HER-2 positive breast cancer is associated with an increased risk of positive cavity margins after initial lumpectomy

Abstract

BackgroundThe effect of breast cancer subtype on margin status after lumpectomy remains unclear. This study aims to determine whether approximated breast cancer subtype is associated with positive margins after lumpectomy, which could be used to determine if there is an increased risk of developing local recurrence (LR) following breast-conserving surgery.MethodsWe studied 1,032 consecutive patients with invasive cancer who received lumpectomies and cavity margin (CM) assessments from January 2003 to November 2012. The following data were collected: patient age, cT stage, pT stage, grade, status of CM, lymph node status, menopausal status, ER, PR, HER-2, and Ki67, as well as the presence of extensive intraductal component (EIC) and lymphovascular invasion (LVI). A χ2 test was used to compare categorical baseline characteristics. Univariate and multivariate logistic regression analyses were performed to evaluate associations between pathologic features of CM status. Kaplan-Meier actuarial cumulative rates of LR (ipsilateral in-breast) were calculated.ResultsA total of 7,884 pieces of marginal tissue were collected from 1,032 patients, and 209 patients had positive CMs. Of the patients tested, 52.3% had luminal A subtype, 14.9% were luminal B, 12.8% were luminal-HER-2, 8.1% were HER-2 enriched, and 11.8% were triple negative. Univariate analysis showed that EIC (P <0.001), LVI (P = 0.026), pN stage (N1 vs. N0: P = 0.018; N3 vs. N0: P <0.001), and luminal B (P = 0.001) and HER-2 (P <0.001) subtypes were associated with positive CMs. Multivariable analysis indicated that only EIC (P <0.001), pN stage (P = 0.003), and HER-2 subtype (P <0.001) were significantly correlated with positive CMs. On multivariable analysis, HER-2 subtype was an independent prognostic factor in LR (P = 0.031).ConclusionsThe HER-2 subtype was the predictive factor most associated with positive CMs and an independent prognostic factor for LR. This result suggests that the increased risk of LR in HER-2 breast cancer is due to an increased microscopic invasive tumor burden, which is indicated by margin status after lumpectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/1477-7819-12-289) contains supplementary material, which is available to authorized users.

Initial Community Hospital Performance of Radioactive Seed Localization for Breast Cancer Patients

“…The Chinese study by Jia reported the increased likelihood of positive margins among patients with Her-2 positive invasive tumors undergoing breast conserving surgery (Jia et al, 2014). We were not able to establish an association between the positive margin rates and the Her-2 copy number or either the ER or PR receptor status.…”

“…A recent Chinese report indicated that patients with Her-2 positive breast cancer had an increased risk of positive margins following breast conserving surgery (Jia H et al, 2014). We wished to see if Her-2 status was similarly associated with positive margins among our patients.…”

Cavity Shaving Reduces Involved Margins and Reinterventions Without Increasing Costs in Breast-Conserving Surgery: A Propensity Score-Matched Study

“…Moreover, the correlation between biological subtypes of breast cancer and involved margins in CSM has been poorly investigated. 9 Our aim was to assess the capability of CSM to reduce positive margin rates and reoperations compared to simple lumpectomy (SL) in a large cohort of breast cancer patients treated in a single center. Secondary aims were to provide a cost analysis between CSM and SL, and to investigate if CSM impacted differently on different biological subtypes of breast cancer.…”

Radioactive Seed Localization for Nonpalpable Breast Lesions in a Community Hospital Setting

“…A recent study of 1,032 patients from China, of whom 209 had positive margins, reported by Jia, demonstrated that patients with Her-2 positive invasive breast cancers were more likely to have positive margins than patients with Her-2 negative tumors (Jia et al, 2014). Her-2 status was not evaluated in our study.…”