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Factors Associated with Negative Margins of Lumpectomy Specimen: Potential Use in Selecting Patients for Intraoperative Radiotherapy

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

Abstract

Background

Lumpectomy followed by radiation is standard treatment for early breast cancer. Recently, the use of partial breast intraoperative radiation (IORT) has been developed, and patients selected for IORT should not have positive margins. This study’s purpose was to identify factors predicting negative margins after lumpectomy.

Methods

Patient age, preoperative investigations, surgery, final pathology, and margin status were examined using a prospective database between 1999 and 2005. Univariate and multivariate logistic regression analysis were performed to identify patient and tumor factors predicting an increased rate of negative margins. The results were used to generate a patient selection algorithm.

Results

The rate of positive margins at first resection was 17% in 730 lumpectomies (708 patients). Multivariate analysis revealed that older age (P = .0006), smaller tumor size (P < .0025), type of surgery (OR = 3.4 for ultrasound vs mammogram-guided wire localization, P = .003), and having a core needle biopsy (CNB) with preoperative cancer diagnosis (P < .0001) were predictive for having a negative margin. Patients older than age 50 with a preoperative CNB showing invasive cancer less that 3 cm that can be localized under ultrasound had a negative margin rate of 98 % (n = 178). These patients would be ideal for consideration of IORT.

Conclusions

Negative margin rates after lumpectomy are predicted by age, tumor size, preoperative investigations, and localization technique. These variables can be used to select patients for IORT with a 2.2% chance of positive margins.

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Acknowledgment

Funding support was received from Tanenbaum Fellowship Program in Surgical Oncology and the Gattuso Chair in Breast Surgical Oncology.

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Authors and Affiliations

  1. Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada

    D. E. Schiller MD, MSc, FRCSC & D. R. McCready MD, MSc, FRCSC

  2. Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada

    L. W. Le MSc

  3. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada

    B. C. J. Cho MD, PhD

  4. Department of Pathology, Princess Margaret Hospital, Toronto, Ontario, Canada

    B. J. Youngson MSc, MD

Authors
  1. D. E. Schiller MD, MSc, FRCSC
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  2. L. W. Le MSc
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  3. B. C. J. Cho MD, PhD
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  4. B. J. Youngson MSc, MD
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  5. D. R. McCready MD, MSc, FRCSC
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Corresponding author

Correspondence to D. R. McCready MD, MSc, FRCSC.

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Schiller, D.E., Le, L.W., Cho, B.C.J. et al. Factors Associated with Negative Margins of Lumpectomy Specimen: Potential Use in Selecting Patients for Intraoperative Radiotherapy. Ann Surg Oncol 15, 833–842 (2008). https://doi.org/10.1245/s10434-007-9711-2

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  • DOI: https://doi.org/10.1245/s10434-007-9711-2

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