Michael Dykstra MD , Jessica Thompson MD , Jessica Aldous BS , Shannon Jiang MD , Tasha Hughes MD, MPH , James Hayman MD, MBA , Aleksandar Dragovic MD , Jennifer Shah MD , Alfred Chang MD , Corey Speers MD, PhD , Michael Sabel MD , Lesly Dossett MD, MPH , Matthew Schipper PhD , Reshma Jagsi MD, DPhil
{"title":"导线与磁性种子定位对腔镜切除术腔室大小的影响","authors":"Michael Dykstra MD , Jessica Thompson MD , Jessica Aldous BS , Shannon Jiang MD , Tasha Hughes MD, MPH , James Hayman MD, MBA , Aleksandar Dragovic MD , Jennifer Shah MD , Alfred Chang MD , Corey Speers MD, PhD , Michael Sabel MD , Lesly Dossett MD, MPH , Matthew Schipper PhD , Reshma Jagsi MD, DPhil","doi":"10.1016/j.prro.2023.12.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p><span>Our purpose was to assess whether an association exists between surgical localization technique and lumpectomy cavity size on </span>radiation therapy planning computed tomography (CT) scan.</p></div><div><h3>Methods and Materials</h3><p>A single-institution retrospective review was conducted of women undergoing breast conserving surgery<span> with wire or magnetic seed guided lumpectomy followed by adjuvant radiation therapy from 2018 to 2021. Patients of a surgeon only performing 1 localization technique or undergoing bracketed localization were excluded. The primary outcome was lumpectomy cavity size on simulation CT. Confounding due to imbalance in patient and tumor factors was addressed with overlap weights derived from a propensity score analysis and used in a weighted multivariable analysis. Secondary outcomes included positive margins, total pathologic volume, boost delivery, and boost modality.</span></p></div><div><h3>Results</h3><p>Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Tumors of patients undergoing seed localization were more likely unifocal, assessable by ultrasound, and smaller. Seed use rates ranged from 27.7% to 70.7% per surgeon. There was no difference in positive margins (6.4 vs 5.4%, <em>P</em> = .79) or second surgeries (9.4 vs 8.1%, <em>P</em><span> = .79) between groups. Close margin rates were similar for ductal carcinoma in situ (</span><em>P</em><span> = .35) and invasive carcinoma (</span><em>P</em> = .97). In unadjusted bivariable analyses, wire localization was associated with larger total pathology volume (<em>P</em> = .004), but localization technique showed no association with CT cavity volume (<em>P</em> = .15). After adjusting for potentially confounding variables, multivariable analysis failed to show an association between localization technique and either CT cavity (<em>P</em> = .35) or total path volume (<em>P</em> = .08). There was no difference in indicated-boost delivery (<em>P</em> = .15) or electron boost (<em>P</em> = .14) by localization technique.</p></div><div><h3>Conclusions</h3><p>There was no significant difference in CT cavity size by localization technique, suggesting choice between surgical techniques does not impede radiation therapy boost delivery.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Effect of Wire Versus Magnetic Seed Localization on Lumpectomy Cavity Size\",\"authors\":\"Michael Dykstra MD , Jessica Thompson MD , Jessica Aldous BS , Shannon Jiang MD , Tasha Hughes MD, MPH , James Hayman MD, MBA , Aleksandar Dragovic MD , Jennifer Shah MD , Alfred Chang MD , Corey Speers MD, PhD , Michael Sabel MD , Lesly Dossett MD, MPH , Matthew Schipper PhD , Reshma Jagsi MD, DPhil\",\"doi\":\"10.1016/j.prro.2023.12.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p><span>Our purpose was to assess whether an association exists between surgical localization technique and lumpectomy cavity size on </span>radiation therapy planning computed tomography (CT) scan.</p></div><div><h3>Methods and Materials</h3><p>A single-institution retrospective review was conducted of women undergoing breast conserving surgery<span> with wire or magnetic seed guided lumpectomy followed by adjuvant radiation therapy from 2018 to 2021. Patients of a surgeon only performing 1 localization technique or undergoing bracketed localization were excluded. The primary outcome was lumpectomy cavity size on simulation CT. Confounding due to imbalance in patient and tumor factors was addressed with overlap weights derived from a propensity score analysis and used in a weighted multivariable analysis. Secondary outcomes included positive margins, total pathologic volume, boost delivery, and boost modality.</span></p></div><div><h3>Results</h3><p>Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Tumors of patients undergoing seed localization were more likely unifocal, assessable by ultrasound, and smaller. Seed use rates ranged from 27.7% to 70.7% per surgeon. There was no difference in positive margins (6.4 vs 5.4%, <em>P</em> = .79) or second surgeries (9.4 vs 8.1%, <em>P</em><span> = .79) between groups. Close margin rates were similar for ductal carcinoma in situ (</span><em>P</em><span> = .35) and invasive carcinoma (</span><em>P</em> = .97). In unadjusted bivariable analyses, wire localization was associated with larger total pathology volume (<em>P</em> = .004), but localization technique showed no association with CT cavity volume (<em>P</em> = .15). After adjusting for potentially confounding variables, multivariable analysis failed to show an association between localization technique and either CT cavity (<em>P</em> = .35) or total path volume (<em>P</em> = .08). There was no difference in indicated-boost delivery (<em>P</em> = .15) or electron boost (<em>P</em> = .14) by localization technique.</p></div><div><h3>Conclusions</h3><p>There was no significant difference in CT cavity size by localization technique, suggesting choice between surgical techniques does not impede radiation therapy boost delivery.</p></div>\",\"PeriodicalId\":54245,\"journal\":{\"name\":\"Practical Radiation Oncology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Practical Radiation Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1879850023003478\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Practical Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1879850023003478","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
The Effect of Wire Versus Magnetic Seed Localization on Lumpectomy Cavity Size
Purpose
Our purpose was to assess whether an association exists between surgical localization technique and lumpectomy cavity size on radiation therapy planning computed tomography (CT) scan.
Methods and Materials
A single-institution retrospective review was conducted of women undergoing breast conserving surgery with wire or magnetic seed guided lumpectomy followed by adjuvant radiation therapy from 2018 to 2021. Patients of a surgeon only performing 1 localization technique or undergoing bracketed localization were excluded. The primary outcome was lumpectomy cavity size on simulation CT. Confounding due to imbalance in patient and tumor factors was addressed with overlap weights derived from a propensity score analysis and used in a weighted multivariable analysis. Secondary outcomes included positive margins, total pathologic volume, boost delivery, and boost modality.
Results
Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Tumors of patients undergoing seed localization were more likely unifocal, assessable by ultrasound, and smaller. Seed use rates ranged from 27.7% to 70.7% per surgeon. There was no difference in positive margins (6.4 vs 5.4%, P = .79) or second surgeries (9.4 vs 8.1%, P = .79) between groups. Close margin rates were similar for ductal carcinoma in situ (P = .35) and invasive carcinoma (P = .97). In unadjusted bivariable analyses, wire localization was associated with larger total pathology volume (P = .004), but localization technique showed no association with CT cavity volume (P = .15). After adjusting for potentially confounding variables, multivariable analysis failed to show an association between localization technique and either CT cavity (P = .35) or total path volume (P = .08). There was no difference in indicated-boost delivery (P = .15) or electron boost (P = .14) by localization technique.
Conclusions
There was no significant difference in CT cavity size by localization technique, suggesting choice between surgical techniques does not impede radiation therapy boost delivery.
期刊介绍：
The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes:
Original articles focusing on patient safety, quality measurement, or quality improvement initiatives
Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues
ASTRO guidelines, position papers, and consensus statements
Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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