PLANNED SEGMENTECTOMY - A NECESSITY FOR BREAST-CARCINOMA

Objective and Design: Some surgeons consider excisional biopsy with gr oss negative margins to be adequate surgical therapy for breast carcin omas, if followed by axillary dissection and radiation. To test our hy pothesis that breast carcinoma necessitates planned operation, we revi ewed the incidence of residual cancer tissue (RCT) and the significanc e of positive margins following excisional breast biopsy and segmentec tomy. Setting, Patients, and Intervention/Outcome Measures: Using the clinical database of our multidisciplinary cancer center, we examined the tumor status of segmentectomy specimens from 375 patients treated for breast carcinoma during the past 10 years. All patients underwent excisional biopsy of the tumor mass before definitive treatment with s egmentectomy and axillary dissection. Median follow-up was 32 months. Results: The 284 patients (76%) whose segmentectomy specimens containe d residual tumor (RCT-positive patients) had a larger median tumor dia meter than RCT-negative patients (2 vs 1 cm, P<.01). Patients with tum or-positive axillary lymph nodes were more likely to be RCT positive ( P<.001). Tumors of RCT-positive patients were more frequently identifi ed by physical examination, whereas those of RCT-negative patients wer e more frequently identified by mammography (P<.001). Overall recurren ce rate was 7% (26/384). Recurrence-free survival rates were statistic ally related to tumor status of the segmentectomy margins (P<.025) but not to RCT in the segmentectomy specimen. Conclusion: Diagnostic brea st biopsy is not a substitute for planned excision to remove all malig nant tissue. Anything less than a preconceived surgical procedure may leave a significant amount of malignant tissue.