Sampling of secondary margins decreases the need for re-excision after partial mastectomy

Julie A Guidroz; Gregory Larrieux; Junlin Liao; Sonia L Sugg; Carol E H Scott-Conner; Ronald J Weigel

doi:10.1016/j.surg.2011.07.064

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Sampling of secondary margins decreases the need for re-excision after partial mastectomy

Journal article

Peer reviewed

Sampling of secondary margins decreases the need for re-excision after partial mastectomy

Julie A Guidroz, Gregory Larrieux, Junlin Liao, Sonia L Sugg, Carol E H Scott-Conner and Ronald J Weigel

Surgery, Vol.150(4), pp.802-809

10/2011

DOI: 10.1016/j.surg.2011.07.064

PMID: 22000194

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Abstract

We analyzed factors that influenced the need for re-excision after partial mastectomy. We conducted a retrospective study of 470 breast cancer patients treated with partial mastectomy with main outcome measures of re-excision, conversion to mastectomy, and recurrence. Of 470 patients, 146 (31%) underwent re-excision for inadequate margins and 42 (8.9%) required mastectomy. Twelve (2.6%) patients had local recurrence of disease with a mean follow-up of 4.2 years. Factors found on multivariate analysis increasing the likelihood of re-excision include wire localization (2.4-fold), tumor or ductal carcinoma in situ (DCIS) close to the margins (<0.2 cm; 12.5-fold), margins involved with tumor or DCIS (25.3-fold), and seen by a non-breast specialist (2.25-fold). Taking secondary margins at initial operation reduced odds ratio of re-excision by 52% (P = .006) without a difference in volume of breast tissue removed (P = .33). Inadequate margins without re-excision had 12.% overall recurrence compared with a 6% recurrence with adequate margin and no re-excision (P = .069). One third of patients treated with partial mastectomy required re-excision, but 89% avoided the need for mastectomy. Taking secondary margins during the initial procedure decreased the need for re-excision by half. The recurrence rate was identical whether clear margins were obtained after primary partial mastectomy or re-excision.

Neoplasm, Residual - pathology

Breast Neoplasms - surgery

Multivariate Analysis

Reoperation

Carcinoma, Ductal, Breast - surgery

Carcinoma, Lobular - pathology

Carcinoma, Lobular - surgery

Neoplasm, Residual - surgery

Humans

Middle Aged

Risk Factors

Treatment Outcome

Neoplasm Recurrence, Local - pathology

Young Adult

Carcinoma, Intraductal, Noninfiltrating - pathology

Breast Neoplasms - pathology

Aged, 80 and over

Adult

Carcinoma, Ductal, Breast - pathology

Female

Aged

Retrospective Studies

Carcinoma, Intraductal, Noninfiltrating - surgery

Mastectomy, Segmental - methods

Details

Title: Subtitle: Sampling of secondary margins decreases the need for re-excision after partial mastectomy
Creators: Julie A Guidroz - Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
Gregory Larrieux
Junlin Liao
Sonia L Sugg
Carol E H Scott-Conner
Ronald J Weigel
Resource Type: Journal article
Publication Details: Surgery, Vol.150(4), pp.802-809
Publisher: United States
DOI: 10.1016/j.surg.2011.07.064
PMID: 22000194
ISSN: 0039-6060
eISSN: 1532-7361
Language: English
Date published: 10/2011
Academic Unit: Molecular Physiology and Biophysics; Anatomy and Cell Biology; Surgery; Biochemistry and Molecular Biology
Record Identifier: 9984025247602771

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