A comparison of ink-directed and traditional whole-cavity re-excision for breast lumpectomy specimens with positive margins

Background: Excising a breast tumor with negative margins minimizes local r ecurrence. With a positive margin, the standard re-excision consists of exc ising the whole cavity and all surrounding breast tissue. By marking the si des of the lumpectomy specimen with six different colored inks, the surgeon can limit the re-excision to the involved margin. We compared the local re currence rate after these two re-excision methods. Methods: Records were reviewed of 527 women (546 breasts) treated with lump ectomy at two institutions. The log-rank test was used to compare the local recurrence-free survival. Results: Of 546 tumors, 245 (45%) had negative margins on the initial lumpe ctomy and were not re-excised. Fifty-five percent had a positive or close m argin; 181 underwent whole-cavity reexcision, and 120 had ink-directed re-e xcision. The mean follow-up time was 3.4 years. There was no significant di fference in local recurrence for the patients whose initial margin was nega tive (3.7%) compared with the 243 patients with initially positive mar.-ins who underwent a re-excision (3.3%). Eleven of 181 (6%) patients undergoing a whole-cavity re-excision developed a local recurrence, compared with non e of 120 (0%) patients with an ink-directed re-excision (P = not significan t). Tissue mass excised was significantly smaller in the ink-directed group (23 vs. 83 g, P < .05). Conclusions: Ink-directed re-excision of lumpectomy specimens with positive margins minimizes. the amount of breast tissue removed without increasing the incidence of local recurrence and is therefore preferable to the standa rd whole-cavity method.