LOCAL RECURRENCE OF BREAST-CANCER AFTER CYTOLOGICAL EVALUATION OF LUMPECTOMY MARGINS

Successful breast conservation therapy with optimal cosmesis requires adequate tumor excision and negative tumor margins. Therefore, more se nsitive techniques are being developed to identify lumpectomy margins intraoperatively with greater accuracy. Unidentified microscopic disea se is seemingly responsible for a local recurrence rate of up to 25 pe r cent 3 to 5 years after lumpectomy and radiotherapy for breast cance r patients. As a result, Moffitt Cancer Center has routinely used an i ntraoperative touch preparation cytology (TPC) protocol to evaluate th e entire resected surface of all lumpectomies. In addition, resection margins were also evaluated by gross examination and by standard histo logy. In rare instances frozen sections were used to evaluate tumor ma rgins. In this study 701 consecutive lumpectomy specimens were evaluat ed by TPC during the period of 9 years with a mean follow-up of 3.5 ye ars. Local cancer recurrence was 2.7 per cent (mean recurrence, 2.53 y ears), in women whose lumpectomy margins were evaluated by TPC. Of int erest, a local recurrence rate of 14.6 per cent was observed in patien ts who had referral lumpectomies evaluated by conventional histopathol ogy. This study suggests that accurate margin assessment with TPC play s an important role in the control of local recurrence after breast co nservation therapy. Therefore, we conclude the routine use of intraope rative TPC provides rapid, reliable, topographically accurate identifi cation of residual microscopic disease at lumpectomy margins.