title: Review of re-excision for narrow or positive margins of invasive and intraductal carcinoma.
abstract: The trend in breast surgery has shifted towards breast conservation. Re-excision rates for narrow or positive margins have been variable in published reports. A retrospective analysis of 3246 patients who underwent either a lumpectomy for a palpable mass or a needle localization biopsy between January 2003 and December 2007 was done. Five hundred and eighty-five patients underwent re-excision surgery for margins. The mean patient age was 59-years-old (range 25-93). Needle localization was used to guide initial excision in 372 of 585 patients (64%). Invasive carcinoma was seen in 402 (69%) patients, ductal carcinoma in situ (DCIS) alone in 183 (31%) patients, and 308 (53%) patients had both invasive carcinoma and DCIS. Well-differentiated carcinomas accounted for only 24 per cent of the re-excisions. Four hundred and sixteen patients underwent re-excision of margins, whereas 169 underwent mastectomy as the second surgery. Residual carcinoma was seen in 38 per cent of cases with involved margins, as compared with 24 per cent with <1 mm margins and only 12 per cent cases with >1 mm margins. Residual DCIS was seen in 65 per cent with involved margins, 50 per cent with <2 mm margins, and 35 per cent of cases with 2 to 5 mm margins (P < 0.001, chi2 association). Lesser re-excision was noted in well-differentiated invasive carcinomas. Only 12 per cent of patients with margins greater than 1 mm had residual tumor on re excision, which raises the possibility of nonoperative management in such cases.
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan 48075, USA. adi_dec17@yahoo.com
authors.forename: Aditya
authors.initials: A
authors.lastname: Gupta
authors.forename: Gokulakkrishna
authors.initials: G
authors.lastname: Subhas
authors.forename: Linda
authors.initials: L
authors.lastname: Dubay
authors.forename: Sumet
authors.initials: S
authors.lastname: Silapaswan
authors.forename: Ramachandra
authors.initials: R
authors.lastname: Kolachalam
authors.forename: William
authors.initials: W
authors.lastname: Kestenberg
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferguson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: Yousif
authors.initials: Y
authors.lastname: Gorieil
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery*; D012086:Reoperation