title: Reexcision for positive margins in breast cancer: A predictive score of residual disease.
abstract: BACKGROUND
  Guidelines recommend re-excision if resection margins are positive in lumpectomy for breast cancer. However, residual disease (RD) is not always found. The aim of our study was to develop a score to predict RD in re-excision specimens.
  
  
  METHODS
  We carried out a multicenter, retrospective study with two population groups. The 'modeling' group was composed of 148 patients treated in the Centre Hospitalier Poissy-St-Germain or the Georges Pompidou European Hospital and the 'validation' group was composed of 67 patients treated in Curie Institute. The score was built with a logistic regression model.
  
  
  RESULTS
  Factors independently associated with RD were: a cumulative length of all positive margins>5 mm, invasion by ductal carcinoma in situ only, a pathological tumor size>30 mm and a pathological tumor size<30 mm with a discrepancy of >50% between pathological and radiological tumor size. The 7-point score allowed the classification of patients into three risk groups for RD: low (16% of patients experienced RD), moderate (65%) and high (100%). The areas under the ROC curve of the score and the logistic model were 0.72(95%CI:0.68-0.75,p = 0.60). The proportion of RD in each group of the validation population (25%, 48%, and 100% in the low, moderate and high group, respectively) confirmed the accuracy of the score in an independent population.
  
  
  CONCLUSIONS
  This score enables the identification of patients at high risk of RD but it cannot provide guidance for the decision to undertake re-excision surgery in the low-risk group. Further studies are needed to test the score in extensive datasets and better identify low-risk patients.
authors: Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, Poissy, France; University Versailles Saint Quentin en Yvelines, Versailles, 10 rue du Champ Gaillard, 78300 Poissy, France; Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, AP-HP Paris, University Paris V, René Descartes, 20 rue Leblanc, 75015 Paris, France; Department of Surgery and Senology, Institut Curie, Université Paris V, René Descartes, 26 rue d'Ulm, 75005 Paris, France. Electronic address: myriam.cohen13@gmail.com.
authors: Myriam
authors: M
authors: Mimouni
authors: Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, AP-HP Paris, University Paris V, René Descartes, 20 rue Leblanc, 75015 Paris, France. Electronic address: fabrice.lecuru@egp.aphp.fr.
authors: Fabrice
authors: F
authors: Lecuru
authors: Department of Surgery and Senology, Institut Curie, Université Paris V, René Descartes, 26 rue d'Ulm, 75005 Paris, France; EA 7285 Clinical Risks and Safety on Women's Health, University Versailles-Saint-Quentin en Yvelines, France. Electronic address: roman.rouzier@curie.fr.
authors: Roman
authors: R
authors: Rouzier
authors: Department of Surgery and Senology, Institut Curie, Université Paris V, René Descartes, 26 rue d'Ulm, 75005 Paris, France. Electronic address: noeloter@hotmail.com.
authors: Noémie
authors: N
authors: Lotersztajn
authors: Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, Poissy, France; University Versailles Saint Quentin en Yvelines, Versailles, 10 rue du Champ Gaillard, 78300 Poissy, France. Electronic address: dheitz@chi-poissy-st-germain.fr.
authors: Denis
authors: D
authors: Heitz
authors: Medistat, Biostatistics, 10-12 rue de la Conception, 13004 Marseille, France. Electronic address: juliencohen1234@gmail.com.
authors: Julien
authors: J
authors: Cohen
authors: Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, Poissy, France; University Versailles Saint Quentin en Yvelines, Versailles, 10 rue du Champ Gaillard, 78300 Poissy, France; EA 7285 Clinical Risks and Safety on Women's Health, University Versailles-Saint-Quentin en Yvelines, France. Electronic address: afauconnier@chi-poissy-st-germain.fr.
authors: Arnaud
authors: A
authors: Fauconnier
authors: Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, Poissy, France; University Versailles Saint Quentin en Yvelines, Versailles, 10 rue du Champ Gaillard, 78300 Poissy, France; EA 7285 Clinical Risks and Safety on Women's Health, University Versailles-Saint-Quentin en Yvelines, France. Electronic address: chuchon@chi-poissy-st-germain.fr.
authors: Cyrille
authors: C
authors: Huchon
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Breast cancer; Breast conserving therapy; Predictive score; Re-excision; Residual disease