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Involved anterior margins after breast conserving surgery: is re-excision required?
R Mullen1, E J Macaskill, A Khalil
1East of Scotland Breast Service, Ninewells Hospital, Dundee DD1 9SY, UK. russmullen@doctors.org.uk
Summary
Re-excision of involved anterior margins (IAM) after breast conserving surgery (BCS) rarely finds residual disease. Multidisciplinary teams should individualize treatment decisions for IAM after BCS.
Area of Science:
- Oncology
- Surgical Pathology
- Breast Cancer Surgery
Background:
- Complete tumor excision is crucial in breast conserving surgery (BCS) for successful outcomes.
- Involved circumferential resection margins correlate with increased disease recurrence.
- The clinical significance of an involved anterior margin (IAM) in BCS remains less understood.
Purpose of the Study:
- To review an aggressive approach to involved anterior margins (IAM) in breast conserving surgery (BCS).
- To assess the clinical benefit of anterior margin re-excision (RE) for IAM.
Main Methods:
- A retrospective review of prospectively collected clinical and pathology data from 2006-2010.
- Inclusion criteria: patients undergoing BCS at a single cancer center.
- Definition of involved margin: < 1 mm clearance of invasive or in-situ breast cancer.
Main Results:
- 1667 patients underwent BCS; 114 had re-excision (RE).
- 170 involved margins identified; anterior margins were most common (52).
- Patients with IAM were more likely to have grade 3 invasive disease but less likely to have residual disease upon RE (2/49 vs. 32/101).
Conclusions:
- Anterior margin re-excision (RE) following breast conserving surgery (BCS) infrequently yields additional disease.
- Multidisciplinary teams should consider patient-specific factors when deciding on further therapy for involved anterior margins (IAM).
