Wire-guided excision of non-palpable breast cancer: determinants and correlations between radiologic and histologic margins and residual disease in re-excisions

In cases of wire-guided excision of non-palpable breast cancer (WGE), data concerning the determinants and correlations between radiologic and histolo gic margins and residual cancer in re-excisions are sparse. A total of 21 v ariables in 66 WGE followed by 49 re-excisions were prospectively analyzed. In multivariate analysis, only large mammographic lesions were clearly rel ated to positive margins in specimen radiography (P < 0.05). Multifocality (P < 0.001), large pathologic size (P < 0.05) and superficial excision (P < 0.05) were related to positive histologic margins and multifocality (P = 0 .001) to residual disease in re-excisions. The sensitivity, specificity and positive predictive values of specimen radiography for predicting histolog ic margins were 33%, 79% and 53%, and those for predicting residual disease 30%, 80% and 38%, respectively. The ability of histologic margins to predi ct residual disease was 91%, 58% and 38%, respectively. In WGE, large mammo graphic lesions carry a significant risk for radiologically incomplete exci sion, while pathologically large and multifocal tumors may be histologicall y incompletely excised, especially if the excision does not extend down to the pectoral fascia. The excision sites of multifocal tumors should be re-e xcised because of the considerable risk of residual disease. The radiologic and histologic margins of the specimen may be misleading. (C) 2001 Harcour t Publishers Ltd.