Factors correlating with reexcision after breast-conserving therapy

Bani, M.R.; Lux, M.P.; Heusinger, K.; Wenkel, E.; Magener, A.; Schulz-Wendtland, R.; Beckmann, M.W.; Fasching, P.A.

doi:10.1016/j.ejso.2008.04.008

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 1 , Pages 32-37, January 2009

Factors correlating with reexcision after breast-conserving therapy

M.R. Bani
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Universitaetsstrasse 21–23, D-91054 Erlangen, Germany
M.P. Lux
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Universitaetsstrasse 21–23, D-91054 Erlangen, Germany
K. Heusinger
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Universitaetsstrasse 21–23, D-91054 Erlangen, Germany
E. Wenkel
- Institute of Diagnostic Radiology, University Breast Center for Franconia, Erlangen University Hospital, Erlangen, Germany
A. Magener
- Institute of Pathology, University Breast Center for Franconia, University of Erlangen-Nuremberg, Erlangen, Germany
R. Schulz-Wendtland
- Institute of Diagnostic Radiology, University Breast Center for Franconia, Erlangen University Hospital, Erlangen, Germany
M.W. Beckmann
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Universitaetsstrasse 21–23, D-91054 Erlangen, Germany
P.A. Fasching
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Universitaetsstrasse 21–23, D-91054 Erlangen, Germany
- Corresponding author. Tel.: +49 9131 853 3508; fax: +49 9131 853 3938.

Accepted 24 April 2008.

Abstract

Aim

The aim of this study was to evaluate factors affecting the risk for reexcision following breast-conserving surgery. Positive tumor margins are critical for local disease control following surgery for breast cancer. Several factors, including tumor size, multifocality, and an extensive in situ component, may be associated with a higher rate of repeat operations due to positive margins. This study included mammographic density in the analysis.

Methods

A total of 565 breast cancer patients were considered eligible for breast-conserving therapy after a core biopsy had confirmed malignancy. The patients’ mammographic findings were reviewed, and mammographic density was documented in addition to the histopathological features of the lesions. Associations between these factors and the risk for a second operation were analyzed using the chi-squared test, and a model was developed for multivariate analysis.

Results

At least one repeat operation was necessary in 121 patients (21.4%), and mastectomy was ultimately necessary in 54 patients (9.6%). Tumor size, multifocality, and the presence of an in situ component were identified as risk factors. A mammographic density of category 4 was associated with a need for further surgery (OR 3.2; 95% CI, 1.2–11).

Conclusions

Mammographic density is an additional risk factor for a second operation following breast-conserving procedures, and it may make radiographic and intraoperative localization of the tumor technically difficult. Using mammographic density to define a group of patients with a higher risk of reexcision might allow these patients to benefit from more sophisticated methods of localization and margin assessment.

Keywords: Tumor margins, Reexcision, Second operation, Breast-conserving surgery, Mammographic density