Positive margins of breast biopsy: Is reexcision always necessary?

Papa, Moshe Z.; Zippel, Douglas; Koller, Moshe; Klein, Ehud; Chetrit, Angela; Ari, Gur Ben

doi:10.1002/(sici)1096-9098(199903)70:3<167::aid-jso4>3.0.co;2-7

Cited by 50 publications

(27 citation statements)

References 16 publications

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“…Some Authors classify these negative distances as greater than 1 mm [5][6][7][8], greater than 2 mm [9][10][11][12][13][14], greater than 3 mm [15] or even greater than 5 mm [16].…”

Section: Surgical Margins Definitionmentioning

confidence: 99%

“…One year later, Papa et al [12] published that small and clinically detectable unifocal tumors with close margins (\2 mm) could probably be treated without the need of further excision. The eradication of possible microscopic residual tumor could be done by radiation treatment alone, thus sparing the patient an additional surgical procedure.…”

Section: Surgical Margin In Invasive Breast Cancer: Review Of the Litmentioning

confidence: 99%

“…An important factor to be considered is the presence of extensive DCIS as a significant predictor of increased residual disease at re-excision [22]. On the other hand, most patients with close or focally positive margins do not have significant residual cancer in the breast [12].…”

Section: Surgical Margin In Invasive Breast Cancer: Review Of the Litmentioning

confidence: 99%

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The surgical margin status after breast-conserving surgery: discussion of an open issue

Luini

Rososchansky

Gatti

et al. 2008

Breast Cancer Res Treat

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Hypothesis The best therapeutic approach to the involved or proximal surgical margins has not been defined yet; surgical margins status can influence the local relapse of disease in breast carcinoma, but the impact on overall survival has not been clearly demonstrated. Purpose of this work is to find in the available literature further evidence to guide the therapeutic behaviour in patients with close margins by invasive carcinoma. Design Review of the currently available literature on the evaluation of surgical margins in breast conserving surgery; influence of margin involvement by invasive component or intraductal component. Patients or other participants Literature research by PubMed on the topics of breast carcinoma, conservative surgery and margin definition and status; therapeutic approach to involved margins. Main outcome measure We reviewed the available literature focusing our attention to the definition of clear surgical margins and to the value of the close proximity of margins in relation to the local control of disease and the best therapeutic management of different situations. Results Further evidence is needed on large numbers of patients to understand how to evaluate surgical margins in invasive breast carcinoma. Conclusions There is no consensus on the definition of "clear surgical margins", and the ideal approach to the close proximity of margins has not been defined. It is not sure whether a new surgical procedure is really needed in every case of close proximity of tumor cells to the margins. Radiation therapy could be a good option in the management of these cases, but further evidence is needed to establish the real impact of clear surgical margins on local control of disease and, furthermore, on survival.

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“…Some Authors classify these negative distances as greater than 1 mm [5][6][7][8], greater than 2 mm [9][10][11][12][13][14], greater than 3 mm [15] or even greater than 5 mm [16].…”

Section: Surgical Margins Definitionmentioning

confidence: 99%

Section: Surgical Margin In Invasive Breast Cancer: Review Of the Litmentioning

confidence: 99%

See 1 more Smart Citation

The surgical margin status after breast-conserving surgery: discussion of an open issue

Luini

Rososchansky

Gatti

et al. 2008

Breast Cancer Res Treat

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“…While a lumpectomy has clear advantages over mastectomy, one disadvantage is the need sometimes to return to the operating room for a re-excision lumpectomy. Re-excision rates are high, ranging from 20% to 70% in the literature, and in addition to the inconvenience and added costs, re-excision lumpectomies may result in added complications and diminish the aesthetic outcome [2][3][4][5][6][7][8][9][10][11][12][13].…”

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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“…These rates are comparable to international studies. 19,27,28 In our study, the final margin status measurements were not captured, and therefore, we are not able to report the final close margin rate. However, we noted one patient (0.52%) who had undergone more than one surgical procedure, a re-excision followed by a mastectomy for persistent positive margin.…”

Section: Discussionmentioning

confidence: 94%

Breast-conserving therapy for breast carcinoma: Margins, re-excision and recurrence rates

2018

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IntroductionBreast cancer affects 1 million women in the developed world every year. 1 The burden of breast cancer is also on the rise in the developing world. According to Jones, 2 it is estimated that 70% of new cancer cases will occur in the developing world by the year 2020.Until the 1970s, the Halsted radical mastectomy had been the surgical procedure in the management of breast cancer irrespective of size. It was described and performed by William Stewart Halsted in 1882.3 It included the excision of the skin, the breast and underlying pectoralis muscles. Patients also underwent an axillary lymph node dissection. A skin graft was often used to close the wound defect. Patients were left with morbid disfiguring appearances.Modified radical mastectomy was shown to be as effectual as radical mastectomy and less mutilating. Modified radical mastectomy remains to be applicable to certain patients. However, breast-conserving therapy (BCT) has become the adopted procedure for the surgical management of early breast cancer. BCT refers to the surgical excision of the primary breast cancer tumour with a rim of normal breast tissue, followed by radiation therapy. It is also referred to in the literature as lumpectomy, partial mastectomy or segmental mastectomy. 4 Over the past 40 years, prospective large multicentre randomised controlled trials (RCTs) in Europe and United States have provided level 1 evidence that there is no statistically significant difference in the overall long-term survival between mastectomy and BCT in appropriately selected patients treated for early breast cancer.5 Although the overall long-term survival is similar between the two procedures, patients undergoing BCT are at a recognised risk of ipsilateral breast tumour recurrence. 6 The success rate of BCT relies upon appropriate patient selection, surgical technique and postoperative radiotherapy to eliminate microscopic tumour cells in the ipsilateral breast. The goals of BCT are therefore to resect the tumour with clear microscopic margins and to achieve acceptable cosmetic outcomes without compromising patient survival.Background: Breast-conserving therapy (BCT) is a wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer. There has not been a formal audit to review BCT outcomes in our unit.

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Positive margins of breast biopsy: Is reexcision always necessary?

Cited by 50 publications

References 16 publications

The surgical margin status after breast-conserving surgery: discussion of an open issue

The surgical margin status after breast-conserving surgery: discussion of an open issue

Residual disease after re‐excision lumpectomy for close margins

Breast-conserving therapy for breast carcinoma: Margins, re-excision and recurrence rates

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