title: A nationwide pathology study on surgical margins and excision volumes after breast-conserving surgery: There is still much to be gained.
abstract: OBJECTIVE
  The current study aims to assess margin status in relation to amount of healthy breast tissue resected in breast-conserving surgery (BCS) on a nationwide scale.
  
  
  METHODS
  Using PALGA (a nationwide network and registry of histology and cytopathology in the Netherlands), all patients who underwent BCS for primary invasive carcinoma in 2012-13 were selected (10,058 excerpts). 9276 pathology excerpts were analyzed for a range of criteria including oncological margin status and distance to closest margin, specimen weight/volume, greatest tumor diameter, and with or without localization method. Calculated resection ratios (CRR) were assessed to determine excess healthy breast tissue resection.
  
  
  RESULTS
  Margins for invasive carcinoma and in situ carcinoma combined were tumor-involved in 498 (5.4%) and focally involved in 1021 cases (11.0%) of cases. Unsatisfactory resections including (focally) involved margins and margins ≤ 1 mm were reported in 33.8% of patients. The median lumpectomy volume was 46 cc (range 1-807 cc; SD 49.18) and median CRR 2.32 (range 0.10-104.17; SD 3.23), indicating the excision of 2.3 the optimal resection volume.
  
  
  CONCLUSIONS
  The unacceptable rate of tumor-involved margins as well as margins ≤ 1 mm in one third of all patients is also achieved at the expense of healthy breast tissue resection, which may carry the drawback of high rates of cosmetic failure. These data clearly suggest the need for improvement in current breast conserving surgical procedures to decrease tumor-involved margin rates while reducing the amount of healthy breast tissue resected.
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: mhaloua@gmail.com.
authors.forename: M H
authors.initials: MH
authors.lastname: Haloua
authors.affiliation: Department of Surgical Oncology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Volders
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: n.krekel@vumc.nl.
authors.forename: N M A
authors.initials: NM
authors.lastname: Krekel
authors.affiliation: Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: e.barbe@vumc.nl.
authors.forename: E
authors.initials: E
authors.lastname: Barbé
authors.affiliation: Department of Surgical Oncology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Sietses
authors.affiliation: Department of Epidemiology and Biostatistics, NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Jóźwiak
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Meijer
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: mp.vandentol@vumc.nl.
authors.forename: M P
authors.initials: MP
authors.lastname: van den Tol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D018365:Neoplasm, Residual; D009426:Netherlands; D011446:Prospective Studies; D055815:Young Adult
keywords: Breast conserving surgery; International guidelines; Intra-operative guidance; Margin status definition; Surgical precision; Ultrasonography