Evidence map›Paper›PMID 37302085›Full record

ArticleBreast cancer research and treatment2023

Conventional specimen radiography in breast-conserving therapy: a useful tool for intraoperative margin assessment after neoadjuvant therapy?

Benedikt Schäfgen, Annabelle Haller, Hans-Peter Sinn, Manuel Feisst, Christina Gomez, Anne Stieber, Juliane Nees, Riku Togawa, André Pfob, André Hennigs and 5 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Breast cancer research and treatment, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.5field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 2 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 2 countries.

Benedikt SchäfgenDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
Annabelle HallerDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
Hans-Peter SinnDepartment of Pathology, University of Heidelberg, Heidelberg, Germany.
Manuel FeisstInstitute for Medical Biometry, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany.
Christina GomezBrustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany.
Anne StieberDepartment of Radiology, University of Heidelberg, Heidelberg, Germany.
Juliane NeesDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
Riku TogawaDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
André PfobDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
André HennigsBrustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany.
Johanna HedererDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
Fabian RiedelDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
Sarah FastnerBrustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany.
Jörg HeilDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
Michael GolattaDepartment of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany. michael.golatta@med.uni-heidelberg.de.ORCID http://orcid.org/0000-0002-2605-0060
Heidelberg University · DENierenzentrum Heidelberg · DEZimmer Biomet (Netherlands) · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeA previous study in our breast unit showed that the diagnostic accuracy of intraoperative specimen radiography and its potential to reduce second surgeries in a cohort of patients treated with neoadjuvant chemotherapy were low, which questions the routine use of Conventional specimen radiography (CSR) in this patient group. This is a follow-up study in a larger cohort to further evaluate these findings.

methodsThis retrospective study included 376 cases receiving breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. CSR was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions.

results362 patients with 2172 margins were assessed. The prevalence of positive margins was 102/2172 (4.7%). CSR had a sensitivity of 37.3%, a specificity of 85.6%, a positive predictive value (PPV) of 11.3%, and a negative predictive value (NPV) of 96.5%. The rate of secondary procedures was reduced from 75 to 37 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 10. In the subgroup of patients with clinical complete response (cCR), the prevalence of positive margins was 38/1002 (3.8%), PPV was 6.5% and the NNT was 34.

conclusionThis study confirms our previous finding that the rate of secondary surgeries cannot be significantly reduced by CSR-guided intraoperative re-excisions in cases with cCR after NACT. The routine use CSR after NACT is questionable, and alternative tools of intraoperative margin assessment should be evaluated.

Indexed as

Breast NeoplasmsCarcinoma, Ductal, BreastFemaleFollow-Up StudiesHumansMargins of ExcisionMastectomy, SegmentalNeoadjuvant TherapyRadiographyRetrospective StudiesBreast cancerBreast conserving therapyIntraoperative re-excisionNeoadjuvant chemotherapySpecimen radiographySurgical margins

Identifiers

PMID37302085
PMCPMC10299925
OpenAlexW4380267452

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.