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BACKGROUND Breast conservative surgery (CS) with radiotherapy (RT) is the most commonly used treatment for early‐stage breast carcinoma. However, there is controversy regarding the importance of the pathologic margin status on the risk of ipsilateral breast tumor recurrence (IBTR). The current study evaluated the effect of the pathologic margin status on IBTR rates in a cohort of women with lymph node‐negative breast carcinoma treated with CS and RT. METHODS Between August 1980 and December 1994, 452 women with pathologically lymph node‐negative breast carcinoma were treated with CS and RT at Westmead Hospital (Westmead, Australia). Central pathology review was performed for all women. The final margins were negative for 352 women (77.9%), positive (invasive and/or in situ) for 42 women (9.3%), and indeterminate for 58 women (12.8%). Information regarding an extensive intraductal component (EIC), lymphovascular invasion, pathologic tumor size, histologic grade, and nuclear grade was available for most women. After macroscopic total excision of the tumor, all women received whole‐breast irradiation (usually 45–50.4 grays [Gy]) and the majority of women also received a local tumor bed boost (range, 8–30 Gy). RESULTS After a median follow‐up of 80 months, 34 women (7.5%) developed an IBTR. The crude 5‐year rates of IBTR for women with negative margins, positive margins, and indeterminate margins were 3.1%, 11.9%, and 6.9%, respectively. For women with negative margins, the 5‐year and 10‐year actuarial rates of freedom from IBTR were 96% and 92%, respectively, compared with 88% and 75%, respectively, for women with positive margins (P = 0.003). Univariate analysis demonstrated that the only factors associated with a significantly higher risk of IBTR were age at diagnosis (P < 0.050) and margin status (P = 0.005). Multivariate analysis showed that both age and margin status were independent predictors of IBTR. None of 24 patients with an EIC and negative margins were found to have developed an IBTR. CONCLUSIONS The results of the current study were comparable to other published reports and supported the association of higher IBTR rates with positive or indeterminate margins compared with negative, pathologic margins. Furthermore, young age (age < 35 years at diagnosis) was associated with the highest risk of IBTR regardless of margin status. Cancer 2004. © 2004 American Cancer Society.

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Adult perianal impalement injuries are uncommon but can carry high morbidity and mortality. We report a case of a penetrating perineal trauma in a construction worker highlighting an innovative use of a Sengstaken tube to control his pelvic bleeding, as well as the operative management of his sphincteric injury. This article illustrates principles of effective acute care and discusses a diagnostic approach to evaluating a potentially complex injury, as well as the decision-making process with regard to fecal diversion and choice of sphincteric repair.

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