J Breast Cancer.  2012 Dec;15(4):420-426. 10.4048/jbc.2012.15.4.420.

Multiple Margin Positivity of Frozen Section Is an Independent Risk Factor for Local Recurrence in Breast-Conserving Surgery

• Lee J
• Lee S
• Bae Y

• KMID: 2286439
• DOI: http://doi.org/10.4048/jbc.2012.15.4.420

Abstract

PURPOSE
Breast-conserving surgery (BCS) with radiotherapy has become a standard treatment for early stage breast cancer, since the installation of NSABP B-06. One of the serious problems in BCS is that of local recurrence. There are many risk factors for local recurrence, such as large tumor size, multiple tumors, axillary lymph node involvement, young age, high nuclear grade, and so on. The aim of this study is to identify patients with a higher risk of local recurrence of breast cancer.
METHODS
Between January 2002 and December 2006, 447 patients with breast cancer, and who had undergone BCS with immediate breast reconstruction, were enrolled in the study. The follow-up period was 5 years from the time of operation and we analyzed local recurrence, disease-free survival (DFS), and overall survival (OS). The analysis included various clinicopathological factors such as age, chemotherapy, radiotherapy, hormone therapy, pathologic characteristics, and margin status. Statistical analysis was performed with log-rank test and Kaplan-Meier method. The p-value <0.05 was considered statistically significant.
RESULTS
The mean follow-up period was 88 months and local recurrence of breast cancer occurred only in 16 cases (3.6%). The actual 5-year DFS, and OS rates were 90.6% and 93.3%, respectively. For the local recurrence of breast cancer, positive margin status, multiple margin positivity, conversed margin cases, T/N stages showed statistical significance in univariate analysis. However, only multiple margin positivity was identified as an independent risk factor for local recurrence in multivariate analysis.
CONCLUSION
When the multiple margin positivity is diagnosed on intraoperative frozen biopsy, surgeons should consider a much wider excision of the breast and a more aggressive management.

Keyword

Breast neoplasms; Local neoplasm recurrence; Segmental mastectomy

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Disease-Free Survival
Female
Follow-Up Studies
Frozen Sections
Humans
Lymph Nodes
Mammaplasty
Mastectomy, Segmental
Neoplasm Recurrence, Local
Recurrence
Risk Factors

Figure

• 

  Figure 1 Definitions of surgical margin status. (A) Negative surgical margin means that the tumor is removed with more than 5 mm of free distances from resection margin. (B) Positive surgical margin (black arrow) is defined as when tumor cells are found on the resection margin. (C) Multiple positive surgical margin (black arrows) is defined as when tumor cells are found on more than two points of the resection margins.

• 

  Figure 2 Disease-free survival (90.6%) (A) and overall survival rates (93.3%) (B) after breast-conserving surgery.

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