An Assessment of Margins after Lumpectomy in Breast Cancer Management

We performed this study to evaluate our indications for margin re-excision (MRE) in the management of cancer patients opting for breast conservation therapy (BCT). We identified patients choosing breast conservation therapy from January 2012 to May 2014. Margins were considered negative if >2 mm, close if <2 mm, and positive if ink was detected abutting tumor. Patients with close and positive margins underwent MRE. We identified 247 patients of which 190 had negative margins and did not require MRE, 46 patients had a close margin, and 11 had a positive margin, leading to an MRE rate of 23 per cent (57 of 247). The following variables were evaluated: tumor size, stage, estrogen receptor, progesterone receptor, HER2/neu receptor, and node status. None predicted the presence of tumor in the MRE specimen ( P > 0.05). Patients with close margins had a 6.5 per cent (3 of 46), and patients with positive margins had a 36.4 per cent (4 of 11) incidence of tumor in the MRE specimens; this difference was statistically significant ( P = 0.02). The low rate of finding tumor in MRE specimens of patients with close margins after lumpectomy for breast carcinoma argues for limiting MRE to patients with positive margins (ink on tumor) only. We have adopted this approach in our institution.

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Residual cancer found on re-excision for close and positive margins after breast conservation for early-stage breast cancer: A single-institution review.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.55 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 55-55

Author(s):

Dahlia Michelle Rice ◽

Karen Beatrice Salud Ching ◽

Sahil Gambhir ◽

Edward Woo

Keyword(s):

Breast Cancer ◽

Ductal Carcinoma ◽

Early Stage ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Published Data ◽

Breast Cancer Patients ◽

Residual Cancer ◽

Positive Margins ◽

Recommended Guidelines

55 Background: The SSO/ASTRO guidelines for margins on breast-conservation therapy (BCT) were recently published, recommending re-excision for positive margins only defined as ink on invasive cancer. The aim of our study is to retrospectively analyze our institution’s re-excision rate and the rate of finding residual cancer in the re-excision specimen when re-excisions were performed for positive and/or close margins. We want to confirm that our institution’s data for re-excision rates and residual cancer rates are comparable to national data from where the SSO/ASTRO guidelines were derived. Methods: A 3-year (2010 to 2012) retrospective review of data from our institution’s prospectively collected breast cancer database was performed for all stage 0, I, and II breast cancer patients who underwent BCT with subsequent re-excision or completion mastectomy for close or positive margins. Close margins were divided into two groups of < 1 mm or 1 to 2 mm margins, and positive margins were defined as tumor cells present on ink of specimen. Results: A total of 688 patients were analyzed. Our population was found to consist mostly of Caucasian females who were postmenopausal and married. 68% (468/688) of patients were found to have invasive ductal carcinoma (IDC), of which 27.8% (130/468) underwent re-excision for positive and/or close margins. Rates of residual cancer found in margins that are positive, < 1 mm, and 1-2 mm were 54.8% (17/31), 56% (14/25), and 6.3% (1/16) respectively. For DCIS, 38.9% (65/167) underwent re-excision. Rates of residual cancer found in margins that are positive, < 1 mm, and 1 to 2 mm were 38.9% (7/18), 28.6 % (4/14), and 20% (2/10) respectively. Conclusions: Our results reveal that in our institution, re-excision rates are comparable to published data. However, in patients with both positive and < 1 mm margins, the rates of finding residual cancer in the re-excision specimen was higher than the national average. Therefore, in our institution, further analysis is necessary prior to adopting the current recommended guidelines by SSO/ASTRO to prevent adverse impact in local recurrence rate.

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The Use of Radiation As a Component of Breast Conservation Therapy in National Comprehensive Cancer Network Centers

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.3127 ◽

2006 ◽

Vol 24 (3) ◽

pp. 361-369 ◽

Cited By ~ 62

Author(s):

Thomas A. Buchholz ◽

Richard L. Theriault ◽

Joyce C. Niland ◽

Melissa E. Hughes ◽

Rebecca Ottesen ◽

...

Keyword(s):

Breast Cancer ◽

National Comprehensive Cancer Network ◽

Invasive Breast Cancer ◽

Systemic Therapy ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Stage I ◽

Cancer Management ◽

Cancer Network ◽

Radiation Use

Purpose Benchmark data regarding quality measures of breast cancer management are needed. We investigated rates of radiation use after breast conservation therapy (BCT) for patients treated for ductal carcinoma-in-situ (DCIS) or invasive breast cancer at National Comprehensive Cancer Network (NCCN) centers. Patients and Methods We studied 3,333 consecutive patients treated between 1997 and 2002 with BCT for DCIS (n = 587) or for stage I or II breast cancer (n = 2,746) in eight NCCN centers. Results The overall rate of radiation therapy use was 91%, with a lower frequency of radiation use in DCIS versus invasive breast cancers (82% v 94%; odds ratio [OR] = 0.31; P < .0001). In a multivariable analysis of the patients with DCIS, the only factor significantly associated with lower rates of radiation use was low/intermediate grade (OR = 0.19; P = .0003). For patients with invasive breast cancer, significant factors were presence of comorbidity (OR = 0.53; P = .0005), tubular histology (OR = 0.39; P = .02), type of health insurance (P = .0072), and the NCCN institution (P = .0005). The model also showed lower rates of radiation use in patients with stage II disease who did not receive systemic therapy (OR = 0.01; P = .0001), younger patients who did not receive systemic therapy (P = .003); and older patients with stage I disease (P < .0001). Conclusion Radiation use as a component of BCT was high for patients seen at NCCN centers; however, there was variability in practice patterns noted across institutions. Radiation was most commonly omitted in patients with favorable disease characteristics, patients with comorbidities, and patients who also did not receive guideline-recommended systemic treatment.

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The Effect of Multiple Wire Localization in Breast Conservation

The American Surgeon ◽

10.1177/000313481207800530 ◽

2012 ◽

Vol 78 (5) ◽

pp. 519-522 ◽

Cited By ~ 4

Author(s):

Michelle M. Fillion ◽

Emily Anne Black ◽

Kathleen B. Hudson ◽

Garnetta Morin-Ducote ◽

John L. Bell ◽

...

Keyword(s):

Ductal Carcinoma ◽

Breast Conservation ◽

Positive Margin ◽

Breast Conservation Therapy ◽

Invasive Disease ◽

Lesion Size ◽

Positive Margins ◽

Needle Localization ◽

Specimen Volume

Variability exists regarding the surgical technique in breast conservation therapy. The purpose of this project was to determine differences between single (SH) or flanking (FH) hooked needle localization wires used for nonpalpable breast lesions. We retrospectively reviewed 201 female patients at a single institution from 2004 to 2008. All patients had biopsy-proven ductal carcinoma in situ or invasive disease. Comparisons were made in regard to margin status, reoperation, completion mastectomy, size of lesion, and breast specimen volume. SH was placed in 122 patients (61%) and FH in 79 patients (39%). In SH, 23 patients (18%) had positive margins and 31 patients (25%) had reoperations as compared with 31 patients (25%) with positive margin and 36 patients (44%) in the FH cohort ( P = 0.039 and 0.0037). Average lesion size and volume resected was 1.5 cm and 137 cm3 in SH and 2.85 cm and 188 cm3 in FH, respectively ( P = 0.0001 and 0.006). Positive margins were associated with lesion size and not volume of tissue excised. The FH technique was associated with more positive margins, reoperation, and completion mastectomy.

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Computerized Decision Support System for Intraoperative Analysis of Margin Status in Breast Conservation Therapy

ISRN Surgery ◽

10.5402/2012/546721 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Manuel E. Ruidíaz ◽

Sarah L. Blair ◽

Andrew C. Kummel ◽

Jessica Wang-Rodriguez

Keyword(s):

Breast Cancer ◽

Breast Conservation ◽

Positive Margin ◽

Breast Conservation Therapy ◽

Automated System ◽

Identification System ◽

Computerized Decision Support ◽

Screening Process ◽

Linear Discriminant ◽

Permanent Section

Background. Breast conservation therapy (BCT) is the standard treatment for breast cancer; however, 32–63% of procedures have a positive margin leading to secondary procedures. The standard of care to evaluate surgical margins is based on permanent section. Imprint cytology (IC) has been used to evaluate surgical samples but is limited by excessive cauterization thus requiring experienced cytopathologist for interpretation. An automated image screening process has been developed to detect cancerous cells from IC on cauterized margins. Methods. IC was prospectively performed on margins during lumpectomy operations for breast cancer in addition to permanent section on 127 patients. An 8-slide training subset and 8-slide testing subset were culled. H&E IC automated analysis, based on linear discriminant analysis, was compared to manual pathologist interpretation. Results. The most important descriptors, from highest to lowest performance, are nucleus color (23%), cytoplasm color (15%), shape (12%), grey intensity (9%), and local area (5%). There was 100% agreement between automated and manual interpretation of IC slides. Conclusion. Although limited by IC sampling variability, an automated system for accurate IC cancer cell identification system is demonstrated, with high correlation to manual analysis, even in the face of cauterization effects which supplement permanent section analysis.

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