Predictive Factors for Positive Margin and the Surgical Learning Curve in Non-Palpable Breast Cancer After Wire-Guided Localization – Prospective Study of 214 Consecutive Patients

Dezső Tóth, Zsolt Varga, Éva Sebő, Miklós Török, I. Kovács

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

To investigate the most commonly used technique, the wire-guided localization (WGL) in non-palpable breast cancer. To analyze the effective factors on positive surgical margins in our practice and determine the surgical learning curve of this method. Prospective consecutive study was performed from January 2005 to December 2011. Inclusion criteria was a non-palpable breast lesion with malignancy on preoperative histology. All lesions were localized by ultrasound or stereotactic guided wire placement. Margins 1 mm or closer were accepted as positive margins which required re-excision. To determine the learning curve of WGL method we investigated the change in the reoperation rate after primary procedure performed by “high-volume” surgeon. Two hundred and fourteen consecutive patients were enrolled. In 23 patients (10.7 %) reexcision was needed. Positive surgical margins were significantly influenced by the patient’s age (p = 0.03), tumor volume (p <=0.001), proportion of tumor volume/specimen volume (p <0.001), presence of DCIS (p <0.001), multifocality (p = 0.03) and the learning curve (p = 0.006) with univariate analysis. Only the tumor volume, presence of DCIS and the learning curve were proved as independent prognostic factor for reoperation by multivariate analysis. The reoperation rate decreased below 20 % after the fortieth operation. Results of our single institutional study suggest, that this localization technique can be performed safely with very good results after 40 procedures as a learning curve for surgeons.

Original languageEnglish
Pages (from-to)209-215
Number of pages7
JournalPathology and Oncology Research
Volume22
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Learning Curve
Prospective Studies
Breast Neoplasms
Tumor Burden
Reoperation
Carcinoma, Intraductal, Noninfiltrating
Statistical Factor Analysis
Histology
Breast
Multivariate Analysis
Margins of Excision
Neoplasms

Keywords

  • Breast cancer
  • Learning curve
  • Non-palpable
  • Surgery
  • Wire-guided localization

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Pathology and Forensic Medicine

Cite this

Predictive Factors for Positive Margin and the Surgical Learning Curve in Non-Palpable Breast Cancer After Wire-Guided Localization – Prospective Study of 214 Consecutive Patients. / Tóth, Dezső; Varga, Zsolt; Sebő, Éva; Török, Miklós; Kovács, I.

In: Pathology and Oncology Research, Vol. 22, No. 1, 01.01.2016, p. 209-215.

Research output: Contribution to journalArticle

@article{417269260add4c1791892c13914c25b3,
title = "Predictive Factors for Positive Margin and the Surgical Learning Curve in Non-Palpable Breast Cancer After Wire-Guided Localization – Prospective Study of 214 Consecutive Patients",
abstract = "To investigate the most commonly used technique, the wire-guided localization (WGL) in non-palpable breast cancer. To analyze the effective factors on positive surgical margins in our practice and determine the surgical learning curve of this method. Prospective consecutive study was performed from January 2005 to December 2011. Inclusion criteria was a non-palpable breast lesion with malignancy on preoperative histology. All lesions were localized by ultrasound or stereotactic guided wire placement. Margins 1 mm or closer were accepted as positive margins which required re-excision. To determine the learning curve of WGL method we investigated the change in the reoperation rate after primary procedure performed by “high-volume” surgeon. Two hundred and fourteen consecutive patients were enrolled. In 23 patients (10.7 {\%}) reexcision was needed. Positive surgical margins were significantly influenced by the patient’s age (p = 0.03), tumor volume (p <=0.001), proportion of tumor volume/specimen volume (p <0.001), presence of DCIS (p <0.001), multifocality (p = 0.03) and the learning curve (p = 0.006) with univariate analysis. Only the tumor volume, presence of DCIS and the learning curve were proved as independent prognostic factor for reoperation by multivariate analysis. The reoperation rate decreased below 20 {\%} after the fortieth operation. Results of our single institutional study suggest, that this localization technique can be performed safely with very good results after 40 procedures as a learning curve for surgeons.",
keywords = "Breast cancer, Learning curve, Non-palpable, Surgery, Wire-guided localization",
author = "Dezső T{\'o}th and Zsolt Varga and {\'E}va Sebő and Mikl{\'o}s T{\"o}r{\"o}k and I. Kov{\'a}cs",
year = "2016",
month = "1",
day = "1",
doi = "10.1007/s12253-015-9999-3",
language = "English",
volume = "22",
pages = "209--215",
journal = "Pathology and Oncology Research",
issn = "1219-4956",
publisher = "Springer Netherlands",
number = "1",

}

TY - JOUR

T1 - Predictive Factors for Positive Margin and the Surgical Learning Curve in Non-Palpable Breast Cancer After Wire-Guided Localization – Prospective Study of 214 Consecutive Patients

AU - Tóth, Dezső

AU - Varga, Zsolt

AU - Sebő, Éva

AU - Török, Miklós

AU - Kovács, I.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - To investigate the most commonly used technique, the wire-guided localization (WGL) in non-palpable breast cancer. To analyze the effective factors on positive surgical margins in our practice and determine the surgical learning curve of this method. Prospective consecutive study was performed from January 2005 to December 2011. Inclusion criteria was a non-palpable breast lesion with malignancy on preoperative histology. All lesions were localized by ultrasound or stereotactic guided wire placement. Margins 1 mm or closer were accepted as positive margins which required re-excision. To determine the learning curve of WGL method we investigated the change in the reoperation rate after primary procedure performed by “high-volume” surgeon. Two hundred and fourteen consecutive patients were enrolled. In 23 patients (10.7 %) reexcision was needed. Positive surgical margins were significantly influenced by the patient’s age (p = 0.03), tumor volume (p <=0.001), proportion of tumor volume/specimen volume (p <0.001), presence of DCIS (p <0.001), multifocality (p = 0.03) and the learning curve (p = 0.006) with univariate analysis. Only the tumor volume, presence of DCIS and the learning curve were proved as independent prognostic factor for reoperation by multivariate analysis. The reoperation rate decreased below 20 % after the fortieth operation. Results of our single institutional study suggest, that this localization technique can be performed safely with very good results after 40 procedures as a learning curve for surgeons.

AB - To investigate the most commonly used technique, the wire-guided localization (WGL) in non-palpable breast cancer. To analyze the effective factors on positive surgical margins in our practice and determine the surgical learning curve of this method. Prospective consecutive study was performed from January 2005 to December 2011. Inclusion criteria was a non-palpable breast lesion with malignancy on preoperative histology. All lesions were localized by ultrasound or stereotactic guided wire placement. Margins 1 mm or closer were accepted as positive margins which required re-excision. To determine the learning curve of WGL method we investigated the change in the reoperation rate after primary procedure performed by “high-volume” surgeon. Two hundred and fourteen consecutive patients were enrolled. In 23 patients (10.7 %) reexcision was needed. Positive surgical margins were significantly influenced by the patient’s age (p = 0.03), tumor volume (p <=0.001), proportion of tumor volume/specimen volume (p <0.001), presence of DCIS (p <0.001), multifocality (p = 0.03) and the learning curve (p = 0.006) with univariate analysis. Only the tumor volume, presence of DCIS and the learning curve were proved as independent prognostic factor for reoperation by multivariate analysis. The reoperation rate decreased below 20 % after the fortieth operation. Results of our single institutional study suggest, that this localization technique can be performed safely with very good results after 40 procedures as a learning curve for surgeons.

KW - Breast cancer

KW - Learning curve

KW - Non-palpable

KW - Surgery

KW - Wire-guided localization

UR - http://www.scopus.com/inward/record.url?scp=84951907147&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951907147&partnerID=8YFLogxK

U2 - 10.1007/s12253-015-9999-3

DO - 10.1007/s12253-015-9999-3

M3 - Article

C2 - 26522009

AN - SCOPUS:84951907147

VL - 22

SP - 209

EP - 215

JO - Pathology and Oncology Research

JF - Pathology and Oncology Research

SN - 1219-4956

IS - 1

ER -