Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery

N. Biglia, R. Ponzone, V. E. Bounous, L. L. Mariani, F. Maggiorotto, C. Benevelli, V. Liberale, M. C. Ottino, P. Sismondi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: To evaluate the incidence of residual disease after additional surgery for positive/close margins and the impact on the rate of local and distant recurrence. Methods: A retrospective analysis on 1339 patients treated for breast cancer with breast conserving-surgery and radiotherapy at a single Institution between 2000 and 2009 was performed. Results: During primary surgery 526 patients (39.3%) underwent intraoperative re-excision. At the final pathological report, the margins were positive in 132 patients (9.9%) and close in 85 (6.3%). To obtain clear margins, 142 of these women underwent a second surgery; 35 patients with positive margins (27%) and 40 with close margins (47%) did not receive additional surgery because of different reasons (patients refusal, old age, comorbidity or for focal margin involvement). At second surgery, residual disease was found in 62.9% of patients with positive margins and in 55.5% of those with close margins. At a median follow-up time of 4 years, local recurrence (LR) rate was 2.9% for patients with clear margins, 5.2% (. p=0.67) for patients with unresected close margins and 11.7% (. p=0.003) for those with unresected positive margins. The HER-2 and the basal-like subtypes had the higher rate of LR and the luminal A the lowest. Conclusions: A significantly higher LR rate was found only among patients with positive margins not receiving additional surgery, but not in those with unresected close margins. Positive margins are a strong predictor for LR and need re-excision that can be avoided for close margins.

Original languageEnglish
Pages (from-to)870-875
Number of pages6
JournalBreast
Volume23
Issue number6
DOIs
Publication statusPublished - Dec 1 2014

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Segmental Mastectomy
Recurrence
Breast Neoplasms
Margins of Excision
Comorbidity
Radiotherapy
Incidence

Keywords

  • Breast cancer
  • Breast-conserving treatment
  • Local recurrence
  • Molecular subtypes
  • Re-excision
  • Surgical margin

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery. / Biglia, N.; Ponzone, R.; Bounous, V. E.; Mariani, L. L.; Maggiorotto, F.; Benevelli, C.; Liberale, V.; Ottino, M. C.; Sismondi, P.

In: Breast, Vol. 23, No. 6, 01.12.2014, p. 870-875.

Research output: Contribution to journalArticle

Biglia, N, Ponzone, R, Bounous, VE, Mariani, LL, Maggiorotto, F, Benevelli, C, Liberale, V, Ottino, MC & Sismondi, P 2014, 'Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery', Breast, vol. 23, no. 6, pp. 870-875. https://doi.org/10.1016/j.breast.2014.09.009
Biglia, N. ; Ponzone, R. ; Bounous, V. E. ; Mariani, L. L. ; Maggiorotto, F. ; Benevelli, C. ; Liberale, V. ; Ottino, M. C. ; Sismondi, P. / Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery. In: Breast. 2014 ; Vol. 23, No. 6. pp. 870-875.
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abstract = "Purpose: To evaluate the incidence of residual disease after additional surgery for positive/close margins and the impact on the rate of local and distant recurrence. Methods: A retrospective analysis on 1339 patients treated for breast cancer with breast conserving-surgery and radiotherapy at a single Institution between 2000 and 2009 was performed. Results: During primary surgery 526 patients (39.3{\%}) underwent intraoperative re-excision. At the final pathological report, the margins were positive in 132 patients (9.9{\%}) and close in 85 (6.3{\%}). To obtain clear margins, 142 of these women underwent a second surgery; 35 patients with positive margins (27{\%}) and 40 with close margins (47{\%}) did not receive additional surgery because of different reasons (patients refusal, old age, comorbidity or for focal margin involvement). At second surgery, residual disease was found in 62.9{\%} of patients with positive margins and in 55.5{\%} of those with close margins. At a median follow-up time of 4 years, local recurrence (LR) rate was 2.9{\%} for patients with clear margins, 5.2{\%} (. p=0.67) for patients with unresected close margins and 11.7{\%} (. p=0.003) for those with unresected positive margins. The HER-2 and the basal-like subtypes had the higher rate of LR and the luminal A the lowest. Conclusions: A significantly higher LR rate was found only among patients with positive margins not receiving additional surgery, but not in those with unresected close margins. Positive margins are a strong predictor for LR and need re-excision that can be avoided for close margins.",
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AU - Ponzone, R.

AU - Bounous, V. E.

AU - Mariani, L. L.

AU - Maggiorotto, F.

AU - Benevelli, C.

AU - Liberale, V.

AU - Ottino, M. C.

AU - Sismondi, P.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Purpose: To evaluate the incidence of residual disease after additional surgery for positive/close margins and the impact on the rate of local and distant recurrence. Methods: A retrospective analysis on 1339 patients treated for breast cancer with breast conserving-surgery and radiotherapy at a single Institution between 2000 and 2009 was performed. Results: During primary surgery 526 patients (39.3%) underwent intraoperative re-excision. At the final pathological report, the margins were positive in 132 patients (9.9%) and close in 85 (6.3%). To obtain clear margins, 142 of these women underwent a second surgery; 35 patients with positive margins (27%) and 40 with close margins (47%) did not receive additional surgery because of different reasons (patients refusal, old age, comorbidity or for focal margin involvement). At second surgery, residual disease was found in 62.9% of patients with positive margins and in 55.5% of those with close margins. At a median follow-up time of 4 years, local recurrence (LR) rate was 2.9% for patients with clear margins, 5.2% (. p=0.67) for patients with unresected close margins and 11.7% (. p=0.003) for those with unresected positive margins. The HER-2 and the basal-like subtypes had the higher rate of LR and the luminal A the lowest. Conclusions: A significantly higher LR rate was found only among patients with positive margins not receiving additional surgery, but not in those with unresected close margins. Positive margins are a strong predictor for LR and need re-excision that can be avoided for close margins.

AB - Purpose: To evaluate the incidence of residual disease after additional surgery for positive/close margins and the impact on the rate of local and distant recurrence. Methods: A retrospective analysis on 1339 patients treated for breast cancer with breast conserving-surgery and radiotherapy at a single Institution between 2000 and 2009 was performed. Results: During primary surgery 526 patients (39.3%) underwent intraoperative re-excision. At the final pathological report, the margins were positive in 132 patients (9.9%) and close in 85 (6.3%). To obtain clear margins, 142 of these women underwent a second surgery; 35 patients with positive margins (27%) and 40 with close margins (47%) did not receive additional surgery because of different reasons (patients refusal, old age, comorbidity or for focal margin involvement). At second surgery, residual disease was found in 62.9% of patients with positive margins and in 55.5% of those with close margins. At a median follow-up time of 4 years, local recurrence (LR) rate was 2.9% for patients with clear margins, 5.2% (. p=0.67) for patients with unresected close margins and 11.7% (. p=0.003) for those with unresected positive margins. The HER-2 and the basal-like subtypes had the higher rate of LR and the luminal A the lowest. Conclusions: A significantly higher LR rate was found only among patients with positive margins not receiving additional surgery, but not in those with unresected close margins. Positive margins are a strong predictor for LR and need re-excision that can be avoided for close margins.

KW - Breast cancer

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KW - Molecular subtypes

KW - Re-excision

KW - Surgical margin

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