title: Breast cancer in patients with residual invasive carcinoma is more accurately staged with additive tumor size assessment.
abstract: BACKGROUND
  Accurate assessment of tumor size for patients with breast cancer undergoing re-excision following breast-conserving therapy is important for appropriate staging and adjuvant treatment. We investigated the accuracy of additive vs. nonadditive size assessment in determining final tumor stage.
  
  
  METHODS
  Patients with infiltrating carcinoma in the initial excision and in at least one additional re-excision (re-excision positive; n = 89) had tumor size assessed with additive and nonadditive techniques. This group was compared with patients undergoing re-excision but without identifiable residual carcinoma (re-excision negative; n = 105) regarding rates of lymph node (LN) metastasis.
  
  
  RESULTS
  The re-excision positive patients had a different median final tumor size depending on the size assessment technique used (nonadditive: 1.8 cm; additive: 3.0 cm; P <.0001). Both groups of patients had a median tumor size consistent with T1c staging in nonadditive size assessment. However, re-excision positive patients had a significantly higher incidence of LN metastasis (P <.05) than did re-excision negative patients. Both groups were then separated into T1 and T2 stages and the LN metastasis rates were assessed. Compared with nonadditive size assessment, additive size assessment distributed re-excision positive patients into T stages whereby the LN metastasis rates more closely approximated those of re-excision negative patients (T1, 3% vs. 6% difference; T2, 4% vs. 13% difference).
  
  
  CONCLUSIONS
  With regard to LN metastasis, staging for patients with residual invasive carcinoma in re-excision specimens is more accurate with additive tumor size assessment.
authors.affiliation: Department of Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Hollenbeck
authors.forename: C
authors.initials: C
authors.lastname: Cellini
authors.forename: P
authors.initials: P
authors.lastname: Christos
authors.forename: Y
authors.initials: Y
authors.lastname: Varnado-Rhodes
authors.forename: D
authors.initials: D
authors.lastname: Martins
authors.forename: M
authors.initials: M
authors.lastname: Nussbaum
authors.forename: M P
authors.initials: MP
authors.lastname: Osborne
authors.forename: R M
authors.initials: RM
authors.lastname: Simmons
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies