Hung-Wen Lai1, Ren-Hung Huang2, Yu-Ting Wu3, Chih-Jung Chen4, Shou-Tung Chen5, Ying-Jen Lin6, Dar-Ren Chen7, Chih-Wei Lee8, Hwa-Koon Wu9, Hui-Yu Lin10, Shou-Jen Kuo11. 1. Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 143809@cch.org.tw. 2. Department of Surgical Pathology, Changhua Christian Hospital, Taiwan. Electronic address: 126294@cch.org.tw. 3. Department of Surgery, Wuri Lin Shin Hospital, Taichung, Taiwan. Electronic address: taichung1031@gmail.com. 4. Department of Surgical Pathology, Changhua Christian Hospital, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: 132540@cch.org.tw. 5. Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 1886@cch.org.tw. 6. Tumor Center, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 180681@cch.org.tw. 7. Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 115045@cch.org.tw. 8. Department of Radiology, Changhua Christian Hospital, Taiwan. Electronic address: 133559@cch.org.tw. 9. Department of Radiology, Changhua Christian Hospital, Taiwan. Electronic address: 17597@cch.org.tw. 10. Breast Surgery Center, Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan. Electronic address: candycarol0227@hotmail.com. 11. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 40225@cch.org.tw.
Abstract
BACKGROUND: To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer. METHODS: Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer. RESULTS: Positive surgical margins were detected in 151 (7.4%) of the 2050 patients. The incidence of positive surgical margins was 11.3% (118/1042) in the BCS group and 3.3% (33/1008) in the mastectomy group (P < 0.001). In multivariate analysis, lower body mass index (BMI), larger tumor size, and pathologic evidence of multifocal disease were associated with positive surgical margin involvement in the BCS group. Younger age and ductal carcinoma in situ (DCIS) histologic subtypes (Odds ratio (OR) = 2.165, 95% CI = 1.253-4.323) were associated with higher risk of re-operations. Preoperative MRI examination was associated with decreased risk for margin involvement in the BCS group (OR = 0.530, 95% CI = 0.332-0.842) and reoperation (OR = 0.302, 95% CI = 0.119-0.728). DCIS histologic subtypes were associated with higher residual tumor incidence than other types of breast cancer. CONCLUSIONS: Lower BMI, larger tumor size, pathologic evidence of multifocal disease, and no preoperative MRI evaluation were associated with increased risk for positive surgical margin involvement. DCIS with positive surgical margins was associated with increased risk for reoperation and residual cancer detection at re-excision.
BACKGROUND: To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer. METHODS: Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer. RESULTS: Positive surgical margins were detected in 151 (7.4%) of the 2050 patients. The incidence of positive surgical margins was 11.3% (118/1042) in the BCS group and 3.3% (33/1008) in the mastectomy group (P < 0.001). In multivariate analysis, lower body mass index (BMI), larger tumor size, and pathologic evidence of multifocal disease were associated with positive surgical margin involvement in the BCS group. Younger age and ductal carcinoma in situ (DCIS) histologic subtypes (Odds ratio (OR) = 2.165, 95% CI = 1.253-4.323) were associated with higher risk of re-operations. Preoperative MRI examination was associated with decreased risk for margin involvement in the BCS group (OR = 0.530, 95% CI = 0.332-0.842) and reoperation (OR = 0.302, 95% CI = 0.119-0.728). DCIS histologic subtypes were associated with higher residual tumor incidence than other types of breast cancer. CONCLUSIONS: Lower BMI, larger tumor size, pathologic evidence of multifocal disease, and no preoperative MRI evaluation were associated with increased risk for positive surgical margin involvement. DCIS with positive surgical margins was associated with increased risk for reoperation and residual cancer detection at re-excision.
Authors: Siun M Walsh; Sandra B Brennan; Emily C Zabor; Laura H Rosenberger; Michelle Stempel; Lizza Lebron-Zapata; Mary L Gemignani Journal: Ann Surg Oncol Date: 2019-08-08 Impact factor: 5.344
Authors: T J A van Nijnatten; L P T van Tiel; A C Voogd; C G M Groothuis-Oudshoorn; S Siesling; M B I Lobbes Journal: Breast Cancer Res Treat Date: 2020-09-15 Impact factor: 4.872