The Role of Margin Status and Reexcision in Local Recurrence Following Breast Conservation Surgery

Abstract

Our reexcision rate is low compared with other reports. This results from a policy that defines "no tumor on ink" as an adequate margin for BCS, and the use of selective irradiation boosts based on margins assessed by our pathologists. Our local recurrence rate compares favorably with those seen in other studies while minimizing the need for additional operations. A higher IBTR rate after reexcision likely reflects tumor biology.

Breast conservative surgery and local recurrence

“…However, as stated in the recent SSO-ASTRO-Guidelines [47] margins need to be cleared in terms of "no ink on margins". Contrary to our findings in this cohort, there is evidence in other studies that unclear margins affect local recurrence and disease-free survival [48], especially in high-risk tumor subtypes, as we also found most recently in a cohort of 2037 patients with triple-negative breast cancer [49]. Traditional prognostic factors like T-size [50,51] in a cohort with a typical distribution of national mammography screening from 50 to 69 years with predominantly T1 and T2-tumors did not show a significant increase of recurrence rate from T1 to T2 stage.…”

Importance of margin width in breast‐conserving treatment of early breast cancer

“…In our study, re‐excision was associated with a high risk of IBTR. A similar result was found by Groot et al and Adams et al . A delay in adjuvant therapy has been proposed as a possible explanation because delays have been associated with IBTR , but inadequate re‐excision due to poor orientation of the initial specimen could also be a contributing factor.…”

The importance of surgical margins in breast cancer

“…Adams et al in concordance with NSABP guidelines, evaluated the role of an institution-wide policy of "no tumor on ink" (See Fig. 1) as a definition of negative margins, and found that this did not lead to an increase in local recurrence in their institution [41]. This is in agreement with several other retrospective cohort studies and opinions from leaders in the field, however these studies are all level 3 evidence [42][43][44].…”