Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Lin, Joseph; Lin, Kuo-Juei; Wang, Yu Fen; Huang, Ling; Chen, Sam Li Sheng; Chen, Dar Ren

doi:10.1186/s12885-020-06955-6

Cited by 12 publications

(8 citation statements)

References 32 publications

(47 reference statements)

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“…The MarginProbe device, which uses radiofrequency spectroscopy, has shown a trend towards reduction in re-excision rates for positive margins after NAC (31% vs. 6%) [20]. In a review from the American Society of Breast Surgeons registry, NST was the highest-ranked actionable factor associated with fewer reoperations for positive margins, a finding corroborated by several other studies [13, 21, 22].…”

Section: Bcs and Margins After Nstmentioning

confidence: 65%

“…BCS, complete resection of the tumor with negative margins with adjuvant radiotherapy is equivalent to mastectomy after NST in terms of disease-free survival (DFS) and OS [7, 11-13].…”

Section: Bcs and Margins After Nstmentioning

confidence: 99%

“…Therefore “no ink on tumor” can be applied after NST [11, 12]. In a recent study by Lin et al, 161 patients who underwent BCS after NAC showed no difference in LRFS between ≤1 mm and >1 mm margins [13].…”

Section: Bcs and Margins After Nstmentioning

confidence: 99%

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Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

et al. 2021

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Background: The goal of neoadjuvant systemic therapy (NST) in breast cancer is to downstage tumors and downgrade treatment. Indications are constantly evolving. These changes raise practical questions for planning of surgery after NST. Summary: In this review we discuss current evolving aspects of surgery of the breast after NST. Breast-conserving surgery (BCS) eligibility increases after NST – both neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy. Adequate margin width in NST and upfront surgery are similar – “no tumor on ink” for invasive cancer. Oncoplastic breast surgery after NST is feasible – both for BCS and mastectomy with reconstruction. There is increasing interest in the possibility of omitting surgery in patients with a complete response to NAC. Several trials are being conducted in aim of achieving acceptable prediction of pathological complete response, by combination of imaging and percutaneous biopsy of the tumor bed, as well as assessing the safety of such an approach. Key Messages: Surgery of the breast after NST should be determined not only according to biologic and anatomic parameters at diagnosis, but is dynamic, and must be tailored according to the response to therapy. The omission of surgery in exceptional responders after NAC is being explored.

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Section: Bcs and Margins After Nstmentioning

confidence: 65%

“…BCS, complete resection of the tumor with negative margins with adjuvant radiotherapy is equivalent to mastectomy after NST in terms of disease-free survival (DFS) and OS [7, 11-13].…”

Section: Bcs and Margins After Nstmentioning

confidence: 99%

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Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

et al. 2021

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“…There is no association between local recurrence and margin distance in lumpectomy resection specimens [ 25 ]. However, in our study, a higher rate of recurrence was found in patients who had clear resection margins of lumpectomy specimens (i.e., 75%) (8/24).…”

Section: Discussionmentioning

confidence: 99%

Recurrence Yield of Stereotactic Biopsy of Suspicious Calcifications After Breast Conservation Therapy

Aleem¹,

Rehman²,

Shafqat³

et al. 2022

Cureus

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Aim To analyze the histopathological outcome of stereotactic biopsies of newly developed suspicious calcifications at lumpectomy scar site in patients with breast conservation surgery (BCS) to determine the incidence of malignancy and the association of mammographic appearance of recurrent microcalcification and their distribution. We also determined the association of disease recurrence with the presence of calcifications in original tumor and lumpectomy resection margins with the risk of recurrence. Materials and methods This study is a retrospective review of mammograms of patients with breast cancer from 2010 to 2021 who underwent stereotactic biopsy of newly developed suspicious calcifications at scar site appreciated on annual follow-up mammogram after breast conservation surgery (BCS) with no mass on correlative ultrasound. The radiological and pathological features of the patients' primary tumor and new calcifications were obtained from the hospital's electronic patient record system. Results A total of 84 patients with breast cancer developed suspicious microcalcifications at the lumpectomy scar site detected on follow-up mammograms after BCS, and 28.6% showed malignant histopathological outcomes. All malignant cases demonstrated pleomorphic morphology. All amorphous (9.5%) and coarse heterogeneous (54.8%) calcifications were benign. The distribution pattern of recurrent malignant calcifications was grouped in 9.5%, regional in 2.4%, linear in 9.5%, and segmental in 7.1%. Calcifications in primary tumors were found in 20.2% of cases. Positive margins were found in 7.1% of these malignant cases. Statistically, there was a strong association between calcification morphology, calcification distribution, presence of calcifications on baseline mammogram, and tumor resection margins. The presence of calcifications in primary tumors and positive resection margins were identified as significant independent risk factors of malignant recurrent calcifications in the logistic regression model and marginal statistical significance in the multivariable logistic regression (MLR) model. Conclusion The interval development of pleomorphic calcifications after BCS with either linear or segmental pattern, positive resection margins, and associated calcifications in primary tumors was related to the increase in the risk of recurrence. Although amorphous and coarse heterogeneous morphology with grouped distribution showed benign outcomes, stereotactic biopsy is recommended to exclude disease recurrence in this high-risk patient population.

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“…Few other studies have assessed the effect of margin width on prognosis in patients treated with BCS-NAC. Rouzier et al [ 40 ] found that margins <2 mm were associated with increased local recurrence ( p = 0.04); conversely, other authors reported no associations between LRFS and margin distances [ 22 , 41 , 42 , 43 , 44 ]. A limitation of this and similar studies for the assessment of the width of excision margins is represented by the pattern of tumor regression after NAC (concentric vs. scattered) because this is not often reported in imaging examination, although it represents a fundamental parameter to perform a “ no ink on tumor ” glandular resection, using the yT size as surgical target.…”

Section: Discussionmentioning

confidence: 99%

“No Ink on Tumor” in Breast-Conserving Surgery after Neoadjuvant Chemotherapy

Atzori

Gipponi

Cornacchia

et al. 2022

JPM

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Background/Aim: Patients with Stage I-II breast cancer undergoing breast-conserving surgery after neoadjuvant chemotherapy (BCS-NAC) were retrospectively assessed in order to evaluate the extent of a safe excision margin. Materials and Methods: Between 2003 and 2020, 151 patients underwent risk-adapted BCS-NAC; margin involvement was always assessed at definitive histology. Patients with complete pathological response (pCR) were classified as the RX group, whereas those with residual disease and negative margins were stratified as R0 < 1 mm (margin < 1 mm) and R0 > 1 mm (margin > 1 mm). Results: Totals of 29 (19.2%), 64 (42.4%), and 58 patients (38.4%) were included in the R0 < 1 mm, R0 > 1 mm, and RX groups, respectively, and 2 patients with margin involvement had a mastectomy. Ten instances of local recurrence (6.6%) occurred, with no statistically significant difference in local recurrence-free survival (LRFS) between the three groups. A statistically significant advantage of disease-free survival (p = 0.002) and overall survival (p = 0.010) was observed in patients with pCR. Conclusions: BCS-NAC was increased, especially in HER-2-positive and triple-negative tumors; risk-adapted BCS should be preferably pursued to highlight the cosmetic benefit of NAC. The similar rate of LRFS in the three groups of patients suggests a shift toward the “no ink on tumor” paradigm for patients undergoing BCS-NAC.

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Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Cited by 12 publications

References 32 publications

Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

Recurrence Yield of Stereotactic Biopsy of Suspicious Calcifications After Breast Conservation Therapy

“No Ink on Tumor” in Breast-Conserving Surgery after Neoadjuvant Chemotherapy

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