Current Perceptions Regarding Surgical Margin Status After Breast-Conserving Therapy

Taghian, Alphonse G.; Mohiuddin, Majid; Jagsi, Reshma; Goldberg, Saveli; Ceilley, Elizabeth; Powell, Simon N.

doi:10.1097/01.sla.0000157272.04803.1b

Cited by 198 publications

(130 citation statements)

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“…While the consensus is quite clear that patients with a positive margin after lumpectomy require re-excision, there is more controversy regarding the patient with close margins, including both the definition of a close margin as well as the need to return to the operating room versus proceeding with radiation [14]. Studies examining whether local recurrence rates are increased when close margins are not re-excised have been mixed [15][16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Residual disease after re‐excision lumpectomy for close margins

Sabel

Rogers

Griffith

et al. 2008

Journal of Surgical Oncology

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Introduction: While a positive margin after an attempt at breast conservation therapy (BCT) is a reason for concern, there is more controversy regarding close margins. When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure. We sought to examine the incidence of residual disease after re-excision for close margins and to identify predictive factors that may better select patients for re-excision. Methods: Our IRB-approved prospective breast cancer database was queried for all breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCT. Close margins are defined as 2 mm for invasive carcinoma and 3 mm for DCIS. Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Three hundred three patients (32%) underwent re-operation for either close (173) or positive (130) margins. Overall, 33% had residual disease identified, 42% of DCIS patients and 29% of patients with invasive disease, nearly identical to patients with positive margins. For patients with DCIS, only younger age was significantly related to residual disease. For patients with invasive cancer, only multifocality was significantly associated with residual disease ). However, patients without multifocality still had a substantial risk of residual disease. Discussion: The presence of residual disease appears equal between re-excisions for close and positive margins. No subset of patients with either DCIS or invasive cancer could be identified with a substantially lower risk of residual disease.

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Section: Introductionmentioning

confidence: 99%

Residual disease after re‐excision lumpectomy for close margins

Sabel

Rogers

Griffith

et al. 2008

Journal of Surgical Oncology

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“…All margins are examined and the microscopic distance between infiltrating and/or in situ carcinoma and inked margins are determined. There is no consensus as to what constitutes a positive or negative margin, 6,7 but we considered like others a margin superior or equal to 3 mm as negative. 8 If the margin is less than 3 mm, a re-excision is proposed to achieve a completely clear margin, as radiotherapy alone does not compensate for incomplete surgery.…”

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confidence: 99%

Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy

et al. 2009

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Margin resection status is a major risk factor for the development of local recurrence in breast conservation therapy for carcinoma. Tumor bed excision sent as separate orientated cavity margins represents a tool to verify the completeness of the carcinoma resection. We aimed to (1) determine the prevalence of positive cavity margin and its influence on subsequent surgical treatment and (2) identify potential predictive factors for positive cavity margins. From 2003From to 2006 30-88) consecutive patients who underwent a lumpectomy for carcinoma with four orientated cavity margins for carcinoma were selected. Preoperative clinical, radiological and histological data, perioperative macroscopic characteristics and definitive histological analysis results were recorded. Lumpectomy or cavity margins were considered as positive when the distance from carcinoma to the margin was less than or equal to 3 mm. Histological examination of cavity margins showed carcinoma in 38 patients (35%), therefore modifying subsequent surgical therapy in 33 cases. Examination of the cavity margins led (1) to avoiding surgical re-excision in 20 cases (lumpectomy margins were positive and the cavity margins negative), (2) to performing a mastectomy or a re-excision in 13 cases (carcinoma was detected in the cavity margins although the lumpectomy margins were negative or tumor size was superior to 3 cm). Between preoperative and perioperative parameters, US scan and macroscopic size of the tumor were predictive factors for positive cavity margins whereas characteristics of the carcinoma determined on biopsy samples and macroscopic status of the lumpectomy margins were not. Our study confirms that the systematic practice of cavity margin resection avoids surgical re-excision and reduces the likelihood of underestimating the extent of the tumor.

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“…When I first started out in surgical oncology, Dr. Fisher's landmark study [9] on breast conservation had just been published. Based on this, I was content with margins of ''no ink on tumor'' for the rest of the 1980s and early 1990s, but owing to varying opinions of the community at large [10] and local custom, I did 1 mm in the late 1990s and 2 mm in the early 2000s. In 2014, the consensus guidelines on resection margins for invasive cancer were published in the Journal of Clinical Oncology [11].…”

Section: Should a Mastectomy Ever Be Done For Dcis?mentioning

confidence: 99%