title: Predictors of re-excision among women undergoing breast-conserving surgery for cancer.
abstract: BACKGROUND
  Up to 60% of breast cancer patients who undergo breast-conserving surgery (BCS) require re-excision to obtain clear margins, causing delays in adjuvant treatment and poor aesthetic results. However, patient and treatment-related factors associated with re-excision are not well defined.
  
  
  METHODS
  We surveyed all women undergoing breast conserving surgery between January 2002 and May 2006 regarding their breast disease (n = 714, response rate = 79.5%). The medical record was reviewed to determine the receipt of re-excision lumpectomy following BCS, and obtain tumor stage, histology, and biopsy method (surgical versus needle biopsy). Patient age, breast size, tumor location in the breast, and receipt of chemotherapy were self-reported. Logistic regression was used to determine significant predictors of re-excision lumpectomy.
  
  
  RESULTS
  In this sample, 51.4% of women required only one breast excision, 41.9% required two breast excisions, and 6.6% required three breast excisions. Overall, 10.8% of women required a mastectomy following initial attempt at BCS. Factors significantly correlated with re-excision lumpectomy included smaller breast size (A cup: OR = 2.7; 95%CI: 1.32-5.52; B cup: 1.63; 95%CI: 1.02-2.62), lobular histology (OR = 1.93; 95%CI: 1.15-3.25), and receipt of surgical biopsy (OR = 3.35; 95%CI: 2.24-5.02). Women who received adjuvant chemotherapy (OR = 2.49; 95%CI: 1.19-5.22) were more likely to require re-excision compared with women who received neoadjuvant chemotherapy.
  
  
  CONCLUSIONS
  Re-excision lumpectomy is common, and is significantly correlated with smaller breast size, lobular histology, surgical biopsy, and chemotherapy timing. Attention to these risk factors can improve the quality of care delivered to BCS patients by decreasing the cost and morbidity associated with multiple re-excision procedures.
authors.affiliation: Section of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. filip@med.umich.edu
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Emily S
authors.initials: ES
authors.lastname: Hu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D019984:Quality Indicators, Health Care; D012086:Reoperation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors