Factors Associated With Residual Breast Cancer After Re-excision for Close or Positive Margins

Cellini, Christina; Hollenbeck, Scott T.; Christos, Paul J.; Martins, Diana; Carson, J.W.; Kemper, Stephanie; Lavigne, Éric; Chan, Emily; Simmons, Rache M.

doi:10.1245/aso.2004.12.037

Cited by 88 publications

(50 citation statements)

References 20 publications

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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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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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“…Therefore, if tumour-involved margins are found at histopathological examination, a re-excision is performed. Residual disease is found in 30-65% of reexcision specimens [13][14][15]. We found a slightly higher percentage of 77%, which can be explained by the fact that we included patients with tumour-transected margins only and considered patients with close surgical margins ineligible for the present analysis.…”

Section: Discussionmentioning

confidence: 80%

Residual disease after re‐excision for tumour‐positive surgical margins in both ductal carcinoma in situ and invasive carcinoma of the breast: The effect of time

Velden

Vrande

Boetes

et al. 2007

Journal of Surgical Oncology

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An increased time interval between primary surgery and re-excision for tumour-positive surgical margins for invasive carcinoma is associated with a decreased incidence of finding residual tumour. This could be explained by inflammatory responses after surgical trauma. For DCIS there was no influence of time on finding residual tumour, which could be explained by a more protective microenvironment of DCIS or re-growth of surviving malignant cells.

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“…From these data, it is clear that resection margin less than 5 mm is definitely not sufficient to achieve tumor negative breast after surgical procedure [17][18] . The other important question is, however, whether obtaining free resection margin will have an impact on local recurrence rate and subsequently on overall survival of breast cancer patients [19][20][21][22][23][24][25][26][27] . All patients undergoing breast conserving surgery are indicated for adjuvant radiotherapy (considering that adjuvant radiotherapy may be omitted in older patients 28 ).…”

Section: Discussionmentioning

confidence: 99%

Significance of resection margin as a risk factor for local control of early stage breast cancer

Gatěk¹,

Vrána²,

Lukešová³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Introduction. Breast conserving surgery combined with sentinel node biopsy represents currently the gold standard of treatment for early breast cancer. Although breast conserving surgery has been a widely accepted method for many years, there remain some highly controversial unresolved issues. The present analysis focused on the resection margin as one of the key factors for local control of the disease. Methods. Patient disease free survival and overall survival were collected from patients undergoing breast conserving surgery from 2004 to 2009 at the Department of Surgery Atlas hospital Zlin, Czech Republic. All patients with resection margin less then 5 mm were re-resected to achieve this clear resection margin of 5mm or more. Disease free survival (more specifically local relapse free survival, metastasis free survival and regional free survival) and overall survival were assessed. Results. The data on 330 patients were analyzed and 286/330 cases had complete follow-up. After a median follow-up of 70 months, 7 patients with isolated local relapse were identified (2.44%), 13 patients with distant metastasis without local relapse (4.54%) and 2 patients with relapse in the axilla without local relapse in the breast (0.7%). Conclusion.The final decision about the extent of resection margin remains controversial but based on the data on local control presented here it seems reasonable to increase the criteria for a clear resection margin to 5 mm.

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Factors Associated With Residual Breast Cancer After Re-excision for Close or Positive Margins

Cited by 88 publications

References 20 publications

Residual disease after re‐excision lumpectomy for close margins

Residual disease after re‐excision lumpectomy for close margins

Residual disease after re‐excision for tumour‐positive surgical margins in both ductal carcinoma in situ and invasive carcinoma of the breast: The effect of time

Significance of resection margin as a risk factor for local control of early stage breast cancer

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