Factors Associated with Clear Biopsy Margins and Clear Reexcision Margins in Breast Cancer Specimens from Candidates for Breast Conservation

Tartter, Paul Ian; Bleiweiss, Ira J.; Levchenko, S V

doi:10.1016/s1072-7515(01)00927-9

Cited by 55 publications

(18 citation statements)

References 11 publications

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“…The difference in treatment of in situ and invasive carcinoma with respect to the (Thompson et al, 1991;Tartter et al, 1997). Our figure of six out of 74 (8%) confirms the fact that DCIS underestimation is also a problem in diagnostic NLBB.…”

Section: Discussionsupporting

confidence: 64%

Diagnostic Accuracy for Different Strategies of Image-Guided Breast Intervention in Cases of Nonpalpable Breast Lesions

&NA;

2004

Ultrasound Quarterly

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To find out whether ultrasound-guided fine-needle aspiration (FNA) and ultrasound and stereotactic-guided large core needle biopsy (LCNB) are reliable alternatives to needle-localised open breast biopsy (NLBB) in daily practice, we performed a retrospective study and evaluated the validity of these methods. In all, 718 women with 749 nonpalpable breast lesions from three Dutch Hospitals were included, and the validity of the various methods for diagnosis was assessed. This was carried out according to a method described by Burbank and Parker for evaluating the quality of an image-guided breast intervention. We compared our results with the outcome of the COBRA study. Overall, all diagnostic strategies (NLBB, FNA, LCNB ultrasound and stereotactic guided) show comparable agreement rates. However, the miss rates differ: 2% for NLBB, 3% for COBRA (LCNB in study setting), 5% for FNA and 8 -12% for LCNB in practice. Fine-needle aspiration was nonconclusive in 29%, and shows an overestimation for DCIS in 9%. The DCIS underestimate rate in NLBB was 8%. For the assessment of lesions consisting of microcalcifications only and to exclude malignancy in all other lesions, a 14-gauge needle should be used. Ultrasound-guided intervention can be performed in a large percentage of nonpalpable lesions. Lesions consisting only of microcalcifications on mammography need special attention. Needle-localised open breast biopsy (NLBB) is considered the gold standard procedure for the diagnosis of nonpalpable breast lesions (NPBL) (Jackman and Marzoni, 1997). Needle-localised open breast biopsy is a surgical procedure with high costs and for most of the patients, is a traumatic experience. In the past few decades, less traumatic and cost-saving nonoperative image-guided techniques, such as fine-needle aspiration (FNA) and large-core needle biopsy (LCNB), have been advocated as an alternative to surgery to obtain material for a microscopic diagnosis. For guidance, ultrasound or stereotaxis are advocated.Recently, a large prospective study on stereotactic-guided LCNB was performed in the Netherlands to evaluate the diagnostic accuracy of this method (COBRA study) (Verkooijen, 2002). This study included 973 patients with 1029 nonpalpable breast lesions and showed a sensitivity rate of 97% and a specificity rate of 99% for stereotactic-guided LCNB. These figures are comparable to NLBB (Jackman and Marzoni, 1997). In the Dutch study, the stereotactic LCNB was always performed on a dedicated prone table, in an optimal setting. The dedicated equipment appears to be highly reliable but has the disadvantage of high initial expense. Therefore, it is not widely available in the Netherlands. The other alternatives for NLBB, such as stereotactic-guided LCNB with upright mammography machine and add on digital attachment, ultrasound-guided FNA and LCNB are more widely available. To find out whether FNA (ultrasound-guided) and LCNB (ultrasound and stereotactic-guided) are reliable alternatives to NLBB in daily practice, a retrospective study on the dia...

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Section: Discussionsupporting

confidence: 64%

Diagnostic Accuracy for Different Strategies of Image-Guided Breast Intervention in Cases of Nonpalpable Breast Lesions

&NA;

2004

Ultrasound Quarterly

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“…Clear margins with palpable cancers have been related to preoperative diagnosis by needle biopsy, absence of calcifications, and small tumor size. 23,25 In our study of nonpalpable breast carcinomas, none of the patients were diagnosed by fine-needle biopsy, and the likelihood of clear margins with calcifications was equal to that of masses.…”

Section: Discussionmentioning

confidence: 67%

“…Several histopathologic parameters have been related to having clear margins on excisional biopsy, and some of these parameters have been related to subsequent local recurrence. [23][24][25][26] However, factors associated with clear margins with palpable cancers are not associated with clear margins with nonpalpable cancers. Clear margins with palpable cancers have been related to preoperative diagnosis by needle biopsy, absence of calcifications, and small tumor size.…”

Section: Discussionmentioning

confidence: 99%

Mammographic Appearance of Nonpalpable Breast Cancer Reflects Pathologic Characteristics

et al. 2002

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ObjectiveTo study the relationship of mammographic appearance of nonpalpable breast cancer to the pathologic characteristics. Summary Background DataThe mammographic appearance of nonpalpable breast cancer may be associated with pathologic variables having prognostic significance, which could influence clinical management. MethodsThe authors correlated the mammographic appearance and pathologic characteristics of 543 nonpalpable malignancies diagnosed in a single institution between July 1993 and July 1999. Cancers were divided into four groups based on mammographic presentation: mass, calcification, mass with calcification, and architectural distortion. ResultsThe majority of masses (95%), masses with calcifications (68%), and architectural distortions (79%) were due to invasive cancers, whereas the majority of calcifications (68%) were due to ductal carcinoma in situ (DCIS). Among invasive cancers, calcifications were associated with more extensive intraductal carcinoma, more Her2/neu immunoreactivity, and more necrosis of DCIS. Lymphatic invasion was more common in cancers presenting as a mass with calcifications. Sixty-nine percent of DCIS associated with invasive cancers presenting as calcifications were of high grade according to the European Organization for Research and Treatment of Cancer. Calcifications in noninvasive tumors were associated with necrosis in DCIS. Two thirds of cancers presenting as architectural distortion had positive margins (65%) compared with 35% to 37% of other mammographic presentations. Mammographic presentation was not significantly related to tumor differentiation or estrogen or progesterone receptor status. The ratio of invasive to noninvasive malignancies increased progressively with increasing age from 1:1 in patients younger than 50 years of age to 3:1 in patients older than 70 years, whereas the proportion presenting as calcifications declined from 63% in patients younger than 50 years to 26% in patients older than 70 years. ConclusionsMalignancies presenting as calcifications on mammography are most commonly DCIS. When invasive malignancies presented as calcifications, the calcifications were associated with accompanying high-grade DCIS, and the invasive cancers were often Her2/Neu positive. Mammographic masses with calcifications were associated with lymphatic invasion. Excisional biopsy margins were most commonly positive with architectural distortions. The mammographic appearance of nonpalpable malignancies is related to pathologic characteristics with prognostic value, which varies with patient age and influences clinical management.

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“…7 Two studies reported increased margin involvement with increase in tumor size. 22,36 Several studies have also shown an association between lobular carcinoma and positive margins. 23,37,38 We investigated the clinical and pathological factors associated with margin positivity.…”

Section: Discussionmentioning

confidence: 99%

Preoperative chemotherapy for T2 breast cancer is associated with improved surgical outcome

Karanlık

Özgür

Cabıoğlu

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Factors Associated with Clear Biopsy Margins and Clear Reexcision Margins in Breast Cancer Specimens from Candidates for Breast Conservation

Cited by 55 publications

References 11 publications

Diagnostic Accuracy for Different Strategies of Image-Guided Breast Intervention in Cases of Nonpalpable Breast Lesions

Diagnostic Accuracy for Different Strategies of Image-Guided Breast Intervention in Cases of Nonpalpable Breast Lesions

Mammographic Appearance of Nonpalpable Breast Cancer Reflects Pathologic Characteristics

Preoperative chemotherapy for T2 breast cancer is associated with improved surgical outcome

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