Abstract
Objective
To identify factors predicting positive margins at lumpectomy prompting intraoperative
reexcision in patients with breast cancer treated at a large referral center.
Patients and Methods
We reviewed all breast cancer lumpectomy cases managed at our institution from January
1, 2012, through December 31, 2013. Associations between rates of positive margin
and patient and tumor factors were assessed using χ2 tests and univariate and adjusted multivariate logistic regression, stratified by
ductal carcinoma in situ (DCIS) or invasive cancer.
Results
We identified 382 patients who underwent lumpectomy for definitive surgical resection
of breast cancer, 102 for DCIS and 280 for invasive cancer. Overall, 234 patients
(61.3%) required intraoperative reexcision for positive margins. The reexcision rate
was higher in patients with DCIS than in those with invasive disease (78.4% [80 of
102] vs 56.4% [158 of 280]; univariate odds ratio, 2.80; 95% CI, 1.66-4.76; P<.001). Positive margin rates did not vary by patient age, surgeon, estrogen receptor,
progesterone receptor, or ERBB2 status of the tumor. Among the 280 cases of invasive
breast cancer, the only factor independently associated with lower odds of margin
positivity was seed localization vs no localization (P=.03).
Conclusion
Ductal carcinoma in situ was associated with a higher rate of positive margins at
lumpectomy than invasive breast cancer on univariate analysis. Within invasive disease,
seed localization was associated with lower rates of margin positivity.
Abbreviations and Acronyms:
DCIS (ductal carcinoma in situ), ER (estrogen receptor), ERBB2 (tyrosine receptor kinase 2), OR (odds ratio), PR (progesterone receptor)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: February 10, 2018
Footnotes
For editorial comment, see page 406; for related articles, see pages 458 and 467
Grant Support: Drs Murphy and Habermann receive salary support from the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Potential Competing Interests: The authors report no competing interests.
Data Previously Presented: These data were presented in part as a poster presentation at the 2016 San Antonio Breast Cancer Symposium in San Antonio, TX.
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Copyright
© 2017 Mayo Foundation for Medical Education and Research
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