Evidence map›Paper›PMID 38520579›Full record

Observational studyAnnals of surgical oncology2024

Clinicopathological Predictors of Positive Resection Margins in Breast-Conserving Surgery.

Hemali Chauhan, Natasha Jiwa, Vikneswaran Raj Nagarajan, Paul Thiruchelvam, Katy Hogben, Ragheed Al-Mufti, Dimitri Hadjiminas, Sami Shousha, Ramsey Cutress, Hutan Ashrafian and 2 more

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

Observational study in Annals of surgical oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.9field-weighted citation impact, top 9% 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

7 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
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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

12 authors at 4 institutions in 1 country.

Hemali ChauhanDepartment of Surgery and Cancer, Imperial College London, London, UK. h.chauhan@imperial.ac.uk.
Natasha JiwaDepartment of Surgery and Cancer, Imperial College London, London, UK.
Vikneswaran Raj NagarajanDepartment of Surgery and Cancer, Imperial College London, London, UK.
Paul ThiruchelvamBreast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK.
Katy HogbenBreast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK.
Ragheed Al-MuftiBreast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK.
Dimitri HadjiminasBreast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK.
Sami ShoushaBreast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK.
Ramsey CutressFaculty of Medicine, University of Southampton, Southampton, UK.
Hutan AshrafianDepartment of Surgery and Cancer, Imperial College London, London, UK.
Zoltan TakatsDepartment of Surgery and Cancer, Imperial College London, London, UK.
Daniel Richard LeffDepartment of Surgery and Cancer, Imperial College London, London, UK.
Charing Cross Hospital · GBImperial College London · GBUniversity of Southampton · GBWest London Mental Health NHS Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDuctal carcinoma in situ (DCIS) is associated with risk of positive resection margins following breast-conserving surgery (BCS) and subsequent reoperation. Prior reports grossly underestimate the risk of margin positivity with IBC containing a DCIS component (IBC + DCIS) due to patient-level rather than margin-level analysis.

objectiveThe aim of this study was to delineate the relative risk of IBC + DCIS compared with pure IBC (without a DCIS component) on margin positivity through detailed margin-level interrogation.

methodsA single institution, retrospective, observational cohort study was conducted in which pathology databases were evaluated to identify patients who underwent BCS over 5 years (2014-2019). Margin-level interrogation included granular detail into the extent, pathological subtype and grade of disease at each resection margin. Predictors of a positive margin were computed using multivariate regression analysis.

resultsClinicopathological details were examined from 5454 margins from 909 women. The relative risk of a positive margin with IBC + DCIS versus pure IBC was 8.76 (95% confidence interval [CI] 6.64-11.56) applying UK Association of Breast Surgery guidelines, and 8.44 (95% CI 6.57-10.84) applying the Society of Surgical Oncology/American Society for Radiation Oncology guidelines. Independent predictors of margin positivity included younger patient age (0.033, 95% CI 0.006-0.060), lower specimen weight (0.045, 95% CI 0.020-0.069), multifocality (0.256, 95% CI 0.137-0.376), lymphovascular invasion (0.138, 95% CI 0.068-0.208) and comedonecrosis (0.113, 95% CI 0.040-0.185).

conclusionsCompared with pure IBC, the relative risk of a positive margin with IBC + DCIS is approximately ninefold, significantly higher than prior estimates. This margin-level methodology is believed to represent the impact of DCIS more accurately on margin positivity in IBC.

Indexed as

Breast NeoplasmsCarcinoma, Intraductal, NoninfiltratingMargins of ExcisionMastectomy, SegmentalAdultAgedAged, 80 and overCarcinoma, Ductal, BreastFemaleFollow-Up StudiesHumansMiddle AgedPrognosisRetrospective StudiesBreast-conserving surgeryPositive margin predictors

Identifiers

PMID38520579
PMCPMC11076377
OpenAlexW4393119300

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.