TY - JOUR
T1 - Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy
AU - Gage, Irene
AU - Schnitt, Stuart J.
AU - Nixon, Asa J.
AU - Silver, Barbara
AU - Recht, Abram
AU - Troyan, Susan L.
AU - Eberlein, Timothy
AU - Love, Susan M.
AU - Gelman, Rebecca
AU - Harris, Jay R.
AU - Connolly, James L.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 1996/11/1
Y1 - 1996/11/1
N2 - BACKGROUND. The relationship between the microscopic margins of resection and ipsilateral breast recurrence (IBR) after breast-conserving therapy for carcinomas with or without an extensive intraductal component (EIC) has not been adequately defined. METHODS. Of 1,790 women with unilateral clinical Stage I or II breast carcinoma treated with radiation therapy as part of breast-conserving therapy, 343 had invasive ductal histology evaluable for an extensive component (EIC), had inked margins that were evaluable on review of the pathology slides, and received ≤60 Gray to the tumor bed; these 343 women constitute the study population. The median follow-up was 109 months. All available slides were reviewed by one of the study pathologists. Final inked margins of excision were classified as negative >1 mm (no invasive or in situ ductal carcinoma within 1 mm of the inked margin); negative ≤ 1 mm, or close (carcinoma ≤ 1 mm from the inked margin but not at the margin); or positive (carcinoma at the inked margin). A focally positive margin was defined as invasive or in situ ductal carcinoma at the margin in three of fewer low-power fields. The first site of recurrent disease was classified as either ipsilateral breast recurrence (IBR) or distant metastasis/regional lymph node failure. RESULTS. Crude rates for the first site of recurrence were calculated first for all 340 patients evaluable at 5 years, then separately for the 272 patients with EIC-negative cancers and the 68 patients with EIC-positive cancers. The 5-year rate of IBR for all patients with negative margins was 2%; and for all patients with positive margins, the rate was 16%. Among patients with negative margins, the 5-year rate of IBR was 2% for all patients with close margins (negative ≤ 1 mm) and 3% for those with negative > 1 mm margins. For patients with close margins, the rates were 2% and 0% for EIC-negative and EIC-positive tumors, respectively; the corresponding rates for patients with negative margins > 1 mm were 1% and 14%. The 5-year rate of IBR for patients with focally positive margins was 9% (9% for EIC-negative and 7% for EIC-positive patients). The 5- year crude rate of IBR for patients with greater than focally positive margins was 28% (19% for EIC-negative and 42% for EIC-negative and 42% for EIC-positive patients). CONCLUSIONS. Patients with negative margins of excision have a low rate of recurrence in the treated breast, whether the negative margin is > 1 mm or ≤ 1 mm and whether the carcinoma is EIC- negative or EIC-positive. Among patients with positive margins, those with focally positive margins have a considerably lower risk of local recurrence than those with more than focally positive margins, and could be considered for breast-conserving therapy.
AB - BACKGROUND. The relationship between the microscopic margins of resection and ipsilateral breast recurrence (IBR) after breast-conserving therapy for carcinomas with or without an extensive intraductal component (EIC) has not been adequately defined. METHODS. Of 1,790 women with unilateral clinical Stage I or II breast carcinoma treated with radiation therapy as part of breast-conserving therapy, 343 had invasive ductal histology evaluable for an extensive component (EIC), had inked margins that were evaluable on review of the pathology slides, and received ≤60 Gray to the tumor bed; these 343 women constitute the study population. The median follow-up was 109 months. All available slides were reviewed by one of the study pathologists. Final inked margins of excision were classified as negative >1 mm (no invasive or in situ ductal carcinoma within 1 mm of the inked margin); negative ≤ 1 mm, or close (carcinoma ≤ 1 mm from the inked margin but not at the margin); or positive (carcinoma at the inked margin). A focally positive margin was defined as invasive or in situ ductal carcinoma at the margin in three of fewer low-power fields. The first site of recurrent disease was classified as either ipsilateral breast recurrence (IBR) or distant metastasis/regional lymph node failure. RESULTS. Crude rates for the first site of recurrence were calculated first for all 340 patients evaluable at 5 years, then separately for the 272 patients with EIC-negative cancers and the 68 patients with EIC-positive cancers. The 5-year rate of IBR for all patients with negative margins was 2%; and for all patients with positive margins, the rate was 16%. Among patients with negative margins, the 5-year rate of IBR was 2% for all patients with close margins (negative ≤ 1 mm) and 3% for those with negative > 1 mm margins. For patients with close margins, the rates were 2% and 0% for EIC-negative and EIC-positive tumors, respectively; the corresponding rates for patients with negative margins > 1 mm were 1% and 14%. The 5-year rate of IBR for patients with focally positive margins was 9% (9% for EIC-negative and 7% for EIC-positive patients). The 5- year crude rate of IBR for patients with greater than focally positive margins was 28% (19% for EIC-negative and 42% for EIC-negative and 42% for EIC-positive patients). CONCLUSIONS. Patients with negative margins of excision have a low rate of recurrence in the treated breast, whether the negative margin is > 1 mm or ≤ 1 mm and whether the carcinoma is EIC- negative or EIC-positive. Among patients with positive margins, those with focally positive margins have a considerably lower risk of local recurrence than those with more than focally positive margins, and could be considered for breast-conserving therapy.
KW - breast carcinoma
KW - breast-conserving therapy
KW - extensive intraductal component
KW - local recurrence
KW - margins
UR - http://www.scopus.com/inward/record.url?scp=10244252711&partnerID=8YFLogxK
U2 - 10.1002/(sici)1097-0142(19961101)78:9<1921::aid-cncr12>3.0.co;2-%23
DO - 10.1002/(sici)1097-0142(19961101)78:9<1921::aid-cncr12>3.0.co;2-%23
M3 - Article
C2 - 8909312
AN - SCOPUS:10244252711
SN - 0008-543X
VL - 78
SP - 1921
EP - 1928
JO - Cancer
JF - Cancer
IS - 9
ER -