Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference

Jeffrey Landercasper, Deanna Attai, Dunya Atisha, Peter Beitsch, Linda Bosserman, Judy Boughey, Jodi Carter, Stephen Edge, Sheldon M. Feldman, Joshua Froman, Caprice Greenberg, Cary Kaufman, Monica Morrow, Barbara Pockaj, Melvin Silverstein, Lawrence Solin, Alicia Staley, Frank Vicini, Lee Wilke, Wei YangHiram Cody

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background: Multiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting. Methods: The conference mission statement was to “reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care.” The goal was to develop a toolbox of recommendations to reduce the variability of reoperation rates and improve cosmetic outcomes. Conference participants included providers from multiple disciplines involved with breast cancer care, as well as a patient representative. Updated systematic reviews of the literature and invited presentations were sent to participants in advance. After topic presentations, voting occurred for choice of tools, level of evidence, and strength of recommendation. Results: The following tools were recommended with varied levels of evidence and strength of recommendation: compliance with the SSO-ASTRO Margin Guideline; needle biopsy for diagnosis before surgical excision of breast cancer; full-field digital diagnostic mammography with ultrasound as needed; use of oncoplastic techniques; image-guided lesion localization; specimen imaging for nonpalpable cancers; use of specialized techniques for intraoperative management, including excisional cavity shave biopsies and intraoperative pathology assessment; formal pre- and postoperative planning strategies; and patient-reported outcome measurement. Conclusions: A practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes.

Original languageEnglish (US)
Pages (from-to)3174-3183
Number of pages10
JournalAnnals of Surgical Oncology
Volume22
Issue number10
DOIs
StatePublished - Oct 29 2015
Externally publishedYes

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Segmental Mastectomy
Reoperation
Cosmetics
Breast Neoplasms
Patient Advocacy
Mastectomy
Needle Biopsy
Mammography
Politics
Neoplasms
Guidelines
Pathology
Biopsy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients : The American Society of Breast Surgeons Consensus Conference. / Landercasper, Jeffrey; Attai, Deanna; Atisha, Dunya; Beitsch, Peter; Bosserman, Linda; Boughey, Judy; Carter, Jodi; Edge, Stephen; Feldman, Sheldon M.; Froman, Joshua; Greenberg, Caprice; Kaufman, Cary; Morrow, Monica; Pockaj, Barbara; Silverstein, Melvin; Solin, Lawrence; Staley, Alicia; Vicini, Frank; Wilke, Lee; Yang, Wei; Cody, Hiram.

In: Annals of Surgical Oncology, Vol. 22, No. 10, 29.10.2015, p. 3174-3183.

Research output: Contribution to journalArticle

Landercasper, J, Attai, D, Atisha, D, Beitsch, P, Bosserman, L, Boughey, J, Carter, J, Edge, S, Feldman, SM, Froman, J, Greenberg, C, Kaufman, C, Morrow, M, Pockaj, B, Silverstein, M, Solin, L, Staley, A, Vicini, F, Wilke, L, Yang, W & Cody, H 2015, 'Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference', Annals of Surgical Oncology, vol. 22, no. 10, pp. 3174-3183. https://doi.org/10.1245/s10434-015-4759-x
Landercasper, Jeffrey ; Attai, Deanna ; Atisha, Dunya ; Beitsch, Peter ; Bosserman, Linda ; Boughey, Judy ; Carter, Jodi ; Edge, Stephen ; Feldman, Sheldon M. ; Froman, Joshua ; Greenberg, Caprice ; Kaufman, Cary ; Morrow, Monica ; Pockaj, Barbara ; Silverstein, Melvin ; Solin, Lawrence ; Staley, Alicia ; Vicini, Frank ; Wilke, Lee ; Yang, Wei ; Cody, Hiram. / Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients : The American Society of Breast Surgeons Consensus Conference. In: Annals of Surgical Oncology. 2015 ; Vol. 22, No. 10. pp. 3174-3183.
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abstract = "Background: Multiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting. Methods: The conference mission statement was to “reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care.” The goal was to develop a toolbox of recommendations to reduce the variability of reoperation rates and improve cosmetic outcomes. Conference participants included providers from multiple disciplines involved with breast cancer care, as well as a patient representative. Updated systematic reviews of the literature and invited presentations were sent to participants in advance. After topic presentations, voting occurred for choice of tools, level of evidence, and strength of recommendation. Results: The following tools were recommended with varied levels of evidence and strength of recommendation: compliance with the SSO-ASTRO Margin Guideline; needle biopsy for diagnosis before surgical excision of breast cancer; full-field digital diagnostic mammography with ultrasound as needed; use of oncoplastic techniques; image-guided lesion localization; specimen imaging for nonpalpable cancers; use of specialized techniques for intraoperative management, including excisional cavity shave biopsies and intraoperative pathology assessment; formal pre- and postoperative planning strategies; and patient-reported outcome measurement. Conclusions: A practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes.",
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AU - Atisha, Dunya

AU - Beitsch, Peter

AU - Bosserman, Linda

AU - Boughey, Judy

AU - Carter, Jodi

AU - Edge, Stephen

AU - Feldman, Sheldon M.

AU - Froman, Joshua

AU - Greenberg, Caprice

AU - Kaufman, Cary

AU - Morrow, Monica

AU - Pockaj, Barbara

AU - Silverstein, Melvin

AU - Solin, Lawrence

AU - Staley, Alicia

AU - Vicini, Frank

AU - Wilke, Lee

AU - Yang, Wei

AU - Cody, Hiram

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