Background The current study aim was to identify predictors of pathologic complete response (pCR) following neoadjuvant therapy. Methods From 2000-2007, 518 breast cancer patients received neoadjuvant therapy. Data were compared using Chi-square, Fisher’s exact test, and MANOVA, where appropriate. Results Of 518 breast cancer patients receiving neoadjuvant therapy, 81 (16%) had a pCR [77 of 456 (17%) chemotherapy; 4 of 62 (6%) endocrine therapy; p<0.05]. Four factors were associated with pCR: higher tumor grade (p=0.015), lack of estrogen and progesterone receptor (ER/PR) expression (p<0.0001), HER-2/neu amplification (p=0.025), and negative lymph node status (p<0.0001). On multivariate analysis, ER/PR negativity, HER-2/neu amplification, and negative lymph node status were found to significantly correlate with pCR. Conclusions Patients with ER/PR negative and Her-2/neu amplified breast cancer phenotypes are more likely to experience a pCR to neoadjuvant therapy. While a pCR is more frequently observed following neoadjuvant chemotherapy, it is rare following neoadjuvant endocrine therapy.

Background Margin status is a significant risk factor for local recurrence. We sought to examine whether the method of tumor localization predicted the margin status and the need for re-excision for both non-palpable and palpable breast cancer. Methods We identified 358 consecutive breast cancer patients who were treated with breast-conserving therapy (BCT) from 1999–2006. Data included patient and tumor characteristics, method of localization (needle versus palpation), and pathologic outcomes. Descriptive statistics were utilized for data summary and data were compared using Chi-square. Results Of 358 patients undergoing BCT, 234 (65%) underwent needle localization for a non-palpable tumor and 124 (35%) underwent a palpation-guided procedure. Patients undergoing palpation-guided procedures were younger and had larger tumors at a more advanced pathologic stage of disease than those undergoing needle localization procedures (p<0.05 for each). Patient race, tumor grade, presence of lymphovascular invasion, biomarker profile, and nodal status were not significantly different between the two groups (p>0.05). Overall, 137 (38%) patients had one or more positive margins; 90 of 234 (38%) who had a needle localization procedure and 47 of 124 (38%) who had a palpation-guided procedure (p>0.05). The number of margins affected did not differ significantly between the two groups. Conclusion Although patients with palpable breast cancer had larger tumors than those with non-palpable breast cancer, the incidence and number of positive margins was similar to those who had needle localization for non-palpable tumors. Improved methods of localization are needed to reduce the rate of positive margins and the need for re-excision.

Although palpable breast cancers can be excised based on direct palpation or needle localization, we believe that US guidance provides an excellent tool to aid the breast surgeon. Only 10% of patients had a positive margin on final pathology as a result, and the overall re-excision rate was acceptable.

Background We investigated factors associated with positive margins following mastectomy and the impact on outcomes. Methods We identified 240 patients with stage I-III invasive breast cancer who underwent mastectomy from 1999-2009. Data included patient and tumor characteristics, pathologic margin assessment, and outcomes. Margin positivity was defined as the presence of in situ or invasive malignancy present at any margin. Descriptive statistics were utilized for data summary and were compared using Chi-square. Results Of the 240 patients, 132 (55%) had a simple mastectomy with sentinel lymph node biopsy and 108 (45%) had a modified radical mastectomy. Overall, 21 (9%) patients had positive margins, including 12 (57%) with one positive margin, 3 (14%) with two positive margins, and 6 (29%) with three or more positive margins. The most commonly affected margin was the deep margin (48% of patients). Eight (38%) of the 21 patients received adjuvant chest wall irradiation. There were no differences between patients who had a positive margin versus those who did not with respect to patient age, race, percentage of in situ component, tumor size, tumor grade, lymphovascular invasion, or immunostain profile (p>0.05 for all). None of the patients with positive margins experienced a local recurrence. Conclusions Positive margins following mastectomy occurred in nearly 10% of our patients. No specific patient or tumor characteristics predicted a risk for having a positive margin. Despite the finding that only approximately 40% of patients received adjuvant radiation in the setting of a positive margin, no local recurrences have been observed.

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