Factors predisposing to cavity margin positivity following conservation surgery for breast cancer

Keşkek, Mehmet; Kothari, Manish; Ardehali, Ben; Betambeau, Nadine; Nasiri, N.; Gui, Gerald

doi:10.1016/j.ejso.2004.07.019

Cited by 100 publications

(61 citation statements)

References 32 publications

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“…21 Similarly, positive cavity margins were reported to be associated with large tumor size and tumor type (intraductal carcinoma, invasive lobular carcinoma) by multivariate analysis. 7 Our results are concordant, as the distance of the initial lumpectomy margin to the carcinoma, the larger size of the tumor and metastatic axillary lymph node appeared as factors associated with positive cavity margins in univariate analysis whereas the latter two were only associated by multivariate analysis. Finally, we found that a US scan size below or equal to 10 mm, after excluding lobular carcinoma in situ, could predict negative cavity margins in 91% of cases (31 out of 34).…”

Section: Discussionsupporting

confidence: 73%

“…On the one hand, it led to surgical re-excision being avoided in 20 patients (19%) as lumpectomy margin was positive and cavity margin negative and on the other, it led to recommending a mastectomy or a re-excision in 12 cases (11%) because carcinoma was detected in cavity margin whereas lumpectomy margin were negative or because cavity margin examination led to a carcinoma of more than 3 cm being disclosed. As for avoiding returning to the operating theater, our results can be compared with three previous published studies, 7,11,15 which reported 61 out of 126 (48%), 60 out of 301 (20%) and 16 out of 45 (35%) negative cavity margin whereas lumpectomy margins were positive. Although our results are consistent with the two later studies, they did not reach half of the cases as described in the Cao et al 11 study.…”

Section: Discussionmentioning

confidence: 55%

“…These separate cavity margins are oriented by suture and the new margin is inked. Some beneficial effects of this procedure that supersede the lumpectomy have been reported in retrospective studies 7,11,12 as the cavity margin procedure significantly decreased the need for re-excision. Although this procedure seems to reduce the need for re-excision in our institution, we also experienced several unexpected occurrences of cavity margin positive for carcinoma or carcinoma in situ whereas lumpectomy margins were negative.…”

mentioning

confidence: 94%

“…These findings on the cavity margin sample led to re-excision or mastectomy when the total size of the carcinoma exceeded 3 cm or presented as a multifocal carcinoma. Patients' age, tumor size in histological report, extensive intraductal component, high histological grade and lymph node metastasis have been reported as factors associated with positive margin, 7,[11][12][13] but the predictive value of preoperative factors such as radiologic size or peroperative factors such as macroscopic assessment of margin have so far not been investigated.…”

mentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 55%

mentioning

confidence: 94%

mentioning

confidence: 99%

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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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“…While a lumpectomy has clear advantages over mastectomy, one disadvantage is the need sometimes to return to the operating room for a re-excision lumpectomy. Re-excision rates are high, ranging from 20% to 70% in the literature, and in addition to the inconvenience and added costs, re-excision lumpectomies may result in added complications and diminish the aesthetic outcome [2][3][4][5][6][7][8][9][10][11][12][13].…”

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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Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

Dixon

Newlands

Dodds

et al. 2016

British Journal of Surgery

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Factors predisposing to cavity margin positivity following conservation surgery for breast cancer

Cited by 100 publications

References 32 publications

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

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

Residual disease after re‐excision lumpectomy for close margins

Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

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