CLINICAL AND RADIOLOGICAL PREDICTORS OF COMPLETE EXCISION IN BREAST-CONSERVING SURGERY FOR PRIMARY BREAST-CANCER

Background: Local recurrence after conservative surgery for breast can cer usually results from growth of residual cancer adjacent to the exc ised primary tumour or from multicentric disease. Complete local excis ion (CLE) confirmed histologically is essential to ensure that the ris k of local recurrence is minimal. This study was undertaken to determi ne that clinical or radiological factors may assist the surgeon at the time of surgery to achieve this aim. Methods: A retrospective review of 101 cases treated by conservative surgery identified 70 cases of CL E and 31 of incomplete local excision (ILE). Clinical, surgical and hi stopathological data were taken from hospital records. Mammographic fe atures and those of specimen X-rays were evaluated without knowledge o f the histopathological outcome of surgery. Results: Complete excision was significantly associated with type of operation (lumpectomy Is wi de local excision/quadrantectomy, P < 0.003), absence of calcification (P < 0.03) and the presence of a mass on mammography (P = 0.05). Tumo ur size (> 2.5 cm) and the presence of extensive ductal carcinoma Br s itu (DCIS) were associated with incomplete excision (P = 0.0005). No r elationship was demonstrated with patient age, breast size, breast den sity, tumour grade, receptor status, axillary nodal status or spicules on X-ray and completeness of excision. Specimen X-ray had a positive predictive value of 94% with CLE. Conclusions: Clinical and pre-operat ive mammographic parameters are important for predicting CLE for breas t cancers treated by breast-conserving surgery. Specimen radiology for palpable lesions can confirm excision of the cancer and permit re-exc ision of breast tissue at the time of initial surgery. Its role in det ermining CLE should be further evaluated.