title: Predictors of re-excision in wire-guided wide local excision for early breast cancer: a Western Australian multi-centre experience.
abstract: BACKGROUND
  A significant proportion of breast cancers present as impalpable lesions requiring radiological guidance prior to surgical excision, commonly by hook-wire placement. Complete lesion excision is an essential part of treatment, and re-excision may be needed to ensure this and minimize local recurrence. We explore a 1-year audit of re-excision of hook-wire-guided excisions in two large public breast units in Western Australia and define factors associated with the requirement for re-excision.
  
  
  METHODS
  A retrospective review of wire-localized wide local excisions for early breast cancer in 2009 at two tertiary breast centres in Western Australia.
  
  
  RESULTS
  Of 148 localized lesions, 44 (30%) underwent re-excision. The only significant preoperative finding was the location of tumour in the breast. The intra-operative specimen radiograph provided useful information that influenced re-excision. Smaller (≤5 mm) and larger (>20 mm) tumours on final pathological size were more likely to undergo re-excision as well as a larger difference in actual size to predicted size. The presence of ductal carcinoma in situ (DCIS) increased re-operation, as did multifocality.
  
  
  CONCLUSIONS
  This study highlights factors that should make the surgeon more cautious for re-excision. Suspicion of DCIS, especially at the periphery of tumours, and a central tumour location increase risk. Lesion localization techniques play an important role in minimizing risk while maintaining cosmesis.
authors: Breast Centre, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: Helen
authors: H
authors: Ballal
authors: Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors: Donna B
authors: DB
authors: Taylor
authors: Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: Anita G
authors: AG
authors: Bourke
authors: Department of Pathology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Bruce
authors: B
authors: Latham
authors: School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors: Christobel M
authors: CM
authors: Saunders
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D009361:Neoplasm Invasiveness; D015641:Radiography, Interventional; D012086:Reoperation; D012189:Retrospective Studies; D014904:Western Australia
keywords: breast neoplasm/pathology; breast neoplasm/surgery; female; human; reoperation