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Predictors of Surgical Margin Status in Breast-Conserving Surgery Within a Breast Screening Program

BACKGROUNDBreast-conserving surgery (BCS) requires clear surgical margins to minimize local recurrence. We sought to identify groups of patients at higher risk of involved margins who might benefit from preoperative counselling and/or more generous excision at the first operation. METHODSWe reviewed... Full description

Journal Title: Annals of Surgical Oncology 2008, Vol.15(9), pp.2542-2549
Main Author: Kurniawan, Emil
Other Authors: Wong, Matthew , Windle, Imogen , Rose, Allison , Mou, Arlene , Buchanan, Malcolm , Collins, John , Miller, Julie , Gruen, Russell , Mann, G.
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 1068-9265 ; E-ISSN: 1534-4681 ; DOI: 10.1245/s10434-008-0054-4
Link: http://dx.doi.org/10.1245/s10434-008-0054-4
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recordid: springer_jour10.1245/s10434-008-0054-4
title: Predictors of Surgical Margin Status in Breast-Conserving Surgery Within a Breast Screening Program
format: Article
creator:
  • Kurniawan, Emil
  • Wong, Matthew
  • Windle, Imogen
  • Rose, Allison
  • Mou, Arlene
  • Buchanan, Malcolm
  • Collins, John
  • Miller, Julie
  • Gruen, Russell
  • Mann, G.
subjects:
  • Breast conserving surgery
  • Margins
  • Residual disease
ispartof: Annals of Surgical Oncology, 2008, Vol.15(9), pp.2542-2549
description: BACKGROUNDBreast-conserving surgery (BCS) requires clear surgical margins to minimize local recurrence. We sought to identify groups of patients at higher risk of involved margins who might benefit from preoperative counselling and/or more generous excision at the first operation. METHODSWe reviewed demographic, clinical, radiological and pathological records of all women diagnosed with ductal carcinoma in situ (DCIS) or invasive cancer (IC) through a population-based breast screening program in Melbourne, Australia between 1994 and 2005. RESULTSA total of 2,160 women were diagnosed with DCIS or IC. We excluded 199 who had mastectomy (TM) as initial procedure or had missing data. Three hundred and thirteen had a diagnostic biopsy. Of 1,648 women who had BCS after a preoperative diagnosis of DCIS or IC, 13.5% had involved margins, 16.6% had close (1 mm) margins. Of the patients, 281/1,648 (17.1%) underwent re-excision, of whom 93 (33.1%) had residual disease identified. Mammographic microcalcifications (P < 0.0001), absence of a mammographic mass (P = 0.002), presence of DCIS (P < 0.0001), high tumour grade (P < 0.0001), large size (P < 0.0001), multifocal disease (P < 0.0001) and lobular histology (P = 0.005) were associated with involved margins. Microcalcifications (odds ratio [OR] 1.97), large size (OR 4.22) and multifocal disease (OR 2.85) were independently associated with involved margins. Residual disease was associated with involved margins (P < 0.0001), presence of DCIS (P = 0.05) and large tumour size (P = 0.01). CONCLUSIONAfter BCS, patients with mammographic microcalcifications, larger tumour size and multifocal tumours are more likely to have involved margins. Patients with involved margins, large tumour size and/or a DCIS component are more likely to have residual disease on re-excision.
language: eng
source:
identifier: ISSN: 1068-9265 ; E-ISSN: 1534-4681 ; DOI: 10.1245/s10434-008-0054-4
fulltext: fulltext
issn:
  • 1534-4681
  • 15344681
  • 1068-9265
  • 10689265
url: Link


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