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Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards

Stephen Ali, Thomas Dobbs, Matt Jovic, Huw Strafford, Arron S. Lacey Orcid Logo, Namor Williams Orcid Logo, Owen Pickrell Orcid Logo, Hayley Hutchings Orcid Logo, Iain Whitaker

Journal of Plastic, Reconstructive and Aesthetic Surgery, Volume: 88, Pages: 443 - 451

Swansea University Authors: Stephen Ali, Thomas Dobbs, Matt Jovic, Huw Strafford, Arron S. Lacey Orcid Logo, Owen Pickrell Orcid Logo, Hayley Hutchings Orcid Logo, Iain Whitaker

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DOI (Published version): 10.1016/j.bjps.2023.10.106

Abstract

Introduction: Data supporting the current British Association of Dermatologists guidelines for the management of basal cell carcinoma (BCC) are based on historic studies and do not consider updated Royal College of Pathologists (RCPath) histological reporting standards. The aim of this study was to...

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Published in: Journal of Plastic, Reconstructive and Aesthetic Surgery
ISSN: 1748-6815
Published: Elsevier BV 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa64779
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Lacey</name><active>true</active><ethesisStudent>true</ethesisStudent></author><author><sid>1c3044b5ff7a6552ff5e8c9e3901c807</sid><ORCID>0000-0003-4396-5657</ORCID><firstname>Owen</firstname><surname>Pickrell</surname><name>Owen Pickrell</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>bdf5d5f154d339dd92bb25884b7c3652</sid><ORCID>0000-0003-4155-1741</ORCID><firstname>Hayley</firstname><surname>Hutchings</surname><name>Hayley Hutchings</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>830074c59291938a55b480dcbee4697e</sid><ORCID/><firstname>Iain</firstname><surname>Whitaker</surname><name>Iain Whitaker</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2023-10-19</date><deptcode>PMSC</deptcode><abstract>Introduction: Data supporting the current British Association of Dermatologists guidelines for the management of basal cell carcinoma (BCC) are based on historic studies and do not consider updated Royal College of Pathologists (RCPath) histological reporting standards. The aim of this study was to use natural language processing (NLP)-derived data and undertake a multivariate analysis with updated RCPath standards, providing a contemporary update on the excision margins required to achieve histological clearance in BCC. Methods: A validated NLP information extraction model was used to perform a rapid multi-centre, pan-specialty, consecutive retrospective analysis of BCCs over a 17-year period (2004-2021) managed with surgical excision using a pre-determined clinical margin at Swansea Bay University Health Board. Logistic regression assessed the relationship between the peripheral and deep margins and histological clearance. Results: We ran our NLP algorithm on 34,955 BCCs. Out of 1,447 BCCs meeting inclusion criteria, the peripheral margin clearance was not influenced by BCC risk level (p = 0.670). A clinical peripheral margin of 6 mm achieved a 95% histological clearance rate (95% CI, 0.93-0.98). Tumour thickness inversely affected deep margin histological clearance (OR 0.720, 95% CI, 0.525-0.991, p &lt; 0.05). Depth level 2 had a 97% probability of achieving deep margin histological clearance across all tumour thicknesses. Conclusion: Updated RCPath reporting standards minimally impact peripheral margin histological clearance in BCC. Larger clinical peripheral margins than current guidelines suggest may be necessary to achieve excision rates of ≥95%. These findings emphasise the need for continuous reassessment of clinical standards to enhance patient care.</abstract><type>Journal Article</type><journal>Journal of Plastic, Reconstructive and Aesthetic Surgery</journal><volume>88</volume><journalNumber/><paginationStart>443</paginationStart><paginationEnd>451</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1748-6815</issnPrint><issnElectronic/><keywords>Basal cell carcinoma, clinical margins, natural language processing, multivariate analysis, histological reporting guidelines, Royal College of Pathologists</keywords><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-01-01</publishedDate><doi>10.1016/j.bjps.2023.10.106</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PMSC</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>SRA and TDD are funded by the Welsh Clinical Academic Training Fellowship. ISW is the surgical Specialty Lead for Health and Care Research Wales, and reports active grants from the American Association of Plastic Surgeons and the European Association of Plastic Surgeons. SRA received a grant from the British Association of Plastic, Reconstructive and Aesthetic Surgeons specifically for this work. The Reconstructive Surgery &amp; Regenerative Medicine Research Centre is funded by The Scar Free Foundation and Health and Care Research Wales. The Scar Free Foundation is the only medical research charity focused on scarring with the mission to achieve scar free healing within a generation.</funders><projectreference/><lastEdited>2024-04-16T16:05:40.2231253</lastEdited><Created>2023-10-19T14:12:59.4136584</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Stephen</firstname><surname>Ali</surname><order>1</order></author><author><firstname>Thomas</firstname><surname>Dobbs</surname><order>2</order></author><author><firstname>Matt</firstname><surname>Jovic</surname><order>3</order></author><author><firstname>Huw</firstname><surname>Strafford</surname><order>4</order></author><author><firstname>Arron S.</firstname><surname>Lacey</surname><orcid>0000-0001-7983-8073</orcid><order>5</order></author><author><firstname>Namor</firstname><surname>Williams</surname><orcid>0009-0006-3264-0215</orcid><order>6</order></author><author><firstname>Owen</firstname><surname>Pickrell</surname><orcid>0000-0003-4396-5657</orcid><order>7</order></author><author><firstname>Hayley</firstname><surname>Hutchings</surname><orcid>0000-0003-4155-1741</orcid><order>8</order></author><author><firstname>Iain</firstname><surname>Whitaker</surname><orcid/><order>9</order></author></authors><documents><document><filename>64779__29274__83bf9fb9206d46688f31a44fa8d4ff83.pdf</filename><originalFilename>64779.VOR.pdf</originalFilename><uploaded>2023-12-15T16:18:13.9854427</uploaded><type>Output</type><contentLength>1886432</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 64779 2023-10-19 Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards 8c210736c07c6aa2514e0f6b3cfd9764 Stephen Ali Stephen Ali true false d18101ae0b4e72051f735ef68f45e1a8 Thomas Dobbs Thomas Dobbs true false c7bbcd83338d226f4c6157a682694a6d Matt Jovic Matt Jovic true false a6389fc6d4d18e7b67033ee04b381e43 Huw Strafford Huw Strafford true false 7af5c8bdd1197f85720e4f3d65e803eb 0000-0001-7983-8073 Arron S. Lacey Arron S. Lacey true true 1c3044b5ff7a6552ff5e8c9e3901c807 0000-0003-4396-5657 Owen Pickrell Owen Pickrell true false bdf5d5f154d339dd92bb25884b7c3652 0000-0003-4155-1741 Hayley Hutchings Hayley Hutchings true false 830074c59291938a55b480dcbee4697e Iain Whitaker Iain Whitaker true false 2023-10-19 PMSC Introduction: Data supporting the current British Association of Dermatologists guidelines for the management of basal cell carcinoma (BCC) are based on historic studies and do not consider updated Royal College of Pathologists (RCPath) histological reporting standards. The aim of this study was to use natural language processing (NLP)-derived data and undertake a multivariate analysis with updated RCPath standards, providing a contemporary update on the excision margins required to achieve histological clearance in BCC. Methods: A validated NLP information extraction model was used to perform a rapid multi-centre, pan-specialty, consecutive retrospective analysis of BCCs over a 17-year period (2004-2021) managed with surgical excision using a pre-determined clinical margin at Swansea Bay University Health Board. Logistic regression assessed the relationship between the peripheral and deep margins and histological clearance. Results: We ran our NLP algorithm on 34,955 BCCs. Out of 1,447 BCCs meeting inclusion criteria, the peripheral margin clearance was not influenced by BCC risk level (p = 0.670). A clinical peripheral margin of 6 mm achieved a 95% histological clearance rate (95% CI, 0.93-0.98). Tumour thickness inversely affected deep margin histological clearance (OR 0.720, 95% CI, 0.525-0.991, p < 0.05). Depth level 2 had a 97% probability of achieving deep margin histological clearance across all tumour thicknesses. Conclusion: Updated RCPath reporting standards minimally impact peripheral margin histological clearance in BCC. Larger clinical peripheral margins than current guidelines suggest may be necessary to achieve excision rates of ≥95%. These findings emphasise the need for continuous reassessment of clinical standards to enhance patient care. Journal Article Journal of Plastic, Reconstructive and Aesthetic Surgery 88 443 451 Elsevier BV 1748-6815 Basal cell carcinoma, clinical margins, natural language processing, multivariate analysis, histological reporting guidelines, Royal College of Pathologists 1 1 2024 2024-01-01 10.1016/j.bjps.2023.10.106 COLLEGE NANME Medicine COLLEGE CODE PMSC Swansea University SU Library paid the OA fee (TA Institutional Deal) SRA and TDD are funded by the Welsh Clinical Academic Training Fellowship. ISW is the surgical Specialty Lead for Health and Care Research Wales, and reports active grants from the American Association of Plastic Surgeons and the European Association of Plastic Surgeons. SRA received a grant from the British Association of Plastic, Reconstructive and Aesthetic Surgeons specifically for this work. The Reconstructive Surgery & Regenerative Medicine Research Centre is funded by The Scar Free Foundation and Health and Care Research Wales. The Scar Free Foundation is the only medical research charity focused on scarring with the mission to achieve scar free healing within a generation. 2024-04-16T16:05:40.2231253 2023-10-19T14:12:59.4136584 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Stephen Ali 1 Thomas Dobbs 2 Matt Jovic 3 Huw Strafford 4 Arron S. Lacey 0000-0001-7983-8073 5 Namor Williams 0009-0006-3264-0215 6 Owen Pickrell 0000-0003-4396-5657 7 Hayley Hutchings 0000-0003-4155-1741 8 Iain Whitaker 9 64779__29274__83bf9fb9206d46688f31a44fa8d4ff83.pdf 64779.VOR.pdf 2023-12-15T16:18:13.9854427 Output 1886432 application/pdf Version of Record true This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. true eng http://creativecommons.org/licenses/by/4.0/
title Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
spellingShingle Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
Stephen Ali
Thomas Dobbs
Matt Jovic
Huw Strafford
Arron S. Lacey
Owen Pickrell
Hayley Hutchings
Iain Whitaker
title_short Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
title_full Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
title_fullStr Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
title_full_unstemmed Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
title_sort Revisiting basal cell carcinoma clinical margins: Leveraging natural language processing and multivariate analysis with updated Royal College of Pathologists histological reporting standards
author_id_str_mv 8c210736c07c6aa2514e0f6b3cfd9764
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a6389fc6d4d18e7b67033ee04b381e43
7af5c8bdd1197f85720e4f3d65e803eb
1c3044b5ff7a6552ff5e8c9e3901c807
bdf5d5f154d339dd92bb25884b7c3652
830074c59291938a55b480dcbee4697e
author_id_fullname_str_mv 8c210736c07c6aa2514e0f6b3cfd9764_***_Stephen Ali
d18101ae0b4e72051f735ef68f45e1a8_***_Thomas Dobbs
c7bbcd83338d226f4c6157a682694a6d_***_Matt Jovic
a6389fc6d4d18e7b67033ee04b381e43_***_Huw Strafford
7af5c8bdd1197f85720e4f3d65e803eb_***_Arron S. Lacey
1c3044b5ff7a6552ff5e8c9e3901c807_***_Owen Pickrell
bdf5d5f154d339dd92bb25884b7c3652_***_Hayley Hutchings
830074c59291938a55b480dcbee4697e_***_Iain Whitaker
author Stephen Ali
Thomas Dobbs
Matt Jovic
Huw Strafford
Arron S. Lacey
Owen Pickrell
Hayley Hutchings
Iain Whitaker
author2 Stephen Ali
Thomas Dobbs
Matt Jovic
Huw Strafford
Arron S. Lacey
Namor Williams
Owen Pickrell
Hayley Hutchings
Iain Whitaker
format Journal article
container_title Journal of Plastic, Reconstructive and Aesthetic Surgery
container_volume 88
container_start_page 443
publishDate 2024
institution Swansea University
issn 1748-6815
doi_str_mv 10.1016/j.bjps.2023.10.106
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Introduction: Data supporting the current British Association of Dermatologists guidelines for the management of basal cell carcinoma (BCC) are based on historic studies and do not consider updated Royal College of Pathologists (RCPath) histological reporting standards. The aim of this study was to use natural language processing (NLP)-derived data and undertake a multivariate analysis with updated RCPath standards, providing a contemporary update on the excision margins required to achieve histological clearance in BCC. Methods: A validated NLP information extraction model was used to perform a rapid multi-centre, pan-specialty, consecutive retrospective analysis of BCCs over a 17-year period (2004-2021) managed with surgical excision using a pre-determined clinical margin at Swansea Bay University Health Board. Logistic regression assessed the relationship between the peripheral and deep margins and histological clearance. Results: We ran our NLP algorithm on 34,955 BCCs. Out of 1,447 BCCs meeting inclusion criteria, the peripheral margin clearance was not influenced by BCC risk level (p = 0.670). A clinical peripheral margin of 6 mm achieved a 95% histological clearance rate (95% CI, 0.93-0.98). Tumour thickness inversely affected deep margin histological clearance (OR 0.720, 95% CI, 0.525-0.991, p < 0.05). Depth level 2 had a 97% probability of achieving deep margin histological clearance across all tumour thicknesses. Conclusion: Updated RCPath reporting standards minimally impact peripheral margin histological clearance in BCC. Larger clinical peripheral margins than current guidelines suggest may be necessary to achieve excision rates of ≥95%. These findings emphasise the need for continuous reassessment of clinical standards to enhance patient care.
published_date 2024-01-01T16:05:36Z
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