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90th Annual Meeting Abstracts


Pre-operative Predictors of Positive or Close Margins Following Initial Partial Mastectomy for Breast Cancer
*Alicia R Privette, MD, Laurence McCahill, MD, *Johanna Sheehey-Jones, RN
University of Vermont/Fletcher Allen Health Care, Burlington, VT

Objective: To identify pre-operative and intra-operative factors associated with involved margins (positive or <1mm) following initial partial mastectomy (PM).
Design: Analysis of prospectively collected surgical outcomes data from all initial breast cancer surgeries performed at a single hospital (March 2003- September 2009).
Setting: University medical center
Patients: All patients undergoing initial breast cancer surgery from March 2003-September 2009.
Interventions: N/A
Main Outcome Measures: Association between involved margins and various factors - patient age, surgeon volume, neoadjuvant therapy, multifocal disease, pre-op nodal status, anesthesia type, tumor localization technique, intra-operative specimen examination technique, tumor size.
Results: 996 initial breast cancer operations: 760 PM, 236 total mastectomies. Of PMs, 568 were for invasive disease and 192 for DCIS. Factors significantly associated with involved margins for invasive disease included: tumor size > 2 cm, presence of multifocal disease, and use of single intra-operative specimen examination techniques. The lack of nodal disease was nearly significant. For DCIS, only tumor size > 2cm was associated with the presence of involved margins. (See table)
Conclusions: Factors predictive of involved margins following initial PM for breast cancer are identifiable pre-operatively. These factors can be used to identify high risk patients, counsel patients regarding likelihood of re-excision, and potentially modify surgical practice to reduce the need for re-excision. Further investigation is needed to validate these factors and evaluate their utility in prospectively optimize initial PM.
Table: Factors associated with involved (positive or <1mm) margins after initial breast cancer surgery. Diagnosis of DCIS = 192, Invasive = 568.
Factors AnalyzedDCIS Involved Marginp-valueInvasive Involved Marginp-value
Surgeon case volume
- High volume
- Low volume
41.3
36.0
0.6128.1
19.0
0.1
Age (mean)
- <= 50
- > 50
45.1
39.0
0.4531.5
25.8
0.2
Neoadjuvant therapy
- Yes
- No
N/A30.8
26.8
0.6
Multifocal Disease
- Yes
- No
39.0
55.0
0.2349.0
24.9
<0.0001
Known axillary disease
- Yes
- No
N/A37.7
26.0
0.068
Type of anesthesia
- General
- Local/IV sedation
38.7
41.9
0.7227.4
25.6
0.72
Tumor localization method
- Palpation
- Mammogram
- Ultrasound
100
43.1
38.1
0.1831.3
33.3
25.2
0.26
Intra-operative specimen examination
- None
- Palpation
- Specimen mammogram
- Ultrasound
- Pathology
N/A23.9
30.9
35.3
38.4
24.9
0.17
Intra-operative specimen examination
- Single Modality
- Multiple Modalities
40.4
42.1
0.8530.4
20.5
0.02
Tumor size
- <= 2 cm
- > 2 cm
35.2
72.4
<0.000124.9
37.3
0.02


 

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