Lisa J Findlay-Shirras1, Oussama Outbih2, Charlene N Muzyka3, Katie Galloway3, Pamela C Hebbard4,5, Maged Nashed6,7. 1. Department of General Surgery, University of Manitoba, Winnipeg, MB, Canada. 2. Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada. 4. Section of General Surgery, Department of General Surgery, University of Manitoba, Winnipeg, MB, Canada. 5. CancerCare Manitoba, Winnipeg, MB, Canada. 6. Radiation Oncology, Department of Radiology, University of Manitoba, Winnipeg, MB, Canada. mnashed1@cancercare.mb.ca. 7. Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. mnashed1@cancercare.mb.ca.
Abstract
INTRODUCTION: Breast-conserving therapy is the standard of care for early-stage breast cancer. In the era of multimodality therapy, the debate on the value of revision surgery for compromised margins continues, and high re-excision rates persist despite updated guidelines. Our study sought to identify the local re-excision rate for compromised margins after lumpectomy, and identify predictors of residual disease at re-excision. METHODS: This population-based retrospective cohort study included women with breast cancer who underwent a lumpectomy between 2009 and 2012 in Manitoba, with close (≤ 2 mm) or positive margins that led to re-excision. Patient demographics and tumor characteristics were identified through provincial cancer registries and chart reviews. For patients with invasive cancer, the six anatomical margins were reported for margin status, width, and pathology type at the margin. RESULTS: Of the 2494 patients identified, 556 women underwent re-excision, yielding a re-excision rate of 22.29%. Of our 311 patients with invasive cancer who underwent re-excision, 62.7% had residual disease identified on revision. On univariable analysis, the size and grade of the invasive component, nodal stage, and the number of positive margins were associated with residual disease on re-excision (p < 0.05). With the exception of nodal stage, the same variables remained statistically significant on multivariable analysis. CONCLUSIONS: Our results suggest that even in the absence of 'no ink on tumor', the cancer size and grade in lumpectomy specimens are high-risk factors for residual disease, and this subgroup of patients may benefit from re-excision. Long-term follow-up of this cohort is required to determine their risk of recurrence after adjuvant treatment.
INTRODUCTION: Breast-conserving therapy is the standard of care for early-stage breast cancer. In the era of multimodality therapy, the debate on the value of revision surgery for compromised margins continues, and high re-excision rates persist despite updated guidelines. Our study sought to identify the local re-excision rate for compromised margins after lumpectomy, and identify predictors of residual disease at re-excision. METHODS: This population-based retrospective cohort study included women with breast cancer who underwent a lumpectomy between 2009 and 2012 in Manitoba, with close (≤ 2 mm) or positive margins that led to re-excision. Patient demographics and tumor characteristics were identified through provincial cancer registries and chart reviews. For patients with invasive cancer, the six anatomical margins were reported for margin status, width, and pathology type at the margin. RESULTS: Of the 2494 patients identified, 556 women underwent re-excision, yielding a re-excision rate of 22.29%. Of our 311 patients with invasive cancer who underwent re-excision, 62.7% had residual disease identified on revision. On univariable analysis, the size and grade of the invasive component, nodal stage, and the number of positive margins were associated with residual disease on re-excision (p < 0.05). With the exception of nodal stage, the same variables remained statistically significant on multivariable analysis. CONCLUSIONS: Our results suggest that even in the absence of 'no ink on tumor', the cancer size and grade in lumpectomy specimens are high-risk factors for residual disease, and this subgroup of patients may benefit from re-excision. Long-term follow-up of this cohort is required to determine their risk of recurrence after adjuvant treatment.
Authors: G Luis Pendola; Roberto Elizalde; Pablo Sitic Vargas; José Caicedo Mallarino; Eduardo González; José Parada; Mauricio Camus; Ricardo Schwartz; Enrique Bargalló; Ruffo Freitas; Mauricio Magalhaes Costa; Vilmar Marques de Oliveira; Paula Escobar; Miguel Oller; Luis Fernando Viaña; Antonio Jurado Bambino; Gustavo Sarria; Francisco Terrier; Roger Corrales; Valeria Sanabria; Juan Carlos Rodríguez Agostini; Gonzalo Vargas Chacón; Víctor Manuel Pérez; Verónica Avilés; José Galarreta; Guillermo Laviña; Jorge Pérez Fuentes; Lía Bueso de Castellanos; Bolívar Arboleda Osorio; Herbert Castillo; Claudia Figueroa Journal: Ecancermedicalscience Date: 2020-10-06
Authors: Kathryn Ottolino-Perry; Anam Shahid; Stephanie DeLuca; Viktor Son; Mayleen Sukhram; Fannong Meng; Zhihui Amy Liu; Sara Rapic; Nayana Thalanki Anantha; Shirley C Wang; Emilie Chamma; Christopher Gibson; Philip J Medeiros; Safa Majeed; Ashley Chu; Olivia Wignall; Alessandra Pizzolato; Cheryl F Rosen; Liis Lindvere Teene; Danielle Starr-Dunham; Iris Kulbatski; Tony Panzarella; Susan J Done; Alexandra M Easson; Wey L Leong; Ralph S DaCosta Journal: Breast Cancer Res Date: 2021-07-12 Impact factor: 6.466