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BMC Cancer
Published in: BMC Cancer 1/2009

Open Access 01-12-2009 | Research article

Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer

Authors: Stephen P Povoski, Rafael E Jimenez, Wenle P Wang, Ronald X Xu

Published in: BMC Cancer | Issue 1/2009

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Abstract

Background

The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve "adequate" or "negative" surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS.

Methods

Retrospective analysis of 204 BCS procedures performed for invasive breast cancer from August 2003 to June 2007, in which patients underwent a standard BCS resection and systematic sampling of nine standardized re-resection margins (superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, and deep-posterior). Multiple variables (including patient, tumor, specimen, and follow-up variables) were evaluated.

Results

6.4% (13/204) of patients had positive BCS specimen margins (defined as tumor at inked edge of BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor within 1 mm or less of inked edge but not at inked edge of BCS specimen). 11.8% (24/204) of patients had at least one re-resection margin containing additional disease, independent of the status of the BCS specimen margins. 7.1% (13/182) of patients with negative BCS specimen margins (defined as no tumor cells seen within 1 mm or less of inked edge of BCS specimen) had at least one re-resection margin containing additional disease. Thus, 54.2% (13/24) of patients with additional disease in a re-resection margin would not have been recognized by a standard BCS procedure alone (P < 0.001). The nine standardized resection margins represented only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen.

Conclusion

Our methodology accurately assesses the adequacy of surgical resection margins for determination of which individuals may need further resection to the affected breast in order to minimize the potential risk of local recurrence while attempting to limit the volume of additional breast tissue excised, as well as to determine which individuals are not realistically amendable to BCS and instead need a completion mastectomy to successfully remove multifocal disease.
Appendix
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Literature
1.
Burak WE, Agnese DM, Povoski SP: Advances in the surgical management of early stage invasive breast cancer. Curr Probl Surg. 2004, 41: 877-936. 10.1067/S0011-3840(04)00113-3.CrossRef
2.
3.
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wolmark N, Deutsch M, Montague E, Saffer E, Wickerman L, Lerner H, Glass A, Shibata H, Deckers P, Ketcham A, Oishi R, Russell I: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985, 312: 665-673.CrossRefPubMed
4.
Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E, Deutsch M, Caplan R, Pilch Y, Glass A, Shibata H, Lerner H, Terz J, Sidorovich L: Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989, 320: 822-828.CrossRefPubMed
5.
Veronesi U, Banfi A, Salvadori B, Luini A, Saccozzi R, Zucali R, Marubini E, Del Vecchio M, Boracchi P, Marchini S: Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer. 1990, 26: 668-670.CrossRefPubMed
6.
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM: Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995, 333: 1456-1461. 10.1056/NEJM199511303332203.CrossRefPubMed
7.
Jacobson JA, Danforth DN, Cowan KH, d'Angelo T, Steinberg SM, Pierce L, Lippman ME, Lichter AS, Glatstein E, Okunieff P: Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995, 332: 907-911. 10.1056/NEJM199504063321402.CrossRefPubMed
8.
Fisher ER: Lumpectomy margins and much more. Cancer. 1997, 79: 1453-1458. 10.1002/(SICI)1097-0142(19970415)79:8<1453::AID-CNCR1>3.0.CO;2-C. discussion 1459–1460.CrossRefPubMed
9.
Carter D: Margins of "lumpectomy" for breast cancer. Hum Pathol. 1986, 17: 330-332. 10.1016/S0046-8177(86)80455-5.CrossRefPubMed
10.
Gould EW, Robinson PG: The pathologist's examination of the "lumpectomy" – the pathologists' view of surgical margins. Semin Surg Oncol. 1992, 8: 129-135.PubMed
11.
Veronesi U: How important is the assessment of resection margins in conservative surgery for breast cancer?. Cancer. 1994, 74: 1660-1661. 10.1002/1097-0142(19940915)74:6<1660::AID-CNCR2820740603>3.0.CO;2-T.CrossRefPubMed
12.
Klimberg VS, Harms S, Korourian S: Assessing margin status. Surg Oncol. 1999, 8: 77-84. 10.1016/S0960-7404(99)00031-6.CrossRefPubMed
13.
Bland KI: Surgical margins in breast cancer: how wide? How accurate? How big? Does it make a difference?. Curr Surg. 2001, 58: 248-253. 10.1016/S0149-7944(00)00375-5.CrossRefPubMed
14.
Taghian A, Mohiuddin M, Jagsi R, Goldberg S, Ceilley E, Powell S: Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005, 241: 629-639. 10.1097/01.sla.0000157272.04803.1b.CrossRefPubMedPubMedCentral
15.
16.
Morrow M: Margins in breast-conserving therapy: have we lost sight of the big picture?. Expert Rev Anticancer Ther. 2008, 8: 1193-1196. 10.1586/14737140.8.8.1193.CrossRefPubMed
17.
Luini A, Rososchansky J, Gatti G, Zurrida S, Caldarella P, Viale G, Rosali dos Santos G, Frasson A: The surgical margin status after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat. 2009, 113: 397-402. 10.1007/s10549-008-9929-0.CrossRefPubMed
18.
Larson RE, Hostetler RP, Edwards BH: Calculus with Analytical Geometry. 1998, New York: Houghton Mifflin
19.
Gilat A, Subramaniam V: Numerical Methods for Engineers and Scientists: An Introduction with Applications using MATLAB. 2008, New York: John Wiley & Sons
20.
McCormick B, Kinne D, Petrek J, Osborne M, Cox L, Shank B, Hellman S, Yahalom J, Rosen PP: Limited resection for breast cancer: a study of inked specimen margins before radiotherapy. Int J Radiat Oncol Biol Phys. 1987, 13: 1667-1671.CrossRefPubMed
21.
Umpleby HC, Herbert A, Royle GT, Taylor I: Wide excision of primary breast cancer: the incidence of residual carcinoma at the site of excision. Ann R Coll Surg Engl. 1988, 70: 246-248.PubMedPubMedCentral
22.
England DW, Chan SY, Stonelake PS, Lee MJ: Assessment of excision margins following wide local excision for breast carcinoma using specimen scrape cytology and tumour bed biopsy. Eur J Surg Oncol. 1994, 20: 425-429.PubMed
23.
MacMillan RD, Purushotham AD, Mallon E, Ramsay G, George WD: Breast-conserving surgery and tumour bed positivity in patients with breast cancer. Br J Surg. 1994, 81: 56-58. 10.1002/bjs.1800810119.CrossRefPubMed
24.
Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, Eberlein TJ, Mayzel K, Silver B, Harris JR: The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994, 74: 1746-1751. 10.1002/1097-0142(19940915)74:6<1746::AID-CNCR2820740617>3.0.CO;2-Y.CrossRefPubMed
25.
Beron PJ, Horwitz EM, Martinez AA, Wimbish KJ, Levine AJ, Gustafson G, Chen PY, Ingold JA, Vicini FA: Pathologic and mammographic findings predicting the adequacy of tumor excision before breast-conserving therapy. AJR Am J Roentgenol. 1996, 167: 1409-1414.CrossRefPubMed
26.
Gage I, Schnitt SJ, Nixon AJ, Silver B, Recht A, Troyan SL, Eberlein T, Love SM, Gelman R, Harris JR, Connolly JL: Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996, 78: 1921-1928. 10.1002/(SICI)1097-0142(19961101)78:9<1921::AID-CNCR12>3.0.CO;2-#.CrossRefPubMed
27.
MacMillan RD, Purushotham AD, Mallon E, Love JG, George WD: Tumour bed positivity predicts outcome after breast-conserving surgery. Br J Surg. 1997, 84: 1559-1562. 10.1002/bjs.1800841119.CrossRefPubMed
28.
Saarela AO, Paloneva TK, Rissanen TJ, Kiviniemi HO: Determinants of positive histologic margins and residual tumor after lumpectomy for early breast cancer: a prospective study with special reference to touch preparation cytology. J Surg Oncol. 1997, 66: 248-253. 10.1002/(SICI)1096-9098(199712)66:4<248::AID-JSO5>3.0.CO;2-B.CrossRefPubMed
29.
Weber S, Storm FK, Stitt J, Mahvi DM: The role of frozen section analysis of margins during breast conservation surgery. Cancer J Sci Am. 1997, 3: 273-277.PubMed
30.
Beck NE, Bradburn MJ, Vincenti AC, Rainsbury RM: Detection of residual disease following breast-conserving surgery. Br J Surg. 1998, 85: 1273-1276. 10.1046/j.1365-2168.1998.00876.x.CrossRefPubMed
31.
DiBiase SJ, Komarnicky LT, Schwartz GF, Xie Y, Mansfield CM: The number of positive margins influences the outcome of women treated with breast preservation for early stage breast carcinoma. Cancer. 1998, 82: 2212-2220. 10.1002/(SICI)1097-0142(19980601)82:11<2212::AID-CNCR16>3.0.CO;2-X.CrossRefPubMed
32.
Taylor I, Mullee MA, Carpenter R, Royle G, McKay CJ, Cross M: The significance of involved tumour bed biopsy following wide local excision of breast cancer. Eur J Surg Oncol. 1998, 24: 110-113. 10.1016/S0748-7983(98)91407-X.CrossRefPubMed
33.
Horiguchi J, Iino Y, Takei H, Maemura M, Yokoe T, Niibe H, Yamakawa M, Nakajima T, Oyama T, Morishita Y: Surgical margin and breast recurrence after breast-conserving therapy. Oncol Rep. 1999, 6: 135-138.PubMed
34.
Malik HZ, George WD, Mallon EA, Harnett AN, MacMillan RD, Purushotham AD: Margin assessment by cavity shaving after breast-conserving surgery: analysis and follow-up of 543 patients. Eur J Surg Oncol. 1999, 25: 464-469. 10.1053/ejso.1999.0680.CrossRefPubMed
35.
Papa MZ, Zippel D, Koller M, Klein E, Chetrit A, Ari GB: Positive margins of breast biopsy: is reexcision always necessary?. J Surg Oncol. 1999, 70: 167-171. 10.1002/(SICI)1096-9098(199903)70:3<167::AID-JSO4>3.0.CO;2-7.CrossRefPubMed
36.
Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, Silver B, Hetelekidis S, Abner A, Harris JR, Schnitt SJ: Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol. 2000, 18: 1668-1675.PubMed
37.
Gibson GR, Lesnikoski BA, Yoo J, Mott LA, Cady B, Barth RJ: A comparison of ink-directed and traditional whole-cavity re-excision for breast lumpectomy specimens with positive margins. Ann Surg Oncol. 2001, 8: 693-704. 10.1007/s10434-001-0693-1.CrossRefPubMed
38.
Jenkinson AD, Al-Mufti RA, Mohsen Y, Berry MJ, Wells C, Carpenter R: Does intraductal breast cancer spread in a segmental distribution? An analysis of residual tumour burden following segmental mastectomy using tumour bed biopsies. Eur J Surg Oncol. 2001, 27: 21-25. 10.1053/ejso.2000.1051.CrossRefPubMed
39.
Moore MM, Whitney LA, Cerilli L, Imbrie JZ, Bunch M, Simpson VB, Hanks JB: Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg. 2001, 233: 761-768. 10.1097/00000658-200106000-00005.CrossRefPubMedPubMedCentral
40.
Swanson GP, Rynearson K, Symmonds R: Significance of margins of excision on breast cancer recurrence. Am J Clin Oncol. 2002, 25: 438-441. 10.1097/00000421-200210000-00002.CrossRefPubMed
41.
Mai KT, Perkins DG, Mirsky D: Location and extent of positive resection margins and ductal carcinoma in situ in lumpectomy specimens of ductal breast carcinoma examined with a microscopic three-dimensional view. Breast J. 2003, 9: 33-38. 10.1046/j.1524-4741.2003.09108.x.CrossRefPubMed
42.
Chagpar AB, Martin RC, Hagendoorn LJ, Chao C, McMasters KM: Lumpectomy margins are affected by tumor size and histologic subtype but not by biopsy technique. Am J Surg. 2004, 188: 399-402. 10.1016/j.amjsurg.2004.06.020.CrossRefPubMed
43.
Keskek M, Kothari M, Ardehali B, Betambeau N, Nasiri N, Gui GP: Factors predisposing to cavity margin positivity following conservation surgery for breast cancer. Eur J Surg Oncol. 2004, 30: 1058-1064. 10.1016/j.ejso.2004.07.019.CrossRefPubMed
44.
Miller AR, Brandao G, Prihoda TJ, Hill C, Cruz AB, Yeh IT: Positive margins following surgical resection of breast carcinoma: analysis of pathologic correlates. J Surg Oncol. 2004, 86: 134-140. 10.1002/jso.20059.CrossRefPubMed
45.
Fleming FJ, Hill AD, Mc Dermott EW, O'Doherty A, O'Higgins NJ, Quinn CM: Intraoperative margin assessment and re-excision rate in breast conserving surgery. Eur J Surg Oncol. 2004, 30: 233-237. 10.1016/j.ejso.2003.11.008.CrossRefPubMed
46.
Balch GC, Mithani SK, Simpson JF, Kelley MC: Accuracy of intraoperative gross examination of surgical margin status in women undergoing partial mastectomy for breast malignancy. Am Surg. 2005, 71: 22-27. discussion 27–28.PubMed
47.
Cao D, Lin C, Woo SH, Vang R, Tsangaris TN, Argani P: Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol. 2005, 29: 1625-1632. 10.1097/01.pas.0000180448.08203.70.CrossRefPubMed
48.
Cendán JC, Coco D, Copeland EM: Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg. 2005, 201: 194-198. 10.1016/j.jamcollsurg.2005.03.014.CrossRefPubMed
49.
Dooley WC, Parker J: Understanding the mechanisms creating false positive lumpectomy margins. Am J Surg. 2005, 190: 606-608. 10.1016/j.amjsurg.2005.06.023.CrossRefPubMed
50.
Nadeem R, Chagla LS, Harris O, Desmond S, Thind R, Titterrell C, Audisio RA: Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL). Breast. 2005, 14: 283-289. 10.1016/j.breast.2005.04.002.CrossRefPubMed
51.
Aziz D, Rawlinson E, Narod SA, Sun P, Lickley HL, McCready DR, Holloway CM: The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer. Breast J. 2006, 12: 331-337. 10.1111/j.1075-122X.2006.00271.x.CrossRefPubMed
52.
Dillon MF, Hill AD, Quinn CM, McDermott EW, O'Higgins N: A pathologic assessment of adequate margin status in breast-conserving therapy. Ann Surg Oncol. 2006, 13: 333-339. 10.1245/ASO.2006.03.098.CrossRefPubMed
53.
Huston TL, Pigalarga R, Osborne MP, Tousimis E: The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg. 2006, 192: 509-512. 10.1016/j.amjsurg.2006.06.021.CrossRefPubMed
54.
Janes SE, Stankhe M, Singh S, Isgar B: Systematic cavity shaves reduces close margins and re-excision rates in breast conserving surgery. Breast. 2006, 15: 326-330. 10.1016/j.breast.2005.10.006.CrossRefPubMed
55.
Méndez JE, Lamorte WW, de Las Morenas A, Cerda S, Pistey R, King T, Kavanah M, Hirsch E, Stone MD: Influence of breast cancer margin assessment method on the rates of positive margins and residual carcinoma. Am J Surg. 2006, 192: 538-540. 10.1016/j.amjsurg.2006.06.009.CrossRefPubMed
56.
Cabioglu N, Hunt KK, Sahin AA, Kuerer HM, Babiera GV, Singletary SE, Whitman GJ, Ross MI, Ames FC, Feig BW, Buchholz TA, Meric-Bernstam F: Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007, 14: 1458-1471. 10.1245/s10434-006-9236-0.CrossRefPubMed
57.
Kotwall C, Ranson M, Stiles A, Hamann MS: Relationship between initial margin status for invasive breast cancer and residual carcinoma after re-excision. Am Surg. 2007, 73: 337-343.PubMed
58.
Smitt MC, Horst K: Association of clinical and pathologic variables with lumpectomy surgical margin status after preoperative diagnosis or excisional biopsy of invasive breast cancer. Ann Surg Oncol. 2007, 14: 1040-1044. 10.1245/s10434-006-9308-1.CrossRefPubMed
59.
Wright MJ, Park J, Fey JV, Park A, O'Neill A, Tan LK, Borgen PI, Cody HS, Van Zee KJ, King TA: Perpendicular inked versus tangential shaved margins in breast-conserving surgery: does the method matter?. J Am Coll Surg. 2007, 204: 541-549. 10.1016/j.jamcollsurg.2007.01.031.CrossRefPubMed
60.
Dillon MF, Maguire AA, McDermott EW, Myers C, Hill AD, O'Doherty A, Quinn CM: Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery. Mod Pathol. 2008, 21: 39-45. 10.1038/modpathol.3800975.CrossRefPubMed
61.
Jacobson AF, Asad J, Boolbol SK, Osborne MP, Boachie-Adjei K, Feldman SM: Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?. Am J Surg. 2008, 196: 556-558. 10.1016/j.amjsurg.2008.06.007.CrossRefPubMed
62.
Schiller DE, Le LW, Cho BC, Youngson BJ, McCready DR: Factors associated with negative margins of lumpectomy specimen: potential use in selecting patients for intraoperative radiotherapy. Ann Surg Oncol. 2008, 15: 833-842. 10.1245/s10434-007-9711-2.CrossRefPubMed
63.
Soucy G, Bélanger J, Leblanc G, Sideris L, Drolet P, Mitchell A, Leclerc YE, Dufresne MP, Beaudet J, Dubé P: Surgical margins in breast-conservation operations for invasive carcinoma: does neoadjuvant chemotherapy have an impact?. J Am Coll Surg. 2008, 206: 1116-1121. 10.1016/j.jamcollsurg.2007.12.025.CrossRefPubMed
64.
Lovrics PJ, Cornacchi SD, Farrokhyar F, Garnett A, Chen V, Franic S, Simunovic M: The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer. Am J Surg. 2009, 197: 740-746. 10.1016/j.amjsurg.2008.03.007.CrossRefPubMed
65.
Sabel MS, Rogers K, Griffith K, Jagsi R, Kleer CG, Diehl KA, Breslin TM, Cimmino VM, Chang AE, Newman LA: Residual disease after re-excision lumpectomy for close margins. J Surg Oncol. 2009, 99: 99-103. 10.1002/jso.21215.CrossRefPubMed
66.
Tengher-Barna I, Hequet D, Reboul-Marty J, Frassati-Biaggi A, Seince N, Rodrigues-Faure A, Uzan M, Ziol M: Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy. Mod Pathol. 2009, 22: 299-305. 10.1038/modpathol.2008.186.CrossRefPubMed
67.
Munhoz AM, Montag E, Arruda E, Aldrighi CM, Filassi JR, Piato JR, Prado LC, Aldrighi JM, Gemperli R, Ferreira MC: Immediate reconstruction following breast-conserving surgery: Management of the positive surgical margins and influence on secondary reconstruction. Breast. 2009, 18: 47-54. 10.1016/j.breast.2008.10.005.CrossRefPubMed
68.
Hewes JC, Imkampe A, Haji A, Bates T: Importance of routine cavity sampling in breast conservation surgery. Br J Surg. 2009, 96: 47-53. 10.1002/bjs.6435.CrossRefPubMed
69.
Holland R, Veling SH, Mravunac M, Hendriks JH: Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985, 56: 979-990. 10.1002/1097-0142(19850901)56:5<979::AID-CNCR2820560502>3.0.CO;2-N.CrossRefPubMed
70.
Johnson JE, Page DL, Winfield AC, Reynolds VH, Sawyers JL: Recurrent mammary carcinoma after local excision. A segmental problem. Cancer. 1995, 75: 1612-1618. 10.1002/1097-0142(19950401)75:7<1612::AID-CNCR2820750710>3.0.CO;2-G.CrossRefPubMed
71.
Holland R, Veling SH, Mravunac M, Hendriks JH: Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985, 56: 979-990. 10.1002/1097-0142(19850901)56:5<979::AID-CNCR2820560502>3.0.CO;2-N.CrossRefPubMed
72.
Schnitt SJ, Connolly JL, Recht A, Silver B, Harris JR: Breast relapse following primary radiation therapy for early breast cancer. II. Detection, pathologic features and prognostic significance. Int J Radiat Oncol Biol Phys. 1985, 11: 1277-1284.CrossRefPubMed
73.
Kurtz JM, Amalric R, Brandone H, Ayme Y, Jacquemier J, Pietra JC, Hans D, Pollet JF, Bressac C, Spitalier JM: Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer. 1989, 63: 1912-1917. 10.1002/1097-0142(19890515)63:10<1912::AID-CNCR2820631007>3.0.CO;2-Y.CrossRefPubMed
74.
Fowble B, Solin LJ, Schultz DJ, Rubenstein J, Goodman RL: Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys. 1990, 19: 833-842.CrossRefPubMed
75.
Vicini FA, Recht A, Abner A, Boyages J, Cady B, Connolly JL, Gelman R, Osteen RT, Schnitt SJ, Silen W, Harris JR: Recurrence in the breast following conservative surgery and radiation therapy for early-stage breast cancer. J Natl Cancer Inst Monogr. 1992, 11: 33-39.PubMed
76.
Komoike Y, Akiyama F, Iino Y, Ikeda T, Tanaka-Akashi S, Ohsumi S, Kusama M, Sano M, Shin E, Suemasu K, Sonoo H, Taguchi T, Nishi T, Nishimura R, Haga S, Mise K, Kinoshita T, Murakami S, Yoshimoto M, Tsukuma H, Inaji H: Analysis of ipsilateral breast tumor recurrences after breast-conserving treatment based on the classification of true recurrences and new primary tumors. Breast Cancer. 2005, 12: 104-111. 10.2325/jbcs.12.104.CrossRefPubMed
77.
Olson TP, Harter J, Muñoz A, Mahvi DM, Breslin T: Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol. 2007, 14: 2953-2960.CrossRefPubMed
78.
Marudanayagam R, Singhal R, Tanchel B, O'Connor B, Balasubramanian B, Paterson I: Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J. 2008, 14: 570-573. 10.1111/j.1524-4741.2008.00649.x.CrossRefPubMed
79.
Fedorcik GG, Sachs R, Goldfarb MA: Oncologic and aesthetic results following breast-conserving therapy with 0.5 cm margins in 100 consecutive patients. Breast J. 2006, 12: 208-211. 10.1111/j.1075-122X.2006.00243.x.CrossRefPubMed
80.
von Smitten K: Margin status after breast-conserving treatment of breast cancer: how much free margin is enough?. J Surg Oncol. 2008, 98: 585-587. 10.1002/jso.21038.CrossRefPubMed
81.
Guidi AJ, Connolly JL, Harris JR, Schnitt SJ: The relationship between shaved margin and inked margin status in breast excision specimens. Cancer. 1997, 79: 1568-1573. 10.1002/(SICI)1097-0142(19970415)79:8<1568::AID-CNCR19>3.0.CO;2-W.CrossRefPubMed
82.
Pourquier D, Lemanski C, Kamar A: Lumpectomy margins and much more. Cancer. 1998, 82: 2289-2293. 10.1002/(SICI)1097-0142(19980601)82:11<2289::AID-CNCR27>3.0.CO;2-P.CrossRefPubMed
83.
Graham RA, Homer MJ, Katz J, Rothschild J, Safaii H, Supran S: The pancake phenomenon contributes to the inaccuracy of margin assessment in patients with breast cancer. Am J Surg. 2002, 184: 89-93. 10.1016/S0002-9610(02)00902-9.CrossRefPubMed
84.
Jimenez RE, Bongers S, Bouwman D, Segel M, Visscher DW: Clinicopathologic significance of ductal carcinoma in situ in breast core needle biopsies with invasive cancer. Am J Surg Pathol. 2000, 24: 123-128. 10.1097/00000478-200001000-00015.CrossRefPubMed
85.
Schnitt SJ, Connolly JL, Khettry U, Mazoujian G, Brenner M, Silver B, Recht A, Beadle G, Harris JR: Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy. Cancer. 1987, 59: 675-681. 10.1002/1097-0142(19870215)59:4<675::AID-CNCR2820590402>3.0.CO;2-U.CrossRefPubMed
86.
Wazer DE, Schmidt-Ullrich RK, Schmid CH, Ruthazer R, Kramer B, Safaii H, Graham R: The value of breast lumpectomy margin assessment as a predictor of residual tumor burden. Int J Radiat Oncol Biol Phys. 1997, 38: 291-299.CrossRefPubMed
87.
Wazer DE, Schmidt-Ullrich RK, Ruthazer R, DiPetrillo T, Boyle T, Kanski J, Safaii H: The influence of age and extensive intraductal component histology upon breast lumpectomy margin assessment as a predictor of residual tumor. Int J Radiat Oncol Biol Phys. 1999, 45: 885-891.CrossRefPubMed
88.
Bartelink H, Borger JH, van Dongen JA, Peterse JL: The impact of tumor size and histology on local control after breast-conserving therapy. Radiother Oncol. 1988, 11: 297-303. 10.1016/0167-8140(88)90200-9.CrossRefPubMed
89.
Bulman AS, Lindley RP, Parsons P, Ellis H: Pathological features of invasive breast cancer associated with a high risk of local recurrence after tumour excision and radical radiotherapy. Ann R Coll Surg Engl. 1988, 70: 289-292.PubMedPubMedCentral
90.
Lindley R, Bulman A, Parsons P, Phillips R, Henry K, Ellis H: Histologic features predictive of an increased risk of early local recurrence after treatment of breast cancer by local tumor excision and radical radiotherapy. Surgery. 1989, 105: 13-20.PubMed
91.
Fourquet A, Campana F, Zafrani B, Mosseri V, Vielh P, Durand JC, Vilcoq JR: Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys. 1989, 17: 719-725.CrossRefPubMed
92.
Zafrani B, Vielh P, Fourquet A, Mosseri V, Durand JC, Salmon RJ, Vilcoq JR: Conservative treatment of early breast cancer: prognostic value of the ductal in situ component and other pathological variables on local control and survival. Long-term results. Eur J Cancer Clin Oncol. 1989, 25: 1645-1650. 10.1016/0277-5379(89)90311-8.CrossRefPubMed
93.
Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, Bressac C, Spitalier JM: Why are local recurrences after breast-conserving therapy more frequent in younger patients?. J Clin Oncol. 1990, 8: 591-598.PubMed
94.
Jacquemier J, Kurtz JM, Amalric R, Brandone H, Ayme Y, Spitalier JM: An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy. Br J Cancer. 1990, 61: 873-876.CrossRefPubMedPubMedCentral
95.
Boyages J, Recht A, Connolly JL, Schnitt SJ, Gelman R, Kooy H, Love S, Osteen RT, Cady B, Silver B, Harris JR: Early breast cancer: predictors of breast recurrence for patients treated with conservative surgery and radiation therapy. Radiother Oncol. 1990, 19: 29-41. 10.1016/0167-8140(90)90163-Q.CrossRefPubMed
96.
Vicini FA, Eberlein TJ, Connolly JL, Recht A, Abner A, Schnitt SJ, Silen W, Harris JR: The optimal extent of resection for patients with stages I or II breast cancer treated with conservative surgery and radiotherapy. Ann Surg. 1991, 214: 200-204. 10.1097/00000658-199109000-00002. discussion 204–5.CrossRefPubMedPubMedCentral
Metadata
Title
Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer
Authors
Stephen P Povoski
Rafael E Jimenez
Wenle P Wang
Ronald X Xu
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2009
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-9-254

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