title: Close and Positive Lumpectomy Margins are Associated with Similar Rates of Residual Disease with Additional Surgery.
abstract: Current guidelines state that "no ink on tumor" constitutes adequate surgical margins for lumpectomy specimens. However, there remains uncertainty when tumor is close (<1 mm) to multiple inked margins.
  
  
  
  All local excisions for invasive breast cancer during 3 years at one center were reviewed. Tumor characteristics, margin status, patient age, reoperations, and pathology of reexcised specimen were recorded. Chi-square analysis and regression models were used to identify factors associated with residual disease upon reoperation.
  
  
  
  In 533 lumpectomies for invasive cancer, 60 (11 %) had at least one positive margin, and 106 (20 %) had one or more close margin. Multiple margins were either close or positive in 67 cases. Reoperation was performed in 125 of 533 cases (23 %) for close or positive margins. Positive margins were significantly more likely to undergo reoperation compared with close margins (p < 0.001). On reoperation, 73 of 125 (58 %) demonstrated residual cancer, including 39 of 68 (57 %) with close margins, and 34 of 57 (60 %) with positive margins (p = 0.52). When multiple margins were close or positive, residual cancer was found on reexcision in 45 of 59 (76 %) cases as opposed to 34 of 79 (43 %) cases with only one involved margin (p < 0.001). When controlling for other factors, positive margins were no more associated with residual disease than close margins (p = 0.32), whereas multiple close or positive margins were associated with significantly higher risk of residual disease (odds ratio 6.1; p = 0.002; 95 % confidence interval 2.6-14.45).
  
  
  
  The only significant predictor of residual tumor was multiple close or positive margins. It may be appropriate to recommend reexcision for patients with multiple close margins.
authors: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Simon
authors: S
authors: Fitzgerald
authors: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Anya
authors: A
authors: Romanoff
authors: St. George's School of Medicine, True Blue, Grenada.
authors: Almog
authors: A
authors: Cohen
authors: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Dubin Breast Center at the Tisch Cancer Institute, New York, NY, USA.
authors: Hank
authors: H
authors: Schmidt
authors: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Dubin Breast Center at the Tisch Cancer Institute, New York, NY, USA.
authors: Christina
authors: C
authors: Weltz
authors: Department of Pathology, The Mount Sinai Hospital, New York, NY, USA.
authors: Ira J
authors: IJ
authors: Bleiweis
authors: Department of Pathology, The Mount Sinai Hospital, New York, NY, USA.
authors: Shabnam
authors: S
authors: Jaffer
authors: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. elisa.port@mountsinai.org.|Dubin Breast Center at the Tisch Cancer Institute, New York, NY, USA. elisa.port@mountsinai.org.
authors: Elisa R
authors: ER
authors: Port
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D012086:Reoperation; D012189:Retrospective Studies