| Abstract | PURPOSE: To evaluate the impact of preoperative diagnosis in obtaining negative lumpectomy margins. MATERIALS AND METHODS: Five hundred and thirty five patients who underwent breast conserving therapy for stage I/II cancer from 1971 to 1996 were included in this IRB-approved retrospective analysis. Three hundred and ninety five patients had a defined inked margin status after initial excision. The following factors were evaluated for correlation with margins at initial excision: age (< or >45), grade (3/1 or 2), family history (present/absent), histology (lobular/other), estrogen receptor (ER) status, presence of extensive intraductal carcinoma (EIC), presence of lymphovascular invasion (LVI), and biopsy type (excisional/preoperative). RESULTS: Biopsy type (P < 0.0001), EIC (P = 0.002), ER status (P = 0.02), lobular histology (P = 0.02) and age (P = 0.02) were significantly correlated with initial margin status among the entire group. For patients who underwent preoperative diagnostic biopsy, 52% (35/67) had negative initial margins as compared to 29% (94/328) for excisional biopsy. Among patients who underwent preoperative biopsy, only lobular histology (P = 0.04) and LVI (P = 0.04) were related to initial margin status. The rate of re-excision was 34% for patients diagnosed preoperatively versus 61% with excisional biopsy (P < 0.0001). The percentage of patients with negative final margin status was similar with either core/needle or excisional biopsy (79 and 78%, respectively). CONCLUSIONS: Preoperative diagnosis is the most significant predictor of initial margin status in patients undergoing breast conservation. Patients with lobular histology may require improved preoperative and/or intraoperative assessment to increase the rate of negative margins at initial excision. |
| Authors | Melanie C Smitt, Kate Horst
(Affiliation: Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Dr, Stanford, CA 94305, USA. melanies94028 at yahoo.com)
|
| Journal | Annals of surgical oncology
(Ann Surg Oncol)
Vol. 14
Issue 3
Pg. 1040-4
(Mar 2007)
ISSN: 1068-9265 United States |
| PMID | 17203329
(Publication Type: Journal Article)
|
| Topics |
- Adult
- Biopsy
- Breast Neoplasms
(pathology, surgery)
- Carcinoma, Ductal, Breast
(pathology, surgery)
- Carcinoma, Intraductal, Noninfiltrating
(pathology, surgery)
- Carcinoma, Lobular
(pathology, surgery)
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
(pathology)
- Neoplasm Staging
- Neoplasm, Residual
- Preoperative Care
- Probability
- Reoperation
- Retrospective Studies
- Risk Assessment
|
