Margins in Breast-Conserving Surgery After Neoadjuvant Therapy

Choi, Jin Won; Laws, Alison; Hu, Jiani; Barry, William T.; Golshan, Mehra; King, Tari A.

doi:10.1245/s10434-018-6702-4

Cited by 56 publications

(54 citation statements)

References 19 publications

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“…In the present study, the overall BCS rate of 40.2% for patients was lower than that of 49.4% in the surgery first cohort from our previous study [18] despite comparable pCR rates of 22.1% with other studies [19,20]. This may have resulted from the higher LRR after BCS in patients who were treated with NACT [8][9][10], as one of our senior surgeons who performed more than half of the analysed BCS cases in this study had a BCS rate of 56%.…”

Section: Discussioncontrasting

confidence: 82%

“…Additional 14.5% [10]. The latest study by Choi et al [20] on 382 patients showed no association between margin width and local recurrence but rather related to intrinsic subtypes, lack of pCR and positive nodal status. Factors such as age, tumour size, lymph node status, surgical margin, histological grade, Ki-67 index and receptor status were not found to be significant predictors of LRR on univariate analysis in our study.…”

Section: Discussionmentioning

confidence: 95%

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Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Lin

Chen

et al. 2020

Preprint

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Background The aim of the current study was to report a single-institution experience using breast-conserving surgery after neoadjuvant chemotherapy (NACT), focusing on the association between microscopic resection margin status and locoregional recurrence (LRR). Methods Our institutional prospectively maintained database was reviewed to identify patients who were treated with NACT between January 2008 and April 2018. Results Among the main partial mastectomy specimens available for analysis (n = 161), 28 had margins < 1 mm, 21 had margin width of 1–2 mm and the remaining 112 had margins > 2 mm. LRR occurred in 16 patients (9.9%) and distant metastases were detected in 27 (16.8%) patients. There was no significant difference in the LRR between the > 2 mm margin group with a 60-month cumulative survival of 85.2% compared with 76.2% for the ≤ 2 mm group ( P = 0.335) in the Kaplan-Meier analysis. When we stratified patients by margin widths of ≥ 1 mm or < 1 mm, there was no LRR-free survival benefit observed for the ≥ 1 mm pathologic excision margin group in the univariate analysis (hazard ratio = 0.443; 95% confidence interval = 0.142–1.383; P = 0.161) with a 60-month cumulative LRR-free survival of 84.9% compared with 69.5% for the < 1 mm margin cohort ( P = 0.150). Conclusions In the absence of multiple scattered microscopic tumour foci, a negative margin of no ink on tumour maybe sufficient for stage I–III invasive breast cancer treated with NACT and breast-conserving surgery.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 95%

Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Lin

Chen

et al. 2020

Preprint

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“…In the present study, 428 women with untreated operable breast cancer received NACT from January 2008 to April 2018; 40.2% (n = 172) of them underwent BCS and the remaining 59.8% (n = 256) had mastectomy. The overall BCS rate of 40.2% for patients was lower than that of 49.4% in the surgery first cohort from the previous study [18] despite comparable pCR rates of 22.1% with other studies [19][20][21]. This may have resulted from the higher LRR after BCS in patients who were treated with NACT [8][9][10], as one of our senior surgeons who performed more than half of the analysed BCS cases in this study had a BCS rate of 56%.…”

Section: Discussioncontrasting

confidence: 53%

Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Lin

Wang

et al. 2020

BMC Cancer

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Background: The aim of the current study was to report a single-institution experience using breast-conserving surgery after neoadjuvant chemotherapy (NACT), focusing on the association between microscopic resection margin status and locoregional recurrence (LRR). Methods: Our institutional prospectively maintained database was reviewed to identify patients who were treated with NACT between January 2008 and April 2018. Results: Among the main partial mastectomy specimens available for analysis (n = 161), 28 had margins < 1 mm, 21 had margin width of 1-2 mm and the remaining 112 had margins > 2 mm. LRR occurred in 16 patients (9.9%) and distant metastases were detected in 27 (16.8%) patients. There was no significant difference in the LRR between the > 2 mm margin group with a 60-month cumulative survival of 85.2% compared with 76.2% for the ≤2 mm group (P = 0.335) in the Kaplan-Meier analysis. When we stratified patients by margin widths of ≥1 mm or < 1 mm, there was no LRR-free survival benefit observed for the ≥1 mm pathologic excision margin group in the univariate analysis (hazard ratio = 0.443; 95% confidence interval = 0.142-1.383; P = 0.161) with a 60-month cumulative LRR-free survival of 84.9% compared with 69.5% for the < 1 mm margin cohort (P = 0.150). Conclusions: In the absence of multiple scattered microscopic tumour foci, a negative margin of no ink on tumour maybe sufficient for stage I-III invasive breast cancer treated with NACT and breast-conserving surgery.

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“…In patients after NAC, no differences in 5-year LRFS, OS or DFS could be found between patients with either closer (\ 2 mm) or wider (C 2 mm) margins. 15 Likewise, Tyler et al investigated whether close margins (\ 2 mm) have an impact on patient outcomes. In a study cohort of over 10,000 patients and a median followup of 8 years, where 87% of patients were administered systemic chemotherapy, close margins were not associated with increased local recurrence or decreased breast cancer specific survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival

et al. 2019

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Background. While ''no tumour on ink'' is an accepted margin width for R 0 resection in primary surgery, it's unclear if it's oncologically safe after neoadjuvant chemotherapy (NAC). Only limited data demonstrate that surgery within new margins in cases of a pathological complete response (pCR) is safe. We therefore investigated the influence of different margins and pCR on local recurrence and survival rates after NAC. Methods. We retrospectively analysed data of 406 women with invasive breast cancer, treated with NAC and breastconserving therapy between 1994 and 2014 in two certified Austrian breast health centres. We compared R B 1 mm, R [ 1 mm and RX (pCR) for local recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS).

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Margins in Breast-Conserving Surgery After Neoadjuvant Therapy

Cited by 56 publications

References 19 publications

Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival

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