Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands
Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between J...
Gespeichert in:
| Veröffentlicht in: | Breast cancer research and treatment 2012-01, Vol.131 (2), p.691-698 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 698 |
|---|---|
| container_issue | 2 |
| container_start_page | 691 |
| container_title | Breast cancer research and treatment |
| container_volume | 131 |
| creator | van der Heiden-van der Loo, Margriet de Munck, Linda Visser, Otto Westenend, Pieter J. van Dalen, Thijs Menke, Marian B. Rutgers, Emiel J. Peeters, Petra H. |
| description | Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between July 1, 2008, and June 30, 2009, who underwent BCS as first surgery, were selected from the Netherlands Cancer Registry. Patients were treated in 96 hospitals. Maximum target values were 30% ‘focally positive’ or ‘more than focally positive’ for DCIS and 10% ‘more than focally positive’ for invasive carcinoma. Results per hospital are presented in funnel plots. For invasive carcinoma, multivariate logistic regression was used to adjust for case mix. Overall 28.5% (95% CI: 25.5–31.4%) of DCIS and 9.1% (95% CI: 8.4–9.8%) of invasive carcinoma had positive margins. Variation between hospitals was substantial. 6 and 10 hospitals, respectively, for DCIS and invasive cancer showed percentages above the upper limit of agreement. Case mix correction led to significant different conclusions for 5 hospitals. After case mix correction, 10 hospitals showed significant higher rates, while 7 hospitals showed significant lower rates. High rates were not related to breast cancer patient volume or type of hospital (teaching vs. non-teaching). Higher rates were related to hospitals where the policy is to aim for BCS instead of mastectomy. The overall percentage of positive margins in the Netherlands is within the predefined targets. The variation between hospitals is substantial but can be largely explained by coincidence. Case mix correction leads to relevant shifts. |
| doi_str_mv | 10.1007/s10549-011-1809-3 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_913720397</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A356581072</galeid><sourcerecordid>A356581072</sourcerecordid><originalsourceid>FETCH-LOGICAL-c531t-376cf3e41c2868b3f72e7d4b243b10e8b318e4c2c0fb4a118afc1394397f92733</originalsourceid><addsrcrecordid>eNp9kk1v1DAQhi0EokvhB3BBERUflxSPncTOsar4kiq4ANfI8Y53XWWdxXZA_fdMmoVSBMiSbY2fmfHMvIw9Bn4KnKtXCXhdtSUHKEHztpR32ApqJUslQN1lKw6NKhvNmyP2IKVLznmreHufHQloteJSr9j2i4neZD-Gosf8HTEU2zHtfTZDKnwo0hQ33pqh2Bm6hFQYlzEWzseUiz6iSbm0Y0gYv_mwucYxXs2eeYvFB6Q9Dias00N2z1FMfHQ4j9nnN68_nb8rLz6-fX9-dlHaWkIupWqsk1iBFbrRvXRKoFpXvahkDxzJAhorKyx3fWUAtHEWZFvJVrlWKCmP2Ysl7j6OXydMudv5ZHGgT-A4pa4FqQQnnMiX_yWpxVpTXtkQ-vQP9HKcYqA65ngS2rrWBJ0s0MYM2PngxhyNnWN2Z7Juag1cCaJO_0LRWuPOUyfRebLfcnj-m8MWzZC3aRymeWbpNggLaOOYUkTX7aOnsV1RJXMxqlv00pFeulkv3dytJ4fCpn6H618ePwVCwLMDYBLJwEUTrE83XF0J0VxzYuESPQXSwE2H_p39BxHp1T0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>913319558</pqid></control><display><type>article</type><title>Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>van der Heiden-van der Loo, Margriet ; de Munck, Linda ; Visser, Otto ; Westenend, Pieter J. ; van Dalen, Thijs ; Menke, Marian B. ; Rutgers, Emiel J. ; Peeters, Petra H.</creator><creatorcontrib>van der Heiden-van der Loo, Margriet ; de Munck, Linda ; Visser, Otto ; Westenend, Pieter J. ; van Dalen, Thijs ; Menke, Marian B. ; Rutgers, Emiel J. ; Peeters, Petra H.</creatorcontrib><description>Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between July 1, 2008, and June 30, 2009, who underwent BCS as first surgery, were selected from the Netherlands Cancer Registry. Patients were treated in 96 hospitals. Maximum target values were 30% ‘focally positive’ or ‘more than focally positive’ for DCIS and 10% ‘more than focally positive’ for invasive carcinoma. Results per hospital are presented in funnel plots. For invasive carcinoma, multivariate logistic regression was used to adjust for case mix. Overall 28.5% (95% CI: 25.5–31.4%) of DCIS and 9.1% (95% CI: 8.4–9.8%) of invasive carcinoma had positive margins. Variation between hospitals was substantial. 6 and 10 hospitals, respectively, for DCIS and invasive cancer showed percentages above the upper limit of agreement. Case mix correction led to significant different conclusions for 5 hospitals. After case mix correction, 10 hospitals showed significant higher rates, while 7 hospitals showed significant lower rates. High rates were not related to breast cancer patient volume or type of hospital (teaching vs. non-teaching). Higher rates were related to hospitals where the policy is to aim for BCS instead of mastectomy. The overall percentage of positive margins in the Netherlands is within the predefined targets. The variation between hospitals is substantial but can be largely explained by coincidence. Case mix correction leads to relevant shifts.</description><identifier>ISSN: 0167-6806</identifier><identifier>EISSN: 1573-7217</identifier><identifier>DOI: 10.1007/s10549-011-1809-3</identifier><identifier>PMID: 21987038</identifier><identifier>CODEN: BCTRD6</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Breast cancer ; Breast Neoplasms - epidemiology ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Cancer ; Cancer research ; Cancer therapies ; Epidemiology ; Female ; Football (College) ; Gynecology. Andrology. Obstetrics ; Hospitals ; Humans ; Lumpectomy ; Mammary gland diseases ; Mastectomy, Segmental - standards ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Staging ; Netherlands - epidemiology ; Oncology ; Quality of care ; Risk Factors ; surgery ; Surgical techniques ; Tumors</subject><ispartof>Breast cancer research and treatment, 2012-01, Vol.131 (2), p.691-698</ispartof><rights>Springer Science+Business Media, LLC. 2011</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Springer</rights><rights>Springer Science+Business Media, LLC. 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c531t-376cf3e41c2868b3f72e7d4b243b10e8b318e4c2c0fb4a118afc1394397f92733</citedby><cites>FETCH-LOGICAL-c531t-376cf3e41c2868b3f72e7d4b243b10e8b318e4c2c0fb4a118afc1394397f92733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10549-011-1809-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10549-011-1809-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25422638$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21987038$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Heiden-van der Loo, Margriet</creatorcontrib><creatorcontrib>de Munck, Linda</creatorcontrib><creatorcontrib>Visser, Otto</creatorcontrib><creatorcontrib>Westenend, Pieter J.</creatorcontrib><creatorcontrib>van Dalen, Thijs</creatorcontrib><creatorcontrib>Menke, Marian B.</creatorcontrib><creatorcontrib>Rutgers, Emiel J.</creatorcontrib><creatorcontrib>Peeters, Petra H.</creatorcontrib><title>Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands</title><title>Breast cancer research and treatment</title><addtitle>Breast Cancer Res Treat</addtitle><addtitle>Breast Cancer Res Treat</addtitle><description>Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between July 1, 2008, and June 30, 2009, who underwent BCS as first surgery, were selected from the Netherlands Cancer Registry. Patients were treated in 96 hospitals. Maximum target values were 30% ‘focally positive’ or ‘more than focally positive’ for DCIS and 10% ‘more than focally positive’ for invasive carcinoma. Results per hospital are presented in funnel plots. For invasive carcinoma, multivariate logistic regression was used to adjust for case mix. Overall 28.5% (95% CI: 25.5–31.4%) of DCIS and 9.1% (95% CI: 8.4–9.8%) of invasive carcinoma had positive margins. Variation between hospitals was substantial. 6 and 10 hospitals, respectively, for DCIS and invasive cancer showed percentages above the upper limit of agreement. Case mix correction led to significant different conclusions for 5 hospitals. After case mix correction, 10 hospitals showed significant higher rates, while 7 hospitals showed significant lower rates. High rates were not related to breast cancer patient volume or type of hospital (teaching vs. non-teaching). Higher rates were related to hospitals where the policy is to aim for BCS instead of mastectomy. The overall percentage of positive margins in the Netherlands is within the predefined targets. The variation between hospitals is substantial but can be largely explained by coincidence. Case mix correction leads to relevant shifts.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - epidemiology</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer</subject><subject>Cancer research</subject><subject>Cancer therapies</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Football (College)</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Lumpectomy</subject><subject>Mammary gland diseases</subject><subject>Mastectomy, Segmental - standards</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Netherlands - epidemiology</subject><subject>Oncology</subject><subject>Quality of care</subject><subject>Risk Factors</subject><subject>surgery</subject><subject>Surgical techniques</subject><subject>Tumors</subject><issn>0167-6806</issn><issn>1573-7217</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk1v1DAQhi0EokvhB3BBERUflxSPncTOsar4kiq4ANfI8Y53XWWdxXZA_fdMmoVSBMiSbY2fmfHMvIw9Bn4KnKtXCXhdtSUHKEHztpR32ApqJUslQN1lKw6NKhvNmyP2IKVLznmreHufHQloteJSr9j2i4neZD-Gosf8HTEU2zHtfTZDKnwo0hQ33pqh2Bm6hFQYlzEWzseUiz6iSbm0Y0gYv_mwucYxXs2eeYvFB6Q9Dias00N2z1FMfHQ4j9nnN68_nb8rLz6-fX9-dlHaWkIupWqsk1iBFbrRvXRKoFpXvahkDxzJAhorKyx3fWUAtHEWZFvJVrlWKCmP2Ysl7j6OXydMudv5ZHGgT-A4pa4FqQQnnMiX_yWpxVpTXtkQ-vQP9HKcYqA65ngS2rrWBJ0s0MYM2PngxhyNnWN2Z7Juag1cCaJO_0LRWuPOUyfRebLfcnj-m8MWzZC3aRymeWbpNggLaOOYUkTX7aOnsV1RJXMxqlv00pFeulkv3dytJ4fCpn6H618ePwVCwLMDYBLJwEUTrE83XF0J0VxzYuESPQXSwE2H_p39BxHp1T0</recordid><startdate>20120101</startdate><enddate>20120101</enddate><creator>van der Heiden-van der Loo, Margriet</creator><creator>de Munck, Linda</creator><creator>Visser, Otto</creator><creator>Westenend, Pieter J.</creator><creator>van Dalen, Thijs</creator><creator>Menke, Marian B.</creator><creator>Rutgers, Emiel J.</creator><creator>Peeters, Petra H.</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7ST</scope><scope>C1K</scope><scope>SOI</scope><scope>7X8</scope></search><sort><creationdate>20120101</creationdate><title>Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands</title><author>van der Heiden-van der Loo, Margriet ; de Munck, Linda ; Visser, Otto ; Westenend, Pieter J. ; van Dalen, Thijs ; Menke, Marian B. ; Rutgers, Emiel J. ; Peeters, Petra H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c531t-376cf3e41c2868b3f72e7d4b243b10e8b318e4c2c0fb4a118afc1394397f92733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - epidemiology</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Cancer</topic><topic>Cancer research</topic><topic>Cancer therapies</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Football (College)</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Lumpectomy</topic><topic>Mammary gland diseases</topic><topic>Mastectomy, Segmental - standards</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Netherlands - epidemiology</topic><topic>Oncology</topic><topic>Quality of care</topic><topic>Risk Factors</topic><topic>surgery</topic><topic>Surgical techniques</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Heiden-van der Loo, Margriet</creatorcontrib><creatorcontrib>de Munck, Linda</creatorcontrib><creatorcontrib>Visser, Otto</creatorcontrib><creatorcontrib>Westenend, Pieter J.</creatorcontrib><creatorcontrib>van Dalen, Thijs</creatorcontrib><creatorcontrib>Menke, Marian B.</creatorcontrib><creatorcontrib>Rutgers, Emiel J.</creatorcontrib><creatorcontrib>Peeters, Petra H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Proquest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Environment Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Environment Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Breast cancer research and treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Heiden-van der Loo, Margriet</au><au>de Munck, Linda</au><au>Visser, Otto</au><au>Westenend, Pieter J.</au><au>van Dalen, Thijs</au><au>Menke, Marian B.</au><au>Rutgers, Emiel J.</au><au>Peeters, Petra H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands</atitle><jtitle>Breast cancer research and treatment</jtitle><stitle>Breast Cancer Res Treat</stitle><addtitle>Breast Cancer Res Treat</addtitle><date>2012-01-01</date><risdate>2012</risdate><volume>131</volume><issue>2</issue><spage>691</spage><epage>698</epage><pages>691-698</pages><issn>0167-6806</issn><eissn>1573-7217</eissn><coden>BCTRD6</coden><abstract>Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between July 1, 2008, and June 30, 2009, who underwent BCS as first surgery, were selected from the Netherlands Cancer Registry. Patients were treated in 96 hospitals. Maximum target values were 30% ‘focally positive’ or ‘more than focally positive’ for DCIS and 10% ‘more than focally positive’ for invasive carcinoma. Results per hospital are presented in funnel plots. For invasive carcinoma, multivariate logistic regression was used to adjust for case mix. Overall 28.5% (95% CI: 25.5–31.4%) of DCIS and 9.1% (95% CI: 8.4–9.8%) of invasive carcinoma had positive margins. Variation between hospitals was substantial. 6 and 10 hospitals, respectively, for DCIS and invasive cancer showed percentages above the upper limit of agreement. Case mix correction led to significant different conclusions for 5 hospitals. After case mix correction, 10 hospitals showed significant higher rates, while 7 hospitals showed significant lower rates. High rates were not related to breast cancer patient volume or type of hospital (teaching vs. non-teaching). Higher rates were related to hospitals where the policy is to aim for BCS instead of mastectomy. The overall percentage of positive margins in the Netherlands is within the predefined targets. The variation between hospitals is substantial but can be largely explained by coincidence. Case mix correction leads to relevant shifts.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>21987038</pmid><doi>10.1007/s10549-011-1809-3</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0167-6806 |
| ispartof | Breast cancer research and treatment, 2012-01, Vol.131 (2), p.691-698 |
| issn | 0167-6806 1573-7217 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_913720397 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Breast cancer Breast Neoplasms - epidemiology Breast Neoplasms - pathology Breast Neoplasms - surgery Cancer Cancer research Cancer therapies Epidemiology Female Football (College) Gynecology. Andrology. Obstetrics Hospitals Humans Lumpectomy Mammary gland diseases Mastectomy, Segmental - standards Medical sciences Medicine Medicine & Public Health Middle Aged Neoplasm Staging Netherlands - epidemiology Oncology Quality of care Risk Factors surgery Surgical techniques Tumors |
| title | Variation between hospitals in surgical margins after first breast-conserving surgery in the Netherlands |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-22T05%3A08%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Variation%20between%20hospitals%20in%20surgical%20margins%20after%20first%20breast-conserving%20surgery%20in%20the%20Netherlands&rft.jtitle=Breast%20cancer%20research%20and%20treatment&rft.au=van%20der%20Heiden-van%20der%20Loo,%20Margriet&rft.date=2012-01-01&rft.volume=131&rft.issue=2&rft.spage=691&rft.epage=698&rft.pages=691-698&rft.issn=0167-6806&rft.eissn=1573-7217&rft.coden=BCTRD6&rft_id=info:doi/10.1007/s10549-011-1809-3&rft_dat=%3Cgale_proqu%3EA356581072%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=913319558&rft_id=info:pmid/21987038&rft_galeid=A356581072&rfr_iscdi=true |