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Surgical Options and Locoregional Recurrence in Patients Diagnosed with Invasive Lobular Carcinoma of the Breast

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Recent consensus guidelines on margins for breast-conserving surgery (BCS) recommend the use of “no ink on tumor” as the standard for an adequate margin. The recommendations extend to invasive lobular carcinoma (ILC), but the data on this subset are limited. We reviewed our modern dataset on margin status with outcomes of ILC.

Methods

We performed a retrospective cohort study on 736 patients with a diagnosis of stage I–III ILC treated at our cancer center between May 1997 and December 2007. Clinicopathologic data were extracted from the Clinical Research Information Systems Database. Margin status was defined using the latest ASCO/ASTRO/SSO consensus guideline criteria.

Results

The initial surgery performed was mastectomy in 352 patients (48 %) and BCS in 384 patients (52 %). In multivariate analysis, tumor size and multifocality were significantly associated with high rates of mastectomy and positive surgical margins at initial BCS. After initial BCS, additional surgery was performed in 92 patients (24 %). During a 72-month median follow-up period, 12 (3.1 %) ipsilateral breast tumor recurrences (IBTR) and 5 (1.3 %) other locoregional recurrences (LRR) were observed. Patients with margins with ink on tumor who did not receive further surgery were found to have significantly increased LRR [odds ratio (OR) 5.5; p = 0.02] and IBTR (OR 8.5; p = 0.006), whereas patients with close margins (1–3 mm) and margins within 1 mm were not.

Conclusions

Our study supports the validity of using “no ink on tumor” as the standard for a negative margin for pure and mixed ILC treated with multimodality therapy.

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Acknowledgment

This work was supported by the Susan G. Komen Foundation for the Cure Grant (PDF14302599) and by the NIH Grant R25CA089017. Dr. Sonal Jhaveri at Dana-Farber’s Postdoc and Graduate Student Affairs Office (PGSAO) edited an earlier version of the manuscript. The authors gratefully acknowledge the support and generosity of Linda Cutone and Hakuaikai Medical Cooperation.

Disclosure

The authors have no conflicts of interest concerning this study.

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Author notes

    Authors and Affiliations

    1. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

      Yasuaki Sagara MD, Melissa Anne Mallory MD, Fatih Aydogan MD & Mehra Golshan MD

    2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

      William T. Barry PhD

    3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

      Ines Vaz-Luis MD, Eric P. Winer MD & Otto Metzger-Filho MD

    4. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

      Jane E. Brock MD, PhD

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    1. Yasuaki Sagara MD
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    Correspondence to Yasuaki Sagara MD.

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    Otto Metzger-Filho and Mehra Golshan are senior authors. They have contributed equally.

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    Sagara, Y., Barry, W.T., Mallory, M.A. et al. Surgical Options and Locoregional Recurrence in Patients Diagnosed with Invasive Lobular Carcinoma of the Breast. Ann Surg Oncol 22, 4280–4286 (2015). https://doi.org/10.1245/s10434-015-4570-8

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    • DOI: https://doi.org/10.1245/s10434-015-4570-8

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