The Effects of Additional Tumor Cavity Sampling at the Time of Breast-Conserving Surgery on Final Margin Status, Volume of Resection, and Pathologist Workload
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Margin status is an important prognostic factor for local recurrence after breast-conserving surgery (BCS) in patients with breast malignancy. It is unclear whether the removal of additional tumor cavity margins reduces the reoperation rate and is cosmetically acceptable. This study compares the reoperation rates, volume of breast excised in cm3, and number of pathology slides examined in two groups of patients who underwent BCS with or without four or five additional margins (BCS + M).
We retrospectively analyzed 320 patients who underwent BCS or BCS + M for stage 0-I-II breast cancer from 2004 to 2007. We classified the margins as negative (≥1 mm), close (<1 mm), or positive based on the distance from the tumor to the margin of resection.
Of 320 cases analyzed, 199 (62.2%) underwent BCS and 121 (37.8%) had BCS + M. Overall, patients with BCS + M had a higher negative margins rate (85.1% vs. 57.2%, P < 0.05) and a lower reoperation rate. However, when ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) were analyzed separately, only patients with IDC showed a higher negative margin rate (91% vs. 62.1%, P < 0.001) and a lower volume of breast tissue excised (205.63 vs. 392.27, P = 0.03). There was no significant increase in pathology workload in both groups.
Resection of four to five additional margins during BCS for early-stage invasive breast cancer results in a higher rate of negative microscopic margins, lower volume of breast excised, and subsequently, a lower reoperation rate. The advantages of this approach include improved patient satisfaction and decreased cost.
- Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41. CrossRef
- Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32. CrossRef
- Veronesi U, Banfi A, Salvadori B, et al. Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer. 1990;26:668–70. CrossRef
- Tartter PI, Kaplan J, Bleiweiss I, et al. Lumpectomy margins, reexcision, and local recurrence of breast cancer. Am J Surg. 2000;179:81–5. CrossRef
- Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76:259–67. CrossRef
- Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93. CrossRef
- Taghian A, Mohiuddin M, Jagsi R, et al. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005;241:629–39. CrossRef
- Schnitt SJ, Abner A, Gelman R, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994;74:1746–51. CrossRef
- Dunne C, Burke JP, Morrow M, et al. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009;27:1615–20. CrossRef
- Waljee JF, Hu ES, Newman LA, et al. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–303. CrossRef
- Waljee JF, Hu ES, Newman LA, et al. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206:274–80. CrossRef
- Bani MR, Lux MP, Heusinger K, et al. Factors correlating with reexcision after breast-conserving therapy. Eur J Surg Oncol. 2009;35:32–7.
- Christy CJ, Thorsteinsson D, Grube BJ, et al. Preoperative chemotherapy decreases the need for re-excision of breast cancers between 2 and 4 cm diameter. Ann Surg Oncol. 2009;16:697–702. CrossRef
- Balch GC, Mithani SK, Simpson JF, et al. Accuracy of intraoperative gross examination of surgical margin status in women undergoing partial mastectomy for breast malignancy. Am Surg. 2005;71:22–7; discussion 27-8.
- Olson TP, Harter J, Munoz A, et al. Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol. 2007; 14(10):2953–60. CrossRef
- Saarela AO, Paloneva TK, Rissanen TJ, et al. Determinants of positive histologic margins and residual tumor after lumpectomy for early breast cancer: a prospective study with special reference to touch preparation cytology. J Surg Oncol. 1997;66:248–53. CrossRef
- Janes SE, Stankhe M, Singh S, et al. Systematic cavity shaves reduces close margins and re-excision rates in breast conserving surgery. Breast. 2006;15:326–30. CrossRef
- Malik HZ, George WD, Mallon EA, et al. Margin assessment by cavity shaving after breast-conserving surgery: analysis and follow-up of 543 patients. Eur J Surg Oncol. 1999;25:464–9. CrossRef
- Jacobson AF, Asad J, Boolbol SK, et al. Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision? Am J Surg. 2008;196:556–8. CrossRef
- Huston TL, Pigalarga R, Osborne MP, et al. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg. 2006;192:509–12. CrossRef
- Cao D, Lin C, Woo SH, et al. Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol. 2005;29:1625–32. CrossRef
- Genestie C, Zafrani B, Asselain B, et al. Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histological grades in a series of 825 cases of breast cancer: major importance of the mitotic count as a component of both grading systems. Anticancer Res. 1998;18(1B):571–6.
- Amat S, Penault-Llorca F, Cure H, et al. Scarff-Bloom-Richardson (SBR) grading: a pleiotropic marker of chemosensitivity in invasive ductal breast carcinomas treated by neoadjuvant chemotherapy. Int J Oncol. 2002;20:791–6.
- Dzierzanowski M, Melville KA, Barnes PJ, et al. Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal component and lumpectomy margins. J Surg Oncol. 2005;90:71–6. CrossRef
- Marudanayagam R, Singhal R, Tanchel B, et al. Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J. 2008;14:570–3. CrossRef
- Barthelmes L, Al Awa A, Crawford DJ. Effect of cavity margin shavings to ensure completeness of excision on local recurrence rates following breast conserving surgery. Eur J Surg Oncol. 2003;29:644–8. CrossRef
- Morrow M, Strom EA, Bassett LW, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52:277–300. CrossRef
- Morrow M, Strom EA, Bassett LW, et al. Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin. 2002;52:256–76. CrossRef
- Guidry JJ, Aday LA, Zhang D, et al. Transportation as a barrier to cancer treatment. Cancer Pract. 1997;5:361–6.
- The Effects of Additional Tumor Cavity Sampling at the Time of Breast-Conserving Surgery on Final Margin Status, Volume of Resection, and Pathologist Workload
Annals of Surgical Oncology
Volume 17, Issue 1 , pp 228-234
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Author Affiliations
- 1. Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
- 2. Avon Breast Center at Grady, Emory University, Atlanta, GA, USA
- 3. Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA