practice.
CONCLUSION: Half of re-excisions after initial lumpectomy were performed for margins that are positive. Most of the remainder were for negative close (<1-2 mm) margins. This information corroborates surgeon survey data regarding reasons for re-excision and provides proof of concept the Mastery(SM) Program can capture surgical outcome data in real time, providing opportunity and a method for future performance improvement.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3185-3191 |
| Number of pages | 7 |
| Journal | Annals of Surgical Oncology |
| Volume | 21 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2014 |
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ASJC Scopus subject areas
- Medicine(all)
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Reasons for re-excision after lumpectomy for breast cancer : insight from the American Society of Breast Surgeons Mastery(SM) database. / Landercasper, Jeffrey; Whitacre, Eric; Degnim, Amy C; Al-Hamadani, Mohammed.
In: Annals of Surgical Oncology, Vol. 21, No. 10, 01.10.2014, p. 3185-3191.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Reasons for re-excision after lumpectomy for breast cancer
T2 - insight from the American Society of Breast Surgeons Mastery(SM) database
AU - Landercasper, Jeffrey
AU - Whitacre, Eric
AU - Degnim, Amy C
AU - Al-Hamadani, Mohammed
PY - 2014/10/1
Y1 - 2014/10/1
N2 - BACKGROUND: There is marked variability of re-excision rates after initial lumpectomy for breast cancer. Reasons for re-excision and variability across surgeons have not been well documented. We hypothesized the American Society of Breast Surgeons (ASBrS) Mastery(SM) Program can identify reasons for re-excision.METHODS: Data from January 1 to 7 November 2013 were evaluated in the ASBrS Mastery(SM) Program to determine re-excision lumpectomy rate (RELR). On 1 June 2013, a tool to track reasons for re-excision was developed. Variation in re-excision rate by surgeon and patient characteristics was performed by Chi square test and Fisher's test for univariate analysis, then logistic regression with backwards elimination method for multivariate analysis.RESULTS: For 6,725 patients undergoing initial lumpectomy for cancer, 328 surgeons reported 1,451 (21.6 %) patients had one or more re-excisions. The most common reasons for re-excision were ink positive margins in 783 (49.7 %), margin <1 mm (34.3 %), and margin 1-2 mm (7.2 %). By multivariate analysis, re-excision rates were lower in patients aged less than 35 years, with White (non-) Hispanic ethnicity, and, among surgeons in solo practice, more years in practice and higher-volume practice.CONCLUSION: Half of re-excisions after initial lumpectomy were performed for margins that are positive. Most of the remainder were for negative close (<1-2 mm) margins. This information corroborates surgeon survey data regarding reasons for re-excision and provides proof of concept the Mastery(SM) Program can capture surgical outcome data in real time, providing opportunity and a method for future performance improvement.
AB - BACKGROUND: There is marked variability of re-excision rates after initial lumpectomy for breast cancer. Reasons for re-excision and variability across surgeons have not been well documented. We hypothesized the American Society of Breast Surgeons (ASBrS) Mastery(SM) Program can identify reasons for re-excision.METHODS: Data from January 1 to 7 November 2013 were evaluated in the ASBrS Mastery(SM) Program to determine re-excision lumpectomy rate (RELR). On 1 June 2013, a tool to track reasons for re-excision was developed. Variation in re-excision rate by surgeon and patient characteristics was performed by Chi square test and Fisher's test for univariate analysis, then logistic regression with backwards elimination method for multivariate analysis.RESULTS: For 6,725 patients undergoing initial lumpectomy for cancer, 328 surgeons reported 1,451 (21.6 %) patients had one or more re-excisions. The most common reasons for re-excision were ink positive margins in 783 (49.7 %), margin <1 mm (34.3 %), and margin 1-2 mm (7.2 %). By multivariate analysis, re-excision rates were lower in patients aged less than 35 years, with White (non-) Hispanic ethnicity, and, among surgeons in solo practice, more years in practice and higher-volume practice.CONCLUSION: Half of re-excisions after initial lumpectomy were performed for margins that are positive. Most of the remainder were for negative close (<1-2 mm) margins. This information corroborates surgeon survey data regarding reasons for re-excision and provides proof of concept the Mastery(SM) Program can capture surgical outcome data in real time, providing opportunity and a method for future performance improvement.
UR - http://www.scopus.com/inward/record.url?scp=84930973519&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84930973519&partnerID=8YFLogxK
U2 - 10.1245/s10434-014-3905-1
DO - 10.1245/s10434-014-3905-1
M3 - Article
C2 - 25047472
AN - SCOPUS:84930973519
VL - 21
SP - 3185
EP - 3191
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
IS - 10
ER -