L. Jardines et al., FACTORS ASSOCIATED WITH A POSITIVE REEXCISION AFTER EXCISIONAL BIOPSYFOR INVASIVE BREAST-CANCER, Surgery, 118(5), 1995, pp. 803-809
Background. Breast-conserving therapy followed by adjuvant radiotherap
y represents an alternative to mastectomy as a treatment for invasive
breast cancer. When excisional biopsy has been performed outside the p
arent institution, reexcision is often performed, with tumor being ide
ntified in 32% to 62% of the subsequent specimens. We analyzed not onl
y the factors associated with a positive reexcision but also those fac
tors associated with final surgical margins that are positive for tumo
r. Methods. Between 1978 and 1998, 956 female patients with American J
oint Committee on Cancer clinical stage I or II breast cancer were tre
ated with breast-conserving therapy where a total of 420 patients unde
rwent reexcision after an initial excisional biopsy. Several factors w
ere analyzed to determine their association with a positive reexcision
, the status of the final surgical margin, and the nature of the disea
se present within the reexcision specimen. Results. Factors that corre
lated with a positive reexcision in both univariate and multivariate a
nalysis were clinical tumor size, method of detection, the pathologic
status of the axillary lymph nodes, and the histologic appearance. Tho
se factors associated with finding invasive disease at the time of ree
xcision were clinical tumor size, clinical presentation, and nodal sta
tus. The single factor associated with finding residual in situ diseas
e at the time of reexcision was histologic appearance of the primary t
umor. A final positive margin was associated with method of tumor dete
ction, age of the patient, and the presence of axillary lymph node met
astases. The most significant factors associated with a positive reexc
ision are clinical tumor size, method of tumor detection, pathologic n
odal status, and histologic appearance. Patients with larger tumors or
those that are detected by physical examination, as well as invasive
lobular carcinomas, may require a more generous initial resection to a
chieve negative surgical margins and avoid the likelihood of reexcisio
n.