Related Experiment Videos
Understanding the mechanisms creating false positive lumpectomy margins
William C Dooley1, Jeanene Parker
1The OU Breast Institute, The University of Oklahoma Health Sciences Center, 920 S.L. Young Blvd., Williams Pav. Suite #2290, Oklahoma City, OK 73104, USA. William-dooley@ouhsc.edu
American Journal of Surgery
|September 17, 2005
Summary
Standardizing specimen handling, including compression, in breast cancer surgery can increase false positive margins. Multiple close or positive margins, or those not related to compression, best predict true margin positivity.
Area of Science:
- Oncology
- Surgical Pathology
- Breast Surgery
Background:
- Close or positive margins after initial breast cancer surgery lead to re-excision, impacting patient outcomes.
- Understanding the causes of false positive margins is crucial for optimizing surgical management.
Purpose of the Study:
- To investigate the mechanisms of false positive margins in breast cancer surgery.
- To evaluate the impact of standardized specimen handling, including compression, on margin status.
Main Methods:
- A prospective study of 220 needle-localized lumpectomies for early-stage breast cancer over 3.5 years.
- Standardized specimen handling, including surgeon inking and compression during radiography, was implemented.
- Specimen radiography used compression from skin to deep margin to assess "pancaking" effect.
Main Results:
- 79.5% of cases had margins ≥10 mm.
- Close margins (<10 mm) occurred in 9.1%, and positive margins in 11.4%.
- Re-excision of deep margin-only close/positive margins found no residual tumor; other single or multiple margin involvements had higher rates of residual tumor.
Conclusions:
- Specimen compression during handling increases false positive margin rates.
- Multiple close or positive margins are the strongest predictors of true margin positivity.
- Margin positivity not associated with ex vivo compression is more likely to indicate true positivity.