Tang Sarah Shuk-Kay, Kaptanis Sarantos, Haddow James B, Mondani Giuseppina, Elsberger Beatrix, Tasoulis Marios Konstantinos, Obondo Christine, Johns Neil, Ismail Wisam, Syed Asim, Kissias Panayioti, Venn Mary, Sundaramoorthy Souganthy, Irwin Gareth, Sami Amtul S, Elfadl Dalia, Baggaley Alice, Remoundos Dionysios Dennis, Langlands Fiona, Charalampoudis Petros, Barber Zoe, Hamilton-Burke Werbena L S, Khan Ayesha, Sirianni Chiara, Merker Louise Anne-Marie Grant, Saha Sunita, Lane Risha Arun, Chopra Sharat, Dupré Sophie, Manning Aidan T, St John Edward R, Musbahi Aya, Dlamini Nokwanda, McArdle Caitlin L, Wright Chloe, Murphy James O, Aggarwal Ravi, Dordea Matei, Bosch Karen, Egbeare Donna, Osman Hisham, Tayeh Salim, Razi Faraz, Iqbal Javeria, Ledwidge Serena F C, Albert Vanessa, Masannat Yazan
St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England SW17 0QT, UK.
Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
Eur J Cancer. 2017 Oct;84:315-324. doi: 10.1016/j.ejca.2017.07.032. Epub 2017 Aug 30.
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.
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.
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.
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.
在英国和爱尔兰，保乳治疗（BCT）的切缘政策存在差异。为响应外科肿瘤学会和美国放射肿瘤学会（SSO-ASTRO）的切缘共识（浸润性癌为“肿瘤无墨染”，导管原位癌[DCIS]为2毫米）以及乳腺外科学会（ABS）的共识（浸润性癌和DCIS均为1毫米），我们报告了英国和爱尔兰目前的切缘实践及单位基础设施情况，并描述了这些因素如何影响再次切除率。
2016年2月1日至5月31日在英国和爱尔兰开展了一项由学员协作主导的多中心前瞻性研究。收集了连续接受BCT患者的数据以及当地基础设施和政策的数据。
共有79个机构参与了数据收集（75%为筛查单位；每年平均372例癌症患者，范围为70 - 900例）。对于DCIS，53.2%的单位接受1毫米切缘，38%接受2毫米切缘。对于浸润性疾病，77.2%的单位接受1毫米切缘，13.9%接受“肿瘤无墨染”。共有2858例患者接受了BCT，各单位的平均再次切除率为17.2%（范围为0 - 41%）。如果所有单位都采用SSO-ASTRO指南，再次切除率将降至15%；如果所有单位都遵循ABS指南，再次切除率将降至14.8%。在那些需要再次手术的患者中，65%的切缘有病变。
各单位的切缘政策和再次切除率仍存在很大差异。将切缘政策改为遵循SSO-ASTRO或ABS指南将使全国再次切除率适度降低。大多数再次切除是因为切缘有病变而非切缘接近。
