Relationship between Initial Margin Status for Invasive Breast Cancer and Residual Carcinoma after Re-Excision

Abstract

Little data exists addressing the relationship between initial margin status in a specimen from an excisional biopsy and the presence of residual carcinoma in a subsequent specimen from lumpectomy or mastectomy. We sought to determine the relationship between initial margin status and the presence of residual invasive cancer, and to identify any relationship to other variables. This study was a retrospective review of pathology reports of 582 early-stage invasive duct carcinomas with open excisional biopsies. The initial specimen was classified into one of six margin categories: multiply focally positive (n = 174), focally positive (n = 132), margins <1 mm (n = 98), margins 1 to 2 mm (n = 20), margins >2 mm (n = 46), and margins undetermined (n = 90). All patients had a subsequent definitive second procedure. Pathology reports from the second procedure revealed the presence of residual invasive cancer by initial margin status as follows: in 30 per cent of the initial procedures with multiply focally positive margins, in 22 per cent with focally positive margins, in 8 per cent, 15 per cent, and 4 per cent with margins of <1 mm, 1 to 2 mm, and >2 mm, respectively, and in 28 per cent with undetermined margins. Women with palpable tumors, larger tumor size, and positive axillary nodes were more likely to have multiply focal and focally positive margins. Multiply focally positive and focally positive margins had similar residual invasive carcinoma rates and should be re-excised. All clear margins were equivalent; thus, re-excision was not necessary.

Towards a personalized surgical margin for breast conserving surgery—Implications of field cancerization in local recurrence

“…Although some studies have shown a strong, inverse correlation between the risk for local recurrence and the distance between the surgical margin and the tumor , others have not found this correlation . The National Comprehensive Cancer Network (NCCN) Guidelines have historically defined a 2 mm surgical margin as adequate to prevent recurrence .…”

Rapid and High-resolution Imaging of Lumpectomy Margins Using Deep Ultraviolet Fluorescence Scanning Microscopy

“…First, DUV-FSM can image large margins of variable size with subcellular resolution. Since the size of lumpectomy margins varies and most positive margins typically involve small microscopic foci of cancer, [51] a device with both large margin coverage and microscopic resolution is highly desirable to rapidly evaluate lumpectomy margin status intraoperatively with both low false-negative and false-positive rates. However, many technologies currently under investigation are either a point device (e.g., optical spectroscopy, i-Knife, MarginProbe) or a high resolution device with very small eld of view (e.g., OCT, confocal) that requires excessive time to manually scan a surgical margin, or a wide-eld imaging device with very low spatial resolution (e.g., uorescence imaging, SFDI).…”

Risk Factors for Re-Excision Following Breast-Conserving Surgery

“…Most studies agreed that multifocality of tumors, infiltrative tumor borders, large tumor size, and younger age predict re-excision (Devouge et al, 2013;Jung et al, 2012;Lovrics et al, 2009;Meier-Meitinger et al, 2012). Some studies also link palpable tumors to increased risk for positive margins (Kotwall, Ranson, Stiles, & Hamann, 2007;Lovrics et al, 2009).…”