The Use of Pathologic Features in Selecting the Extent of Surgical Resection Necessary for Breast Cancer Patients Treated by Primary Radiation Therapy

Abstract

The extent of the surgical resection necessary for breast cancer patients treated by primary radiation therapy is unknown. A simple gross excision of the tumor provides the best cosmetic result, but a wide local resection may be important to prevent local recurrence in some patients. In order to identify patients who are not adequately treated by gross excision of the tumor and radiation therapy, we performed a retrospective clinical-pathologic review of 221 treated women with infiltrating duct carcinoma. There were 53 cases in which the excision specimen showed a constellation of three pathologic features: prominent intraductal carcinoma in the tumor, intraductal carcinoma in the grossly-normal adjacent tissue, and poorly-differentiated nuclei. These cases had a 37% risk of a local recurrence at 6 years compared to eight per cent for all other cases (p less than 0.0001). In cases with all three features, the use of a supplemental dose of radiation to the primary site did not significantly reduce the risk of a local recurrence. Local recurrence at 6 years was 34% in cases with all three features, who received supplemental local radiation, compared to 49% in cases not receiving a supplemental dose (p = 0.28). Survival was also worse for patients with all three features compared to other cases (69% vs. 90% at 6 years, p = 0.002). These results indicate that patients with all three pathologic features have a high risk of local recurrence following gross excision of the tumor and radiation therapy. If primary radiation therapy is selected for these patients, they should first undergo a re-excision of the tumor site in order to be certain that areas of extensive intraductal carcinoma have been adequately resected. Patients whose tumors do not show all three features are adequately treated by gross excision of the tumor prior to radiation therapy.

DNA ploidy of primary breast cancer and local recurrence after breast-conserving therapy

“…The small size of the tumours in our series may have obscured such relationships; even in larger-scale studies these correlations are still controversial (Harris et al, 1985;Fisher et al, 1986;Lindley et al, 1989;Locker et al, 1989;Kurtz et al, 1990b). In cases that did recur, the tumour specimens had macroscopically positive margins more often than those in the matched control group did.…”

An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy

“…The exclusion of the 10% of patients having positive margins from breast-conserving therapy may account for the failure of the pathologists of the National Surgical Adjuvant Breast Project to identify EIC as a risk factor for local failure (Fisher et al, 1986). Harris et al (1985) have proposed a strategy of re-excision in patients with EIC, in the hopes of reducing local recurrence rates by achieving more generous margins. Our retrospective analysis of resection margins, however, suggests that local recurrence risk may be inherently high for EIC + patients, despite apparently adequate excision.…”

Multidetector row computed tomography for diagnosing intraductal extension of breast carcinoma

“…Several reports supported the association of higher ipsilateral breast tumor recurrence rates with positive or intermediate margins compared with negative pathologic margins. Precise evaluation of intraductal component and adequate surgical margin are important factors affecting the tumor recurrence after breast conserving surgery [5][6][7]. Margins of the resected specimens that are free of cancer cell are associated with optimal local control for patients who choose BCT [8,9].…”