Kt. Mai et al., Resection margin status in lumpectomy specimens for duct carcinoma of the breast: Correlation with core biopsy and mammographic findings, J SURG ONC, 78(3), 2001, pp. 189-193
Background: The strategy for surgical treatment of breast carcinoma proven
by biopsy is mainly based on the physical and mammographic examinations. To
investigate if the pathological findings in core biopsy are contributory t
o planning the surgical strategy, we correlated the status of ductal carcin
oma in situ (DCIS) in the core needle biopsy of breast, the mammographic ch
anges and the status of resection margins in the subsequent lumpectomy.
Study Design: Consecutive 130 core needle biopsies with prior mammography a
nd subsequent lumpectomy were reviewed. Biopsies were divided into: group I
, DCIS; group II, DCIS and infiltrating carcinoma (IC); and group III, IC.
Mammographic findings were categorized into four groups: (a) nonspecific fi
ndings; (b) calcification (Ca++); Ca++ and mass, and mass only. The status
of margins in correlating lumpectomy specimens was reviewed. Close margin w
as defined as a free margin at less than 0.1 cm from the carcinoma.
Results: The rates of positive or close margins in three groups I, II, and
III were 13/18, 18/48, and 2/64 (P < 0.001); and in mammography groups of n
onspecific finding, Ca++, Ca++ mass and mass only were 5/6, 7/15, 8/37, and
13/72 (P < 0.001), respectively. Of the total of 14 cases with positive ma
rgins of more than 0.5 cm in length, 8, 4, and 2 cases were from group I, I
I, and II, respectively. In addition, 13 of 21 cases with nonspecific chang
es or with only Ca++ in mammograms belonged to the group I; 10 of these 13
cases were associated with positive margins. Forty-one of 72 cases presenti
ng as a mass only in mammograms belonged to the group III; only 2 of these
41 cases were associated positive margins.
Conclusions: Correlation of the extent of carcinoma with pre-operative hist
opathological findings was better than with mammography. Core biopsies cont
aining only. DCIS, particularly in cases with nonspecific findings or with
only Ca++ in mammograms, represent group of breast carcinoma that pose the
high risk for incomplete resection in lumpectomy. Surgical management of Pa
tients, having these cores includes wider resection margins than would othe
rwise be taken. Most core biopsies with only IC were associated with negati
ve margins. (C) 2001 Wiley-Liss, Inc.