Skip to main content

Advertisement

SpringerLink
Log in

A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens With Positive Margins

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

Abstract

Background: Excising a breast tumor with negative margins minimizes local recurrence. With a positive margin, the standard re-excision consists of excising the whole cavity and all surrounding breast tissue. By marking the sides of the lumpectomy specimen with six different colored inks, the surgeon can limit the re-excision to the involved margin. We compared the local recurrence rate after these two re-excision methods.

Methods: Records were reviewed of 527 women (546 breasts) treated with lumpectomy at two institutions. The log-rank test was used to compare the local recurrence–free survival.

Results: Of 546 tumors, 245 (45%) had negative margins on the initial lumpectomy and were not re-excised. Fifty-five percent had a positive or close margin; 181 underwent whole-cavity re-excision, and 120 had ink-directed re-excision. The mean follow-up time was 3.4 years. There was no significant difference in local recurrence for the patients whose initial margin was negative (3.7%) compared with the 243 patients with initially positive margins who underwent a re-excision (3.3%). Eleven of 181 (6%) patients undergoing a whole-cavity re-excision developed a local recurrence, compared with none of 120 (0%) patients with an ink-directed re-excision (P = not significant). Tissue mass excised was significantly smaller in the ink-directed group (23 vs. 83 g, P < .05).

Conclusions: Ink-directed re-excision of lumpectomy specimens with positive margins minimizes the amount of breast tissue removed without increasing the incidence of local recurrence and is therefore preferable to the standard whole-cavity method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Freedman G, Fowble B, Hanlon A, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 1999; 44: 1005–15.

    Article  PubMed  CAS  Google Scholar 

  2. Gage I, Schnitt SJ, Nixon AJ, et al. Pathologic margin and the risk of recurrence in patients treated with breast-conserving therapy. Cancer 1996; 78: 1921–8.

    Article  PubMed  CAS  Google Scholar 

  3. Fisher ER, Constantino J, Fisher B, Palekar A, Redmond C, Mamounas E. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) Protocol B-17. Cancer 1995; 75: 1310–9.

    Article  PubMed  CAS  Google Scholar 

  4. Silverstein MJ, Lagios MD, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999; 340: 1455–61.

    Article  PubMed  CAS  Google Scholar 

  5. Wazer DE, Schmidt-Ulrich RK, Ruthazer R, et al. Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed. Int J Radiat Oncol Biol Phys 1998; 40: 851–8.

    Article  PubMed  CAS  Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. Cady B. Duct carcinoma in situ. Surg Oncol Clin N Am 1993; 2: 75–91.

    Google Scholar 

  8. Rose MA, Olivotto IA, Cady B, et al. Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg 1989; 124: 153–7.

    Article  PubMed  CAS  Google Scholar 

  9. Wazer DE, DiPetrillo T, Schmidt-Ulrich R, Weld L, Marchant DJ, Robert NJ. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992; 10: 356–63.

    PubMed  CAS  Google Scholar 

  10. Olivotto IA, Rose MA, Osteen RT, et al. Late cosmetic outcome after conservative surgery and radiotherapy: analysis of causes of cosmetic failure. Int J Radiat Oncol Biol Phys 1989; 17: 747–53.

    Article  PubMed  CAS  Google Scholar 

  11. Veronesi U, Volterrani F, Luini A, et al. Quadrantectomy versus lumpectomy for small size breast cancer. Eur J Cancer 1990; 26: 671–3.

    Article  PubMed  CAS  Google Scholar 

  12. Pezner RD, Patterson MP, Lipsett JA, et al. Factors effecting cosmetic outcome in breast-conserving cancer treatment—objective quantitative assessment. Breast Cancer Res Treat 1992; 20: 85–92.

    Article  PubMed  CAS  Google Scholar 

  13. Kearney TJ, Morrow M. Effect of re-excision on the success of breast-conserving surgery. Ann Surg Oncol 1995; 2: 303–7.

    Article  PubMed  CAS  Google Scholar 

  14. Gwin JL, Eisenburg BL, Hoffman JP, Ottery FD, Boraas M, Solin LJ. Incidence of gross and microscopic carcinoma in specimens from patients with breast cancer after re-excision lumpectomy. Ann Surg 1993; 218: 729–34.

    Article  PubMed  CAS  Google Scholar 

  15. Anscher MS, Jones P, Prosnitz LR, et al. Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy. Ann Surg 1993; 218: 22–8.

    Article  PubMed  CAS  Google Scholar 

  16. Solin LJ, Kurtz J, Fourquet A, et al. Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol 1996; 14: 754–63.

    PubMed  CAS  Google Scholar 

  17. Kestin LL, Goldstein NS, Martinez AA, et al. Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy. Patterns of failure and 10-year results. Ann Surg 2000; 231: 235–45.

    Article  PubMed  CAS  Google Scholar 

  18. Cox CE, KuNN, Reintgen DS, Greenberg HM, Nicosoa SV, Wangensteen S. Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg 1991; 126: 490–3.

    Article  PubMed  CAS  Google Scholar 

  19. Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and surgical margins in breast cancer. Ann Surg Oncol 1998; 5: 220–6.

    Article  PubMed  CAS  Google Scholar 

  20. Tartter PI, Kaplan J, Bleiweiss I, et al. Lumpectomy margins, re-excision, and local recurrence of breast cancer. Am J Surg 2000; 179: 81–5.

    Article  PubMed  CAS  Google Scholar 

  21. Harlow SP, Krag DN, Ames SE, Weaver DL. Intraoperative ultrasound localization to guide surgical excision of nonpalpable breast carcinoma. J Am Coll Surg 1999; 189: 241–6.

    Article  PubMed  CAS  Google Scholar 

  22. Yim JH, Barton P, Weber B, et al. Mammographically detected breast cancer. Benefits of stereotactic core versus wire localization biopsy. Ann Surg 1996; 223: 688–700.

    Article  PubMed  CAS  Google Scholar 

  23. Whitten TM, Wallace TW, Bird RE, et al. Image-guided core biopsy has advantages over needle localization biopsy for the diagnosis of nonpalpable breast cancer. Am Surg 1997; 63: 1072–8.

    PubMed  CAS  Google Scholar 

  24. Ngai JH, Zelles GW, Rumore GJ, Sawicki JE, Godfrey RS. Breast biopsy techniques and adequacy of margins. Arch Surg 1991; 126: 1343–7.

    Article  PubMed  CAS  Google Scholar 

  25. Al-Sobhi SS, Helvie MA, Pass HA, Chang AE. Extent of lumpectomy for breast cancer after diagnosis by stereotactic core versus wire localization biopsy. Ann Surg Oncol 1999; 6: 330–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

    Glen R. Gibson MD, Leila A. Mott MS & Richard J. Barth Jr. MD

  2. Beth Israel-Deaconess Medical Center, Boston, Massachusetts

    Beth-Ann Lesnikoski MD & James Yoo MD

  3. Women and Infants’ Hospital, Providence, Rhode Island

    Blake Cady MD

  4. Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756

    Richard J. Barth Jr. MD

Authors
  1. Glen R. Gibson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beth-Ann Lesnikoski MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Yoo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leila A. Mott MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Blake Cady MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard J. Barth Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard J. Barth Jr. MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gibson, G.R., Lesnikoski, BA., Yoo, J. et al. A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens With Positive Margins. Ann Surg Oncol 8, 693–704 (2001). https://doi.org/10.1007/s10434-001-0693-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-001-0693-1

Key Words:

Search

Navigation