DETERMINANTS OF POSITIVE HISTOLOGIC MARGINS AND RESIDUAL TUMOR AFTER LUMPECTOMY FOR EARLY BREAST-CANCER - A PROSPECTIVE-STUDY WITH SPECIAL REFERENCE TO TOUCH PREPARATION CYTOLOGY

Background and Objectives: Removal of the entire tumor by breast-conse rving surgery is important, but the determinants of adequate excision have not been established. Methods: A prospective study of 55 consecut ive lumpectomies for early breast cancer was performed to study the co rrelation between touch preparation cytology and histologic margins an d the determinants of positive histologic margins and residual disease after the initial excision. Results: The correlation between touch pr eparation cytology and histologic margins was poor: sensitivity and sp ecificity were 37.5% and 85.1%, respectively. The histologic margins w ere positive in 8 cases (14.5%) and were related to the presence of in traductal carcinoma and to the large pathologic size of the index tumo r. Re-excision specimen of the tumor bed (34 of 55 cases) contained re sidual cancer in seven cases (20.6%). Multifocal and nonpalpable index tumors predicted residual cancer. Residual disease was found in 37.5% of the cases (3 of 8) with positive and in 15.4% of the cases (4 of 2 6) with negative histologic margins. Conclusions: Touch preparation cy tology cannot be recommended as a method of assessing lumpectomy margi ns for early breast cancer. Histologic margins are misleading in predi cting residual cancer in re-excision specimens. To minimize the risk o f residual cancer, wide excision or mastectomy should be considered in the management of multifocal and nonpalpable tumors. (C) 1997 Wiley-L iss, Inc.