title: Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?
abstract: OBJECTIVE
  Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates.
  
  
  METHODS
  We identified 1423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model.
  
  
  RESULTS
  Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level.
  
  
  CONCLUSIONS
  Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS.
authors.affiliation: Yale New Haven Hospital, New Haven, CT, USA. Electronic address: sarah.persing@yale.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Persing
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Mairin A
authors.initials: MA
authors.lastname: Jerome
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Ted A
authors.initials: TA
authors.lastname: James
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Callas
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: John
authors.initials: J
authors.lastname: Mace
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Sowden
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Goodwin
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
authors.affiliation: The University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D004282:Documentation / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018365:Neoplasm, Residual; D010336:Pathology / Q000592:standards; D017410:Practice Guidelines as Topic; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Breast cancer; Breast conserving surgery; Mastectomy; Partial mastectomy; Re-excision; Surgical margins