ABCR  Vol.3 No.4 , October 2014
The Centricity Score: A Novel Measurement to Aid in Conservative Breast Cancer Surgery
ABSTRACT
Introduction: This study describes an intra-operative scoring system to advise the surgeon of the centricity of the tumour in the excised specimen. Methods: Spatial estimations were prospectively made in 10 consecutive patients undergoing wide local excision (WLE) using Bioptics intra-operative digital specimen imaging. The centricity score was defined as 100 – (ICD/SD × 100), where ICD is the inter-centre distance between the specimen’s centre and the tumour’s centre. Results: 10 patients with invasive breast cancer (T1b to T4a), mean age 56 years (range 44 - 71) were studied. The mean tumour and specimen diameter was 24 mm ± 10 (range 12 - 48) and 101 mm ± 22 (range 64 - 140). The mean centricity score was 86 ± 9 (range 65 - 95). Conclusion: This study successfully describes an intraoperative radiological spatial scoring system for patients undergoing WLE. Tumours were well centered in specimens with an overall score of 86/100. The centricity score could be used to guide excision and potentially set benchmarks for conservative breast surgery.

Cite this paper
Sugrue, R. , McGowan, K. , McNamara, C. and Sugrue, M. (2014) The Centricity Score: A Novel Measurement to Aid in Conservative Breast Cancer Surgery. Advances in Breast Cancer Research, 3, 118-123. doi: 10.4236/abcr.2014.34018.
References
[1]   Jeevan, R., Cromwell, D.A., Trivella, M., et al. (2012) Reoperation Rates after Breast Conserving Surgery for Breast Cancer among Women in England: Retrospective Study of Hospital Episode Statistics. BMJ, 345, e4505. http://dx.doi.org/10.1136/bmj.e4505

[2]   Fisher, B., Anderson, S., Bryant, J., et al. (2012) Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy Plus Irradiation for the Treatment of Invasive Breast Cancer. NEJM, 347, 1233-1241. http://dx.doi.org/10.1056/NEJMoa022152

[3]   Park, C.C., Mitsumori, M., Nixon, A., et al. (2000) Outcome at 8 Years after Breast-Conserving Surgery and Radiation Therapy for Invasive Breast Cancer: Influence of Margin Status and Systemic Therapy on Local Recurrence. Journal of Clinical Oncology, 18, 1668-1675.

[4]   Morrow, M., Harris, J.R. and Schnitt, S.J. (2012) Surgical Margins in Lumpectomy for Breast Cancer-Bigger Is Not Better. NEJM, 367, 79-82. http://dx.doi.org/10.1056/NEJMsb1202521

[5]   Olivotto, I.A., Rose, M.A., Osteen, R.T., et al. (1989) Late Cosmetic Outcome after Conservative Surgery and Radiotherapy: Analysis of Causes of Cosmetic Failure. International Journal of Radiation Oncology*Biology*Physics, 17, 747-753. http://dx.doi.org/10.1016/0360-3016(89)90061-8

[6]   McCahill, L.E., Single, R.M., Aiello Bowles, E.J., et al. (2012) Variability in Re-Excision Following Breast Conservation Surgery. JAMA, 307, 467-475. http://dx.doi.org/10.1001/jama.2012.43

[7]   Morrow, M., Katz, S.J. (2012) The Challenge of Developing Quality Measures for Breast Cancer Surgery. JAMA, 307, 509-510. http://dx.doi.org/10.1001/jama.2012.74

[8]   Moo, T.A., Choi, L., Culpepper, C., Olcese, C., Heerdt, A., Sclafani, L., et al. (2014) Impact of Margin Assessment Method on Positive Margin Rate and Total Volume Excised. Annals of Surgical Oncology, 21, 86-92. http://dx.doi.org/10.1245/s10434-013-3257-2

[9]   Bedwinek, J.M., Perez, C.A., Kramer, S., et al. (1980) Irradiation as the Primary Management of Stage I and II Adenocarcinoma of the Breast. Cancer Clinical Trials, 3, 11-18.

[10]   Singletary, S.E. (2002) Surgical Margins in Patients with Early-Stage Breast Cancer Treated with Breast Conservation Therapy. The American Journal of Surgery, 184, 383-393.
http://dx.doi.org/10.1016/S0002-9610(02)01012-7

[11]   Blair, S.L., Thompson, K., Rococco, J., Malcarne, V., Beitsch, P.D. and Ollila, D.W. (2009) Attaining Negative Margins in Breast-Conservation Operations: Is There a Consensus among Breast Surgeons? Journal of the American College of Surgeons, 209, 608-613.
http://dx.doi.org/10.1016/j.jamcollsurg.2009.07.026

[12]   Aguilar, B., Sheikh, F., Pockaj, B., Wasif, N. and Gray, R. (2011) The Effect of Junior Residents on Surgical Quality: A Study of Surgical Outcomes in Breast Surgery. The American Journal of Surgery, 202, 654-657. http://dx.doi.org/10.1016/j.amjsurg.2011.05.018

[13]   Sugrue, R., MacGregor, G., Sugrue, M., Curran, S. and Murphy, L. (2013) An Evaluation of Patient Reported Outcomes Following Breast Reconstruction Utilizing Breast Q. The Breast, 22, 158-161. http://dx.doi.org/10.1016/j.breast.2012.12.001

[14]   Britton, P.D., Sonoda, A.K., Yamamoto, B., Koo, B., Soh, E. and Goud, A. (2011) Breast Surgical Specimen Radiographs: How Reliable Are They? European Journal of Radiology, 79, 245-249.
http://dx.doi.org/10.1016/j.ejrad.2010.02.012

[15]   Graham, R.A., Homer, M.J., Katz, J., Rothschild, J., Safaii, H. and Supran, S. (2012) The Pancake Phenomenon Contributes to the Inaccuracy of Margin Assessment in patients with Breast Cancer. The American Journal of Surgery, 184, 89-93. http://dx.doi.org/10.1016/S0002-9610(02)00902-9

[16]   Bimston, D.N., Bebb, G.G. and Wagman, L.D. (2000) Is Specimen Mammography Beneficial? Archives of Surgery, 135, 1083-1086. http://dx.doi.org/10.1001/archsurg.135.9.1083

[17]   Chilcote, W.A., Davis, G.A., Suchy, P. and Paushter, D.M. (1988) Breast Specimen Radiography: Evaluation of a Compression Device. Radiology, 168, 425-427.
http://dx.doi.org/10.1148/radiology.168.2.3393660

[18]   Clingan, R., Griffin, M., Phillips, J., Coberly, W. and Jennings, W. (2003) Potential Margin Distortion in Breast Tissue by Specimen Mammography. Archives of Surgery, 138, 1371-1374.
http://dx.doi.org/10.1001/archsurg.138.12.1371

[19]   Aitkin, R.J., Going, J.J. and Chetty, U. (1990) Assessment of Surgical Excision during Breast Conservation Surgery by Intraoperative Two-Dimensional Specimen Radiology. British Journal of Surgery, 77, 322-323. http://dx.doi.org/10.1007/s00268-012-1577-1

[20]   Bernardi, S., Bertozzi, S., Londero, A.P., Gentile, G., Giacomuzzi, F. and Carbone, A. (2012) Incidence and Risk Factors of the Intraoperative Localization Failure of Nonpalpable Breast Lesions by Radio-Guided Occult Lesion Localization: A Retrospective Analysis of 579 Cases. World Journal of Surgery, 36, 1915-1921. http://dx.doi.org/10.1007/s00268-012-1577-1

[21]   Cox, E.C., Furman, B., Stowell, N., Ebert, M., Clark, J., Dupont, E., et al. (2003) Radioactive Seed Localization Breast Biopsy and Lumpectomy: Can Specimen Radiographs Be Eliminated? Annals of Surgical Oncology, 10, 1039-1047. http://dx.doi.org/10.1245/ASO.2003.03.050

[22]   Allweis, T.M., Kaufman, Z., Lelcuk, S., Pappo, I., Karni, T., Schneebaum, S., et al. (2008) A Prospective, Randomized, Controlled, Multicenter Study of a Real-Time, Intraoperative Probe for Positive Margin Detection in Breast-Conserving Surgery. The American Journal of Surgery, 196, 483-489.
http://dx.doi.org/10.1016/j.amjsurg.2008.06.024

[23]   Feldman, S.M. (2013) Editorial-Surgical Margins in Breast Conservation. International Journal of Surgical Oncology, 2013, Article ID: 136387. http://dx.doi.org/10.1155/2013/136387

[24]   Murphy, J.O., Moo, T.A., King, T.A., Van Zee, K.J., Villegas, K.A., Stempel, M., et al. (2013) Radioactive Seed Localization Compared to Wire Localization in Breast-Conserving Surgery: Initial 6-Month Experience. Annals of Surgical Oncology, 20, 4121-4127. http://dx.doi.org/10.1245/s10434-013-3166-4

[25]   Ramos, M., Diaz, J.C., Ramos, T., Ruano, R., Aparicio, M., Sancho, M., et al. (2012) Ultrasound-Guided Excision Combined with Intraoperative Assessment of Gross Macscopic Margins Decreases the Rate of Reoperations for NonPalpable Invasive Breast Cancer. The Breast, 22, 520-524.
http://dx.doi.org/10.1016/j.breast.2012.10.006

[26]   Cancela, M., Comber, H. and Sharp, L. (2013) Hospital and Surgeon Caseload Are Associated with Risk of Re-Operation Following Breast-Conserving Surgery. Breast Cancer Research and Treatment, 140, 535-544. http://dx.doi.org/10.1007/s10549-013-2652-5

[27]   Margenthaler, J.A., Gao, F. and Klimberg, V.S. (2010) Margin Index: A New Method for Prediction of Residual Disease after Breast-Conserving Surgery. Annals of Surgical Oncology, 17, 2696-2701.
http://dx.doi.org/10.1111/j.1524-4741.2012.01249.x

[28]   Bolger, J.C., Solon, J.G., Power, C. and Hill, A.D. (2012) Analysis of Margin Index as a Method for Predicting Residual Disease after Breast-Conserving Surgery in a European Cancer Center. Annals of Surgical Oncology, 19, 207-211.

[29]   Atalay, C. and Irkkan, C. (2012) Predictive Factors for Residual Disease in Re-Excision Specimens after Breast-Conserving Surgery. The Breast Journal, 18, 339-344.
http://dx.doi.org/10.1111/j.1524-4741.2012.01249.x

[30]   Waljee, J.F., Hu, E.S., Newman, L.A. and Alderman, A.K. (2008) Predictors of Re-Excision among Woman Undergoing Breast-Conserving Surgery for Cancer. Annals of Surgical Oncology, 15, 1297-1303.
http://dx.doi.org/10.1245/s10434-007-9777-x

[31]   Krekel, N.M., Haloua, M.H., Cardozo, A.M.L., de Wit, R.H., Bosch, A.M., de Widt-Levert, L.M., et al. (2013) Intraoperative Ultrasound Guidance for Palpable Breast Cancer Excision (COBALT Trial): A Multicentre, Randomised Controlled Trial. The Lancet Oncology, 14, 48-54.
http://dx.doi.org/10.1016/S1470-2045(12)70527-2

[32]   Moran, M.S., Schnitt, S.J., Giuliano, A.E., Harris, J.R., Khan, S.A., Horton, J., et al. (2014) Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer. Journal of Clinical Oncology, 32, 1507-1515. http://dx.doi.org/10.1200/JCO.2013.53.3935

 
 
Top