Focally positive margins in breast conserving surgery: predictors, residual disease, and local recurrence

Publication date: Available online 23 June 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Elvira L. Vos, José Gaal, Cornelis Verhoef, Krista Brouwer, Carolien H.M. van Deurzen, Linetta B. Koppert
BackgroundRe-excision after breast conserving surgery (BCS) for invasive breast cancer (IBC) can be omitted for focally positive margins in the Netherlands, but this guideline is not routinely followed. Focally positive and extensively positive margins have rarely been studied separately and compared to negative margins regarding clinicopathological predictors, residual disease incidence, and local recurrence.MethodsAll females with BCS for Tis-T3, without neo-adjuvant chemotherapy between 2005-2014 at one university hospital were included. Clinicopathological and follow-up information was collected from electronic patient records. Index tumor samples from all patients with re-excision were reviewed by one pathologist. Margins were classified as negative(≥2mm width), close(<2mm width), focally positive(≤4mm length of tumor touching inked margin), or extensively positive(>4mm length).ResultsFrom 499 patients included, 212(43%) had negative, 161(32%) had close, 59(12%) had focally positive, and 67(13%) had extensively positive margins. Increasingly involved margins were associated with lobular type, tumor size, and adjacent DCIS in IBC patients and lesion size in purely DCIS patients. In IBC patients, 17%, 49%, and 77% had re-excision after close, focally positive, and extensively positive margins and residual disease incidence was 55%, 50%, and 70% respectively. In purely DCIS patients, 26(65%), 13(87%), and 16(94%) had re-excision after close, focally positive, and extensively positive margins and residual disease incidence was 39%, 46%, and 90% respectively.ConclusionIncidence of residual disease after focally positive margins was not different from close margins, but was significantly higher after extensively positive margins. We recommend quantifying extent of margin involvement in all pathology reports.



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