- Email: [email protected]
21. Assessing technical skills in oncoplastic breast surgery: Procedure specific global rating scales for wide local excision are construct valid
ABSTRACTS
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accurate short-term estimates. Prediction in the short-term may be most relevant for the increasing number of women considering risk-reducing bilateral mastectomy. Acknowledgements: Funding for data collection/analysis of the POSH study by CRUK (grants A7572, A11699, C1275/A15956). Study sponsored by UHS NHS
Foundation Trust. We also thank the NIHR NCRN for supporting patient recruitment and all participating patients. http://dx.doi.org/10.1016/j.ejso.2015.03.020
Monday 15th June 2015, Session 12 Submitted Papers. 17:00 to 18:30 20. Breast surgeons’ attitudes towards bilateral risk reducing mastectomy e A comparison between the UK, the US, France and Germany Narendra Nath Basu1, M. Den-Heijer3, C.J. Van Asperen4, H. Harris5, I. Nippert6, F. Schmidtke7, A.D. Bouhnik8, C. Julian-Reynier8, A. Tibben4, D. Gareth Evans2 1 Queen Elizabeth Hospital, Birmingham, UK 2 St Mary’s Hospital, Manchester, UK 3 Erasmus Medical Centre, Rotterdam, The Netherlands 4 Leiden University Medical Centre, Leiden, The Netherlands 5 University of Manchester, Manchester, UK 6 M€ unster Medical School, M€unster, Germany 7 Hanover Medical School, Hanover, Germany 8 Aix-Marseille Universite, Marseille, France Introduction: Bilateral risk-reducing mastectomy (BRRM) confers the greatest risk-reduction in women at high-risk of developing breast cancer. Uptake of BRRM is influenced by the attitudes of these women as well as the breast surgeons offering these procedures. We followed up an international study to assess any differences amongst breast surgeons in the US and 4 countries in Europe. Methods: An International Cancer Risk Communication Study (InCRisC) questionnaire was sent to 5941 breast surgeons (US n ¼ 2648, Europe n ¼ 3293). Personal and occupational characteristics were recorded and knowledge of cancer genetics and attitudes to BRRM were assessed using clinical vignettes. Results: 1660 breast surgeons responded (US n ¼ 439, Europe n ¼ 1221). 98% of surgeons from the US actively took a family history of the father, compared to 90% in the UK and Netherlands, with only 72% and 57% from Germany and France respectively. Country of residence and knowledge of breast genetics was associated with a positive attitude towards BRRM. Almost 100% of US and Dutch surgeons reported a positive attitude towards BRRM, followed by 97% in the UK, 78% in France and lowest in Germany (66%). US surgeons were most likely to order BRCA testing (70%) compared to 26% in the UK and 57% in Germany. Over 50% of UK surgeons would definitely not request BRCA testing. Discussion: Considerable variation in attitudes towards BRRM exists between Europe and the US. This variation is multi-factorial based on cultural and professional experiences but ultimately objective evidence should govern surgeons and their attitudes towards risk-reducing surgery. http://dx.doi.org/10.1016/j.ejso.2015.03.021
21. Assessing technical skills in oncoplastic breast surgery: Procedure specific global rating scales for wide local excision are construct valid Daniel Leff, George Petrou, Stella Mavrovelli, Monica Bersihand, Daniel Cocker, Ragheed Al-Mufti, Ara Darzi, George Hanna, Dimitri Hadjiminas Imperial College London, London, UK Introduction: Simulation enables safe deliberate-practice and facilitates objective assessment of technical skills. However, before assessments
on simulators can be incorporated into trainee review of progress and competence, reliability and validity needs to be demonstrated. Construct validity is the ability of the simulator to differentiate experienced from inexperienced surgeons. The aim was to evaluate construct validity of assessments of technical skills in oncoplastic wide local excision (WLE). Methods: Thirty-four surgeons (expert surgeons ¼ 12; specialty trainees (ST) ¼ 12; core trainees (CT) ¼ 10) performed a wide local excision of 25mm palpable breast lesion located 30mm from the nipple areolar complex in the 3 ‘o’ clock position, on an in-house synthetic breast simulator. Procedures were video taped (blinded) and were retrospectively reviewed and independently rated against procedure-specific global ratings of performance (VAS) by two expert breast surgeons. Specimen radiographs were obtained and macroscopic distance (mm) from “tumour” to resection margin in four cardinal directions was recorded. Specimen weights (g) and whether visible “tumour” was evident at the resection margin (Y/N) was recorded. Results: Video based rating scores varied hierarchically depending on operator expertise (p < 0.05). Statistically significant differences were observed on pair-wise comparisons between each grade of surgeon for scores in ‘exposure’, ‘skin flap development’, ‘glandular remodelling’, ‘skin closure’ and ‘final product’ review (p < 0.05). There was no significant difference in specimen weights between operator grades, although specimen weights in CTs were lighter on average [median weight (g) experts ¼ 38.0, ST ¼ 39.4, CT ¼ 31.0, p ¼ 0.172]. Compared to experts (median ¼ 9mm), wider margins were observed amongst STs (median ¼ 12.5mm) and narrower amongst CTs (median ¼ 7.1mm), p ¼ 0.001. There was no significant difference between experience groups in the frequency of macroscopic margin positivity (X2 ¼ 0.223, p ¼ 0.203). Conclusion: Specimen weights, and gross margin positivity did not significantly differentiate between operators. However, video ratings of performance do differentiate operators based on technical skills in WLE and may be used for trainee assessment. http://dx.doi.org/10.1016/j.ejso.2015.03.022
22. Partial breast reconstruction: An alternative to mastectomy? Alexandra Tenovici, Asha Adwani, Ruth James, Pankaj Roy Oxford University Hospitals NHS Trust, Oxford, UK Redundant skin folds on the lateral chest wall are suitable donor sites for partial breast reconstruction in women with outer quadrant tumours in small-moderate, non-ptotic breasts. We have performed partial breast reconstruction with lateral chest wall perforator flaps over last three-years in women with breast cancers where wide local excision would have resulted in poor aesthetic outcome. Data on clinicopathological features, complications and aesthetic outcome were collected prospectively. Patients were asked to complete an anonymised Body Image Scale. A visual analogue scale evaluating cosmetic results was completed by two observers. 29 patients underwent surgery involving perforator flaps. All except 1 received radiotherapy. The median size of the tumour on pre-operative imaging was 35 mm. Adequate radial margins were achieved in all but two
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accurate short-term estimates. Prediction in the short-term may be most relevant for the increasing number of women considering risk-reducing bilateral mastectomy. Acknowledgements: Funding for data collection/analysis of the POSH study by CRUK (grants A7572, A11699, C1275/A15956). Study sponsored by UHS NHS
Foundation Trust. We also thank the NIHR NCRN for supporting patient recruitment and all participating patients. http://dx.doi.org/10.1016/j.ejso.2015.03.020
Monday 15th June 2015, Session 12 Submitted Papers. 17:00 to 18:30 20. Breast surgeons’ attitudes towards bilateral risk reducing mastectomy e A comparison between the UK, the US, France and Germany Narendra Nath Basu1, M. Den-Heijer3, C.J. Van Asperen4, H. Harris5, I. Nippert6, F. Schmidtke7, A.D. Bouhnik8, C. Julian-Reynier8, A. Tibben4, D. Gareth Evans2 1 Queen Elizabeth Hospital, Birmingham, UK 2 St Mary’s Hospital, Manchester, UK 3 Erasmus Medical Centre, Rotterdam, The Netherlands 4 Leiden University Medical Centre, Leiden, The Netherlands 5 University of Manchester, Manchester, UK 6 M€ unster Medical School, M€unster, Germany 7 Hanover Medical School, Hanover, Germany 8 Aix-Marseille Universite, Marseille, France Introduction: Bilateral risk-reducing mastectomy (BRRM) confers the greatest risk-reduction in women at high-risk of developing breast cancer. Uptake of BRRM is influenced by the attitudes of these women as well as the breast surgeons offering these procedures. We followed up an international study to assess any differences amongst breast surgeons in the US and 4 countries in Europe. Methods: An International Cancer Risk Communication Study (InCRisC) questionnaire was sent to 5941 breast surgeons (US n ¼ 2648, Europe n ¼ 3293). Personal and occupational characteristics were recorded and knowledge of cancer genetics and attitudes to BRRM were assessed using clinical vignettes. Results: 1660 breast surgeons responded (US n ¼ 439, Europe n ¼ 1221). 98% of surgeons from the US actively took a family history of the father, compared to 90% in the UK and Netherlands, with only 72% and 57% from Germany and France respectively. Country of residence and knowledge of breast genetics was associated with a positive attitude towards BRRM. Almost 100% of US and Dutch surgeons reported a positive attitude towards BRRM, followed by 97% in the UK, 78% in France and lowest in Germany (66%). US surgeons were most likely to order BRCA testing (70%) compared to 26% in the UK and 57% in Germany. Over 50% of UK surgeons would definitely not request BRCA testing. Discussion: Considerable variation in attitudes towards BRRM exists between Europe and the US. This variation is multi-factorial based on cultural and professional experiences but ultimately objective evidence should govern surgeons and their attitudes towards risk-reducing surgery. http://dx.doi.org/10.1016/j.ejso.2015.03.021
21. Assessing technical skills in oncoplastic breast surgery: Procedure specific global rating scales for wide local excision are construct valid Daniel Leff, George Petrou, Stella Mavrovelli, Monica Bersihand, Daniel Cocker, Ragheed Al-Mufti, Ara Darzi, George Hanna, Dimitri Hadjiminas Imperial College London, London, UK Introduction: Simulation enables safe deliberate-practice and facilitates objective assessment of technical skills. However, before assessments
on simulators can be incorporated into trainee review of progress and competence, reliability and validity needs to be demonstrated. Construct validity is the ability of the simulator to differentiate experienced from inexperienced surgeons. The aim was to evaluate construct validity of assessments of technical skills in oncoplastic wide local excision (WLE). Methods: Thirty-four surgeons (expert surgeons ¼ 12; specialty trainees (ST) ¼ 12; core trainees (CT) ¼ 10) performed a wide local excision of 25mm palpable breast lesion located 30mm from the nipple areolar complex in the 3 ‘o’ clock position, on an in-house synthetic breast simulator. Procedures were video taped (blinded) and were retrospectively reviewed and independently rated against procedure-specific global ratings of performance (VAS) by two expert breast surgeons. Specimen radiographs were obtained and macroscopic distance (mm) from “tumour” to resection margin in four cardinal directions was recorded. Specimen weights (g) and whether visible “tumour” was evident at the resection margin (Y/N) was recorded. Results: Video based rating scores varied hierarchically depending on operator expertise (p < 0.05). Statistically significant differences were observed on pair-wise comparisons between each grade of surgeon for scores in ‘exposure’, ‘skin flap development’, ‘glandular remodelling’, ‘skin closure’ and ‘final product’ review (p < 0.05). There was no significant difference in specimen weights between operator grades, although specimen weights in CTs were lighter on average [median weight (g) experts ¼ 38.0, ST ¼ 39.4, CT ¼ 31.0, p ¼ 0.172]. Compared to experts (median ¼ 9mm), wider margins were observed amongst STs (median ¼ 12.5mm) and narrower amongst CTs (median ¼ 7.1mm), p ¼ 0.001. There was no significant difference between experience groups in the frequency of macroscopic margin positivity (X2 ¼ 0.223, p ¼ 0.203). Conclusion: Specimen weights, and gross margin positivity did not significantly differentiate between operators. However, video ratings of performance do differentiate operators based on technical skills in WLE and may be used for trainee assessment. http://dx.doi.org/10.1016/j.ejso.2015.03.022
22. Partial breast reconstruction: An alternative to mastectomy? Alexandra Tenovici, Asha Adwani, Ruth James, Pankaj Roy Oxford University Hospitals NHS Trust, Oxford, UK Redundant skin folds on the lateral chest wall are suitable donor sites for partial breast reconstruction in women with outer quadrant tumours in small-moderate, non-ptotic breasts. We have performed partial breast reconstruction with lateral chest wall perforator flaps over last three-years in women with breast cancers where wide local excision would have resulted in poor aesthetic outcome. Data on clinicopathological features, complications and aesthetic outcome were collected prospectively. Patients were asked to complete an anonymised Body Image Scale. A visual analogue scale evaluating cosmetic results was completed by two observers. 29 patients underwent surgery involving perforator flaps. All except 1 received radiotherapy. The median size of the tumour on pre-operative imaging was 35 mm. Adequate radial margins were achieved in all but two