Medical Student Research Fellowship for Summer 2009

Mentor: Roshni Rao, MD
Department: Surgery, Division of Surgical Oncology
Room number:E6222
Mail Code:9155
Phone number:214-648-5647
E-mail:Roshni.Rao@utsouthwestern.edu
Project title: Factors Influencing Re-excision Rates in Breast Conservation for Cancer

Human subjects IRB approved project number (where applicable):Pending, submitted for expedited review

Animal subjects IRB approved project number (where applicable):NA

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects) Patient-based

Brief Description of Project:
Purpose:
The purpose of this study is to:
1. Characterize the current rate of re-excision required for breast conservation performed for a diagnosis of breast cancer.
2. Identify what factors decrease the need for re-excision

Background:
One option in the current treatment of breast cancer involves surgical excision to negative margins followed by radiation therapy. This is a choice made by nearly half of all patients diagnosed with breast cancer in the United States(Morrow, White et al.). Recent studies, however, report a 30-50% need for a second operation in order to achieve adequate negative margins (Wiley, Diaz et al. 2003; Sabel, Rogers et al. 2009). Removal of additional tissue during the time of the initial operation may decrease re-excision rates (Marudanayagam, Singhal et al. 2008). These separate additional cavity margins, typically referred to as "shave" margins, are carefully oriented and sent for pathological analysis. In October of 2007, the primary investigator in this study routinely began taking shave margins in patients with breast cancer who were undergoing breast conservation therapy (BCT). The aim of this study is to determine whether there has been a decrease in the need for re-excisions with the shave margin protocol.

Concise Summary of Project:
Tumor registry data will identify all patients undergoing BCT between August 2005-January 2009. Retrospective review will then evaluate the need for additional operations beyond the initial surgery. Patient demographics, radiologic assessments, tumor characteristics, and surgical interventions will then be evaluated to determine their relationship with the need for re-excision. Patients will be separated into 2 groups depending on the date of surgery. We hypothesize that rates of re-excision will be lower in patients undergoing surgery after October of 2007 when compared to patients who underwent surgery prior to this date.

Study Procedures:
1. Tumor registry query to identify patients undergoing BCT between August 2005 to January 2009.
2. Retrospective review of charts with entry of information into a de-identfied Excel database. Data to be collected will include patient demographics, presenting complaint, radiologic analysis, pathological evaluation, treatment course, therapeutic outcome.
3. Statistical analysis of re-excision rates and correlation with factors contributing to need for re-excision.

References:
Morrow, M., J. White, et al. (2001). "Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma." J Clin Oncol 19(8): 2254-62.

Sabel, M. S., K. Rogers, et al. (2009). "Residual disease after re-excision lumpectomy for close margins." J Surg Oncol 99(2): 99-103.

Wiley, E. L., L. K. Diaz, et al. (2003). "Effect of time interval on residual disease in breast cancer." Am J Surg Pathol 27(2): 194-8.

Marudanayagam, R., R. Singhal, et al. (2008). "Effect of cavity shaving on reoperation rate following breast-conserving surgery." Breast J 14(6): 570-3.

Previous Research Activities or Publications with Medical Students:
This would be the first project done with a medical student. Prior presentations/publications with residents, pre-PA student, nurse practitioners and fellows (all in bold) that have been mentored include:

Ostapoff K MD, Moldrem A MD, Rao R MD Axillary Lymph Node Dissection performed utilizing Ultrasonic Dissection Versus Standard Hemostatic Clips and Electrocautery. Miami Breast Conference, March 4-7, 2009.

Rao, R. MD, Lilley, L. NP, Andrews, V. MD, Radford, L. MD, Ulissey, M. MD. Axillary Staging Utilizing Percutaneous Biopsy: Sensitivity of Fine Needle Aspiration Versus Core Needle Biopsy. Annals of Surgical Oncology DOI 10.1245/s10434-009-0421-9

Iyengar, R. MD, Saint-Cyr M. MD, Gokaslan, T MD, Rao R. MD. Breast Paraffinoma: A case report. The Breast Journal, 2008 Sep-Oct;14(5):504-5.

Lodrigues W NP, Dumas J BS, Lilley L, Rao R. National Surgical Quality Improvement Project (NSQIP) Date: A Call for Center Self-Evaluation. American Society of Breast Diseases, San Diego, CA, April 9-12, 2008.

Rao R. Moldrem A. Residual Tumor in Re-Excision Specimens: Correlation Between Time Interval and Degree of Inflammation. American College of Surgeons, Dallas, TX., February 22-23, 2008.

Ma A, Bowling M, Hatef D, Andrews V, Zogakis T, St. Cyr M, Rao R. Prediction of Post-operative Epidermolysis After Mastectomy: A Pilot Study Utilizing Optical Diffusion Imaging Spectroscopy, Miami Breast Conference, Miami FL, February 2007.