Risk Factors for Positive Margins in Breast-Conserving Surgery

Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Curēus (Palo Alto, CA) CA), 2023-05, Vol.15 (5), p.e38399-e38399
Hauptverfasser: Abdulla, Hussain A, Rajab, Basma, Hammad, Maryam, Alrayes, Amal
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page e38399
container_issue 5
container_start_page e38399
container_title Curēus (Palo Alto, CA)
container_volume 15
creator Abdulla, Hussain A
Rajab, Basma
Hammad, Maryam
Alrayes, Amal
description Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.
doi_str_mv 10.7759/cureus.38399
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10231845</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2831709142</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2159-7aeda6d6f044062e49f9e76d91593ce897a58ec7da15e5b4e63701cbf9daddfc3</originalsourceid><addsrcrecordid>eNpdkc1Lw0AQxRdRbKm9eZaAFw-m7keSzV4ULVaFiuLHedluJnFrmq27SaH_vamtpXqagffjMfMeQscEDziPxYVuHDR-wFImxB7qUpKkYUrSaH9n76C-91OMMcGcYo4PUYdxmsSC4i66fDH-MxgpXVvng9y64Nl6U5sFBI_KFabygamCGwfK1-HQVh7cwlRF8Nq4AtzyCB3kqvTQ38weeh_dvg3vw_HT3cPwehxqSmIRcgWZSrIkx1GEEwqRyAXwJBOtyDSkgqs4Bc0zRWKIJxEkjGOiJ7nIVJblmvXQ1dp33kxmkGmoaqdKOXdmptxSWmXkX6UyH7KwC0kwZW0GcetwtnFw9qsBX8uZ8RrKUlVgGy9pSukqloi16Ok_dGobV7X_tRQjHAsS0ZY6X1PaWe8d5NtrCJarcuS6HPlTTouf7H6whX-rYN84W4wW</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2831709142</pqid></control><display><type>article</type><title>Risk Factors for Positive Margins in Breast-Conserving Surgery</title><source>PubMed Central</source><source>PubMed Central Open Access</source><creator>Abdulla, Hussain A ; Rajab, Basma ; Hammad, Maryam ; Alrayes, Amal</creator><creatorcontrib>Abdulla, Hussain A ; Rajab, Basma ; Hammad, Maryam ; Alrayes, Amal</creatorcontrib><description>Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.38399</identifier><identifier>PMID: 37265920</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Breast cancer ; Cancer therapies ; Epidermal growth factor ; Estrogens ; General Surgery ; Histology ; Hyperplasia ; Localization ; Lumpectomy ; Mammography ; Mastectomy ; Oncology ; Pathology ; Patients ; Risk factors ; Surgery ; Sutures ; Tumors</subject><ispartof>Curēus (Palo Alto, CA), 2023-05, Vol.15 (5), p.e38399-e38399</ispartof><rights>Copyright © 2023, Abdulla et al.</rights><rights>Copyright © 2023, Abdulla et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2023, Abdulla et al. 2023 Abdulla et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2159-7aeda6d6f044062e49f9e76d91593ce897a58ec7da15e5b4e63701cbf9daddfc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231845/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231845/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37265920$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abdulla, Hussain A</creatorcontrib><creatorcontrib>Rajab, Basma</creatorcontrib><creatorcontrib>Hammad, Maryam</creatorcontrib><creatorcontrib>Alrayes, Amal</creatorcontrib><title>Risk Factors for Positive Margins in Breast-Conserving Surgery</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.</description><subject>Breast cancer</subject><subject>Cancer therapies</subject><subject>Epidermal growth factor</subject><subject>Estrogens</subject><subject>General Surgery</subject><subject>Histology</subject><subject>Hyperplasia</subject><subject>Localization</subject><subject>Lumpectomy</subject><subject>Mammography</subject><subject>Mastectomy</subject><subject>Oncology</subject><subject>Pathology</subject><subject>Patients</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Sutures</subject><subject>Tumors</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkc1Lw0AQxRdRbKm9eZaAFw-m7keSzV4ULVaFiuLHedluJnFrmq27SaH_vamtpXqagffjMfMeQscEDziPxYVuHDR-wFImxB7qUpKkYUrSaH9n76C-91OMMcGcYo4PUYdxmsSC4i66fDH-MxgpXVvng9y64Nl6U5sFBI_KFabygamCGwfK1-HQVh7cwlRF8Nq4AtzyCB3kqvTQ38weeh_dvg3vw_HT3cPwehxqSmIRcgWZSrIkx1GEEwqRyAXwJBOtyDSkgqs4Bc0zRWKIJxEkjGOiJ7nIVJblmvXQ1dp33kxmkGmoaqdKOXdmptxSWmXkX6UyH7KwC0kwZW0GcetwtnFw9qsBX8uZ8RrKUlVgGy9pSukqloi16Ok_dGobV7X_tRQjHAsS0ZY6X1PaWe8d5NtrCJarcuS6HPlTTouf7H6whX-rYN84W4wW</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Abdulla, Hussain A</creator><creator>Rajab, Basma</creator><creator>Hammad, Maryam</creator><creator>Alrayes, Amal</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230501</creationdate><title>Risk Factors for Positive Margins in Breast-Conserving Surgery</title><author>Abdulla, Hussain A ; Rajab, Basma ; Hammad, Maryam ; Alrayes, Amal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2159-7aeda6d6f044062e49f9e76d91593ce897a58ec7da15e5b4e63701cbf9daddfc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Breast cancer</topic><topic>Cancer therapies</topic><topic>Epidermal growth factor</topic><topic>Estrogens</topic><topic>General Surgery</topic><topic>Histology</topic><topic>Hyperplasia</topic><topic>Localization</topic><topic>Lumpectomy</topic><topic>Mammography</topic><topic>Mastectomy</topic><topic>Oncology</topic><topic>Pathology</topic><topic>Patients</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Sutures</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abdulla, Hussain A</creatorcontrib><creatorcontrib>Rajab, Basma</creatorcontrib><creatorcontrib>Hammad, Maryam</creatorcontrib><creatorcontrib>Alrayes, Amal</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdulla, Hussain A</au><au>Rajab, Basma</au><au>Hammad, Maryam</au><au>Alrayes, Amal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Positive Margins in Breast-Conserving Surgery</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>15</volume><issue>5</issue><spage>e38399</spage><epage>e38399</epage><pages>e38399-e38399</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>37265920</pmid><doi>10.7759/cureus.38399</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2168-8184
ispartof Curēus (Palo Alto, CA), 2023-05, Vol.15 (5), p.e38399-e38399
issn 2168-8184
2168-8184
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10231845
source PubMed Central; PubMed Central Open Access
subjects Breast cancer
Cancer therapies
Epidermal growth factor
Estrogens
General Surgery
Histology
Hyperplasia
Localization
Lumpectomy
Mammography
Mastectomy
Oncology
Pathology
Patients
Risk factors
Surgery
Sutures
Tumors
title Risk Factors for Positive Margins in Breast-Conserving Surgery
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T22%3A43%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20Factors%20for%20Positive%20Margins%20in%20Breast-Conserving%20Surgery&rft.jtitle=Cur%C4%93us%20(Palo%20Alto,%20CA)&rft.au=Abdulla,%20Hussain%20A&rft.date=2023-05-01&rft.volume=15&rft.issue=5&rft.spage=e38399&rft.epage=e38399&rft.pages=e38399-e38399&rft.issn=2168-8184&rft.eissn=2168-8184&rft_id=info:doi/10.7759/cureus.38399&rft_dat=%3Cproquest_pubme%3E2831709142%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2831709142&rft_id=info:pmid/37265920&rfr_iscdi=true