title: Sampling of secondary margins decreases the need for re-excision after partial mastectomy.
abstract: BACKGROUND
  We analyzed factors that influenced the need for re-excision after partial mastectomy.
  
  
  METHODS
  We conducted a retrospective study of 470 breast cancer patients treated with partial mastectomy with main outcome measures of re-excision, conversion to mastectomy, and recurrence.
  
  
  RESULTS
  Of 470 patients, 146 (31%) underwent re-excision for inadequate margins and 42 (8.9%) required mastectomy. Twelve (2.6%) patients had local recurrence of disease with a mean follow-up of 4.2 years. Factors found on multivariate analysis increasing the likelihood of re-excision include wire localization (2.4-fold), tumor or ductal carcinoma in situ (DCIS) close to the margins (<0.2 cm; 12.5-fold), margins involved with tumor or DCIS (25.3-fold), and seen by a non-breast specialist (2.25-fold). Taking secondary margins at initial operation reduced odds ratio of re-excision by 52% (P = .006) without a difference in volume of breast tissue removed (P = .33). Inadequate margins without re-excision had 12.% overall recurrence compared with a 6% recurrence with adequate margin and no re-excision (P = .069).
  
  
  CONCLUSIONS
  One third of patients treated with partial mastectomy required re-excision, but 89% avoided the need for mastectomy. Taking secondary margins during the initial procedure decreased the need for re-excision by half. The recurrence rate was identical whether clear margins were obtained after primary partial mastectomy or re-excision.
authors: Department of Surgery, University of Iowa, Iowa City, IA 52242, USA.
authors: Julie A
authors: JA
authors: Guidroz
authors: Gregory
authors: G
authors: Larrieux
authors: Junlin
authors: J
authors: Liao
authors: Sonia L
authors: SL
authors: Sugg
authors: Carol E H
authors: CE
authors: Scott-Conner
authors: Ronald J
authors: RJ
authors: Weigel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult