Piero Fregatti1,2, Marco Gipponi3, Giulia Atzori1, Raffaele DE Rosa1, Raquel Diaz1, Chiara Cornacchia1, Marco Sparavigna1, Alessandro Garlaschi4, Liliana Belgioia5,6, Alessandra Fozza5, Francesca Pitto7, Luca Boni8, Eva Blondeaux8, Francesca Depaoli2, Federica Murelli1,2, Simonetta Franchelli2, Gabriele Zoppoli9,10, Matteo Lambertini9,10,11, Daniele Friedman1,2. 1. Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy. 2. Breast Surgery Clinic, San Martino Policlinic Hospital, Genoa, Italy. 3. Breast Surgery Clinic, San Martino Policlinic Hospital, Genoa, Italy; marco.gipponi@hsanmartino.it. 4. Diagnostic Senology, San Martino Policlinic Hospital, Genoa, Italy. 5. Radiation Oncology Department, San Martino Policlinic Hospital, Genoa, Italy. 6. Radiation Oncology Department, San Martino Policlinic Hospital, School of Medicine, University of Genoa (DISSAL), Genoa, Italy. 7. Pathology Unit, San Martino Policlinic Hospital, Genoa, Italy. 8. Clinical Epidemiology Unit, San Martino Policlinic Hospital, Genoa, Italy. 9. Internal Medicine and Oncology Unit, San Martino Policlinic Hospital, Genoa, Italy. 10. Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy. 11. Department of Medical Oncology, U.O.C Medical Oncology Clinic, San Martino Policlinic Hospital, Genoa, Italy.
Abstract
BACKGROUND/AIM: Clinicopathological features of patients undergoing margin enlargement after lumpectomy for early breast cancer with positive/close excision margins were analyzed in order to define whether a re-operative procedure could have been avoided. Furthermore, a standardized protocol of specimen orientation was adopted in order to optimize both the widening procedure as well as the oncologic outcome. PATIENTS AND METHODS: A retrospective analysis was performed including pre-, peri-, and post-operative parameters, and a predictive score by means of a multivariate model was developed using all clinically and statistically significant variables associated with residual disease (RD). RESULTS: RD was significantly related to positive tumor margins, hormone receptor negative, HER2-positive, and tumors with high Ki67 proliferation index (p<0.001); the corresponding contribution to the prognostic score was as follows: close margins, 3 points; hormone receptor positive disease, 2 points; low Ki67, 2 points; HER2 negativity, 1 point. In 102 patients with a score >3, only 2 patients (2.0%) had RD, while in 81 patients with a score ≤3, 55 patients (67.9%) had RD (p<0.001). CONCLUSION: This predictive model might aid in clinical-decision making of patients with positive margins who actually require a widening procedure after intraoperative and/or definitive histology. Copyright
BACKGROUND/AIM: Clinicopathological features of patients undergoing margin enlargement after lumpectomy for early breast cancer with positive/close excision margins were analyzed in order to define whether a re-operative procedure could have been avoided. Furthermore, a standardized protocol of specimen orientation was adopted in order to optimize both the widening procedure as well as the oncologic outcome. PATIENTS AND METHODS: A retrospective analysis was performed including pre-, peri-, and post-operative parameters, and a predictive score by means of a multivariate model was developed using all clinically and statistically significant variables associated with residual disease (RD). RESULTS: RD was significantly related to positive tumor margins, hormone receptor negative, HER2-positive, and tumors with high Ki67 proliferation index (p<0.001); the corresponding contribution to the prognostic score was as follows: close margins, 3 points; hormone receptor positive disease, 2 points; low Ki67, 2 points; HER2 negativity, 1 point. In 102 patients with a score >3, only 2 patients (2.0%) had RD, while in 81 patients with a score ≤3, 55 patients (67.9%) had RD (p<0.001). CONCLUSION: This predictive model might aid in clinical-decision making of patients with positive margins who actually require a widening procedure after intraoperative and/or definitive histology. Copyright
Authors: Ariella M Altman; David D Nguyen; Benjamin Johnson; Schelomo Marmor; Molly E Klein; Todd M Tuttle; Jane Yuet Ching Hui Journal: Breast J Date: 2019-09-03 Impact factor: 2.431
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