Reply to “Preoperative Chemotherapy and Potential Impact on Re-Excision for Early Breast Cancer”

Excerpt

We appreciate the comments offered by Batsis et al.1 regarding our article entitled “Preoperative Chemotherapy Decreases the need for Re-excision of Breast Cancers Between 2 and 4 cm Diameter.”2 We also recognize that our article has all of the limitations inherent in a small, retrospective, single-institution study. Our article clearly explained that the groups were not randomized, and we also demonstrated that the preoperative chemotherapy group was younger and had larger tumors than the postoperative adjuvant therapy group. Seemingly, these characteristics would make negative margins even more challenging to attain. The fact that our results showed such a dramatic reduction in the re-excision rate with preoperative chemotherapy, despite this imbalance in the groups, serves to strengthen our conclusions. Batsis et al.1 correctly point out that the initial lumpectomy rate did not differ between the groups; however, this overlooks a major point of our article. We found that because of the lower incidence of positive margins, the final lumpectomy rate was significantly higher in the preoperative chemotherapy group: 64% (30/47) vs. 45% (49/109; P < 0.05).2 Certainly, our results need to be confirmed in other clinical settings. If other small studies can duplicate our findings, this may be an issue that can be resolved without the need for a large, randomized trial. …