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Margin Status and Local Recurrence After Breast-Conserving Surgery

Brian Spivack, MD; Monica M. Khanna, MD; Lorraine Tafra, MD; Guy Juillard, MD; Armando E. Giuliano, MD
Arch Surg. 1994;129(9):952-957. doi:10.1001/archsurg.1994.01420330066013.
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Objective:  To examine the effect of microscopic tumor at the margins on local recurrence after breast-conserving surgery for invasive carcinoma.

Design:  Retrospective review of patients treated with surgical resection followed by radiation therapy.

Setting:  A university-based radiation department and a community-based cancer referral center.

Patients:  A consecutive series of 272 women treated between 1982 and 1990.

Main Outcome Measure:  Local recurrence according to the histopathologic status of excised margins and the total dose of radiation.

Results:  During a mean follow-up period of 48 months, the overall rate of local recurrence was 6.3%. Local recurrence was more frequent (P=.0001) in patients with histologically positive margins (18.2%) than in those with unknown margins (7.1%) or negative margins (3.7%). In the 44 patients with positive margins, the local recurrence rate was 8.3% after radiation doses of 66 Gy or more compared with 21.9% following lower doses.

Conclusions:  Microscopic involvement of resection margins increases the risk of local recurrence following breast-conserving surgery for invasive carcinoma. Therefore, every effort should be made to achieve negative margins intraoperatively.(Arch Surg. 1994;129:952-957)


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