Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

Edwards, Sara B.; Wengrofsky, Aaron J; Giddins, M.; Mills, Catherine M.; Cassaro, Sebastiano; Leitman, I. Michael

doi:10.1016/j.jss.2013.11.755

Cited by 7 publications

(8 citation statements)

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“…Dillon and colleagues also showed a significant decrease in the rate of residual tumour tissue with a 2‐mm free margin . In another study, residual tumour was identified in 38% cases with tumour at margin, 21% in cases with margins measuring between 0.1 and 0.9 mm and in 14% in cases with margins from 1.0 to 1.9 mm . Confirming this, a number of studies have shown that shaved margins revealed residual tumour in cases with less than 2 mm free margins, but the incidence decreased with 2 mm or more margins .…”

Section: Studies With a 2‐mm Margin Width As An Optimal Negative Marginmentioning

confidence: 77%

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Breast conservation in ductal carcinoma in situ (DCIS): what defines optimal margins?

et al. 2016

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The introduction of mammographic screening has resulted in a rise in the detection rate of ductal carcinoma in situ (DCIS), currently accounting for one-fifth of screen-detected breast cancers. Although 60-70% of DCIS are treated with breast-conserving surgery (BCS) with or without radiotherapy, the frequency of subsequent surgery to re-excise positive margins in order to reduce the probability of recurrences remains high. DCIS recurrence is associated not only with financial, health and psychological implications; approximately half these recurrences are invasive disease. An appropriate margin width for patients undergoing BCS for invasive breast cancer has been largely agreed. Although there is a perception that such recommendations may be applicable to DCIS, major differences exist which may affect this application. Importantly, DCIS patients often do not receive systemic adjuvant (endocrine) therapy and not all receive radiotherapy in routine practice. There is evidence that wide margins (i.e. >10 mm) confer better protection against recurrence than positive (i.e. 0 mm) margins; however, there remains a debate concerning the optimum margin width between 0 and 10 mm. Previous studies have demonstrated that radiation therapy may not compensate for lack of re-excision in those patients with positive or close margins, while wide margins will inevitably compromise cosmesis and patients' body image perception. This review aims to address the clinical question of the minimal margin width in DCIS treated with BCS that is associated with the lowest recurrence rate and when, therefore, further surgical intervention for re-excision can be safely avoided. A range of clinical circumstances that might affect this are considered.

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Section: Studies With a 2‐mm Margin Width As An Optimal Negative Marginmentioning

confidence: 77%

“…One main drawback of BCS for DCIS is the high re‐excision rate associated with positive margins. The range of surgical re‐excision frequency reported varies widely, from 20% to 70%, with an average of 30% . This variation is due mainly to the inconsistency in the definition of positive margins.…”

Section: Introductionmentioning

confidence: 99%

Breast conservation in ductal carcinoma in situ (DCIS): what defines optimal margins?

et al. 2016

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“…Resection of radiographic breast lesions large enough to require bracketed localization poses a significant challenge to minimize volume loss and to ensure complete resection with adequate margins. WL has been traditionally used for bracketing radiographically large breast lesions and been shown to be associated with a higher probability of positive margins if a bracketed approach is required . Studies have demonstrated that RSL excision is superior to WL in respect to need for re‐excision and SVs .…”

Section: Discussionmentioning

confidence: 99%

Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery

et al. 2017

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Multiple localizers placed in a bracketed fashion facilitates excision of radiographically extensive breast lesions. In this study, bracketed radioactive seed localization (bRSL) was compared to bracketed wire localization (bWL). We hypothesized that bRSL would achieve adequate margins and decrease re-operation rates with similar or less specimen volumes (SV) than bWL. Retrospective review identified patients who underwent bracketed breast procedures at an academic medical center. Data collected included patient demographics, tumor features, treatment variables, and surgical outcomes. Wilcoxon rank-sum test and chi-square test were used to compare continuous and categorical data, respectively. A multivariable logistic regression model was used to evaluate the association between re-excision and localization technique after adjusting for clinically relevant variables. Patients who underwent bWL were 3.9 times more likely to undergo re-excision compared to patients in bRSL group (OR=3.9, 95% CI: 2.0-7.4). Initial and total SV did not significantly differ between the two groups (P=.4). Patients were significantly more likely to undergo a mastectomy in the bWL group than in the bRSL group (24% vs 7%; P<.01). For patients undergoing excision of radiologically extensive breast lesions, bRSL serves as an alternative to bWL. In this retrospective study, bRSL was associated with a decreased re-excision rate with similar SV and a lower rate of mastectomy when compared to bWL.

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“…There is, however, some discrepancy of views concerning the clinical value of the specimen evaluated with this method. In the opinion of Britton et al [26] and of Edwards et al [28], this is the most useful method of verification of the resection margins out of all radiological assessment techniques. This view is additionally confirmed by the recommendations of SSO-ASTRO, concerning patients requiring a pre-operative staining of an extensive area of micro-calcifications with the use of bracketing.…”

Section: Radiological (Imaging) Techniquesmentioning

confidence: 98%

“…More than 95% of patients treated in this way did not require a secondary procedure, which was also the result of the peri-operative ultrasound assessment of the surgical margins [30]. Some other studies show, however, that a more useful method for this purpose is verification with the use of a peri-operative mammography [28].…”

Section: Radiological (Imaging) Techniquesmentioning

confidence: 99%

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

Nowikiewicz¹,

Zegarski²

2018

Nowotwory. Journal of Oncology

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In accordance with the current standards of treatment of breast cancer patients, the application of breast conserving treatment (BCT) requires a radical resection of the tumour and post-operative radiotherapy. This means the necessity of obtaining tumour-free primary resection margins, i.e. without the presence of cancer tissue. In spite of the correct pre-operative diagnostic process and appropriate surgical treatment, in about 20-30% BCT cases, the tumour resection turns out to be not radical. The necessity of performing another surgery leads to the prolongation of the overall operative time and increases costs. A histopathological evaluation of the margin of the primary tumour resection performed on an immediate basis is not a standard procedure in patients undergoing BCT. In spite of the definite limitations of this method, its application may decrease the overall rate of revision surgeries. The paper discusses some other currently available possibilities of perioperative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT.

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Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

Cited by 7 publications

References 0 publications

Breast conservation in ductal carcinoma in situ (DCIS): what defines optimal margins?

Breast conservation in ductal carcinoma in situ (DCIS): what defines optimal margins?

Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

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