Rate of Re-excision after Breast-conserving Surgery for Invasive Lobular Carcinoma

2013 ◽  
Vol 79 (10) ◽  
pp. 1119-1122 ◽  
Author(s):  
Morcos L. Wanis ◽  
Jennifer A. Wong ◽  
Samuel Rodriguez ◽  
Jasmine M. Wong ◽  
Brice Jabo ◽  
...  
Keyword(s):  
Invasive Lobular Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Margin ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Close Margin ◽  
Cross Sectional ◽  
Positive Margins

Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. The objective was to investigate the rate of re-excision resulting from positive or close margin (1 mm or less) in patients who underwent breast-conserving surgery (BCS) for ILC compared with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Of the 836 patients treated, 416 patients underwent BCS. The rate of re-excision after BCS for ILC was 35.1 versus 17.7 per cent for IDC and 20.0 per cent for DCIS ( P = 0.04). Re-excisions were more often performed for positive margin in patients with ILC (11 of 37 [29.7%]) versus IDC (36 of 334 [10.8%]) and DCIS (five of 45 [11.1%];( P = 0.004). In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.

Predictive factor for residual tumor after lumpectomy for close margins

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11538-e11538
Author(s):  
V. Ozmen ◽  
S. Ozkan Gurdal ◽  
M. Muslumanoglu ◽  
A. Igci ◽  
S. S. Tuzlali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Ductal Carcinoma ◽  
Residual Disease ◽  
Surgical Margin ◽  
Residual Tumor ◽  
Excisional Biopsy ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Breast Cancer Patients

e11538 Background: It is critical to obtain clear margins to minimize local recurrence after breast conserving surgery(BCS). When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for re-excision(s) or mastectomy. The aim of the present study was to identify factors predicting a histologically positive re-excision specimen. Methods: Our prospective breast cancer database was queried for all invasive breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCS. Close margins are defined as ≤ 2 mm for invasive carcinoma and presence of ductal carcinoma in situ(DCIS). Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Between February 1997 and August 2008, 2054 patients with early breast cancer underwent surgical treatment in our breast unit. 939(45.7%) of them had BCS. In 543 patients(26.4%), re-excision required due to close margins on the permanent section analysis of their initial surgical specimens. 186 patients(34.3%) had previous excisional biopsy in other clinics. Median age of 543 patients was 50 years. In 290 patients(53.4%), mastectomy was performed due to positive surgical margin or poor cosmetic results. There were no residual tumors in re-excision(65.6 %) or mastectomy(42.4%) specimens of patients. The factors associated with tumor positive re-excision specimen were, age ≤50 years(p=0.044), lymphovascular invasion (p=0.029), multifocality(p<0.001), tumor size >2cm(p=0.008), presence of DCIS(p=0.018), focal margin positivity(p<0.001), DCIS at resection margin(p=0.008) and node positivity (p<0.001). Conclusions: Most of our patients with early breast cancer had unnecessary re-excisions or mastectomy to obtain clear surgical margins. In subset group of patients, re-excision or mastectomy may not be required. No significant financial relationships to disclose.

scholarly journals Frequency of Positive Surgical Margin at Prostatectomy and Its Effect on Patient Outcome

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Kenneth A. Iczkowski ◽  
M. Scott Lucia
Keyword(s):  
Patient Outcome ◽  
Tumor Cells ◽  
Surgical Margin ◽  
Positive Margin ◽  
Positive Surgical Margin ◽  
Positive Margins ◽  
Operator Experience ◽  
The Past ◽  
Psa Failure ◽  
Main Determinants

A positive surgical margin at prostatectomy is defined as tumor cells touching the inked edge of the specimen. This finding is reported in 8.8% to 42% of cases (median about 20%) in various studies. It is one of the main determinants of eventual biochemical (PSA) failure, generally associated with a doubled or tripled risk of failure. The effect of a positive margin on outcome can be modified by stage or grade and the length, number and location of positive margins, as well as by technical operative approach and duration of operator experience. This paper tabulates data from the past decade of studies on margin status.

The Effect of Lumpectomy and Cavity Shave Margin Status on Recurrence and Survival in Breast-Conserving Surgery

2021 ◽  
pp. 000313482110304
Author(s):  
Jad M. Abdelsattar ◽  
Faryal G. Afridi ◽  
Zheng Dai ◽  
Natasha Yousaf ◽  
Ashlee Seldomridge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Positive Margin ◽  
Cancer Registries ◽  
Breast Conserving Surgery ◽  
Breast Cancer Patients ◽  
Cancer Specific Survival ◽  
Kaplan Meier

Background/Objective Cavity shave margins (CSMs) decrease rate of positive margins and need for re-excision. Recurrence data following breast-conserving surgery (BCS) are not always available in large cancer registries. We sought to define our recurrence and survival data in BCS with routine excision of CSMs. Methods A single institution, 10-year retrospective review of breast cancer patients who underwent BCS with routine CSMs was conducted. Cavity shave margin technique was standard. Cox proportional hazard analyses and the Kaplan-Meier method were used to estimate recurrence and survival. Results Breast-conserving surgery with CSM was performed in 839 patients. Re-excision rate to achieve negative margins was 8.5%. Fifty-two patients (75%) underwent margin re-excision vs 18 patients (25%) underwent salvage mastectomy. Positive margin rate stratified by tumor histology was highest for invasive lobular carcinoma followed by mixed invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS), followed by pure DCIS and lowest for IDC. Length of follow-up was (4.7 ± 2.6, years). Overall recurrence rate (locoregional and systemic) was 4.3%: highest in patients with negative lumpectomy margin but positive CSM (L−S+ = 15%) followed by positive lumpectomy and CSMs (L+S+ = 14%), followed by patients with positive lumpectomy margin but negative CSMs (L+S− = 13%) and lowest for negative lumpectomy and CSM (L−S− = 5%), ( P = .0008). There was no difference in 5-year breast cancer–specific survival between the 4 subgroups: 96% for L−S−, 86.7% L−S+, 94.7% L+S+ and 90% L+S− ( P = .094). Conclusions Recurrence following BCS with CSMs can be stratified based on both lumpectomy and cavity shave margin positivity. Routine excision of CSMs allows identification of these patient subsets.

scholarly journals Adequacy of diagnostic tests and surgical management of symptomatic invasive lobular carcinoma of the breast

2015 ◽  
Vol 97 (8) ◽  
pp. 578-583 ◽  
Author(s):  
DJ Hadjiminas ◽  
KE Zacharioudakis ◽  
MK Tasoulis ◽  
JCC Hu ◽  
S Lanitis ◽  
...  
Keyword(s):  
Invasive Lobular Carcinoma ◽  
Fast Track ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Breast Conserving Surgery ◽  
Carcinoma Of The Breast ◽  
One Stop ◽  
Radiological Changes ◽  
The One ◽  
The Uk

Introduction Invasive lobular carcinoma (ILC) presents diagnostic and therapeutic challenges as it produces subtle radiological changes. It has been suggested that it is not suitable for breast conserving surgery (BCS). The aim of this study was to ascertain the diagnostic adequacy of modern mammography and ultrasonography in the context of a fast track symptomatic diagnostic clinic in the UK. It also sought to compare the mastectomy, re-excision and BCS rates for ILC with those for invasive ductal carcinoma (IDC). Methods A retrospective analysis of prospectively collected data was carried out on all new symptomatic cancers presenting to the one-stop diagnostic clinic of a single breast unit between 1998 and 2007. Results Compared with IDC, ILC was significantly larger at presentation (46mm vs 25mm), needed re-excision after BCS more often (38.8% vs 22.3%) and required mastectomy more frequently (58.8% vs 40.8%). Although mammography performs poorly in diagnosing ILC compared with IDC, when combined with ultrasonography, sensitivity of the combined imaging was not significantly different between these two histological types. Conclusions Provided ultrasonography is performed, standard radiological imaging is adequate for initial diagnosis of symptomatically presenting ILC but some additional preoperative workup should clearly be employed to reduce the higher number of reoperations for this histological type.

scholarly journals The Utilization of Physics Parameter to Classify Histopathology Types of Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC) by using K-Nearest Neighbourhood (KNN) Method

2018 ◽  
Vol 8 (4) ◽  
pp. 2442
Author(s):  
Anak Agung Ngurah Gunawan ◽  
I Wayan Supardi ◽  
S. Poniman ◽  
Bagus G. Dharmawan
Keyword(s):  
Breast Cancer ◽  
Invasive Ductal Carcinoma ◽  
Invasive Lobular Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Diagnose Breast Cancer ◽  
Object Based ◽  
Computer Aided ◽  
The Mean ◽  
Learning Data

<p>Medical imaging process has evolved since 1996 until now. The forming of Computer Aided Diagnostic (CAD) is very helpful to the radiologists to diagnose breast cancer. KNN method is a method to do classification toward the object based on the learning data which the range is nearest to the object. We analysed two types of cancers IDC dan ILC. 10 parameters were observed in 1-10 pixels distance in 145 IDC dan 7 ILC. We found that the Mean of Hm(yd,d) at 1-5 pixeis the only significant parameters that distingguish IDC and ILC. This parameter at 1-5 pixels should be applied in KNN method. This finding need to be tested in diffrerent areas before it will be applied in cancer diagnostic.</p>

scholarly journals Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

2020 ◽  
Vol 13 (6) ◽  
pp. 419-424
Author(s):  
T Ellul ◽  
P Grice ◽  
A Mainwaring ◽  
N Bullock ◽  
A Shanahan ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Penile Cancer ◽  
Frozen Section ◽  
Surgical Margin ◽  
Positive Margin ◽  
Surgical Excision ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Positive Margins ◽  
Positive Margin Rate

Introduction and objectives: The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis. Materials and methods: We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates. Results: A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%). Conclusions: In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer. Level of evidence: Not applicable for this multicentre audit.

scholarly journals Mammographic Evaluation of Breast Mass & Comparison with Histopathological Findings

2018 ◽  
Vol 4 (2) ◽  
pp. 53-57
Author(s):  
Lovely Yesmin ◽  
Rued Hossain ◽  
Bibekananda Haldar ◽  
Mohammad Sazzad Hossain ◽  
Sajida Nahid ◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Medullary Carcinoma ◽  
Breast Mass ◽  
Histopathological Diagnosis ◽  
Cross Sectional ◽  
Predictive Values ◽  
Imaging Department ◽  
Mass Comparison ◽  
Malignant Breast

Background: Mammography is used for the detection of breast cancer.Objective: The purpose of the present study was to evaluate the diagnostic performance of Mammography in the diagnosis of benign and malignant breast mass.Methodology: This cross-sectional type of study was carried out in the Radiology & Imaging department of Sir Salimullah Medical College and Mitford Hospital, Dhaka, during July 2013 to June 2015. Patients clinically suspected as having breast mass, referred in the above mentioned hospitals and enrolled for surgical management were included in this study. Mammography were done in all these patients and they were followed up from the admission up to the post-operative tissue diagnosis of breast mass in respective pathology departments for histopathological correlation.Results: A total of 41 patients had mass among them, 3(7.3%) cases were malignant and 38(92.7%) cases were benign patients. Histopathological diagnosis of invasive ductal carcinoma, invasive lobular carcinoma and medullary carcinoma were 8(14. %), 4(7.00%) and 1(1.8%) respectively. Mammography malignant was found 14 cases out of which 10(76.9%) malignant and 4(9.1%) benign evaluated by histopathology. Mammography benign was found 43 cases out of which 3(23.1%) malignant and 40(90.9%) benign evaluated by histopathology. The sensitivity was 76.9%, specificity 90.9%, accuracy 87.7%, positive predictive values 71.4% and negative predictive values 93.0% in mammography.Conclusion:  Mammography is highly sensitive, specific, reliable and useful method in the differentiation of malignant and benign breast masses.Journal of Current and Advance Medical Research 2017;4(2):53-57

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