Positive Margin Rates Following Breast-Conserving Surgery for Stage I-III Breast Cancer: Palpable Versus Non-Palpable Tumors

Abstract Background Preoperative breast magnetic resonance imaging (MRI) provides more information than mammography and ultrasonography for determining the surgical plan for patients with breast cancer. This study aimed to determine whether breast MRI is more useful for patients with ductal carcinoma in situ (DCIS) lesions than for those with invasive ductal carcinoma (IDC). Methods A total of 1113 patients with breast cancer underwent mammography, ultrasonography, and additional breast MRI before surgery. The patients were divided into 2 groups: DCIS (n = 199) and IDC (n = 914), and their clinicopathological characteristics and oncological outcomes were compared. Breast surgery was classified as follows: conventional breast-conserving surgery (Group 1), partial mastectomy with volume displacement (Group 2), partial mastectomy with volume replacement (Group 3), and total mastectomy with or without reconstruction (Group 4). The initial surgical plan (based on routine mammography and ultrasonography) and final surgical plan (after additional breast MRI) were compared between the 2 groups. The change in surgical plan was defined as group shifting between the initial and final surgical plans. Results Changes (both increasing and decreasing) in surgical plans were more common in the DCIS group than in the IDC group (P < 0.001). These changes may be attributed to the increased extent of suspicious lesions on breast MRI, detection of additional daughter nodules, multifocality or multicentricity, and suspicious findings on mammography or ultrasonography but benign findings on breast MRI. Furthermore, the positive margin incidence in frozen biopsy was not different (P = 0.138). Conclusions Preoperative breast MRI may provide more information for determining the surgical plan for patients with DCIS than for those with IDC.

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Cost Implications of the SSO-ASTRO Consensus Guideline on Margins for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-014-3605-x ◽

2014 ◽

Vol 21 (5) ◽

pp. 1512-1514 ◽

Cited By ~ 18

Author(s):

Rachel A. Greenup ◽

Jeffrey Peppercorn ◽

Mathias Worni ◽

E. Shelley Hwang

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Breast Conserving Surgery ◽

Stage I ◽

Whole Breast Irradiation ◽

Consensus Guideline ◽

Breast Irradiation ◽

Cost Implications

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13. A Navigated Intelligent Knife for Breast Cancer Surgery

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.11732 ◽

2018 ◽

Author(s):

Mark Asselin

Keyword(s):

Breast Cancer ◽

Tracking System ◽

Treatment Options ◽

Three Dimensional ◽

Positive Margin ◽

Breast Conserving Surgery ◽

Breast Cancer Surgery ◽

Feasibility Trial ◽

Clinical Safety ◽

Surgical Smoke

When a woman is diagnosed with breast cancer, several treatment options are considered including breast conserving surgery. In this type of surgery, the goal is to completely remove the cancer while leaving as much healthy breast tissue as possible. This is a clinical judgement of high consequence since resecting less tissue is cosmetically appealing but increases the chances of leaving cancer cells behind, known as a positive margin. Conventionally, this operation is performed with an electrocautery – imagine it as an electronic knife – which seals tissue as it cuts and produces small amounts of surgical smoke in the process. In most operating rooms today this smoke is treated as a by product, and it is discarded with no further consideration. But this smoke is rich with useful information; it contains traces of the molecules the knife passed through when the smoke was generated. The intelligent knife (iKnife) analyzes this smoke to determine the pathology of tissue the surgeon’s knife has passed through – whether the tissue is cancerous or not. We have coupled the iKnife with an electromagnetic position tracking system to create a three dimensional spatially resolved malignancy map showing where the surgeon’s knife has encountered cancerous tissue. We have developed a functional prototype and have approval for a first clinical safety and feasibility trial. We hope the spatial map will help surgeons to successfully remove the entire malignancy with the smallest amount of healthy tissue while maintaining negative margins – a successful surgical outcome for the patient.

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Does Conventional Specimen Radiography After Neoadjuvant Chemotherapy of Breast Cancer Help To Reduce The Rate of Second Surgeries?

10.21203/rs.3.rs-700849/v1 ◽

2021 ◽

Author(s):

Benedikt Schaefgen ◽

Annika Funk ◽

Peter Sinn ◽

Thomas Bruckner ◽

Christina Gomez Andreu ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

False Negative ◽

Positive Margin ◽

Complete Response ◽

Breast Conserving Surgery ◽

Target Lesion ◽

Number Needed To Treat ◽

Positive Margins ◽

Specimen Radiography

Abstract PurposeThis is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. MethodsThis retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration of the target lesion and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. A subgroup analysis was performed for patients with and without clinical complete response. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a PPV of 7.7% and a NPV of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9% and the NNT was 85. ConclusionPositive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR.

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