Factors affecting positive excision margins
Association of Breast Surgery ePoster Library. Green N. 05/15/17; 166294; P133
Nikki Green
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Abstract
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Introduction:
The majority of patients presenting with a breast cancer undergo breast conserving surgery. Literature reports of re-excision rates vary although are often reported up to 20-25%. There are multiple factors affecting re-excision rates. Our aim was to investigate the re-excision rates in our breast unit and the factors accounting for this.
Methods:
All patients undergoing breast conserving surgery in a 1 year period (2015-16) in a single breast unit were included (symptomatic and screen detected). Data was collected in a database including number of re-excisions, number of positive margins (<1mm), size on palpation, disease at the margin, pre-invasive and invasive imaging and pathology size and pathology of re-excisions.
Results:
Over a 1 year period 454 patients underwent breast conserving operations with 99 (21.8%) requiring at least 1 re-excision. The second and third re-excision rates were 17.2% and 11.8%. The mean difference between imaging and pathology size was 10.1mm (range -48 to 92mm). 70 out of 99 specimens were larger on pathology than expected. 46 specimens were ≥50% larger than expected on imaging, 31 of these were ≥100% larger than expected. In patients with palpable disease the mean difference in size (where documented) from pathology was 18.8mm, including non-invasive disease. The re-excision specimens were clear of disease in 56.1% of patients.
Conclusions:
This study demonstrates that there are multiple factors involved in the increased risk of positive excision margins, including underestimation on imaging size and palpation size. Palpation size is often unreliable.
The majority of patients presenting with a breast cancer undergo breast conserving surgery. Literature reports of re-excision rates vary although are often reported up to 20-25%. There are multiple factors affecting re-excision rates. Our aim was to investigate the re-excision rates in our breast unit and the factors accounting for this.
Methods:
All patients undergoing breast conserving surgery in a 1 year period (2015-16) in a single breast unit were included (symptomatic and screen detected). Data was collected in a database including number of re-excisions, number of positive margins (<1mm), size on palpation, disease at the margin, pre-invasive and invasive imaging and pathology size and pathology of re-excisions.
Results:
Over a 1 year period 454 patients underwent breast conserving operations with 99 (21.8%) requiring at least 1 re-excision. The second and third re-excision rates were 17.2% and 11.8%. The mean difference between imaging and pathology size was 10.1mm (range -48 to 92mm). 70 out of 99 specimens were larger on pathology than expected. 46 specimens were ≥50% larger than expected on imaging, 31 of these were ≥100% larger than expected. In patients with palpable disease the mean difference in size (where documented) from pathology was 18.8mm, including non-invasive disease. The re-excision specimens were clear of disease in 56.1% of patients.
Conclusions:
This study demonstrates that there are multiple factors involved in the increased risk of positive excision margins, including underestimation on imaging size and palpation size. Palpation size is often unreliable.
Introduction:
The majority of patients presenting with a breast cancer undergo breast conserving surgery. Literature reports of re-excision rates vary although are often reported up to 20-25%. There are multiple factors affecting re-excision rates. Our aim was to investigate the re-excision rates in our breast unit and the factors accounting for this.
Methods:
All patients undergoing breast conserving surgery in a 1 year period (2015-16) in a single breast unit were included (symptomatic and screen detected). Data was collected in a database including number of re-excisions, number of positive margins (<1mm), size on palpation, disease at the margin, pre-invasive and invasive imaging and pathology size and pathology of re-excisions.
Results:
Over a 1 year period 454 patients underwent breast conserving operations with 99 (21.8%) requiring at least 1 re-excision. The second and third re-excision rates were 17.2% and 11.8%. The mean difference between imaging and pathology size was 10.1mm (range -48 to 92mm). 70 out of 99 specimens were larger on pathology than expected. 46 specimens were ≥50% larger than expected on imaging, 31 of these were ≥100% larger than expected. In patients with palpable disease the mean difference in size (where documented) from pathology was 18.8mm, including non-invasive disease. The re-excision specimens were clear of disease in 56.1% of patients.
Conclusions:
This study demonstrates that there are multiple factors involved in the increased risk of positive excision margins, including underestimation on imaging size and palpation size. Palpation size is often unreliable.
The majority of patients presenting with a breast cancer undergo breast conserving surgery. Literature reports of re-excision rates vary although are often reported up to 20-25%. There are multiple factors affecting re-excision rates. Our aim was to investigate the re-excision rates in our breast unit and the factors accounting for this.
Methods:
All patients undergoing breast conserving surgery in a 1 year period (2015-16) in a single breast unit were included (symptomatic and screen detected). Data was collected in a database including number of re-excisions, number of positive margins (<1mm), size on palpation, disease at the margin, pre-invasive and invasive imaging and pathology size and pathology of re-excisions.
Results:
Over a 1 year period 454 patients underwent breast conserving operations with 99 (21.8%) requiring at least 1 re-excision. The second and third re-excision rates were 17.2% and 11.8%. The mean difference between imaging and pathology size was 10.1mm (range -48 to 92mm). 70 out of 99 specimens were larger on pathology than expected. 46 specimens were ≥50% larger than expected on imaging, 31 of these were ≥100% larger than expected. In patients with palpable disease the mean difference in size (where documented) from pathology was 18.8mm, including non-invasive disease. The re-excision specimens were clear of disease in 56.1% of patients.
Conclusions:
This study demonstrates that there are multiple factors involved in the increased risk of positive excision margins, including underestimation on imaging size and palpation size. Palpation size is often unreliable.
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