title: Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery.
abstract: OBJECTIVE
  To evaluate the incidence of residual disease after additional surgery for positive/close margins and the impact on the rate of local and distant recurrence.
  
  
  METHODS
  A retrospective analysis on 1339 patients treated for breast cancer with breast conserving-surgery and radiotherapy at a single Institution between 2000 and 2009 was performed.
  
  
  RESULTS
  During primary surgery 526 patients (39.3%) underwent intraoperative re-excision. At the final pathological report, the margins were positive in 132 patients (9.9%) and close in 85 (6.3%). To obtain clear margins, 142 of these women underwent a second surgery; 35 patients with positive margins (27%) and 40 with close margins (47%) did not receive additional surgery because of different reasons (patients refusal, old age, comorbidity or for focal margin involvement). At second surgery, residual disease was found in 62.9% of patients with positive margins and in 55.5% of those with close margins. At a median follow-up time of 4 years, local recurrence (LR) rate was 2.9% for patients with clear margins, 5.2% (p = 0.67) for patients with unresected close margins and 11.7% (p = 0.003) for those with unresected positive margins. The HER-2 and the basal-like subtypes had the higher rate of LR and the luminal A the lowest.
  
  
  CONCLUSIONS
  A significantly higher LR rate was found only among patients with positive margins not receiving additional surgery, but not in those with unresected close margins. Positive margins are a strong predictor for LR and need re-excision that can be avoided for close margins.
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy. Electronic address: nicoletta.biglia@unito.it.
authors.forename: N
authors.initials: N
authors.lastname: Biglia
authors.affiliation: Gynecological Oncology Unit, Institute for Cancer Research and Treatment (IRCC) of Candiolo, FPO, Turin, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Ponzone
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: V E
authors.initials: VE
authors.lastname: Bounous
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: L L
authors.initials: LL
authors.lastname: Mariani
authors.affiliation: Gynecological Oncology Unit, Institute for Cancer Research and Treatment (IRCC) of Candiolo, FPO, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Maggiorotto
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Benevelli
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Liberale
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Ottino
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sismondi
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D009378:Neoplasms, Multiple Primary / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Breast cancer; Breast-conserving treatment; Local recurrence; Molecular subtypes; Re-excision; Surgical margin