Rates of residual disease with close but negative margins in breast cancer surgery

Erin M. Garvey, Derek A. Senior, Barbara A Pockaj, Nabil Wasif, Amylou Dueck, Ann E. McCullough, Idris T. Ocal, Richard J. Gray

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: A recent multidisciplinary consensus defined an adequate breast cancer margin as no ink on tumor. The purpose of this study was to analyze rates of residual disease at re-excision by margin width. Materials and methods: A prospective database at a single institution was reviewed from 2000 to 2012. Institutional protocol had been to perform re-excision surgery when margins were <2 millimeters (mm). Results: There were 2520 procedures. Re-excision surgery was performed for 12% of breast conserving therapy (BCT) procedures and 2% of mastectomies; residual disease was present in 38% and 26%, respectively. The rates of residual disease for all patients with positive, 0.1-0.9 mm, and 1.0-1.9 mm margins were 40%, 38%, and 33%, respectively. Age, race, menopause status, width of closest final margin, tumor histology, hormone receptor status, triple-negative disease and presence of lymphovascular invasion (LVI) were not significantly associated with the presence of residual disease. The presence of multiple margins <2 mm trended toward significance (p = 0.06).Median follow-up was 43 months. The five-year local recurrence rates (5-year LR) were 1.1% for mastectomy patients and 1.9% for BCT patients. Conclusions: Breast cancer patients with margins of excision <2 mm have a substantial risk of residual disease but the rates far exceed LR rates. These findings suggest that using residual disease rates to determine the appropriate margin width is not reliable, but also serve as a note of caution to track LR rates as institutions conform to new national guidelines for margin management.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalBreast
Volume24
Issue number4
DOIs
StatePublished - Aug 1 2015

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Breast Neoplasms
Mastectomy
Breast
Ink
Menopause
Neoplasms
Histology
Databases
Hormones
Guidelines
Recurrence
Therapeutics
Margins of Excision

Keywords

  • Breast cancer surgery
  • Breast conserving therapy
  • Local recurrence
  • Margins
  • Mastectomy
  • Residual disease

ASJC Scopus subject areas

  • Surgery

Cite this

Rates of residual disease with close but negative margins in breast cancer surgery. / Garvey, Erin M.; Senior, Derek A.; Pockaj, Barbara A; Wasif, Nabil; Dueck, Amylou; McCullough, Ann E.; Ocal, Idris T.; Gray, Richard J.

In: Breast, Vol. 24, No. 4, 01.08.2015, p. 413-417.

Research output: Contribution to journalArticle

Garvey, Erin M. ; Senior, Derek A. ; Pockaj, Barbara A ; Wasif, Nabil ; Dueck, Amylou ; McCullough, Ann E. ; Ocal, Idris T. ; Gray, Richard J. / Rates of residual disease with close but negative margins in breast cancer surgery. In: Breast. 2015 ; Vol. 24, No. 4. pp. 413-417.
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abstract = "Objectives: A recent multidisciplinary consensus defined an adequate breast cancer margin as no ink on tumor. The purpose of this study was to analyze rates of residual disease at re-excision by margin width. Materials and methods: A prospective database at a single institution was reviewed from 2000 to 2012. Institutional protocol had been to perform re-excision surgery when margins were <2 millimeters (mm). Results: There were 2520 procedures. Re-excision surgery was performed for 12{\%} of breast conserving therapy (BCT) procedures and 2{\%} of mastectomies; residual disease was present in 38{\%} and 26{\%}, respectively. The rates of residual disease for all patients with positive, 0.1-0.9 mm, and 1.0-1.9 mm margins were 40{\%}, 38{\%}, and 33{\%}, respectively. Age, race, menopause status, width of closest final margin, tumor histology, hormone receptor status, triple-negative disease and presence of lymphovascular invasion (LVI) were not significantly associated with the presence of residual disease. The presence of multiple margins <2 mm trended toward significance (p = 0.06).Median follow-up was 43 months. The five-year local recurrence rates (5-year LR) were 1.1{\%} for mastectomy patients and 1.9{\%} for BCT patients. Conclusions: Breast cancer patients with margins of excision <2 mm have a substantial risk of residual disease but the rates far exceed LR rates. These findings suggest that using residual disease rates to determine the appropriate margin width is not reliable, but also serve as a note of caution to track LR rates as institutions conform to new national guidelines for margin management.",
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AU - Senior, Derek A.

AU - Pockaj, Barbara A

AU - Wasif, Nabil

AU - Dueck, Amylou

AU - McCullough, Ann E.

AU - Ocal, Idris T.

AU - Gray, Richard J.

PY - 2015/8/1

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N2 - Objectives: A recent multidisciplinary consensus defined an adequate breast cancer margin as no ink on tumor. The purpose of this study was to analyze rates of residual disease at re-excision by margin width. Materials and methods: A prospective database at a single institution was reviewed from 2000 to 2012. Institutional protocol had been to perform re-excision surgery when margins were <2 millimeters (mm). Results: There were 2520 procedures. Re-excision surgery was performed for 12% of breast conserving therapy (BCT) procedures and 2% of mastectomies; residual disease was present in 38% and 26%, respectively. The rates of residual disease for all patients with positive, 0.1-0.9 mm, and 1.0-1.9 mm margins were 40%, 38%, and 33%, respectively. Age, race, menopause status, width of closest final margin, tumor histology, hormone receptor status, triple-negative disease and presence of lymphovascular invasion (LVI) were not significantly associated with the presence of residual disease. The presence of multiple margins <2 mm trended toward significance (p = 0.06).Median follow-up was 43 months. The five-year local recurrence rates (5-year LR) were 1.1% for mastectomy patients and 1.9% for BCT patients. Conclusions: Breast cancer patients with margins of excision <2 mm have a substantial risk of residual disease but the rates far exceed LR rates. These findings suggest that using residual disease rates to determine the appropriate margin width is not reliable, but also serve as a note of caution to track LR rates as institutions conform to new national guidelines for margin management.

AB - Objectives: A recent multidisciplinary consensus defined an adequate breast cancer margin as no ink on tumor. The purpose of this study was to analyze rates of residual disease at re-excision by margin width. Materials and methods: A prospective database at a single institution was reviewed from 2000 to 2012. Institutional protocol had been to perform re-excision surgery when margins were <2 millimeters (mm). Results: There were 2520 procedures. Re-excision surgery was performed for 12% of breast conserving therapy (BCT) procedures and 2% of mastectomies; residual disease was present in 38% and 26%, respectively. The rates of residual disease for all patients with positive, 0.1-0.9 mm, and 1.0-1.9 mm margins were 40%, 38%, and 33%, respectively. Age, race, menopause status, width of closest final margin, tumor histology, hormone receptor status, triple-negative disease and presence of lymphovascular invasion (LVI) were not significantly associated with the presence of residual disease. The presence of multiple margins <2 mm trended toward significance (p = 0.06).Median follow-up was 43 months. The five-year local recurrence rates (5-year LR) were 1.1% for mastectomy patients and 1.9% for BCT patients. Conclusions: Breast cancer patients with margins of excision <2 mm have a substantial risk of residual disease but the rates far exceed LR rates. These findings suggest that using residual disease rates to determine the appropriate margin width is not reliable, but also serve as a note of caution to track LR rates as institutions conform to new national guidelines for margin management.

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KW - Local recurrence

KW - Margins

KW - Mastectomy

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