10th June 2015 at 1:10 pm #7704
The LSRG is setting up a national margins audit on invasive breast cancer.
The recommended margin width following breast conservation therapy in the UK is not clearly defined and considerable variation in accepted margin diameter is seen in units across the country.
In the NICE guidelines for early and locally advanced breast cancer (NICE, 2009), the margin clearance for DCIS is defined at 2mm but a recommendation for the minimum margin width for invasive disease is not made. The London Cancer Alliance Breast Cancer guidelines from October 2013 state that radial margins must comply with the local MDT standard. These guidelines also state that there are no data to support a specific margin of excision but it should be at least greater or equal to 1mm (LCA, 2013)
WHY DO WE NEED A NATIONAL AUDIT FOR MARGINS IN BCS?
Current practice in the UK is variable. In the light of the recent metanalysis on margins and the adoption of “clear at the inked margin” as the standard by the Society of Surgical Oncology and American Society for Radiation Oncology in 2014, even local guidelines including that of the LCA (equal or greater than 1mm) can be considered out of date.
Excessively wide margins may have a detrimental impact on patient outcome. There may be a cosmetic penalty which may be further impacted by radiotherapy. Further procedures such at lipomodelling may be required to address this at additional cost to the NHS. Patients undergoing margin re-excision may suffer worsening cosmesis (when previously considered acceptable) and are placed at an increased risk wound infection, chronic pain, seroma, poor scarring and anaesthetic complications. The process of margin re-excision raises patient anxiety, and places additional burden on already busy theatre lists and may delay the onset of adjuvant treatment. Additional costs are associated with a second (or third) anaesthetic, a hospital bed and further histological analysis.26th February 2016 at 5:16 pm #8080
We have had a great response to the National Margins Audit. 139 investigators in 105 breast units have registered. Data collection started on the 1st February and is going well. A full list of units and investigators can be found on the project page.
25th May 2016 at 5:52 pm #8109
- This reply was modified 3 years, 4 months ago by stang.
NATIONAL MARGINS AUDIT UPDATE 25th May 2016
As we enter our final week of the audit period, I would like to encourage you to make a final push in your data entries.
We have already achieved so much with 1700 entries already in REDCap and a further 100 entries made on paper proformas. It would be great if we could approach our target of 2000 entries making this the largest national prospective study on margins in the UK and one of the largest studies internationally on margins following ASCO’s endorsement of the SSO/ASTRO guidelines.
While the overall number of entries is impressive, this has partly been a result of some centres contributing very large numbers. Our data will be much more meaningful and a true national study if we can maximise the number of units in the study.
Of the 100 units that registered, 70 have entered data into REDCap. Some of these 70 units have entered quite small numbers and will be contacted by a member of the London Surgical Research Group in the next few days to establish whether it is still possible to reach the 20 patient target. Particularly for smaller units, we appreciate that case volume may be low and your data will be considered in the study if has been collected in a consecutive manner and is a true reflection of the case load. You will be able to see from the bar chart in the project webpage (in “downloads”), how your unit stands compared to others (http://lsrg.org.uk/projects/national-margins-audit/) .
For units that have not entered data, there is still time to enter data on the target of 20 consecutive patients. Your contribution will add real weight to the study and I strongly encourage you to do this!
If it is not possible to contribute patient data, then completion of the UNIT QUESTIONNAIRE will be immensely valuable to the study. The questionnaire should not take any more than 5 minutes of your time.
In this final week, please try to upload any outstanding data into REDCap. Senior investigators should undergo a process of validating entries by junior investigators. REDCap will remain live for capturing data on margin re-excisions until July 2016 but we ask that you complete data on all other patients in the next 2 weeks.
Well done everyone and I look forward to analysing our data!
National Margins Audit Lead
On behalf of the London Surgical Research Group19th August 2016 at 2:52 pm #8188JamesKeymaster
The National Margin’s Audit data collection phase is now complete. On behalf of the London Surgical Research Group, I would like to thank the investigators from 74 hospitals who have contributed over 2900 data sets. This is an excellent example of how successful collaborative work on a national level can be!
Our first priority is to extract data from the unit questionnaires and a review of national variation in margin practice will be submitted for publication hopefully in September. Of the 74 hospitals, we are still missing questionnaires from 15 hospitals. Investigators who have submitted margin data but not questionnaires should do so immediately.
For those who are interested in the study but have not taken part yet, it is still possible to contribute to the review in variation in practice by completing a unit questionnaire. Please contact Sarah directly on firstname.lastname@example.org . More information on the study can be found on our website lsrg.org.uk/projects/national-margins-audit .
Miss Sarah Tang
Consultant Oncoplastic Breast Surgeon
St Georges Hospital, London
National Margins Audit Lead, London Surgical Research Group14th July 2018 at 12:28 am #9318adminMember
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