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Annals of Surgical Oncology

, Volume 20, Issue 7, pp 2250–2255 | Cite as

The Role of Margin Status and Reexcision in Local Recurrence Following Breast Conservation Surgery

  • Barbara J. AdamsEmail author
  • Christine K. Zoon
  • Christina Stevenson
  • Padma Chitnavis
  • Luke Wolfe
  • Harry D. Bear
Breast Oncology

Abstract

Introduction

Breast conservation surgery (BCS) results in survival equal to mastectomy for early-stage breast cancer. Ipsilateral breast tumor recurrence (IBTR) after BCS is thought to be related to margin status. At our institution, reexcision is performed only if tumor is at inked margin or with extensive disease close to multiple margins. The purpose of this study was to determine rates of reexcision and recurrences among BCS patients using this policy.

Methods

We performed an institutional review board-approved retrospective analysis of BCS patients who underwent surgery between January 2001 and June 2005. We identified patients who had a second breast excision within 8 weeks of the first, and those patients with an IBTR. Clinical and pathologic features of patients’ tumors were reviewed.

Results

We identified 543 patients who underwent BCS, 84 patients (15.5 %) underwent reexcision for margin status. The crude IBTR rate was 3.4 %, and the 5-year local recurrence-free survival of the reexcised group was 90.6 % compared with 97.4 % in the non-reexcised group (p = 0.0097). Of the 64 reexcision patients, 6 (9.4 %) had an IBTR versus 12 (2.6 %) of the 459 non-reexcised patients (p = 0.0151).

Discussion

Our reexcision rate is low compared with other reports. This results from a policy that defines “no tumor on ink” as an adequate margin for BCS, and the use of selective irradiation boosts based on margins assessed by our pathologists. Our local recurrence rate compares favorably with those seen in other studies while minimizing the need for additional operations. A higher IBTR rate after reexcision likely reflects tumor biology.

Keywords

Positive Margin Margin Status Margin Width Ipsilateral Breast Tumor Recurrence Infiltrate Ductal Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

No disclosures

References

  1. 1.
    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(16):1233–41.PubMedCrossRefGoogle Scholar
  2. 2.
    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(16):1227–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Mirza NQ, Vlastos G, Meric F, et al. Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy. Ann Surg Oncol. 2002;9(3):256–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Gage I, Schnitt SJ, Nixon AJ, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78(9):1921–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Park CC, Mitsumori M, Nixon A, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol. 2000;18(8):1668–75.PubMedGoogle Scholar
  6. 6.
    Vicini FA, Kestin L, Huang R, Martinez A. Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer. 2003;97(4):910–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Heil J, Breitkreuz K, Golatta M, et al. Do reexcisions impair aesthetic outcome in breast conservation surgery? Exploratory analysis of a prospective cohort study. Ann Surg Oncol. 2012;19(2):541–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Smitt MC, Nowels K, Carlson RW, Jeffrey SS. Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys. 2003;57(4):979–85.PubMedCrossRefGoogle Scholar
  9. 9.
    Kouzminova NB, Aggarwal S, Aggarwal A, Allo MD, Lin AY. Impact of initial surgical margins and residual cancer upon reexcision on outcome of patients with localized breast cancer. Am J Surg. 2009;198(6):771–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Dillon MF, Hill AD, Quinn CM, McDermott EW, O’Higgins N. A pathologic assessment of adequate margin status in breast-conserving therapy. Ann Surg Oncol. 2006;13(3):333–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Swanson GP, Rynearson K, Symmonds R. Significance of margins of excision on breast cancer recurrence. Am J Clin Oncol. 2002;25(5):438–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Jones HA, Antonini N, Hart AA, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27(30):4939–47.PubMedCrossRefGoogle Scholar
  14. 14.
    Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010;46:3219–32.PubMedCrossRefGoogle Scholar
  15. 15.
    Wang SY, Chu H, Shamliyan T, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst. 2012;104(7):507–16.PubMedCrossRefGoogle Scholar
  16. 16.
    Meric F, Mirza NQ, Vlastos G, et al. Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast-conserving therapy. Cancer. 2003;97(4):926–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Sabel MS, Rogers K, Griffith K, et al., Residual disease after re-excision lumpectomy for close margins. J Surg Oncol. 2009;99(2):99-–03.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Barbara J. Adams
    • 1
    Email author
  • Christine K. Zoon
    • 1
  • Christina Stevenson
    • 2
  • Padma Chitnavis
    • 3
  • Luke Wolfe
    • 1
  • Harry D. Bear
    • 1
    • 4
  1. 1.Department of SurgeryVirginia Commonwealth UniversityRichmondUSA
  2. 2.Department of Surgery and Neag Comprehensive Cancer Center University of Connecticut Health CenterFarmingtonUSA
  3. 3.School of Medicine, Virginia Commonwealth UniversityRichmondUSA
  4. 4.Massey Cancer CenterVirginia Commonwealth UniversityRichmondUSA

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