Re-Excision Rate in Breast Conservation Surgery after Neoadjuvant Chemotherapy

Abstract

The purpose of this study was to compare the success rate of re-excision and breast-conserving surgery (BCS) between patients who received neoadjuvant chemotherapy and those who did not. Methods: In this retrospective cohort study, 256 women who had clinical T2 breast cancer and planned to receive, as initial treatment either BCS (n= 197) or neoadjuvant chemotherapy (n= 59) between January 2009 and December 2012 were included. The data, including age, initial tumor size, mammographic microcalcification, ultrasound multifocality and axillary nodal status, were collected. The pathologic tumor size, p-multifocality, histologic type, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, ductal carcinoma in situ (DCIS) and extensive intraductal component (EIC) were also reviewed. The re-excision and BCS success rates were investigated. Univariate analysis and regression model were used. To reduce the effect of selection bias, propensity score matching-based analysis was also performed. Results: Of the 256 patients, 178 patients (90.4%, 178/197) in the non-neoadjuvant group and 56 patients (94.9%, 56/59) in the neoadjuvant group received BCS (p= 0.406). In propensity-matched cohorts (n= 118), the re-excision rate was similar in the two groups (35.6% in neoadjuvant group vs. 35.6% in non-neoadjuvant group, p= 1.000). BCS success rate was slightly higher in neoadjuvant group (94.9%, 56/59) than in non-neoadjuvant group (86.4% [51/59], p= 0.205). In logistic regression model, clinicopathologic factors associated with re-excision were pathologic multifocality (odds ratio [OR], 4.56; p= 0.0142), high Ki-67 (≥ 50%) (OR, 0.7; p= 0.0243) and DCIS component (OR, 2.67; p= 0.0261). Conclusion: This study showed that neoadjuvant chemotherapy could increase the success rate of BCS but could not decrease that of re-excision. The re-excision rate is more associated with pathologic finding rather than the effect of neoadjuvant chemotherapy.

Use of Preoperative Radiation Therapy in Early-stage and Locally Advanced Breast Cancer

“…In the NACT setting, no standard approach to breast conservation and margin interpretation has been delineated. There are conflicting reports about whether NACT is associated with lower [2, 15] or higher [16] rates of re-excision following lumpectomy. We found that preopRT was associated with higher rates of positive surgical margins (8.2% vs 4.2%).…”