Breast conserving surgery and re-excision rates: A single-institution’s experience.

Abstract

181 Background: Quality measures (QM) in breast surgery vary among organizations world-wide. Although the rate of breast conserving surgery is an accepted QM, the incorporation of a standard for re-excision rates (RER) remains controversial. RER clearly has an impact on cost and efficiency of care. The purpose of this study is to look at techniques that can reduce burden to the patient and the healthcare system by decreasing RER. Methods: Our institutional Breast Cancer Database was queried to identify all patients from 2010-2016 who underwent lumpectomy for Stage 0-III breast cancer by three high-volume breast surgeons. We analyzed the RER based on method of detection, localization technique, use of circumferential cavity shave margins, and use of device MarginProbe (DUNE Medical Devices). Results: Of 1420 women, the overall RER was 22% (312/1420). The RER was not decreased by addition of pre-operative MRI. Localization techniques were used for all non-palpable tumors and did not affect RER. The use of shave margins decreased RER from 28% to 17% (p<0.0001). The use of MarginProbe decreased RER from 24 to 11% (p<0.0001). Conclusions: Adjunctive use of circumferential cavity shave margins or directed margin excision with the MarginProbe during breast-conserving surgery decreased the RER to less than 20%. The burden of each additional surgery in financial cost, missed work, child care, and transportation can be significant. Rate of re-operation in Breast Surgery should be considered strongly within the quality efforts of any institution. [Table: see text]