<p>Positive margins (R1) risk factors in breast cancer conservative surgery</p>

Abstract

Background The primary goal in conservative breast cancer surgery is the complete excision of the tumor, but at the same time attempting to obtain a satisfactory postoperative esthetic result. The notion of “No Ink on Tumor” that indicates exclusively the presence of tumor cells on the inked surface of the surgical specimen is now the gold standard; however, the problem of the free margin is still a fundamental topic of debate that has not yet found a definitive solution. Methods Our retrospective analysis takes into account 1440 patients undergoing breast conservative surgery, from October 2004 to November 2018, all treated at the breast unit of our institution. Results Positive margins (R1) rate was 10.2% (147 cases out of 1440). Overall survival was 95% at 5 years and 89% at 10 years. No differences in mortality and local recurrence rate between R0 and R1 patients were found. Half of the R1 patients underwent secondary surgery with enlargement of margins, while in the other half we performed direct mastectomy. Among the analyzed variables, age, histological size, histological type, grading, multifocality, lympho-vascular invasion and lymph node status were significantly correlated with the R1 status. The multivariate analysis shows the association of age and surgical technique (oncoplastic) with R1 status. Conclusion Further studies will allow the creation of a statistical model, for better pre-operative prediction of patients with higher risk of R1 and better selection of patients to be candidates for conservative surgery.

Intraoperative Specimen Ultrasonography: Is It a Reliable Tool for Margin Assessment Following Breast Conservation Surgery for Breast Carcinoma?

“…The primary aim in BCS is to achieve a negative surgical margin while still preserving the aesthetically appealing breast. Adequate surgical margins have shown to decrease the incidence of local recurrence of the primary tumor [6][7][8][9][10]. To ensure negative margins, many techniques are suggested to assess the surgical margins.…”

“…It was observed that in various treatment strategies (BCS alone, BCS with radiation therapy, or mastectomy), negative margin status strongly correlated with long-term disease-free survival. Positive margin has a negative effect on local recurrence and disease-free and overall survival of the patient [9,10]. To minimize the current reported high re-excision rates, intraoperative assessment of margins has become increasingly desired.…”

Male axillary accessory breast cancer

“…Radical resection is the main treatment for this disease. [ 24 ] The patient in this case underwent ipsilateral axillary lymph nodes clearance after extensive resection of the tumor. The margin of the lesion and the status of metastasis in axillary lymph nodes were determined by rapid frozen pathological examinations during the operation, to diminish the operational region as much as possible while completely removing the lesion.…”

Cost-Effectiveness of Digital Breast Tomosynthesis vs. Abbreviated Breast MRI for Screening Women with Intermediate Risk of Breast Cancer—How Low-Cost Must MRI Be?

“…Tumor-related death rates were estimated based on the PREDICT prognostication model [ 34 ]. The probability of nodal disease and R0 resection rates were extracted from the literature [ 35 , 36 ].…”