Conservative Surgery for Breast Cancer: Comparison of Two Surgical Techniques To Obtain Negative Margins
Jessica Niakan, Susan Fineberg. Montefiore Medical Center, Bronx, NY
Background: Margin status is the most important determinant of local recurrence after breast conservatiive surgery for breast cancer (BC). Literature suggests that lumpectomy with separate cavity margins (CM technique) reduces positive margin rate (mr) compared to lumpectomy alone. Another technique, which includes intraoperative inking and gross margin assessment of a lumpectomy with the addition of intraoperative excision of grossly close margins (LM technique) also reduces the positive mr compared to lumpectomy alone. We compare these two methods (CM vs LM) for margin status, volume of tissue and slide production.
Design: We searched pathology data from the Medical Center from 2010 to July 2011 for cases of BC removed using the CM or the LM techniques. In the CM technique a unoriented lumpectomy is received along with 4 separate margins designated medial, lateral, inferior and superior. Anterior and deep margins are received in some cases. In the LM technique a oriented lumpectomy specimen is inked and sectioned intraoperatively by the pathologist alongside the surgeon. Additional margins are taken if a grossly close margin is identifed. We identified 161 cases with 82 cases included in the CM technique (49 invasive and 33 DCIS) and 79 cases in the LM technique (49 invasive and 30 DCIS). We compared margin status, volume of tissue and slide production. A positive margin was defined as less than 2mm. Anterior and deep margins were not considered in the analysis.
Results: In the CM group, a positive margin was present in 20 of 82 cases (24%). In the LM group a positive margin was present in 15 of 79 cases (19%) (p=0.44). The positive mr for invasive BC was 16% for LM technique and 18% for CM technique. The positive mr for DCIS was 23% for the LM technique and 33% for the CM technique. Gross intraoperative examinatoin of margins in LM cases resulted in additional separate margins being obtained intraoperatively in 17 of 79 cases. The average volume of tissue excised for CM was 100 cm3 and for LM was 111cm3. The number of glass slides per case was 37 for CM and 18 for LM.
Conclusions: CM and LM techniques both provide excellent and comparable negative margin rates for breast conservative surgery for invasive BC. Our data suggest that negative margin rates may be better for LM technique then CM technique in cases of DCIS as a continous piece may best reflect the ductal anatomy. This however requires confirmation with a larger data set. The volume of tissue removed in both techniques is similar however glass slide production is more than double for CM over LM.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 4, Wednesday Afternoon