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Pathologic margin involvement and the risk of recurrence in patients treated with breast‐conserving therapy
Author(s) -
Gage Irene,
Schnitt Stuart J.,
Nixon Asa J.,
Silver Barbara,
Recht Abram,
Troyan Susan L.,
Eberlein Timothy,
Love Susan M.,
Gelman Rebecca,
Harris Jay R.,
Connolly James L.
Publication year - 1996
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19961101)78:9<1921::aid-cncr12>3.0.co;2-#
Subject(s) - medicine , ductal carcinoma , surgical margin , breast conserving surgery , radiation therapy , stage (stratigraphy) , breast cancer , mastectomy , carcinoma , breast carcinoma , population , lymph node , carcinoma in situ , radiology , cancer , pathology , paleontology , environmental health , biology
BACKGROUND The relationship between the microscopic margins of resection and ipsilateral breast recurrence (IBR) after breast‐conserving therapy for carcinomas with or without an extensive intraductal component (EIC) has not been adequately defined. METHODS Of 1,790 women with unilateral clinical Stage I or II breast carcinoma treated with radiation therapy as part of breast‐conserving therapy, 343 had invasive ductal histology evaluable for an extensive intraductal component (EIC), had inked margins that were evaluable on review of their pathology slides, and received; ce60 Gray to the tumor bed; these 343 women constitute the study population. The median follow‐up was 109 months. All available slides were reviewed by one of the study pathologists. Final inked margins of excision were classified as negative > 1 mm (no invasive or in situ ductal carcinoma within 1 mm of the inked margin); negative; cc 1 mm, or close (carcinoma; cc 1 mm from the inked margin but not at the margin); or positive (carcinoma at the inked margin). A focally positive margin was defined as invasive or in situ ductal carcinoma at the margin in three or fewer low‐power fields. The first site of recurrent disease was classified as either ipsilateral breast recurrence (IBR) or distant metastasis/regional lymph node failure. RESULTS Crude rates for the first site of recurrence were calculated first for all 340 patients evaluable at 5 years, then separately for the 272 patients with EIC‐negative cancers and the 68 patients with EIC‐positive cancers. The 5‐year rate of IBR for all patients with negative margins was 2%; and for all patients with positive margins, the rate was 16%. Among patients with negative margins, the 5‐year rate of IBR was 2% for all patients with close margins (negative; cc 1 mm) and 3% for those with negative > 1 mm margins. For patients with close margins, the rates were 2% and 0% for EIC‐negative and EIC‐positive tumors, respectively; the corresponding rates for patients with negative margins > 1 mm were 1% and 14%. The 5‐year rate of IBR for patients with focally positive margins was 9% (9% for EIC‐negative and 7% for EIC‐positive patients). The 5‐year crude rate of IBR for patients with greater than focally positive margins was 28% (19% for EIC‐negative and 42% for EIC‐positive patients). CONCLUSIONS Patients with negative margins of excision have a low rate of recurrence in the treated breast, whether the margin is >1 mm or; cc1 mm and whether the carcinoma is EIC‐negative or EIC‐positive. Among patients with positive margins, those with focally positive margins have a considerably lower risk of local recurrence than those with more than focally positive margins, and could be considered for breast‐conserving therapy. Cancer 1996;78:1921‐8.