title: Accuracy of AJCC staging for breast cancer patients undergoing re-excision for positive margins. American Joint Committee on Cancer.
abstract: BACKGROUND
  The current AJCC protocol for breast cancer staging does not include additional tumor found at the time of re-excision in the calculation of tumor size. We hypothesize that the AJCC protocol may result in understaging and undertreatment of breast cancer patients who have additional tumor found at re-excision.
  
  
  METHODS
  In a retrospective chart review of breast cancer patients, patients with tumor present at re-excision for positive margins were placed in group 1 (n=72); patients with no tumor present at re-excision, or who underwent a single, negative margin procedure were placed in group 2 (n=147).
  
  
  RESULTS
  Patients in group 1 had a higher risk of nodal metastases when compared to patients in group 2. Mean tumor size did not differ significantly between the subgroups. Positive re-excision was strongly associated with lymph node metastases on multivariate analysis after correction for age, grade, stage, and lymphatic invasion (odds ratio=3.13, 95% CI=1.58 6.18, P=.0011).
  
  
  CONCLUSIONS
  Current AJCC guidelines may result in undertreatment of breast cancer patients with positive re-excisions. The presence of additional tumor at the time of re-excision should be considered when determining the need for systemic therapy, and may be relevant in determining T stage.
authors.affiliation: Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Brenin
authors.forename: M
authors.initials: M
authors.lastname: Morrow
mesh_terms: D001943:Breast Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000145:classification / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D012086:Reoperation; D012189:Retrospective Studies