September 1994

Margin Status and Local Recurrence After Breast-Conserving Surgery

Author Affiliations

From the Joyce Eisenberg Keefer Breast Center, the John Wayne Cancer Institute, Saint John's Hospital and Health Center, Santa Monica, Calif (Drs Spivack, Tafra, and Giuliano), and the Department of Radiation Oncology, the School of Medicine, the University of California—Los Angeles (Drs Khanna and Juillard).

Arch Surg. 1994;129(9):952-957. doi:10.1001/archsurg.1994.01420330066013

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)