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The Effect of Simultaneous Peripheral Excision in Breast Conservation upon Margin Status

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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Abstract

Background

Negative margins in breast conservation therapy (BCT) decrease local recurrence risk. Excision may be performed via two techniques: either as a single lumpectomy specimen or as a central segment with simultaneously resected peripheral segments (PSs). There is little data directly comparing these methods for their effect on margin status.

Materials and Methods

A retrospective review of all patients undergoing BCT for invasive breast cancer was conducted to evaluate and compare the two techniques. Presentation, pathologic characteristics, surgical technique, specimen volume, and final margin status were recorded.

Results

Among 259 cancers in 257 women, 33 had positive margins. A single segment was removed in 69 patients, while 190 patients had 1–6 PSs simultaneously removed. By univariate analysis, smaller tumor size (P = .017) and greater numbers of segments removed (P = .01) lowered the risk of positive margins. In a multivariate model, smaller tumor size (P = .0024), lack of EIC (P = .049), and greater numbers of segments removed (P = .0061) lowered the risk of margin positivity. Despite this last predictor, the total resected specimen volume did not increase with the number of PSs removed (P = .4). There was no residual tumor in 49.2% of PSs despite a compromised primary segment margin.

Conclusions

Smaller tumor size, lack of EIC, and greater numbers of simultaneous PSs excised decrease the likelihood of positive margins, despite a lack of correlation between segment numbers and excised volume. These findings suggest that excision of simultaneous PSs may assist in achieving negative margins, in part, because of avoidance of pathologic artifact.

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References

  1. Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer. 1999;86:429–438.

    Article  CAS  PubMed  Google Scholar 

  2. van Dongen JA, Voogd AC, Fentiman IS et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.

    Article  PubMed  Google Scholar 

  3. Besana-Ciani I, Greenall MJ. The importance of margins status after breast conservative surgery and radiotherapy in node positive patients: a follow-up of 10–15 years. Int Semin Surg Oncol. 2008;5:13.

    Article  PubMed  Google Scholar 

  4. Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009;27:1615–20.

    Article  PubMed  Google Scholar 

  5. 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;241:629–39.

    Article  PubMed  Google Scholar 

  6. Menes TS, Tartter PI, Bleiweiss I, Godbold JH, Estabrook A, Smith SR. The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients. Ann Surg Oncol. 2005;12:881–5.

    Article  PubMed  Google Scholar 

  7. Freedman G, Fowble B, Hanlon A, Nicolaou N, Fein D, Hoffman J, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys. 1999;44:1005–15.

    CAS  PubMed  Google Scholar 

  8. O’Sullivan MJ, Li T, Freedman G, Morrow M. The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery. Ann Surg Oncol. 2007;14:3133–40.

    Article  PubMed  Google Scholar 

  9. Wazer DE, DiPetrillo T, Schmidt-Ullrich R, Weld L, Smith TJ, Marchant DJ, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.

    CAS  PubMed  Google Scholar 

  10. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93.

    Article  PubMed  Google Scholar 

  11. Ramanah R, Pivot X, Sautiere JL, Maillet R, Riethmuller D. Predictors of re-excision for positive or close margins in breast-conservation therapy for pT1 tumors. Am J Surg. 2008;195:770–4.

    Article  PubMed  Google Scholar 

  12. Bani MR, Lux MP, Heusinger K, Wenkel E, Magener A, Schulz-Wendtland R, et al. Factors correlating with reexcision after breast-conserving therapy. Eur J Surg Oncol. 2009;35:32–7.

    CAS  PubMed  Google Scholar 

  13. Sabel MS, Rogers K, Griffith K, Jagsi R, Kleer CG, Diehl KA, et al. Residual disease after re-excision lumpectomy for close margins. J Surg Oncol. 2009;99:99–103.

    Article  PubMed  Google Scholar 

  14. Cabioglu N, Hunt KK, Sahin AA, Kuerer HM, Babiera GV, Singletary SE, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458–71.

    Article  PubMed  Google Scholar 

  15. 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;30:1058–64.

    Article  CAS  PubMed  Google Scholar 

  16. Chagpar AB, Martin RC, 2nd, 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.

    Article  PubMed  Google Scholar 

  17. Gage I, Schnitt SJ, Nixon AJ, Silver B, Recht A, Troyan SL, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78:1921–8.

    Article  CAS  PubMed  Google Scholar 

  18. Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, et al. 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;18:1668–75.

    CAS  PubMed  Google Scholar 

  19. Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–303.

    Article  PubMed  Google Scholar 

  20. 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;29:1625–32.

    Article  PubMed  Google Scholar 

  21. 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;196:556–8.

    Article  PubMed  Google Scholar 

  22. White RR, Halperin TJ, Olson JA, Jr., Soo MS, Bentley RC, Seigler HF. Impact of core-needle breast biopsy on the surgical management of mammographic abnormalities. Ann Surg. 2001;233:769–77.

    Article  CAS  PubMed  Google Scholar 

  23. 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;192:509–12.

    Article  PubMed  Google Scholar 

  24. Liberman L, Kaplan J, Van Zee KJ, Morris EA, LaTrenta LR, Abramson AF, et al. Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 2001;177:565–72.

    CAS  PubMed  Google Scholar 

  25. Mumtaz H, Hall-Craggs MA, Davidson T, Walmsley K, Thurell W, Kissin MW, Taylor I. Staging of symptomatic primary breast cancer with MR imaging. AJR Am J Roentgenol. 1997;169:417–24.

    CAS  PubMed  Google Scholar 

  26. Bleicher RJ, Ciocca RM, Egleston BL, Sesa L, Evers K, Sigurdson ER, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209:180–7; quiz 294–5.

    Google Scholar 

  27. Hwang N, Schiller DE, Crystal P, Maki E, McCready DR. Magnetic resonance imaging in the planning of initial lumpectomy for invasive breast carcinoma: Its effect on ipsilateral breast tumor recurrence after breast-conservation therapy. Ann Surg Oncol. 2009;16:3000–9.

    Article  PubMed  Google Scholar 

  28. Gould EW, Robinson PG. The pathologist’s examination of the “lumpectomy”—The pathologists’ view of surgical margins. Semin Surg Oncol. 1992;8:129–35.

    CAS  PubMed  Google Scholar 

  29. Holland R, Connolly JL, Gelman R, Mravunac M, Hendriks JH, Verbeek AL, et al. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990;8:113–8.

    CAS  PubMed  Google Scholar 

  30. Noguchi M, Minami M, Earashi M, Taniya T, Miyazaki II, Mizukami Y, et al. Pathologic assessment of surgical margins on frozen and permanent sections in breast conserving surgery. Breast Cancer. 1995;2:27–33.

    Article  PubMed  Google Scholar 

  31. Olson TP, Harter J, Munoz 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;14:2953–60.

    Article  CAS  PubMed  Google Scholar 

  32. Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol. 1998;5:220–6.

    Article  CAS  PubMed  Google Scholar 

  33. Cox CE, Ku NN, Reintgen DS, Greenberg HM, Nicosia SV, Wangensteen S. Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg. 1991;126:490–3.

    CAS  PubMed  Google Scholar 

  34. Valdes EK, Boolbol SK, Ali I, Feldman SM, Cohen JM. Intraoperative touch preparation cytology for margin assessment in breast-conservation surgery: does it work for lobular carcinoma? Ann Surg Oncol. 2007;14:2940–5.

    Article  PubMed  Google Scholar 

  35. Karni T, Pappo I, Sandbank J, Lavon O, Kent V, Spector R, et al. A device for real-time, intraoperative margin assessment in breast-conservation surgery. Am J Surg. 2007;194:467–73.

    Article  PubMed  Google Scholar 

  36. Schnitt SJ, Connolly JL. Processing and evaluation of breast excision specimens. A clinically oriented approach. Am J Clin Pathol. 1992;98:125–37.

    CAS  PubMed  Google Scholar 

  37. Molina MA, Snell S, Franceschi D, Jorda M, Gomez C, Moffat FL, et al. Breast specimen orientation. Ann Surg Oncol. 2009;16:285–8.

    Article  CAS  PubMed  Google Scholar 

  38. Dooley WC, Parker J. Understanding the mechanisms creating false positive lumpectomy margins. Am J Surg. 2005;190:606–8.

    Article  PubMed  Google Scholar 

  39. Clingan R, Griffin M, Phillips J, Coberly W, Jennings W. Potential margin distortion in breast tissue by specimen mammography. Arch Surg. 2003;138:1371–4.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24:2028–37.

    Article  PubMed  Google Scholar 

  42. Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, et al. 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;74:1746–51.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

This work was supported, in part, by U.S. Public Health Services grant 5P30 CA06927 and by an appropriation from the Commonwealth of Pennsylvania.

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Authors and Affiliations

  1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Roshani R. Patel MD, Linda Sesa MSN, CRNP, AOCNP, Elin R. Sigurdson MD, PhD & Richard J. Bleicher MD

  2. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA

    Tianyu Li MS & Eric A. Ross PhD

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  1. Roshani R. Patel MD
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  2. Tianyu Li MS
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  6. Richard J. Bleicher MD
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Correspondence to Richard J. Bleicher MD.

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Patel, R.R., Li, T., Ross, E.A. et al. The Effect of Simultaneous Peripheral Excision in Breast Conservation upon Margin Status. Ann Surg Oncol 17, 2933–2939 (2010). https://doi.org/10.1245/s10434-010-1123-z

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  • DOI: https://doi.org/10.1245/s10434-010-1123-z

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