Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy

Freedman, Gary M.; Fowble, Barbara; Hanlon, Alexandra L.; Nicolaou, Nicos; Fein, Douglas A.; Hoffman, John P.; Sigurdson, Elin R.; Boraas, Marcia; Goldstein, Lori J.

doi:10.1016/s0360-3016(99)00112-1

Cited by 251 publications

(144 citation statements)

References 46 publications

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“…In breast conservation, positive margins are associated with an increased long-term risk of cancer recurrence in the ipsilateral breast (Fourquet et al, 1989;Anscher et al, 1993;Pittinger et al, 1994;Dewar et al, 1995;Gage et al, 1996;Wazer et al, 1998;Freedman et al, 1999;Cowen et al, 2000) and, therefore, patients with positive margins, following BCS, require further surgery. In our series, the re-operation rate was 9.5% (two patients) but no histological evidence of residual tumour was found on the mastectomy specimen.…”

Section: Discussionmentioning

confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Patients were prospectively recruited to undergo MRI as well as conventional methods of clinical examination, mammography (MM) and ultrasonography (USS) and response was assessed by each of these methods. Thirty-two patients with primary breast cancer were recruited. Magnetic resonance imaging correlation with histopathological size (r ¼ 0.71) was superior to USS (r ¼ 0.65) and to MM where tumour size was not measurable following chemotherapy in 71% of patients. Magnetic resonance imaging had 87.5% sensitivity (95% CI ¼ 68 -97%) and 50% specificity (95% CI ¼ 16 -84%) for a PPV (positive predictive value) of 99.8% and NPV (negative predictive value) of 80% for the detection of residual invasive cancer. Magnetic resonance imaging displayed 80% sensitivity (95% CI ¼ 28.4 -99.5%) and 89% specificity (95% CI ¼ 71 -98%) to detect pathological pCR in the breast. Eighty-four per cent of recruited patients were identified as potentially suitable candidates for BCS following chemotherapy and of those choosing to accept BCS, breast conservation was achieved in 90.5%, or 65.6% of all patients. Of those who proceeded to BCS, 9.5% required a re-do mastectomy because of positive margins; however, no residual tumour was found on histological examination of mastectomy specimens. Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

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Section: Discussionmentioning

confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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“…In some series, the presence of close margins was associated with an increased local recurrence rate compared to widely negative margins [15,16,[18][19][20]. Other studies, however, failed to demonstrate this [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Studies examining whether local recurrence rates are increased when close margins are not re-excised have been mixed [15][16][17][18][19][20][21][22][23]. When reexcisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure.…”

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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“…For example, overexpression of the HER2/neu oncoprotein and insulinlike growth factor-1 receptor, and accumulation of the p53 protein have all been reported to be associated with an increased local recurrence risk following conservative surgery and radiation therapy. 54 However, these results should be considered preliminary, and additional studies of this important question are needed. At the present time, it is premature to base recommendations regarding local therapy on the results of such biological marker studies.…”

Section: Elements Of the Breast Physical Exammentioning

confidence: 94%

“…In the majority of the reported series, positive margins of resection have been associated with an increased risk of breast recurrence, although the magnitude has varied considerably (Table 10). 48,[53][54][55][56][57][58][59][60][61] The variation in these results may be related to the extent of the surgical resection for the primary tumor, the presence or absence of an EIC, the definition of a positive margin, the number of margins that are positive, and the extent of the margin positivity.…”

Section: Elements Of the Breast Physical Exammentioning

confidence: 99%

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

298

165

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Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

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Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy

Cited by 251 publications

References 46 publications

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Residual disease after re‐excision lumpectomy for close margins

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

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