Positive margins following surgical resection of breast carcinoma: Analysis of pathologic correlates

Miller, Alexander; Brandao, Guillermo; Prihoda, Thomas J.; Hill, Cheryl; Cruz, Anatolio B.; Yeh, I‐Tien

doi:10.1002/jso.20059

Cited by 71 publications

(52 citation statements)

References 37 publications

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“…[7][8][9][10][11]16,17 As far as we know, this is the first study to reveal that BPE is a significant independent factor associated with positive resection margin.…”

Section: Discussionmentioning

confidence: 72%

“…Instead, HER2 tended to be associated with positive resection margin (p 5 0.08). One retrospective study by Miller et al 16 suggested increased risk of positive resection margin associated with HER2 positivity. Similarly, Atalay and Irkkan 30 reported increased risk of having residual disease on re-excision specimen with initial positive margin associated with HER2 positivity.…”

Section: Discussionmentioning

confidence: 99%

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Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients?

Park¹,

Kang²,

Kim³

2015

BJR

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Objective: The purpose of our study was to evaluate whether strong background parenchymal enhancement (BPE) would be a significant independent factor associated with positive resection margin in patients treated initially with breast-conserving surgery (BCS). Methods: Retrospective evaluation of breast MRI examinations of 314 patients with breast cancer was carried out. Breast cancer was histologically confirmed in all patients who underwent BCS from January 2008 to December 2010. BPE was dichotomized into weak (minimal or mild) and strong (moderate or marked) enhancement for statistical analysis. Histopathological features of attained specimens were evaluated by an experienced pathologist and were also dichotomized for statistical analysis. Results: On univariate analysis, positive extensive intraductal component (p , 0.001), strong BPE (p 5 0.001) and human epidermal growth factor receptor 2 (HER2) positivity (p 5 0.08) had significant association with positive surgical margin. Tumour size, axillary lymph node metastasis, nuclear grade, histological grade, lymphovascular invasion, oestrogen receptor and progesterone receptor did not show significant correlation with positive surgical margin. On multivariate analysis, the significant independent predictors were extensive intraductal component [odds ratio, 5.68; 95% confidence interval (CI), 2.72-11.82] and strong BPE (odds ratio, 2.39; 95% CI, 1.20-4.78). Conclusion: Strong BPE is a significant independent factor for positive resection margin along with positive extensive intraductal component, and performing MRI during the period of lower parenchymal enhancement is needed in patients with strong BPE. Advances in knowledge: As far as we know, this is the first study to reveal that BPE is a significant independent factor associated with positive resection margin.Overall survival after breast-conserving surgery (BCS) followed by adjuvant radiation therapy has been shown to be equivalent to that after mastectomy for early stage breast cancer.1-4 Nowadays, BCS has become the standard treatment for early stage breast cancer. However, the rate of local recurrence is higher in patients with BCS than in those with mastectomy, 2 and the most important predictor of local recurrence is margin status. 5 In a meta-analysis reporting local recurrence relative to margin status, odds ratio for local recurrence was 2.42 (p , 0.001) with a positive margin. 6 There are many known risk factors associated with positive resection margin, including younger age, less than 45 years of age, mammographic density of Category 4, larger tumour size, positive lymph nodes, tumour multifocality, the presence of microcalcification in mammography, lobular histology, higher grade, the presence of extensive intraductal component and the presence of lymphovascular invasion. 7-11Accurate pre-operative assessment of tumour extent is essential for surgical planning and for reducing positive surgical margin. Breast MRI has been widely used for preoperative evaluation of tumour extent and could substant...

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“…[7][8][9][10][11]16,17 As far as we know, this is the first study to reveal that BPE is a significant independent factor associated with positive resection margin.…”

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients?

Park¹,

Kang²,

Kim³

2015

BJR

View full text Add to dashboard Cite

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“…Irregular (stellate) margins did not associate with PgR expression. An association between the tumour margin status and Her-2, ER, or PgR expression has been investigated in several studies [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Putti et al [29] recently demonstrated that breast tumours with a pushing margin (another terminology for irregular or stellate margin) were found to be ER negative and over expressing Her-2.…”

Section: Discussionmentioning

confidence: 99%

Pathobiological features of breast tumours in the State of Kuwait: a comprehensive analysis

Saleh¹,

Abdeen²

2008

European Journal of Cancer Supplements

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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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Positive margins following surgical resection of breast carcinoma: Analysis of pathologic correlates

Abstract: These data suggest certain pathologic factors that may portend difficulty in achieving negative resection margins in patients in whom breast conservation therapy is considered.

Cited by 71 publications

References 37 publications

Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients?

Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients?

Pathobiological features of breast tumours in the State of Kuwait: a comprehensive analysis

Residual disease after re‐excision lumpectomy for close margins

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