Petrousjka van den Tol
VU University Medical Center, The Nederlands
Title: A nationwide pathology study on surgical margins and excision volumes after breast-conserving surgery: there is still much to be gained
Biography
Biography: Petrousjka van den Tol
Abstract
ABSTRACT
Aim of the study: The current study aims to assess margin status in relation to amount of healthy breast tissue resected in breast-conserving surgery (BCS) on a nationwide scale.
Methods: Using PALGA (a nationwide network and registry of histology and cytopathology in the Netherlands), all patients who underwent BCS for primary invasive carcinoma in 2012-13 were selected (10,058 excerpts). 9276 pathology excerpts were analysed for a range of criteria including oncological margin status and distance to closest margin, specimen weight/volume, greatest tumour diameter, and with or without localisation method. Calculated resection ratios (CRR) were assessed to determine excess healthy breast tissue resection.
Results: Margins for invasive carcinoma and in situ carcinoma combined were tumour-involved in 498 (5.4%) and focally involved in 1021 cases (11.0%) of cases. Unsatisfactory resections including (focally) involved margins and margins ≤1mm were reported in 33.8% of patients. The median lumpectomy volume was 46 cc (range 1 – 807 cc; SD 49.18) and median CRR 2.32 (range 0.10 – 104.17; SD 3.23), indicating the excision of 2.3 the optimal resection volume.
Conclusion: The unacceptable rate of tumour-involved margins as well as margins ≤ 1mm in one third of all patients is also achieved at the expense of healthy breast tissue resection, which may carry the drawback of high rates of cosmetic failure. These data clearly suggest the need for improvement in current breast conserving surgical procedures to decrease tumour-involved margin rates while reducing the amount of healthy breast tissue resected.