BACKGROUND: Neoadjuvant chemotherapy (NAC) has enabled more patients to be eligible for breast-conservation surgery (BCS). Achieving negative lumpectomy margins, however, is challenging due to changes in tissue composition and potentially scattered residual carcinoma in the tumor bed. Data regarding BCS after NAC have shown variable re-excision rates. MarginProbe (Dilon Technologies, Newport News, VA, USA) has been shown to identify positive resection margins intraoperatively and to reduce the number of re-excisions in primary BCS, but has not been studied in NAC+BCS cases. This study aimed to investigate the clinicopathologic characteristics, margin status, and re-excision rates for NAC+BCS patients with and without the use of MarginProbe. METHODS: The Institutional Breast Cancer Database was queried for patients who received NAC and had BCS from 2010 to 2019. The variables of interest were demographics, tumor characteristics, pathologic complete response (pCR), MarginProbe use, and re-excision rates. RESULTS: The study population consisted of 214 patients who had NAC, 61 (28.5 %) of whom had NAC+BCS. The median age of the patients was 53.5 years. A pCR was achieved for 19 of the patients (31.1 %). Of the remaining 42 patients, 9 (21 %) had close or positive margins that required re-excision. Re-excision was associated with a larger residual tumor size (p = 0.025) and estrogen receptor (ER)-positive disease before NAC (p = 0.041). MarginProbe use was associated with a lower re-excision rate for the patients who had NAC+BCS (6 % vs. 31 %, respectively). CONCLUSION: The patients with a larger residual tumor burden and ER-positive disease had a greater risk for inadequate margins at surgery. MarginProbe use was associated with a lower re-excision rate. Techniques to reduce the need for re-excision will support the use of BCS after NAC.
BACKGROUND: Neoadjuvant chemotherapy (NAC) has enabled more patients to be eligible for breast-conservation surgery (BCS). Achieving negative lumpectomy margins, however, is challenging due to changes in tissue composition and potentially scattered residual carcinoma in the tumor bed. Data regarding BCS after NAC have shown variable re-excision rates. MarginProbe (Dilon Technologies, Newport News, VA, USA) has been shown to identify positive resection margins intraoperatively and to reduce the number of re-excisions in primary BCS, but has not been studied in NAC+BCS cases. This study aimed to investigate the clinicopathologic characteristics, margin status, and re-excision rates for NAC+BCS patients with and without the use of MarginProbe. METHODS: The Institutional Breast Cancer Database was queried for patients who received NAC and had BCS from 2010 to 2019. The variables of interest were demographics, tumor characteristics, pathologic complete response (pCR), MarginProbe use, and re-excision rates. RESULTS: The study population consisted of 214 patients who had NAC, 61 (28.5 %) of whom had NAC+BCS. The median age of the patients was 53.5 years. A pCR was achieved for 19 of the patients (31.1 %). Of the remaining 42 patients, 9 (21 %) had close or positive margins that required re-excision. Re-excision was associated with a larger residual tumor size (p = 0.025) and estrogen receptor (ER)-positive disease before NAC (p = 0.041). MarginProbe use was associated with a lower re-excision rate for the patients who had NAC+BCS (6 % vs. 31 %, respectively). CONCLUSION: The patients with a larger residual tumor burden and ER-positive disease had a greater risk for inadequate margins at surgery. MarginProbe use was associated with a lower re-excision rate. Techniques to reduce the need for re-excision will support the use of BCS after NAC.
Authors: José H Volders; Vera L Negenborn; Max H Haloua; Nicole M A Krekel; Katarzyna Jóźwiak; Sybren Meijer; Petrousjka M van den Tol Journal: J Surg Oncol Date: 2017-03-23 Impact factor: 3.454
Authors: Renee L Arlow; Lisa E Paddock; Xiaoling Niu; Laurie Kirstein; Bruce G Haffty; Sharad Goyal; Thomas Kearney; Deborah Toppmeyer; Antoinette M Stroup; Atif J Khan Journal: Am J Clin Oncol Date: 2018-12 Impact factor: 2.339
Authors: Allen M Chen; Funda Meric-Bernstam; Kelly K Hunt; Howard D Thames; Elesyia D Outlaw; Eric A Strom; Marsha D McNeese; Henry M Kuerer; Merrick I Ross; S Eva Singletary; Fredrick C Ames; Barry W Feig; Aysegul A Sahin; George H Perkins; Gildy Babiera; Gabriel N Hortobagyi; Thomas A Buchholz Journal: Cancer Date: 2005-02-15 Impact factor: 6.860
Authors: Geneviève Soucy; Julie Bélanger; Guy Leblanc; Lucas Sideris; Pierre Drolet; Andrew Mitchell; Yves E Leclerc; Michel P Dufresne; Julie Beaudet; Pierre Dubé Journal: J Am Coll Surg Date: 2008-03-03 Impact factor: 6.113
Authors: J H Volders; M H Haloua; N M A Krekel; V L Negenborn; E Barbé; C Sietses; K Jóźwiak; S Meijer; M P van den Tol Journal: Eur J Surg Oncol Date: 2016-05-04 Impact factor: 4.424
Authors: José H Volders; Vera L Negenborn; Pauline E Spronk; Nicole M A Krekel; Linda J Schoonmade; Sybren Meijer; Isabel T Rubio; M Petrousjka van den Tol Journal: Breast Cancer Res Treat Date: 2017-12-06 Impact factor: 4.872