Preoperative breast MRI can reduce the rate of tumor-positive resection margins and reoperations in patients undergoing breast-conserving surgery.

OBJECTIVE: In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations. SUBJECTS AND METHODS: The study group consisted of 123 consecutive patients diagnosed with either breast cancer or ductal carcinoma in situ eligible for breast-conserving surgery between April 2007 and July 2010. For these patients, a first plan for breast-conserving surgery was made on the basis of clinical examination and conventional imaging. The final surgical plan was made with knowledge of the preoperative breast MRI. The rates of tumor-positive resection margins and reoperations were compared with those of a historical control group consisting of 119 patients who underwent 123 breast-conserving procedures between January 2005 and December 2006. The percentage of change in the surgical plan was recorded. RESULTS: Preoperative breast MRI changed the surgical plan to more extensive surgery in 42 patients (34.1%), mainly to mastectomy (29 patients, 23.6%). Ninety-four patients underwent 95 breast-conserving procedures. Significantly fewer patients had tumor-positive resection margins than in the control group (15.8%, 15/95 versus 29.3%, 36/123; p < 0.01). Patients in the study group underwent significantly fewer reoperations compared with the historical control group (18.9%, 18/95 vs 37.4%, 46/123; p < 0.01). CONCLUSION: Preoperative breast MRI can substantially decrease the rate of tumor-positive resection margins and reoperations in breast cancer patients eligible for breast-conserving surgery.

[Percentage of local recurrence following treatment for breast cancer is not a suitable performance indicator]. / Weinig lokaal recidieven na mammachirurgie: goede kwaliteit van de Nederlandse borstkankerzorg.

OBJECTIVE: To describe the percentage of local recurrences within 5 years after surgery for breast cancer as a performance indicator for Dutch hospitals. DESIGN: Descriptive, cohort study. METHOD: All women diagnosed with a primary invasive breast cancer in 2003 for which they underwent curatively intended surgical treatment (with or without radiotherapy), were selected from the Netherlands Cancer Registry (NCR). NCR registration clerks collected additional information on recurrences within 5 years after initial diagnosis following standardized protocol. Percentages of local recurrences per hospital were estimated using Kaplan Meier analysis and were presented in forest plots and funnel plots. RESULTS: In 2003, 9898 women diagnosed with primary breast cancer were curatively treated in one of the 99 Dutch hospitals. 266 patients experienced local recurrences within 5 years. The 5-year percentage of local recurrences was 3.03% (95% CI: 2.69-3.41). Following breast conserving surgery the 5-year percentage of local recurrence was 2.63% (95% CI: 2.21-3.12), and following mastectomy 3.50% (95% CI: 2.97-4.13). Stratification by hospital shows large variation in recurrence rates (0-17%). However, the number of patients treated in most hospitals is too small to provide reliable estimates. CONCLUSION: The percentage of local recurrences following surgical treatment for breast cancer in the Netherlands was lower than the accepted standard of 5% within 5 years. Statements on differences in quality of care between hospitals cannot be made on the basis of these data, on account of the low average recurrence rate and the small number of cases per hospital.