Resection margin status in lumpectomy specimens for duct carcinoma of the breast: Correlation with core biopsy and mammographic findings

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.