The unsatisfactory margin in breast cancer surgery

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Surgical margin involvement in breast cancer often necessitates reexcision or mastectomy.
• Factors influencing margin clearance include unalterable host/pathologic elements and surgical technique.
• Improving surgical techniques may enhance the likelihood of achieving clear margins during initial excision.

Purpose of the Study:

• To identify factors associated with achieving satisfactory surgical margins in breast-conserving surgery.
• To evaluate the impact of surgical technique and patient-specific factors on margin status and treatment outcomes.

Main Methods:

• Retrospective analysis of 235 breast conservation therapy candidates (1991-1996).
• Definition of "unsatisfactory" margins: microscopic tumor involvement or close proximity at initial biopsy.
• Multiple logistic regression used to analyze factors influencing margin status.

Main Results:

• 56% of patients had unsatisfactory margins, with rates increasing from 51% (1991) to 59% (1996).
• Unsatisfactory margins led to more procedures (2.0 vs 1.2) and lower breast conservation rates (64% vs 99%).
• Factors improving margin clearance included fine needle aspiration biopsy, specimen margin orientation, and prompt reexcision; pathology factors included extensive intraductal component, lobular/ductal extension, and tumor size.

Conclusions:

• Surgical technical factors significantly influence the achievement of clear margins in breast cancer.
• Biological factors, such as extensive intraductal component, also play a crucial role in the success of breast conservation therapy.