title: Positive margins following breast cancer tumorectomy. Can we predict the occurrence of residual disease?
abstract: OBJECTIVE
  In conservative early stage breast cancer surgery, the sample's margins are directly related to relapse, and positive or close margins indicate the need for additional surgery. Since the range of residual disease in secondary surgeries and the related pathological factors are highly variable, we intended to evaluate the number of additional surgeries due to compromised margins and identify the percentage of residual disease and factors related to it.
  
  
  METHODS
  We retrospectively analyzed the clinical records of 659 tumorectomy or needle localization surgery patients with breast carcinoma at the Hospital Universitario Austral in Buenos Aires, Argentina, between December 2000 and December 2012. The variables considered were age, type of surgery, type of margin, tumor size, histological grade, extensive intraductal component and immunohistochemical profile. We investigated how they related to the presence of residual disease.
  
  
  RESULTS
  We identified 68 patients (10%) who were reoperated because of positive (75%) or close (25%) margins. Residual disease was identified in 68% of them; the positive (66%) and close (70%) margin ratio was similar. The individual analysis of variables was statistically significant only for tumors larger than 3 cm (Pearson's chi square [1] = 6.7194; P = 0.0095; relative risk = 1.56 [95% CI 1.09-2.21]) with an association between age and tumor size: Pearson's chi square (1) = 3.8984; P = 0.0483; relative risk = 1.56 (95% CI 1.09-2.21).
  
  
  CONCLUSIONS
  The need for second surgery due to compromised margins is not common, with variable residual tumor identifying ranges. Some pathological factors can predict the persistence of residual disease. In our series, tumor size >3 cm was the variable identified as an independent predictor.
authors.forename: Diana
authors.initials: D
authors.lastname: Montoya
authors.forename: Andrea Silvina
authors.initials: AS
authors.lastname: Elias
authors.forename: Julian
authors.initials: J
authors.lastname: Mosto
authors.forename: Darío
authors.initials: D
authors.lastname: Schejtman
authors.forename: Eduardo
authors.initials: E
authors.lastname: Beccar Varela
authors.forename: Claudio
authors.initials: C
authors.lastname: Paleta
authors.forename: Leonardo H
authors.initials: LH
authors.lastname: McLean
authors.forename: Marta
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Vanina
authors.initials: V
authors.lastname: Bastacini
authors.forename: Paola
authors.initials: P
authors.lastname: Nasute
authors.forename: Elide
authors.initials: E
authors.lastname: Benedek
authors.forename: Mónica
authors.initials: M
authors.lastname: Varela
authors.forename: Jorge
authors.initials: J
authors.lastname: Chiozza
authors.forename: Ignacio
authors.initials: I
authors.lastname: McLean
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D001943:Breast Neoplasms / Q000453:epidemiology / 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; D008499:Medical Records; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018365:Neoplasm, Residual; D012086:Reoperation; D012189:Retrospective Studies