Intraoperative Pathologic Margin Analysis and Re-Excision to Minimize Reoperation for Patients Undergoing Breast-Conserving Surgery

Background Reoperation rates following breast-conserving surgery (BCS) range from 10 to 40%, with marked surgeon and institutional variation. Objective The aim of this study was to identify factors associated with intraoperative margin re-excision, evaluate for any differences in local recurrence ba...

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Bibliographic Details
Published in:Annals of surgical oncology 2020-12, Vol.27 (13), p.5303-5311
Main Authors: Racz, Jennifer M., Glasgow, Amy E., Keeney, Gary L., Degnim, Amy C., Hieken, Tina J., Jakub, James W., Cheville, John C., Habermann, Elizabeth B., Boughey, Judy C.
Format: Article
Language:English
Subjects:
Breast cancer
Breast Neoplasms - surgery
Breast Oncology
Breast surgery
Cancer
Carcinoma, Ductal, Breast - surgery
Carcinoma, Intraductal, Noninfiltrating - surgery
Humans
Invasiveness
Mastectomy
Mastectomy, Segmental
Medicine
Medicine & Public Health
Neoplasm Recurrence, Local - surgery
Oncology
Reoperation
Retrospective Studies
Surgery
Surgical Oncology
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Summary:Background Reoperation rates following breast-conserving surgery (BCS) range from 10 to 40%, with marked surgeon and institutional variation. Objective The aim of this study was to identify factors associated with intraoperative margin re-excision, evaluate for any differences in local recurrence based on margin re-excision and determine reoperation rates with use of intraoperative margin analysis. Patients and Methods We analyzed consecutive patients with ductal carcinoma in situ (DCIS) or invasive breast cancer who underwent BCS at our institution between 1 January 2005 and 31 December 2016. Routine intraoperative frozen section margin analysis was performed and positive or close margins were re-excised intraoperatively. Univariate analysis was used to compare margin status and the Kaplan–Meier method was used to compare recurrence. Multivariable logistic regression was utilized to analyze factors associated with re-excision. Results We identified 3201 patients who underwent BCS—688 for DCIS and 2513 for invasive carcinoma. Overall, 1513 (60.2%) patients with invasive cancer and 434 (63.1%) patients with DCIS had close or positive margins that underwent intraoperative re-excision. Margin re-excision was associated with larger tumor size in both groups. The permanent pathology positive margin rate among all patients was 1.2%, and the 30-day reoperation rate for positive margins was 1.1%. Five-year local recurrence rates were 0.6% and 1.2% for patients with DCIS and invasive cancer, respectively. There was no difference in recurrence between patients with and without intraoperative margin re-excision ( p  = 0.92). Conclusion Both DCIS and invasive carcinoma had similar rates of intraoperative margin re-excision. Although intraoperative margin re-excision was common, the reoperation rate was extremely low and there was no difference in recurrence between those with or without intraoperative re-excision.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-020-08785-z