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Jpn J Clin Oncol. 2011 May;41(5):600-8. doi: 10.1093/jjco/hyr018. Epub 2011 Feb 24.

The impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy.

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1
Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemun-gu, Seoul 120-752, Republic of Korea.

Abstract

OBJECTIVE:

The aim of the study was to investigate the parameters affecting positive margin and the impact of positive margin on outcomes after breast-conserving therapy in patients with breast cancer.

METHODS:

Characteristics and survival of 705 patients attempted breast-conserving therapy between January 1994 and December 2004 were retrospectively analyzed using χ(2) tests, the Kaplan-Meier methods and multivariate analyses.

RESULTS:

Ninety-five (13.5%) showed positive margins at initial resection. Among them, 28 (4.0%) had negative margin on the initial frozen section; however, they finally turned out a focally positive margin with intraductal carcinoma on the permanent pathology. Positive margin at initial resection was significantly associated with lobular histology (P = 0.001), four or more involved lymph nodes (P = 0.015) and the presence of extensive intraductal component (P < 0.001). A focally positive margin did not influence local (P = 0.250; 95% confidence interval, 0.612-6.592) or regional failure (P = 0.756; 95% confidence interval, 0.297-5.311). Patients with a focally positive margin showed an advanced nodal stage and received a higher dose of irradiation and more systemic therapy. Nodal involvements were the most significant factor for locoregional failure.

CONCLUSIONS:

Although the achievement of negative margins is the best way to reduce local failure, patients with a focally positive margin and favorable risk factors such as node negativity and older age could have an option of close follow-up with adequate boost irradiation and adjuvant therapy instead of conversion to total mastectomy.

PMID:
21355001
DOI:
10.1093/jjco/hyr018
[Indexed for MEDLINE]

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