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Related Experiment Videos

Margin status and local recurrence after breast-conserving surgery

B Spivack1, M M Khanna, L Tafra

  • 1Joyce Eisenberg Keefer Breast Center, Saint John's Hospital and Health Center, Santa Monica, Calif.

Archives of Surgery (Chicago, Ill. : 1960)
|September 1, 1994
PubMed
Summary

Positive microscopic tumor margins significantly increase local recurrence risk after breast-conserving surgery for invasive carcinoma. Achieving negative margins during surgery is crucial for better outcomes.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Radiation Oncology

Background:

  • Breast-conserving surgery (BCS) is a standard treatment for invasive breast carcinoma.
  • Local recurrence remains a concern after BCS.
  • The status of surgical margins is a key factor influencing recurrence risk.

Purpose of the Study:

  • To evaluate the impact of microscopic tumor at the resection margins on local recurrence rates following BCS for invasive carcinoma.
  • To determine if achieving negative margins affects local control in breast cancer patients.

Main Methods:

  • Retrospective review of 272 women treated with BCS and radiation therapy between 1982 and 1990.
  • Analysis of local recurrence based on histopathologic margin status (positive, unknown, negative) and radiation dose.

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  • Data collected from a university-based radiation department and a community cancer center.

    • Main Results:

    • The overall local recurrence rate was 6.3% over a mean follow-up of 48 months.
    • Patients with positive margins had a significantly higher local recurrence rate (18.2%) compared to those with unknown (7.1%) or negative margins (3.7%) (P = .0001).
    • For patients with positive margins, higher radiation doses (≥66 Gy) were associated with a lower recurrence rate (8.3%) compared to lower doses (21.9%).

    Conclusions:

    • Microscopic tumor involvement at surgical margins is a significant predictor of local recurrence after BCS for invasive breast cancer.
    • Intraoperative efforts to achieve pathologically negative margins are essential to minimize the risk of local recurrence.
    • Adjuvant radiation therapy plays a role, particularly in the context of positive margins, but margin status remains a critical determinant of local control.