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At the Edge: Anterior and Posterior Margins in Invasive Breast Disease
*Lana Shikhman, *Kate Dinh, *Sanaz Leilabadi, *Alexander Christakis, *Ashling O'Connor, *Marie Ward, Anne Larkin, Robert M Quinlan
University of Massachusetts, Worcester, MA
Objective: Attempt at re-excision to achieve negative margins often results in poor cosmesis and higher mastectomy rates. We evaluated close anterior and posterior margins after breast conservation therapy (BCT) and their influence on local recurrence. Tumor biology, nodal status, molecular signature, and adjuvant therapy were also evaluated for their influence on recurrence. In addition, rates of margin re-excision and evidence of residual disease were reported.
Design: Retrospective chart review
Setting: Tertiary referral center
Patients: 711 breast cancer specimens were reviewed from 2000-2008. Of those, only 165 patients had invasive disease, underwent BCT associated with ≤ 2mm anterior/posterior margins, and had complete records available to include ≥ 5 year follow up.
Interventions: none
Main outcome measures: 5 year recurrence rate
Results: Margin status (p 0.618), patient age (p 0.386), primary tumor size (p 0.440), and multifocality (p 0.447) had no influence on the rate of recurrence. Radiation therapy (p 0.453) and Her2 status (0.117) also did not affect recurrence. However presence of lymphovascular invasion (p 0.002), nodal involvement (p 0.047), higher grade (p 0.001), advanced staging (p 0.027), and systemic chemotherapy (p 0.002) demonstrated higher recurrence rates. ER positive tumors (p 0.006) and adjuvant hormonal therapy (p 0.008) conferred fewer recurrences. Re-excision rates increased with close or positive anterior and/or posterior margins; however the rate of residual tumor identified was not statistically significant (p 0.215)
Conclusions: Close margin alone has no influence on tumor recurrence and the yield for residual invasive tumor after re-excision remains low. Adjuvant hormonal therapy allows for significant reduction in local recurrence rates. Routine re-excision for close anterior or posterior margins does not to improve clinical outcomes.
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