<p>Positive or close margins: reoperation rate and second conservative resection or total mastectomy?</p>

Abstract

Introduction Reoperation after breast-conserving surgery (BCS) could be proposed for positive or close margins. Reoperation type, re-excision or mastectomy, depends on several factors in relation to patient’s and tumor’s characteristics. We have analyzed our breast cancer (BC) database in order to determine second and third attempts for BCS and mastectomy rates, as well as associated factors for type of surgery. Methods All patients with BCS between 1995 and 2017 were included. Patient’s characteristics, pathologic results, and treatments were analyzed. Reoperation rate, type of reoperation, second reoperation, and associated factors of reoperation, mastectomy, and third intervention were determined. Three periods were determined: P1–P3. Results We analyzed 10,761 patients: 1,161 with ductal carcinoma in situ (DCIS) and 9,600 with invasive BC. The reoperation rate was 41.4% for DCIS and 28.0% for invasive BC. Using multivariate analysis, we identified tumor size >20 mm as being a risk factor for reoperation, whereas age >50 years, P2–3, and some localization decreased reoperation rates. For invasive BC, age >40 years, triple-negative tumors, neoadjuvant chemotherapy, and noncentral tumors decreased reoperation rates and lobular tumor, multifocal tumors, lymphovascular invasion, DCIS component, and Her2-positive tumors increased reoperation rates. For patients requiring reoperation, re-excision was performed in 48.1% (1,523/3,168) and mastectomy was required after first re-excision in 13.46% (205/1,523). For DCIS, mastectomy rates were higher for grade 2 and tumor ≥20 mm. For invasive BC, mastectomy rates were higher for lobular, multifocal, ≥20 mm, Her2-positive tumors and diffuse positive margins and lower for age >50 years and during the last period. Even if interval time between surgery and adjuvant treatments was higher for patients with reoperation, survival rates were not different between patients with and without reoperation. Conclusion A decrease in reoperation and mastectomy rates had been reported with several associated factors. A third intervention with mastectomy was required in 13.5% of patients. This information should be done in case of reoperation.

Implementing radar reflector‐guided localization of nonpalpable breast lesions: Feasibility, challenges, outcomes, and lessons learned

“…1,6,9 Positive margins, close margins, and re-excision rates for reflector-guided localization were reported to be 14.9%, 14.9%, and 16.8% by Cox et al 1 and 9.5%, 7.1%, and 7.1% by Patel et al 11 In comparison, reported positive margin and re-excision rates for wire localization vary widely, ranging from less than 10% to over 30%. 12,13 In our series, we found positive margin and close margin rates…”

“…Prior literature has also demonstrated reflector‐guided localization to be accurate and reliable 1,6,9 . Positive margins, close margins, and re‐excision rates for reflector‐guided localization were reported to be 14.9%, 14.9%, and 16.8% by Cox et al 1 and 9.5%, 7.1%, and 7.1% by Patel et al 11 In comparison, reported positive margin and re‐excision rates for wire localization vary widely, ranging from less than 10% to over 30% 12,13 …”

Non-contact reflection-mode optical absorption spectroscopy using photoacoustic remote sensing

“…The standard management of DCIS is breast conserving surgery which aims to remove the minimum amount of healthy tissue. About 20% of patients require secondary resections to convert resections with DCIS-involved surgical margins to DCIS free margins 37 . Tissue blocks from breast tissue resections are typically 3 mm thick and highly opaque, making transmissionmode modalities impractical.…”

Success rates of re-excision after positive margins for invasive lobular carcinoma of the breast

“…An institutional series of over 10,000 breast cancer patients undergoing BCS found that 62.7% of the 1215 ILC patients had a completion mastectomy. 17 Our data suggest that for women with ILC who have positive margins after BCS, attempting a re-excision lumpectomy is reasonable and likely to be successful. These high rates of completion mastectomy may not be necessary in all women with ILC who have positive margins.…”