Clinical and Histopathological Analysis of Reoperation Cases in Breast Conserving Surgery

ABSTRACT

PURPOSE: The residual microscopic carcinoma after breast conserving surgery is the most important risk factor of local recurrence. As local recurrences usually develop around resected margins, it is ge nerally accepted that every effort should be made to achieve negative margins intraoperatively, and the presence of microscopically positive margins requires reexcision. Interestingly, sizable percentage of reexcisions results in a specimen free of residual tumor, and may not contribute to disease control, but do add morbidity, cost, and possibly compromise cosmetic result. The goal of our study was to identify which clinico-pathologic factors were associated with positive resection margin, and to identify the variables associated with no residual carcinoma on reexcision or total mastectomy specimens. METHODS: From Sepember 1994 to July 1999, 322 breast conserving surgery were performed on breast cancer patients at the Department of General Surgery, Samsung Medical Center. Among them, 13 patients had positive surgical margins and were treated with reexcision (reexcising the previous lumpectomy cavity with a margin of 1-2 cm of normal tissue) or total mastectomy. RESULTS: The factors associated with positive resection margins were large tumor size, the presence of extensive intraductal component (EIC), and suspicious mammographic microcalcifications without mass density. Six (46.3%) of these reoperation cases for positive margins were negative for residual tumor. The factors correlating with no residual carcinoma on reexcision or mastectomy specimens were small histologic primary tumor size and only one positive resection margin rather than 2 or more positive margins. CONCLUSION: The patients with above-mentioned factors associated with positive resection margins should be treated with more wide local excision or total mastectomy to avoid a second surgical procedure. If the patients with only one positive margin and small tumor size refuse second operation, they could be treated with irradiation only sparing an additional surgical procedure.