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Because the DNA segments are cut and reorganized in a direction-specific manner, site-specific recombination has emerged as an efficient genetic engineering technique. Flippase and Cyclization recombinases or Flp and Cre, respectively, are two members of the tyrosine recombinase family derived from bacteriophages, that are used to mediate site-specific DNA insertions, deletions, and targeted expression of proteins in mammalian cell lines.
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Variability in reexcision following breast conservation surgery.

Laurence E McCahill1, Richard M Single, Erin J Aiello Bowles

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Reexcision rates after partial mastectomy for invasive breast cancer vary significantly between surgeons and hospitals. This variability may indicate differences in the quality of breast cancer surgery care.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Health Services Research

Background:

  • Healthcare reform emphasizes physician accountability and outcome transparency.
  • Partial mastectomy is a common procedure for invasive breast cancer, frequently necessitating reexcision.
  • Variability in reexcision rates may reflect disparities in the quality of surgical care.

Purpose of the Study:

  • To evaluate variations in reexcision rates following partial mastectomy.
  • To assess hospital and surgeon-specific differences in reexcision rates for invasive breast cancer.

Main Methods:

  • An observational study analyzed breast cancer surgeries from 2003-2008 across four institutions.
  • Data from electronic medical records and chart abstractions included surgical, pathology, and radiology details, focusing on surgical margin status.
  • Logistic regression with surgeon-level random effects identified predictors of reexcision.

Main Results:

  • Of 2220 invasive breast cancers, 22.9% required reexcision after partial mastectomy.
  • Reexcision rates varied widely among surgeons (0%-70%) and institutions (1.7%-20.9%) for patients with negative margins.
  • Reexcision rates were not associated with surgeon procedure volume after adjusting for case mix.

Conclusions:

  • Significant variation exists in reexcision rates among surgeons and institutions for partial mastectomy in invasive breast cancer.
  • These findings highlight potential quality variations in breast cancer surgical care that warrant further investigation.