Pathologic evaluation of surgical margins and local recurrences after breast-conserving surgery without irradiation

This study was undertaken to evaluate the status of margins of the excised breast tissue using our own method. We also determined the indications for breast-conserving surgery without irradiation by examining the characterist ics of patients with local recurrence and comparing relapse-free survival ( RFS) and overall survival (OS) of patients who underwent wide excision with out irradiation with those of 267 patients who underwent total mastectomy. Eighty-two patients with a 3 cm diameter or less invasive carcinoma were tr eated with wide excision and axillary dissection between 1987 and 1996, Pat ients who histologically had four or more axillary lymph node metastases, p ositive pathologic margins, or a high degree of in situ ductal carcinoma ar ound the main tumor in consecutive step-sections were excluded from this st udy. During a median follow-up of 6 years (range 2-11 years), six patients (7.3%) had local recurrence and five (6.0%) had regional or distant recurre nces as their site of first failure. At 11 Sears the life-table values for RFS and OS for the wide excision-treated group were 84.7% and 92.1%, respec tively, compared with 85.0% and 90.0%, respectively, for patients treated b y total mastectomy. RFS and OS were similar in the two treatment groups. Re sults in the present study indicate that if the patients treated by breast- conserving surgery are carefully selected and there are no foci in the path ologic margins, there is a low degree of in situ ductal carcinoma around th e tumor, and no multicentricity, it might he unnecessary to administer radi ation therapy.