Complete Excision with Narrow Margins Provides Equivalent Local Control to Wider Excision in Breast Conservation for Invasive Cancer

Overview

Journal BJS Open

Publisher Oxford University Press

Specialty General Surgery

Date 2019 Apr 9

PMID 30957062

Citations 2

Authors

S S K Tang

F Rapisarda

A Nerurkar

P Osin

F MacNeill

I Smith

S Johnston

G Ross

K Mohammed

G P H Gui

Affiliations

Soon will be listed here.

Abstract

Background: Society of Surgical Oncology and American Society for Radiation Oncology guidelines define clear margins in breast-conserving therapy (BCT) as 'no ink on tumour', in contrast to the attainment of margins of at least 1 mm widely practised in the UK. The primary aim of this study was to explore clinical, surgical and tumour-related factors associated with local recurrence after BCT, with a secondary aim of assessing the impact of margin re-excision on the risk of local recurrence.

Methods: Patient demographics, surgical details, tumour characteristics and local recurrence were recorded for consecutive women with BCT undergoing surgery between January 1997 and January 2007. Margins were defined as clear (greater than 1 mm), close (less than 1 mm but no ink on tumour), reaches (ink on tumour) and clear after re-excision.

Results: A total of 1045 women of median age 54 (range 18-86) years were studied. Median follow-up was 89 (range 4-196) months. Local recurrence occurred in 52 patients (5·0 per cent). Ink on tumour was associated with local recurrence (hazard ratio (HR) 4·86, 95 per cent c.i. 1·49 to 15·79; = 0·009). Risk of local recurrence was the same for close and clear margins (HR 1·03, 0·40 to 2·62; = 0·954). In women with involved margins, re-excision was still associated with an increased local recurrence risk (HR 2·50, 1·32 to 4·72; = 0·005). Oestrogen receptor negativity increased risk (HR 2·28, 1·28 to 4·06; = 0·005).

Conclusion: Adequately excised margins, even when under 1 mm, provide equivalent outcomes to wider margins in BCT. Achieving complete excision at primary surgery achieves the lowest rates of local recurrence.

Citing Articles

Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis.

Bundred J, Michael S, Stuart B, Cutress R, Beckmann K, Holleczek B BMJ. 2022; 378:e070346.

PMID: 36130770 PMC: 9490551. DOI: 10.1136/bmj-2022-070346.

Radiological Underestimation of Tumor Size Influences the Success Rate of Re-Excision after Breast-conserving Surgery.

Simpson D, Allan J, McFall B Eur J Breast Health. 2021; 17(4):363-370.

PMID: 34651116 PMC: 8496123. DOI: 10.4274/ejbh.galenos.2021.2021-4-7.

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