Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer

Stephen P Povoski, Rafael E Jimenez, Wenle P Wang, Ronald X Xu, Stephen P Povoski, Rafael E Jimenez, Wenle P Wang, Ronald X Xu

Abstract

Background: The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve "adequate" or "negative" surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS.

Methods: Retrospective analysis of 204 BCS procedures performed for invasive breast cancer from August 2003 to June 2007, in which patients underwent a standard BCS resection and systematic sampling of nine standardized re-resection margins (superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, and deep-posterior). Multiple variables (including patient, tumor, specimen, and follow-up variables) were evaluated.

Results: 6.4% (13/204) of patients had positive BCS specimen margins (defined as tumor at inked edge of BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor within 1 mm or less of inked edge but not at inked edge of BCS specimen). 11.8% (24/204) of patients had at least one re-resection margin containing additional disease, independent of the status of the BCS specimen margins. 7.1% (13/182) of patients with negative BCS specimen margins (defined as no tumor cells seen within 1 mm or less of inked edge of BCS specimen) had at least one re-resection margin containing additional disease. Thus, 54.2% (13/24) of patients with additional disease in a re-resection margin would not have been recognized by a standard BCS procedure alone (P < 0.001). The nine standardized resection margins represented only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen.

Conclusion: Our methodology accurately assesses the adequacy of surgical resection margins for determination of which individuals may need further resection to the affected breast in order to minimize the potential risk of local recurrence while attempting to limit the volume of additional breast tissue excised, as well as to determine which individuals are not realistically amendable to BCS and instead need a completion mastectomy to successfully remove multifocal disease.

Figures

Figure 1
Figure 1
Photograph of a typical example of a breast-conserving surgery (BCS) specimen taken from a left breast.
Figure 2
Figure 2
Computer-generated representation of the resultant breast-conserving surgery (BCS) resection bed cavity and the BCS specimen resulting from a BCS procedure performed on a left breast. In this example, the area of the BCS resection bed cavity has been bisected along its long axis to illustrate the exact spatial location from where the nine standardized re-resection margins were sampled from the superior (S), superior-medial (SM), superior-lateral (SL), medial (M), lateral (L), inferior (I), inferior-medial (IM), inferior-lateral (IL), and deep-posterior (DP) aspects of the BCS resection bed cavity.
Figure 3
Figure 3
Photograph of a typical example of the nine standardized re-resection margins sampled from the superior (S), superior-medial (SM), superior-lateral (SL), medial (M), lateral (L), inferior (I), inferior-medial (IM), inferior-lateral (IL), and deep-posterior (DP) aspects of a left-sided breast-conserving surgery (BCS) resection bed cavity.

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Source: PubMed

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