Positive margin rates following breast-conserving surgery for stage I–III breast cancer: palpable versus nonpalpable tumors

Abstract

Background Margin status is a significant risk factor for local recurrence. We sought to examine whether the method of tumor localization predicted the margin status and the need for re-excision for both non-palpable and palpable breast cancer. Methods We identified 358 consecutive breast cancer patients who were treated with breast-conserving therapy (BCT) from 1999–2006. Data included patient and tumor characteristics, method of localization (needle versus palpation), and pathologic outcomes. Descriptive statistics were utilized for data summary and data were compared using Chi-square. Results Of 358 patients undergoing BCT, 234 (65%) underwent needle localization for a non-palpable tumor and 124 (35%) underwent a palpation-guided procedure. Patients undergoing palpation-guided procedures were younger and had larger tumors at a more advanced pathologic stage of disease than those undergoing needle localization procedures (p<0.05 for each). Patient race, tumor grade, presence of lymphovascular invasion, biomarker profile, and nodal status were not significantly different between the two groups (p>0.05). Overall, 137 (38%) patients had one or more positive margins; 90 of 234 (38%) who had a needle localization procedure and 47 of 124 (38%) who had a palpation-guided procedure (p>0.05). The number of margins affected did not differ significantly between the two groups. Conclusion Although patients with palpable breast cancer had larger tumors than those with non-palpable breast cancer, the incidence and number of positive margins was similar to those who had needle localization for non-palpable tumors. Improved methods of localization are needed to reduce the rate of positive margins and the need for re-excision.

Factors Associated with Re-excision after Breast-Conserving Surgery for Early-Stage Breast Cancer

“…Needle localization is the most popular and traditional method. A study of needle localization reported the same positive resection margin rate for palpable tumors and needle-localized non-palpable tumors, but the rate remained high (38%) [28]. USG-guided resection has also been suggested for reducing the resection margin positive rate [29].…”

Fluorescence-guided surgery with live molecular navigation — a new cutting edge

“…Operations that are invariably successful or futile are less likely to benefit. Examples of surgeries that have high local recurrence (that is, recurrence at the site of the initial surgery) or positive margin rates are resections of malignant gliomas (80%) 27 , radical prostatectomy for prostate cancer (10–20%) 28–30 and conservation surgery for breast cancer (20–40%) 31,32 . In these situations, a fluorescently labelled, molecularly targeted probe would provide real-time, intra-operative distinction of the molecular edge between cancer and adjacent normal tissue, potentially decreasing the incidence of leaving residual cancer cells behind (that is, positive margins) (FIG.…”

Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery

“…23 This trend was observed by McIntosh et al in an analysis of 200 patients undergoing BCT for T1-2 tumors who had close or positive margins, did not undergo re-excision prior to radiation therapy, yet had low 5- and 10-year local recurrence rates at 3% and 5%, respectively. In 34 of 37 patients (92%) with a close or positive anterior margin, surgeons documented tumor superficiality as the predominant rationale for moving ahead with radiation therapy instead of attempting re-excision first.…”