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
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
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DOI：
10.1016/j.ejca.2017.07.032
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发表时间：
2017-10-01
影响因子：
8.4
通讯作者：
Masannat, Yazan
中科院分区：
文献类型：
--
作者：
Tang, Sarah Shuk-Kay;Kaptanis, Sarantos;Masannat, Yazan
引言：在英国和爱尔兰，保乳治疗（BCT）的保证金政策存在差异。外科肿瘤学会和美国放射肿瘤学会（SSO-ASTRO）差额共识（对于浸润性导管癌[DCIS]，“肿瘤上无墨水”;对于导管原位癌[DCIS]，2 mm）和乳腺外科协会（ABS）共识（侵入性和DCIS为1 mm），我们报告了英国和爱尔兰目前的保证金实践和单位基础设施，并描述了这些因素如何影响再切除率。2016年2月1日至5月31日，在英国和爱尔兰进行了一项由实习生合作领导的多中心前瞻性研究。数据收集连续BCT患者和当地的基础设施和policy.Results：共79个网站参加了数据收集（75%的筛查单位，平均每年372癌症，范围70-900）。对于DCIS，53.2%的装置接受1 mm的边缘，38%接受2 mm的边缘。对于浸润性疾病，77.2%接受1 mm，13.9%接受“肿瘤上无墨水”。共有2858例患者接受了BCT，各单位的平均再切除率为17.2%（范围0-41%）。如果所有单位都采用SSO-ASTRO准则，再切除率将降至15%，如果所有单位都遵循ABS准则，再切除率将降至14.8%。那些谁需要再次手术，65%的疾病目前在margin.Conclusion：继续有很大的变化，保证金政策和再切除率跨单位。按照SSO-ASTRO或ABS的指导方针改变保证金政策，将使全国再次切割率略有下降。大多数再切除术是针对累及的切缘而不是闭合的切缘。(C)2017爱思唯尔有限公司版权所有
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 2mm 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. (C) 2017 Elsevier Ltd. All rights reserved.