title: Factors influencing outcomes for breast conservation therapy of mammographically detected malignancies.
abstract: OBJECTIVE
  To evaluate the importance of surgeon caseload, lesion type, and biopsy type on outcomes in breast conservation therapy (BCT).
  
  
  BACKGROUND
  Breast conservation therapy has low rates of morbidity and mortality and is being performed with increasing frequency. Its primary advantage is cosmetic, and the amount of breast tissue resected is the main determinant of cosmetic outcomes.
  
  
  METHODS
  Two hundred seventeen consecutive patients undergoing breast conservation therapy at Northwestern Memorial Hospital for mammographically detected breast cancer were evaluated. The volume of tissue excised was compared with the volume of the tumor as a ratio. Univariate and multivariate analyses of the relationships between the specimen-to-tumor-volume ratio (STVR) and histologic diagnosis, biopsy type, surgeon caseload, and lesion type were examined.
  
  
  RESULTS
  The mean (log scale) STVR was significantly lower when the mammographic lesion was identified as a mass or architectural distortion versus calcifications (p < 0.001 in multivariate analysis). Mean log (STVR) was also decreased for higher-caseload surgeons (p = 0.02). Core biopsy before lumpectomy was associated with significantly increased mean log (STVR) (83 versus 50, p = 0.05) without significantly increasing the rate of negative margins.
  
  
  CONCLUSIONS
  Mammographic lesion type and biopsy method were associated with the amount of tissue excised relative to tumor size as measured by STVR. In addition, surgeons with higher caseloads were better able to perform needle localization lumpectomy to negative margins while limiting the volume of normal breast tissue excised.
authors.affiliation: Lynn Sage Breast Center, Department of Surgery, Division of Surgical Oncology, Northwestern University Medical School, 201 E. Huron Street, Galter 10-105, Chicago, IL 60611, USA
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Staradub
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000704:Analysis of Variance; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies