title: Multiple re-excisions versus mastectomy in patients with persistent residual disease following breast conservation surgery.
abstract: BACKGROUND
  Persistently involved margins following breast conservation surgery (BCS) create a diagnostic dilemma regarding the recommendation of further BCS or mastectomy.
  
  
  METHODS
  A retrospective review of 276 breast cancer patients who underwent BCS and required additional surgical treatment between 1990-2002 was performed.
  
  
  RESULTS
  For treatment of persistently involved margins, 63% of subjects underwent re-excision the first time, 49% the second time, and 37% the third time. The incidence of residual carcinoma increased linearly with the number of initially involved margins (P = .03). Ductal carcinoma-in-situ (DCIS) or infiltrating lobular carcinoma (IFLC) primary histology was associated with a higher rate of residual cancer compared to invasive ductal carcinoma (IFDC) (62% vs. 69% vs. 54%, respectively, P = .56). A trend towards an increased risk of residual cancer in primary tumors > or =2 cm versus tumors under 2 cm was also evident (63%% vs. 50%, respectively, P = .38).
  
  
  CONCLUSIONS
  Approximately half of patients repeatedly selected BCS over mastectomy. It is important to realistically discuss the probability of definitive resection with patients who are undergoing breast conservation with re-excision.
authors.affiliation: Weill Medical College of Cornell University, Department of Surgery, New York, NY, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Cellini
authors.forename: Tara L
authors.initials: TL
authors.lastname: Huston
authors.forename: Diana
authors.initials: D
authors.lastname: Martins
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Josh
authors.initials: J
authors.lastname: Carson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kemper
authors.forename: Rache M
authors.initials: RM
authors.lastname: Simmons
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018365:Neoplasm, Residual; D011980:Receptors, Progesterone / Q000032:analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D011980:Receptors, Progesterone