Positive margins (R1) risk factors in breast cancer conservative surgery
Received 28 April 2019
Accepted for publication 12 June 2019
Published 26 July 2019 Volume 2019:11 Pages 243—248
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Melinda Thomas
Peer reviewer comments 2
Editor who approved publication: Professor Pranela Rameshwar
Augusto Lombardi,1 Elena Pastore,1 Stefano Maggi,1 Gianluca Stanzani,2 Valeria Vitale,2 Camilla Romano,1 Laura Bersigotti,1 Andrea Vecchione,3 Claudio Amanti1
1Breast Surgery, Università La Sapienza, Ospedale Sant’Andrea, Rome, Italy; 2Breast Surgery, Ospedale Sant’Andrea, Rome, Italy; 3Department of Pathology, Università La Sapienza, Ospedale Sant’Andrea, Rome, Italy
Background: The primary goal in conservative breast cancer surgery is the complete excision of the tumor, but at the same time attempting to obtain a satisfactory postoperative esthetic result. The notion of “No Ink on Tumor” that indicates exclusively the presence of tumor cells on the inked surface of the surgical specimen is now the gold standard; however, the problem of the free margin is still a fundamental topic of debate that has not yet found a definitive solution.
Methods: Our retrospective analysis takes into account 1440 patients undergoing breast conservative surgery, from October 2004 to November 2018, all treated at the breast unit of our institution.
Results: Positive margins (R1) rate was 10.2% (147 cases out of 1440). Overall survival was 95% at 5 years and 89% at 10 years. No differences in mortality and local recurrence rate between R0 and R1 patients were found. Half of the R1 patients underwent secondary surgery with enlargement of margins, while in the other half we performed direct mastectomy. Among the analyzed variables, age, histological size, histological type, grading, multifocality, lympho-vascular invasion and lymph node status were significantly correlated with the R1 status. The multivariate analysis shows the association of age and surgical technique (oncoplastic) with R1 status.
Conclusion: Further studies will allow the creation of a statistical model, for better pre-operative prediction of patients with higher risk of R1 and better selection of patients to be candidates for conservative surgery.
Keywords: breast-conserving therapy, margin status, age, oncoplastic surgery
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