Katie Ludwig FY1. 50, 285 New cases of breast cancer - 2011 11, 716 deaths - 2012 78% - 10 year...
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Transcript of Katie Ludwig FY1. 50, 285 New cases of breast cancer - 2011 11, 716 deaths - 2012 78% - 10 year...
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Katie Ludwig FY1Katie Ludwig FY1
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50, 285 New cases of breast cancer - 2011 11, 716 deaths - 2012 78% - 10 year survival rates 27% preventable cases
Source: Cancer Research UK
Background
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58% of women diagnosed with breast cancer
opt for breast conserving surgery 1 in 5 women with breast cancer who have
opted for breast conserving surgery rather than mastectomy go on to have reoperation
Source: British Medical Journal (2012)
After Diagnosis
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2mm radial margin of excision is
recommended Microscopically review Consider re-excision if margin in <2mm
Source: NICE Guidelines (“Early and Locally Advanced Breast Cancer” 2009 )
Wide Local Excision (WLE)
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156 NHS trusts 55, 297 women had breast conserving surgery 20% had at least one re-operation Reoperation rate - 29.5% in carcinoma in situ,
18% isolated invasive cancer. 40% underwent further mastectomy
Source: (BMJ “Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics” 2012)
Our Benchmark Study
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Anonymous data collected from Medway Between: 01/04/2012- 21/08/2013 The study considered patients who had WLE
then went onto have further re-excision Does not count subsequent operation to axilla Only included re-operations ipsilateral to
original WLE due to histological finding of close borders and NOT early recurrence
Collection Method
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77 patient had WLE
14 (18%) had further surgery (mastectomy or further breast conserving surgery)
8 (57%) had further excision.
6 (43%) had mastectomy
Results
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11 had bigger tumour on histology than
indicated on radiology
1 tumour was smaller on histological review
8 (57%) had cavity shaves on first operation
In comparison: 17/63 (27%) who did not have re-excision had cavity shaves
Of the 14 that had further surgery
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8 underwent further excision 6 had mastectomy after initial WLE (43%) Reasons why patient had mastectomy:
Two or more close margins on histology (2 cases)
Extensive lymph node involvement (2 cases) Large tumour already excised and margins still
close (1 case) One case of Squamous cell ca. extending
posteriorly
Re-excision: Mastectomy vs. WLE
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8 had Invasive Ductal Carcinoma (IDC)
4 had IDC with Ductal Carcinoma In Situ (DCIS) on either on margin or foci away from main site.
1 case of mucinous carcinoma with DCIS foci away from main lesion
1 case of squamous cell carcinoma
Histology
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Re-operation rate: 18%
Further operation: 43% - mastectomy, 57% - Further breast conserving surgery
Within the whole study: further excision rate is 10 % and mastectomy rate is 8%
Summary
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Nearly all had tumour sizes were underestimated
on radiology
Comparable re-operation rates with the cohort study
Marginally higher mastectomy rates after initial operation
Patients the risk of re-operation
Conclusions
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Mr. N Rahman Mr. P Arora Mr. S Ellenbogen Mr. A Dhebri Mr. S Sabri
Thank You