Number of Surgical Excisions Needed To Achieve Pathologically Negative Margins and Ultimate Total Mastectomy (TM) Rates for Invasive Mammary Carcinoma (IMC) and DCIS in a Nationally Accredited Breast Center.
Shimin Hu, Ramon Jimenez, Andrew Ricci, Jr. Hartford Hospital, CT; Hartford Hospital
Background: Conservative surgery (CS) is a cornerstone of initial breast cancer treatment. Whether this can be achieved however is largely a function of disease extent and in particular, pathologic margin status. We conducted this study to determine the number of excisions required to achieve negative margins and to determine the ultimate TM rate when repeated attempts at conservative surgery failed.
Design: Our Copath® database was queried for breast core biopsies (CB) diagnosed as primary IMC or DCIS in 2008. CB and all subsequent breast accessions were abstracted with particular attention to margin status. Margins reported as positive or < 1 mm were considered “positive” for this study; margins > 1 mm were considered “negative”. A pathologic review was performed in 25% of cases. Surgical revisions under the same anaesthesia were recorded as one excision.
Results: Sixty cases of DCIS & 246 cases of IMC (w/w/o DCIS) were collected. Two cases of DCIS & 24 of IMC were treated elsewhere leaving, respectively 58 & 222 cases for this study. For DCIS 11/58 (19%) of patients opted for immediate TM. Of the remaining 47, 27 had positive margins (PM) after the first excision and ultimately (after 1-2 re-excisions) an additional 7 patients underwent TM (overall TMs = 18/58; 31%). For IMC 68/222 (31%) patients opted for immediate TM. Of the remaining 154, 89 had PM (DCIS and/or invasive carcinoma) after the first excision and ultimately (after 1-2 re-excisions) an additional 22 patients underwent TM (overall TMs = 90/222; 40%). For DCIS 20/47 had initial negative margins (NM), 11/21 had NM after re-excision and 1/4 had NM after re-re-excision (total CS rate = 40/58 (69%) including patients radiated with focally PM). For IMC 65/154 had initially NM, 48/64 had NM after re-excision & 5/7 had NM after re-re-excision (total CS rate = 132/222 (60%) including patients radiated with focally PM).
Conclusions: In 2008 successful CS was achieved for 40/58 (69%) of DCIS and 132/222 (60%) of IMC. Whereas initial TM rates may reflect patient preference and/or surgical counselling, ultimate TM rates are a function of disease extent and pathologic marginal status. Although generally preferred over TM(1), to press conservation much beyond this point could put patients at risk for ipsilateral breast tumor recurrences (IBTR).
(1)NCI Recommendation http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page5
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 28, Tuesday Morning