Aims: To examine the correlation between margin and cavity biopsy status following conservative surgery for invasive breast cancer. Does cavity biopsy increase the detection of residual disease? Methods: In 510 patients who had conservative surgery for invasive breast cancer, four quadrant biopsies of the residual cavity were compared with the margin. Where repeat excision was performed, the presence of residual disease was recorded. Results: The margins were positive in 102 cases and the cavity in 112, but the concordance was only 57/157 cases (36 per cent). Simultaneously, clear margins and cavities were found in 353 cases (69 per cent). Cavity biopsy was the sole evidence of incomplete resection in 40 per cent of ductal and 19 per cent of lobular cancers. Evidence of residual disease after re‐excision was found in 33 per cent of ductal and 52 per cent of lobular cancers. Conclusion: There is poor correlation between margin status and cavity biopsy. Biopsy of the residual cavity after conservative surgery for breast cancer increases the detection of residual disease by 35 per cent.
Aims: To determine whether primary tumour characteristics of breast cancer – size, histological type, grade, vascular invasion (VI) and receptor status (ER) correlate with axillary nodal involvement. Can we select a group of breast cancer patients in whom axillary surgery can be safely avoided? Methods: A retrospective analysis of 1496 patients with breast cancer presenting between 1986 and 2001 was carried out. All patients had been treated by wide local excision/mastectomy as well as an axillary four‐node sample/level‐III clearance. Results: Five hundred and sixty (37.4 per cent) out of a total 1496 patients had metastases in axillary nodes. The following table shows the lymph node (LN) involvement compared with size, grade and VI. Univariate analysis showed VI [Pearson Chi‐square (pcs): 128.1; df: 2; P < 0.0001], size [pcs: 106.8; df: 4; P < 0.0001], grade [pcs: 39.9; df: 2; P < 0.0001] and ER status [pcs: 9.5; df: 2; P < 0.009] to correlate positively with positive LN status in decreasing order of strength. However, multivariate analysis showed that only VI and size independently predict LN positivity. Even tumours less than 5 mm had nodal involvement in over 10 per cent of cases. Only those tumours less than 4.5 mm diameter were free of nodal metastases (n = 22). Conclusions: Although axillary LN involvement correlated positively with size and vascular invasion, it would be unwise to presume negative axillary node status in any subgroup of invasive breast cancer.
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