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Subhas, Gokulakkrishna, Asha J. Shah, Aditya Gupta, Jonathan Cook, Linda Dubay, Sumet Silapaswan, Ramachandra Kolachalam, et al. "Review of Third and Fourth Re-Excision for Narrow or Positive Margins of Invasive and Intraductal Carcinoma." International Surgery 96, no. 1 (January 1, 2011): 18–20. http://dx.doi.org/10.9738/1340.1.
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Abstract The trend in breast surgery has shifted toward breast conservation. We reviewed our third and fourth breast re-excision cases, with an analysis of various factors used in making this decision. A retrospective analysis identified 585 patients who underwent re-excision surgery for positive or close margins of invasive carcinoma or ductal carcinoma in situ (DCIS). Of these patients 75 (13%) and 17 (3%) underwent third and fourth re-excisions, respectively. The indication for a third re-excision was the presence of positive and/or close (≤1 mm) margins for invasive carcinoma or DCIS in 72/75 patients. A third re-excision was done 31 days (range 8–123 days) after the second re-excision. Re-excision of margins was done in 45 (60%) patients, whereas 30 (40%) patients underwent mastectomy. Residual tumor mandated a fourth re-excision in 17 patients, which was done 45 days (range 14–87 days) after the third surgery. Re-excision of margins was done in 6 patients, whereas 11 patients underwent mastectomy. Involved or close margins with DCIS were the most common indication for re-excision, accounting for 61/75 (82%) of third and 16/17 (94%) of fourth re-excisions. Histopathology revealed that 28/75 (37%) of third and 7/17 (41%) of fourth re-excision patients had no residual tumor. In conclusion, the majority of re-excisions was done for margins <1 mm. Lower rates of re-excision were noted in well-differentiated invasive carcinomas. A close or involved DCIS margin was more likely to lead to a third and even a fourth re-excision. The absence of residual tumors in 40% of patients undergoing third and fourth re-excisions calls for a review of margin guidelines for breast re-excision.
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Ozmen, V., S. Ozkan Gurdal, M. Muslumanoglu, A. Igci, S. S. Tuzlali, B. Ozcinar, E. Canbay, M. Kecer, and T. Dagoglu. "Predictive factor for residual tumor after lumpectomy for close margins." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11538-e11538. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11538.
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e11538 Background: It is critical to obtain clear margins to minimize local recurrence after breast conserving surgery(BCS). When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for re-excision(s) or mastectomy. The aim of the present study was to identify factors predicting a histologically positive re-excision specimen. Methods: Our prospective breast cancer database was queried for all invasive breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCS. Close margins are defined as ≤ 2 mm for invasive carcinoma and presence of ductal carcinoma in situ(DCIS). Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Between February 1997 and August 2008, 2054 patients with early breast cancer underwent surgical treatment in our breast unit. 939(45.7%) of them had BCS. In 543 patients(26.4%), re-excision required due to close margins on the permanent section analysis of their initial surgical specimens. 186 patients(34.3%) had previous excisional biopsy in other clinics. Median age of 543 patients was 50 years. In 290 patients(53.4%), mastectomy was performed due to positive surgical margin or poor cosmetic results. There were no residual tumors in re-excision(65.6 %) or mastectomy(42.4%) specimens of patients. The factors associated with tumor positive re-excision specimen were, age ≤50 years(p=0.044), lymphovascular invasion (p=0.029), multifocality(p<0.001), tumor size >2cm(p=0.008), presence of DCIS(p=0.018), focal margin positivity(p<0.001), DCIS at resection margin(p=0.008) and node positivity (p<0.001). Conclusions: Most of our patients with early breast cancer had unnecessary re-excisions or mastectomy to obtain clear surgical margins. In subset group of patients, re-excision or mastectomy may not be required. No significant financial relationships to disclose.
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Semple, Harriet K., and Marc J. Langbart. "Margin of error: accuracy of estimated excision margins by surgical experience." Australasian Journal of Plastic Surgery 5, no. 1 (March 31, 2022): 13–16. http://dx.doi.org/10.34239/ajops.v5n1.257.
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Guidelines for recommended margins for common lesions are well documented. While it is recommended that all margins be measured prior to excision, time pressures, lack of equipment or clinician confidence may result in margins that are estimated rather than formally measured. This increases the risk of involved margins and need for re-excision to prevent recurrence. We reviewed the estimated margins of common excisions and compared these between groups of different surgical experience. We found that while accuracy generally improves with surgical experience, margins are largely underestimated by all groups. We hope to encourage the use of formally measured margins in all lesion excisions.
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O’Connell, L., S. Walsh, D. Evoy, A. O’Doherty, C. Quinn, J. Rothwell, J. Geraghty, EW McDermott, and R. Prichard. "The approach to an isolated close anterior margin in breast conserving surgery." Annals of The Royal College of Surgeons of England 101, no. 4 (April 2019): 268–72. http://dx.doi.org/10.1308/rcsann.2019.0017.
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Introduction Although close radial margins after breast-conserving surgery routinely undergo re-excision, appropriate management of patients with close anterior margins remains a topic of controversy. An increasing body of literature suggests that re-excision of close anterior margins yields low rates of residual malignancy and may only be necessary in selected patients. The aim of this study was to examine the management of close anterior margins after breast conserving surgery in a single institution and to analyse the rate of residual disease in re-excised anterior margins. Methods All patients having breast conserving surgery at St Vincent’s University Hospital from January 2008 to December 2012 were reviewed retrospectively. Data collected included patient demographics, tumour characteristics, margin positivity, re-excision rates and definitive histology of the re-excision specimens. A close margin was defined as les than 2 mm. Results A total of 930 patients were included with an average age of 65 years (range 29–94 years). Of these, 121 (13%) had a close anterior margin. Further re-excison of the anterior margin was carried out in 37 patients (30.6%) and a further 16 (13.2%) proceeded to mastectomy. Residual disease was found in 18.5% (7/36) of those who underwent re-excision and 7/16 (43.75%) of those who underwent mastectomy. Overall, 11.57% (14/121) of patients with close anterior margins were subsequently found to have residual disease. Conclusion The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence.
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Ghosh, S., S. Duvvi, P. Goodyear, E. Reddy, and A. Kumar. "Evaluation of surgeons' marking of excision margins for superficial facial skin cancer lesions." Journal of Laryngology & Otology 123, no. 2 (May 19, 2008): 195–98. http://dx.doi.org/10.1017/s0022215108002612.
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AbstractIntroduction:We established a series of exercises that evaluated surgeons' marking of excision margins, and we sought to identify factors influencing such marking.Methods:Twenty-four participants were asked to draw preset margins (3, 4, 5, 8 or 10 mm) on a series of life-size images representing noncosmetically and cosmetically sensitive facial sites, and also to draw circles of set diameters (3, 5 and 8 mm) on white paper. Margins were measured with vernier callipers calibrated to 0.05 mm.Results:In the small margin (3 mm) and noncosmetically sensitive exercises, the mean margins drawn were greater than required. When a 10 mm margin was required in cosmetically sensitive areas and nonsensitive areas, the margin was consistently underestimated in the former group by all participants (p < 0.05).Conclusion:Surgeons marking facial lesions for excision should use a measurement of scale, in order to eliminate the inherent tendency to underestimate the margin required for large excisions and for cosmetically sensitive areas.
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Sebastian, Mary L., Alice Marie Police, Stephanie Akbari, and Beth Anglin. "Combined experience at three breast centers with routine use of an intraoperative margin assessment device including comparison to historical re-excision rates." Journal of Clinical Oncology 32, no. 26_suppl (September 10, 2014): 79. http://dx.doi.org/10.1200/jco.2014.32.26_suppl.79.
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79 Background: Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. This study is the first compellation of data among three breast centers to assess the impact of an intraoperative margin assessment tool (MarginProbe) on re-excision rates. This device has been approved for clinical use in the United States since 2013. We present groups of consecutive patients in each of these breast centers – before and after the implementation of routine intraoperative use of the margin assessment device during lumpectomy procedures. Methods: Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. We established the historical re-excision rates of each surgeon on a consecutive set of patients in a corresponding period just before we began using the device. Results: In total, 165 patients were treated in three institutions up until April 2014. Sixteen patients (9.7%, 16/165) required re-excision. Historical re-excision rates corresponding to periods of use before the intraoperative margin assessment device was put into use were 25.8% (48/186). The re-excision rate was reduced by 62% (P<0.0001). Six re-excisions were due to a positive shaving which was not measured by the device. Conclusions: Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.
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Lupu, Mihai, Vlad Mihai Voiculescu, Ana Caruntu, Tiberiu Tebeica, and Constantin Caruntu. "Preoperative Evaluation through Dermoscopy and Reflectance Confocal Microscopy of the Lateral Excision Margins for Primary Basal Cell Carcinoma." Diagnostics 11, no. 1 (January 14, 2021): 120. http://dx.doi.org/10.3390/diagnostics11010120.
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Complete removal of malignant skin lesions with minimal impact on the aesthetic and functional aspects is the ideal of every dermatologic surgeon. Incomplete surgical excisions and tumor recurrences of basal cell carcinomas (BCC) commonly occur due to the subclinical extension of tumor lateral margins. Presently, the lateral excision margins for BCC cannot be objectively assessed preoperatively, dermoscopy proving to be relatively inefficient in this respect. The question is whether BCC lateral excision margins can be precisely determined preoperatively through the use of complementary non-invasive imaging techniques such as dermoscopy and reflectance confocal microscopy (RCM), thus permitting the complete removal of the lesion in a single stage, estimation of the post-excisional defect, and planning an appropriate reconstruction, especially in medical centers where Mohs micrographic surgery is not available. We present the results of a prospective, histopathologically controlled study designed to determine the feasibility of preoperative, non-invasive, in vivo evaluation of the lateral excision margins for primary basal cell carcinoma, through dermoscopy and RCM.
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Ross, M. "Margins of excision." Melanoma Research 3, no. 1 (March 1993): 9. http://dx.doi.org/10.1097/00008390-199303000-00020.
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Batsakis, John G. "Surgical Excision Margins." Advances in Anatomic Pathology 6, no. 3 (May 1999): 140–48. http://dx.doi.org/10.1097/00125480-199905000-00002.
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Schnabel, Freya Ruth, Shira Schwartz, Deirdre Kiely, and Jennifer Chun. "Improving breast-conserving surgery: A focus on margins." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 127. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.127.
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127 Background: Inadequate lumpectomy margins are associated with an increased risk of ipsilateral recurrence in patients undergoing breast conserving surgery for cancer. Multiple procedures are often required to achieve acceptable margins, increasing the burden to the patient and the health care system, and potentially delaying other adjuvant treatments. A novel device for intraoperative assessment of lumpectomy margins (MarginProbe) has been associated with a 25% reduction in the rate of positive margins at the conclusion of primary lumpectomy surgery. Our aim was to establish a baseline re-excision rate among surgeons and to initiate a follow up study to assess the impact of incorporating this new technology for intraoperative margin assessment. Methods: The NYU Langone Medical Center Breast Cancer Database was queried for patients who underwent breast conserving surgery including ≥ 1 re-excision procedure from 1/2010-1/2013. Variables of interest included re-excision rates, stage of disease, and additional margins taken at primary lumpectomy surgery. Statistical analyses included descriptive analyses and Pearson’s Chi-Square. Results: During the study period 957 patients had breast conserving surgery and 229 required ≥ 1 re-excision procedures (24%). Re-excision rates varied widely among surgeons (10-36%). Stage 0 disease (ductal carcinoma in situ) was associated with an increased frequency of re-excisions (p<0.0001). These parameters will be re-evaluated in patients undergoing breast conserving surgery with adjunctive intraoperative use of the MarginProbe device. Re-excision rates and the accuracy of intraoperative assessment of lumpectomy margins will be compared with the historical cohort. Conclusions: The necessity for multiple surgical procedures to complete breast conserving surgery results in an added burden to the patient and the health care system. Improved intraoperative assessment of lumpectomy margins represents an opportunity to improve the quality of breast cancer surgery. A critical analysis of the impact of a new device on re-excision rates will be important to understand its potential benefit to the conduct of breast conserving surgery.
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Zaiem, Fadi, Anna Numi, Mira Kheil, Asem AbuJamea, Deepti Jain, Omar Abbas, Lauren Larson, et al. "Abstract PO2-03-03: The Significance of Cavity Shave Margins in Breast Carcinoma on Margin Status and Re-excision Rates." Cancer Research 84, no. 9_Supplement (May 2, 2024): PO2–03–03—PO2–03–03. http://dx.doi.org/10.1158/1538-7445.sabcs23-po2-03-03.
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Abstract Context: The comparative outcomes of breast conserving surgery (BCS) with and without cavity shave margins are not well established. We aim to evaluate the impact of each procedure on final margin status and rate of re-excision. Design: A total of 529 breast cancer cases from our institution between 2013-2015 were included. Demographic and clinicopathological data including procedure type, tumor type, grade, margins status, and re-excision rates were collected. H&E slides of positive margins (tumor on ink) were reviewed by two pathologists. Appropriate statistical analysis was performed. Results: Out of 529 breast cancer cases, 125 were Ductal Carcinoma in situ (DCIS), 152 were Invasive Ductal Carcinoma (IDC) and 252 had both pathologies. The median age of patients was 59 years (range: 24-90). Patients who underwent excision with shave margins were 162 (35 DCIS, 56 IDC, 71 both) while excision without shave margins were 367 (90 DCIS, 96 IDC, 181 both). Re-excision rates were significantly lower 1) in patients who underwent BCS with cavity shave margins compared to those without (OR 0.32, p< 0.001) and 2) in patients who did not require lymph node excision compared to those who did (OR 4.26, p< 0.001). Additionally, patients who had DCIS had a higher rate of re-excision than those with invasive cancer only (OR 5.17, P< .001). After adjusting for type of tumor, patients who underwent cavity shaving compared to those who did not, no significant difference was seen in tumor at margins (OR 0.73, p=0.282) or tumor within 2mm (OR 1.14, p=0.512) from margins. However, patients with IDC who underwent cavity shave had a higher proportion of negative tumor at the margins (76.5% vs. 67.0%; p=0.051). We found that patients who had an invasive carcinoma (IC) had a lower risk of having tumor at the margin or within 2 mm from the margin than those with DCIS or DCIS+IC, (p< .05). Conclusions: Our data shows that BCS with cavity shave margins is superior with regards to negative margin and re-excision rates when compared to without cavity shave margins. Citation Format: Fadi Zaiem, Anna Numi, Mira Kheil, Asem AbuJamea, Deepti Jain, Omar Abbas, Lauren Larson, Noor Suleiman, Saleh Al-Juburi, Sanaa Awada, Ragad Almsaddi, Hyejeong Jang, Seongho Kim, Nagla Salem, Lydia Choi, Sudeshna Bandyopadhyay, Sunil Jaiman, Rouba Ali-Fehmi. The Significance of Cavity Shave Margins in Breast Carcinoma on Margin Status and Re-excision Rates [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-03-03.
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Klooz, Andrea, Terrence Kumar, and Jessica Maxwell. "Malignant phyllodes tumour of the breast with early recurrence in a young patient." BMJ Case Reports 17, no. 3 (March 2024): e258352. http://dx.doi.org/10.1136/bcr-2023-258352.
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A young woman in her 20s was found to have a left breast malignant phyllodes tumour by ultrasound-guided core needle biopsy, after identifying a palpable lump. She then underwent lumpectomy excision with >1 cm gross margins; however, final pathology demonstrated <1 cm margins at the superior margin. She then underwent re-excision of superior and medial margins to ensure at least a 1 cm margin. Biopsy tract was not excised at initial or re-excision surgery. Approximately 6 weeks after completion lumpectomy, the patient noted a new palpable mass near the previous biopsy site and underwent punch biopsy. Final pathology of this new mass was concordant with early recurrence. The patient then underwent lumpectomy of the new mass along with excision of the overlying skin and biopsy tract with >1 cm margins.
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Bilden, Tylert, Katherine C. Benedict, Patrick W. Lamb, and Jaron Mcmullin. "Intraoperative Frozen Section Analysis for the Excision of Nonmelanoma Skin Cancer: A Single-Center Experience." American Surgeon 85, no. 12 (December 2019): 1397–401. http://dx.doi.org/10.1177/000313481908501236.
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Surgical resection of nonmelanoma skin cancer (NMSC) may be performed via Mohs micrographic surgery (MMS) or standard surgical excision with complete margin analysis. Whereas MMS may necessitate delayed reconstruction surgery, intraoperative frozen section analysis (IFSA) may be used to ensure clear surgical margins before proceeding with reconstruction. To achieve curative resection while optimizing aesthetic outcomes, surgeons may use surgical excision guided by IFSA to forego extensive or delayed reconstruction. Patients undergoing wide local excision for NMSC using IFSA from October 2008 to November 2016 were evaluated. Analysis included IFSA versus permanent section outcomes, the number of required excisions, and the recurrence rate. Our analysis contained 145 patients involving 162 lesions. IFSA demonstrated that 73.4 per cent of margins were negative after one excision and 26.5 per cent were re-excised until achieving negative margins. Analysis revealed one false-positive case (0.62%) and four false-negative cases (2.47%). Nine patients had local recurrence (5.56%). Frozen section sensitivity was 88.99 per cent and specificity 99.20 per cent. The positive predictive value was 96.97 per cent, and negative predictive value was 96.90 per cent. Mean follow-up time was 39 months. Both resection and recurrence data of excised NMSC lesions at our institution suggest that surgical excision using IFSA is a safe and effective alternative to MMS.
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Raleigh, Matthew L., Mark M. Smith, and Kendall Taney. "Curative Intent Surgery of Oral Malignant Melanoma and Regional Lymph Node Biopsy Assessment in 25 Dogs: 2006–2017." Journal of Veterinary Dentistry 38, no. 4 (December 2021): 193–98. http://dx.doi.org/10.1177/08987564211072396.
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Medical records were searched for dogs that had received curative intent surgery for oral malignant melanoma and ipsilateral excisional regional lymph node biopsy. Twenty-seven dogs were operated on and 25 dogs of these dogs met the inclusion criteria of signalment, post-excision margin status, presence of metastasis for each biopsied lymphocentrum, survival time post-excision, presence of recurrence or metastasis at follow-up or at death/euthanasia, location of the primary tumor, and any postoperative adjuvant treatment. These 25 dogs had complete tumor excision with tumor-free margins and 19 (76%) had postoperative adjuvant therapy. Median survival time after excision for the dogs in this study was 335.5 days. Results of this study support previous work that documents prolonged survival time following complete excision of oral malignant melanoma with tumor-free surgical margins in dogs. Additionally, 4 dogs (16%) had histologically confirmed regional lymph node metastasis at the time of definitive surgery.
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Kotwall, Cyrus, Mark Ranson, Anquonette Stiles, and Mary Sue Hamann. "Relationship between Initial Margin Status for Invasive Breast Cancer and Residual Carcinoma after Re-Excision." American Surgeon 73, no. 4 (April 2007): 337–43. http://dx.doi.org/10.1177/000313480707300405.
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Little data exists addressing the relationship between initial margin status in a specimen from an excisional biopsy and the presence of residual carcinoma in a subsequent specimen from lumpectomy or mastectomy. We sought to determine the relationship between initial margin status and the presence of residual invasive cancer, and to identify any relationship to other variables. This study was a retrospective review of pathology reports of 582 early-stage invasive duct carcinomas with open excisional biopsies. The initial specimen was classified into one of six margin categories: multiply focally positive (n = 174), focally positive (n = 132), margins <1 mm (n = 98), margins 1 to 2 mm (n = 20), margins >2 mm (n = 46), and margins undetermined (n = 90). All patients had a subsequent definitive second procedure. Pathology reports from the second procedure revealed the presence of residual invasive cancer by initial margin status as follows: in 30 per cent of the initial procedures with multiply focally positive margins, in 22 per cent with focally positive margins, in 8 per cent, 15 per cent, and 4 per cent with margins of <1 mm, 1 to 2 mm, and >2 mm, respectively, and in 28 per cent with undetermined margins. Women with palpable tumors, larger tumor size, and positive axillary nodes were more likely to have multiply focal and focally positive margins. Multiply focally positive and focally positive margins had similar residual invasive carcinoma rates and should be re-excised. All clear margins were equivalent; thus, re-excision was not necessary.
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Paternostro, Chiara, Elmar A. Joura, Christina Ranftl, Eva-Maria Langthaler, Robin Ristl, Tim Dorritke, and Sophie Pils. "Rate of Involved Endocervical Margins According to High-Risk Human Papillomavirus Subtype and Transformation Zone Type in Specimens with Cone Length ≤ 10 mm versus > 10 mm—A Retrospective Analysis." Life 13, no. 8 (August 20, 2023): 1775. http://dx.doi.org/10.3390/life13081775.
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The aim of this study was to evaluate the endocervical margin status according to transformation zone (TZ) and high-risk HPV (hr-HPV) subtype in specimens with cone length ≤ 10 mm versus > 10 mm to provide data for informed decision making and patients counseling especially for women wishing to conceive. In this retrospective cohort study, 854 patients who underwent large loop excision of the transformation zone during a nine-year period (2013–2021) for cervical disease were analyzed. The main outcome parameters were excision length, histological result, TZ type, HPV subtype and endocervical margin status. A subgroup analysis was performed according to excision length, with a cut-off value of 10 mm. A two-step surgical procedure was performed in case of an excision length of > 10 mm. The overall rate of positive endocervical margins irrespective of excision length was 17.2%, with 19.3% in specimens with ≤ 10 mm and 15.0% with > 10 mm excision length. Overall, 41.2% of women with a visible TZ and HPV 16/hr infection and 27.0% of women with HPV 18 received an excisional treatment of > 10 mm length without further oncological benefit, respectively. In contrast, assuming that only an excision of ≤ 10 mm length had been performed in women with visible TZ, the rate of clear endocervical margins would have been 63.7% for HPV 16/hr infections and 49.3% for HPV 18 infections. In conclusion, the decision about excision length should be discussed with the patient in terms of oncological safety and the risk of adverse pregnancy events. An excision length > 10 mm increases the number of cases with cervical tissue removed without further oncological benefit, which needs to be taken into account in order to provide an individual therapeutic approach. Furthermore, HPV 18 positivity is related to a higher rate of positive endocervical margins irrespective of TZ.
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Attrill, Grace Heloise, Teresa A. Bailey, Trina Lum, Jordan W. Conway, Georgina V. Long, James S. Wilmott, and Richard A. Scolyer. "Abstract 2221: Molecular analysis finds excision margin width predictive of recurrence in acral melanoma." Cancer Research 82, no. 12_Supplement (June 15, 2022): 2221. http://dx.doi.org/10.1158/1538-7445.am2022-2221.
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Abstract Surgical excision with histologically clear margins results in cure of most melanoma patients. Involvement of the margins is associated with tumour recurrence and adverse outcomes. Determining whether or not the histological margins are involved by melanoma, particularly in situ melanoma, can be very difficult particularly in acral locations where insitu melanoma can be extremely subtle. This study sought to determine the proximity of acral melanoma in situ to the surgical excision margin using multiple methods including routine histopathological assessment, FISH (CCND1 amplification), and multiplex immunofluorescence (mIF: SOX10, p16, Cyclin D1 and PRAME) in primary acral melanomas with initially histopathologically reported clear excision margins of >0.3mm (n=85). The clear excision margins determined by each modality were compared between those melanomas which recurred (n=47) and those which remained recurrence-free at last follow-up (median = 46 months, range = 1-260 months) (n=35). Histopathologically confirmed excision margin width was smaller in the tumours of patients who recurred (mean = 7.083mm vs 9.964mm, p = 0.0811). Intratumoural CCND1 amplification was increased in recurrence-free patients in comparison to recurrence patients (16.2% vs 7.7%). FISH and mIF confirmed the correlation of intratumoural CCND1 amplification with Cyclin D1 expression SOX10+ melanoma cells (p=0.0347). No correlations between recurrence status and Cyclin D1, PRAME or p16 expression levels in the tumour or epidermis were identified. In histopathologically normal epidermal tissue as assessed on H&E sections,Cyclin D1+, p16- and PRAME+ cells were classified as malignant cells when co-expressed with SOX10. Upon measuring the distance from the tumour margin to the nearest malignant cell, we found that malignant cells were closer to the tumour in recurrence patients in comparison to recurrence-free patients (mean = 7.324mm vs 9.464mm, p = 0.2735). These distances closely correlated with the excision margin width as determined via histopathological assessment (R2 = 0.7424, p<0.0001). In conclusion, histological assessment, FISH and mIF determined excision margins are highly correlative in acral melanomas. Narrower excision margins were associated with local recurrence of melanoma. Citation Format: Grace Heloise Attrill, Teresa A. Bailey, Trina Lum, Jordan W. Conway, Georgina V. Long, James S. Wilmott, Richard A. Scolyer. Molecular analysis finds excision margin width predictive of recurrence in acral melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2221.
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Gupta, Aditya, Gokulakkrishna Subhas, Linda Dubay, Sumet Silapaswan, Ramachandra Kolachalam, William Kestenberg, Lorenzo Ferguson, Michael J. Jacobs, Yousif Goriel, and Vijay K. Mittal. "Review of Re-Excision for Narrow or Positive Margins of Invasive and Intraductal Carcinoma." American Surgeon 76, no. 7 (July 2010): 731–34. http://dx.doi.org/10.1177/000313481007600729.
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The trend in breast surgery has shifted towards breast conservation. Re-excision rates for narrow or positive margins have been variable in published reports. A retrospective analysis of 3246 patients who underwent either a lumpectomy for a palpable mass or a needle localization biopsy between January 2003 and December 2007 was done. Five hundred and eighty-five patients underwent re-excision surgery for margins. The mean patient age was 59-years-old (range 25-93). Needle localization was used to guide initial excision in 372 of 585 patients (64%). Invasive carcinoma was seen in 402 (69%) patients, ductal carcinoma in situ (DCIS) alone in 183 (31%) patients, and 308 (53%) patients had both invasive carcinoma and DCIS. Well-differentiated carcinomas accounted for only 24 per cent of the re-excisions. Four hundred and sixteen patients underwent re-excision of margins, whereas 169 underwent mastectomy as the second surgery. Residual carcinoma was seen in 38 per cent of cases with involved margins, as compared with 24 per cent with <1 mm margins and only 12 per cent cases with >1 mm margins. Residual DCIS was seen in 65 per cent with involved margins, 50 per cent with <2 mm margins, and 35 per cent of cases with 2 to 5 mm margins ( P <0.001, χ2 association). Lesser re-excision was noted in well-differentiated invasive carcinomas. Only 12 per cent of patients with margins greater than 1 mm had residual tumor on re excision, which raises the possibility of nonoperative management in such cases.
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Ito, Takamichi, Yumiko Kaku-Ito, Maiko Wada-Ohno, and Masutaka Furue. "Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?" Journal of Clinical Medicine 9, no. 7 (July 16, 2020): 2266. http://dx.doi.org/10.3390/jcm9072266.
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In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with narrow margins (N-group). A total of 65 patients underwent narrow-margin excision. Positive margin status or local recurrence rarely occurred regardless of the excision margins, whereas fatal events frequently occurred, particularly among the patients with T4 melanoma. The mortality rates of N- and R-group with T1–3 melanomas were similar (1.36 and 1.28 per 100 person-years, respectively). However, patients with T4 melanoma treated with narrow-margin excision had a higher mortality rate (11.44 vs. 5.03 per 100 person-years). Kaplan–Meier analyses showed a worse prognosis in the N-group (p = 0.045) but this group had thicker Breslow thickness (4.21 mm vs. 2.03 mm, p = 0.0013). A multivariate analysis showed that Breslow thickness was an independent risk factor, but surgical margin was not a risk factor for melanoma-specific survival or disease-free survival. In conclusion, although we could not find a difference between the narrow-margin excision and recommended-margin excision in this study, we suggest following current recommendations of guidelines. Our study warrants the prospective collection of data on acral melanoma to better define the prognosis of this infrequent type of melanoma.
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Shirazi, Shahram, Hamed Hajiesmaeili, Muskaan Khosla, Saima Taj, Tapan Sircar, and Raghavan Vidya. "Comparison of Wire and Non-Wire Localisation Techniques in Breast Cancer Surgery: A Review of the Literature with Pooled Analysis." Medicina 59, no. 7 (July 13, 2023): 1297. http://dx.doi.org/10.3390/medicina59071297.
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Background and Objectives: Wide local excision is a common procedure in the treatment of breast cancer. Wire-guided localisation (WGL) has been the gold standard for many years; however, several issues have been identified with this technique, and therefore, wire-free techniques have been developed. This scoping review synthesises the available literature comparing wire-guided localisation with the wire-free techniques used in breast-conserving cancer surgery. Materials and Methods: Multiple databases including Pubmed and MEDLINE were used to search articles between 1 January 2000 and 31 December 2022. Terms included “breast neoplasms”, “margins of excision”, and “reoperation”. In total, 34/256 papers were selected for review. Comparisons were made between positive margins and re-excision rates of WGL with wire-free techniques including SAVI SCOUT, Magseed, ROLL, and RSL. Pooled p-values were calculated using chi-square testing to determine statistical significance. Results: Pooled analysis demonstrated statistically significant reductions in positive margins and re-excision rates when SAVI SCOUT, RSL, and ROLL were compared with WGL. When SAVI SCOUT was compared to WGL, there were fewer re-excisions {(8.6% vs. 18.8%; p = 0.0001) and positive margins (10.6% vs. 15.0%; p = 0.0105)}, respectively. This was also the case in the ROLL and RSL groups. When compared to WGL; lower re-excision rates and positive margins were noted {(12.6% vs. 20.8%; p = 0.0007), (17.0% vs. 22.9%; p = 0.0268)} for ROLL and for RSL, respectively {(6.8% vs. 14.9%),(12.36% vs. 21.4%) (p = 0.0001)}. Magseed localisation demonstrated lower rates of re-excision than WGL (13.44% vs. 15.42%; p = 0.0534), but the results were not statistically significant. Conclusions: SAVI SCOUT, Magseed, ROLL, and RSL techniques were reviewed. Pooled analysis indicates wire-free techniques, specifically SAVI SCOUT, ROLL, and RSL, provide statistically significant reductions in re-excision rates and positive margin rates compared to WGL. However, additional studies and systematic analysis are required to ascertain superiority between techniques.
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Wanis, Morcos L., Jennifer A. Wong, Samuel Rodriguez, Jasmine M. Wong, Brice Jabo, Arjun Ashok, Sharon S. J. Lum, et al. "Rate of Re-excision after Breast-conserving Surgery for Invasive Lobular Carcinoma." American Surgeon 79, no. 10 (October 2013): 1119–22. http://dx.doi.org/10.1177/000313481307901034.
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Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. The objective was to investigate the rate of re-excision resulting from positive or close margin (1 mm or less) in patients who underwent breast-conserving surgery (BCS) for ILC compared with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Of the 836 patients treated, 416 patients underwent BCS. The rate of re-excision after BCS for ILC was 35.1 versus 17.7 per cent for IDC and 20.0 per cent for DCIS ( P = 0.04). Re-excisions were more often performed for positive margin in patients with ILC (11 of 37 [29.7%]) versus IDC (36 of 334 [10.8%]) and DCIS (five of 45 [11.1%];( P = 0.004). In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.
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Krishna, Kanyadhara Lohita, B. S. Srinath, Divya Santosh, Shanthi Velusamy, K. P. Divyamala, J. Sariya Mohammadi, Vishnu Kurpad, et al. "A comparative study of perioperative techniques to attain negative margins and spare healthy breast tissue in breast conserving surgery." Breast Disease 39, no. 3-4 (January 6, 2021): 127–35. http://dx.doi.org/10.3233/bd-200443.
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BACKGROUND AND AIM: Traditionally lumpectomy as a part of breast-conserving surgery (BCS) is performed by palpation-guided method leading to positive margins and large excision volumes. There is no evidence suggesting that wide margin excisions decrease intra-breast tumour recurrence. Various perioperative techniques are used for margin assessment. We aimed to compare three commonly used techniques, i.e., ultrasound-guided surgery, palpation-guided surgery and cavity shaving for attaining negative margins and estimating the extent of healthy breast tissue resection. METHOD: A prospective comparative study was performed on 90 patients who underwent breast conservation surgery for early breast cancer between August 2018 and June 2019. Tumour excision with a minimum of 1 cm margin was done either using ultrasound, palpation or cavity shaving. Histopathological evaluation was done to assess the margin status and excess amount of resected normal breast tissue. Calculated resection ratio (CRR) defining the excess amount of the resected breast tissue was achieved by dividing the total resection volume (TRV) by optimal resection volume (ORV). The time taken for excision was also recorded. RESULTS: Histopathology of all 90 patients (30 in each group) revealed a negative resection margin in 93.3% of 30 patients in palpation-guided surgery group and 100% in both ultrasound-guided surgery and cavity shaving groups. Two patients (6.7%) from the cavity shaving group had positive margins on initial lumpectomy but shave margins were negative. TRV was significantly less in the ultrasound-guided surgery group compared to the palpation-guided surgery group and cavity shaving group (76.9 cm3, 94.7 cm3 and 126.3 cm3 respectively; p < 0.0051). CRR was 1.2 in ultrasound group compared to 1.9 in palpation group and 2.1 in cavity shave group which was also statistically significant (p < 0.0001). Excision time was significantly less (p < 0.001) in palpation-guided surgery group (13.8 min) compared to cavity shaving group (15.1 min) and ultrasound-guided group (19.4 min). CONCLUSION: Ultrasound-guided surgery is more accurate in attaining negative margins with the removal of least amount of healthy breast tissue compared to palpation-guided surgery and cavity shaving.
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Rice, Dahlia Michelle, Karen Beatrice Salud Ching, Sahil Gambhir, and Edward Woo. "Residual cancer found on re-excision for close and positive margins after breast conservation for early-stage breast cancer: A single-institution review." Journal of Clinical Oncology 32, no. 26_suppl (September 10, 2014): 55. http://dx.doi.org/10.1200/jco.2014.32.26_suppl.55.
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55 Background: The SSO/ASTRO guidelines for margins on breast-conservation therapy (BCT) were recently published, recommending re-excision for positive margins only defined as ink on invasive cancer. The aim of our study is to retrospectively analyze our institution’s re-excision rate and the rate of finding residual cancer in the re-excision specimen when re-excisions were performed for positive and/or close margins. We want to confirm that our institution’s data for re-excision rates and residual cancer rates are comparable to national data from where the SSO/ASTRO guidelines were derived. Methods: A 3-year (2010 to 2012) retrospective review of data from our institution’s prospectively collected breast cancer database was performed for all stage 0, I, and II breast cancer patients who underwent BCT with subsequent re-excision or completion mastectomy for close or positive margins. Close margins were divided into two groups of < 1 mm or 1 to 2 mm margins, and positive margins were defined as tumor cells present on ink of specimen. Results: A total of 688 patients were analyzed. Our population was found to consist mostly of Caucasian females who were postmenopausal and married. 68% (468/688) of patients were found to have invasive ductal carcinoma (IDC), of which 27.8% (130/468) underwent re-excision for positive and/or close margins. Rates of residual cancer found in margins that are positive, < 1 mm, and 1-2 mm were 54.8% (17/31), 56% (14/25), and 6.3% (1/16) respectively. For DCIS, 38.9% (65/167) underwent re-excision. Rates of residual cancer found in margins that are positive, < 1 mm, and 1 to 2 mm were 38.9% (7/18), 28.6 % (4/14), and 20% (2/10) respectively. Conclusions: Our results reveal that in our institution, re-excision rates are comparable to published data. However, in patients with both positive and < 1 mm margins, the rates of finding residual cancer in the re-excision specimen was higher than the national average. Therefore, in our institution, further analysis is necessary prior to adopting the current recommended guidelines by SSO/ASTRO to prevent adverse impact in local recurrence rate.
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Cate, Sarah P., Arielle Brooke Greenberg, Leah Bassin, Alyssa Gillego, Manjeet Chadha, Gina Aharonoff, and Susan K. Boolbol. "The SSO/ASTRO Consensus on Breast Margins: Has it affected clinical practice?" Journal of Clinical Oncology 33, no. 28_suppl (October 1, 2015): 148. http://dx.doi.org/10.1200/jco.2015.33.28_suppl.148.
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148 Background: Adequate margin width remains a subject of much controversy in breast conserving surgery. The Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) presented a consensus statement on margins in December 2014. This guideline stated that re-excision is recommended only in cases where tumor is present on inked margin. In this study, we sought to determine the consensus statement’s impact on re-excision practices at our institution. We examined re-excision rates eleven months before the release and 17 months after the release of the statement. Methods: Patients included in this IRB approved study had a diagnosis of invasive breast carcinoma, underwent breast conserving surgery, and were treated with adjuvant radiotherapy. Patients with pure DCIS were excluded. Results: One hundred and two women treated from January to November 2013 were included in the pre-consensus group. One hundred and three women were treated from December 2013 to May 2015 in the post-consensus group. The women treated prior to the consensus statement (n = 102) and those women treated after the statement (n = 103) were equally matched in terms of patient age, hormone positivity, and tumor size. A close margin at our institution is defined as < 2mm from the tumor edge. There were 16/102 women prior to the consensus who had close margins and 32/103 women in the post-consensus group. Of these, 68.8% (11/16) underwent re-excision for close margins in the pre-consensus group compared to 3.1% (1/32) after the consensus statement was released (p value < 0.01). Conclusions: The rapid adoption of the SSO/ASTRO margin consensus statement at our institution, although not statistically significant, led to a decrease in the number of patients who underwent a re-excision for close margins. Women with a close surgical margin were less likely to undergo additional surgery for re-excision after the guidelines were released. In our institution, using a standard criterion for re-excision, the re-excision rate for close margins decreased from 68.8% to 3.1%. Further studies are needed to examine the impact of the consensus statement on re-excision practices in a larger group of patients.
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Morinaga, Sei, Shinji Miwa, Norio Yamamoto, Katsuhiro Hayashi, Akihiko Takeuchi, Kentaro Igarashi, Kaoru Tada, et al. "Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors." Journal of Orthopaedic Surgery 29, no. 3 (September 2021): 230949902110575. http://dx.doi.org/10.1177/23094990211057597.
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Introduction Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed. Methods Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1 year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed. Results Mean patient age was 57.3 years (15–85 years) and the mean observation period was 72.5 months (14–181 months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5 cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS ( p < 0.01). Conclusion Most of the tumors underwent unplanned excisions were small (<5 cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.
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Vanni, Gianluca, Marco Pellicciaro, Nicola Di Lorenzo, Rosaria Barbarino, Marco Materazzo, Federico Tacconi, Andrea Squeri, Rolando Maria D’Angelillo, Massimiliano Berretta, and Oreste Claudio Buonomo. "Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS." Cancers 16, no. 4 (February 10, 2024): 743. http://dx.doi.org/10.3390/cancers16040743.
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The current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose of this study is to understand the importance of surgical margin width, re-excision, and treatments to avoid additional surgery on locoregional recurrence (LRR). The study is retrospective and analyzed surgical margins, adjuvant treatments, re-excision, and LRR in patients with DCIS who underwent breast-conserving surgery (BCS). A total of 197 patients were enrolled. Re-operation for a close margin rate was 13.5%, and the 3-year recurrence was 7.6%. No difference in the LRR was reported among the patients subjected to BCS regardless of the margin width (p = 0.295). The recurrence rate according to margin status was not significant (p = 0.484). Approximately 36.9% (n: 79) patients had resection margins < 2 mm. A sub-analysis of patients with margins < 2 mm showed no difference in the recurrence between the patients treated with a second surgery and those treated with radiation (p = 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant (p = 0.161). The margin was not a predictive factor of LRR p = 0.999. Surgical re-excision should be avoided in patients with a focally positive margin and no evidence of the disease at post-surgical imaging.
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Marsden, J. R., Nigel Kirkham, Julia Newton, and Meirion Thomas. "Malignant melanoma excision margins." Lancet 341, no. 8838 (January 1993): 184. http://dx.doi.org/10.1016/0140-6736(93)90051-h.
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Cigna, Emanuele, Mauro Tarallo, Michele Maruccia, Valentina Sorvillo, Alessia Pollastrini, and Nicolò Scuderi. "Basal Cell Carcinoma: 10 Years of Experience." Journal of Skin Cancer 2011 (2011): 1–5. http://dx.doi.org/10.1155/2011/476362.
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Introduction. Basal cell carcinoma (BCC) is a locally invasive malignant epidermal tumour. Incidence is increasing by 10% per year; incidence of metastases is minimal, but relapses are frequent (40%–50%). The complete excision of the BCC allows reduction of relapse.Materials and Methods. The study cohort consists of 1123 patients underwent surgery for basal cell carcinoma between 1999 and 2009. Patient and tumor characteristics recorded are: age; gender; localization (head and neck, trunk, and upper and lower extremities), tumor size, excisional margins adopted, and relapses.Results. The study considered a group of 1123 patients affected by basal cell carcinoma. Relapses occurred in 30 cases (2,67%), 27 out of 30 relapses occurred in noble areas, where peripheral margin was <3 mm. Incompletely excised basal cell carcinoma occurred in 21 patients (1,87%) and were treated with an additional excision.Discussion. Although guidelines indicate 3 mm peripheral margin of excision in BCC <2 cm, in our experience, a margin of less than 5 mm results in a high risk of incomplete excisions.
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Baba, Natsuki, Yasuhiro Nakamura, Hiroshi Kato, Shigeto Matsushita, Noriki Fujimoto, Shiro Iino, Shintaro Saito, et al. "Survival analysis between narrower surgical margins and guideline-recommended margins for excision of cutaneous squamous cell carcinoma: A multicenter, retrospective study of 1,204 Japanese cases." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 10063. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.10063.
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10063 Background: Controversy exists regarding the optimal surgical margin for cutaneous squamous cell carcinoma (cSCC). Current NCCN Guidelines recommend excision with a 4–6-mm clinical margin for low-risk cSCC and wider ( > 6-mm) clinical margin for high-risk cSCC tumors. However, adherence to this guideline is often difficult, as high-risk cSCCs frequently occur on the faces of elderly patients. Thus, we aim to investigate the correlation between different surgical margins and prognosis in patients with cSCC. Methods: Patients with cSCC who had undergone surgical excision of the primary site between 2011 and 2019 at 11 Japanese institutions were included in this study. Patients were divided into two groups: the standard margin group (SMG) with excisions adhering to the guideline-recommended margins, and narrower margin group (NMG) with excisions with narrower margins than are guideline-recommended. Local recurrence-free survival (LRFS), relapse-free survival (RFS), and overall survival (OS) were estimated using Kaplan–Meier analysis and compared between the two groups. Results: A total of 1204 patients with cSCC (SMG, 637; NMG, 567) were included in this study. RFS was significantly lower in SMG than in NMG (5-year RFS 72% vs 79%; P = 0.03); however, no statistically significant differences were observed between the two groups in LRFS (5-year LRFS 80% vs 82%; P = 0.41) or OS (5-year OS 84% vs 83%; P = 0.90). Due to striking statistical significance in several characteristics of patients between the two groups, subgroup analyses, focusing on the cohort of head and neck cSCCs, were also performed. The patient characteristics were similar between SMG and NMG in both the T1-sized tumor ( < 2 cm, SMG, 182; NMG, 250) and T2-sized tumor (2 cm ≤ tumor < 4 cm, SMG, 130; NMG, 136) cohorts, based on AJCC-TNM staging (8th edition). There were also no significant differences between the SMG and NMG in LRFS (5-year LRFS, T1: 80% vs 86%; P = 0.59; T2: 85% vs 84%; P = 0.84), RFS (5-year RFS, T1: 80% vs 81%; P = 0.84; T2: 77% vs 76%; P = 0.99), or OS (5-year OS, T1: 82% vs 87%; P = 0.42; T2: 88% vs 85%; P = 0.68). Furthermore, when the NMG was divided into the two margin groups (margins reduced by < 3 mm or ≥3 mm from the standard margin), no significant difference was observed in LRFS, RFS, and OS. Conclusions: This study did not reveal a significant impact of the size of clinical excision margins on survival in patients with cSCCs. Strikingly, the narrower margins may be more appropriate for < 4 cm-sized head and neck cSCCs.
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Chokechanachaisakul, A., C. A. Wesen, T. M. Hall, and J. S. Falk. "Multivariate analysis of predictors of positive or close margins in breast-conserving therapy." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 105. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.105.
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105 Background: Local recurrence rates after breast-conserving therapy (BCT) are increased with positive or close margin lumpectomy. This group of patients usually requires a re-excision lumpectomy or a completion mastectomy, causing delays in systemic therapy, and a less desirable cosmetic outcome. The objectives of this study were to identify any predictive risk factors that might be associated with positive or close lumpectomy margins (<1mm), and thus have implications for the planning of appropriate primary surgical excision. Methods: This was a retrospective cohort study of 195 consecutive patients from a prospectively collected, single-institution database. Patients who underwent primary lumpectomy for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, and invasive lobular carcinoma from October 2007 to July 2010 were reviewed. Statistical analysis of the data was performed using Chi-squared analyses, multivariate logistic regression and Student’s t-test to identify significant predictors of a close or positive margin following lumpectomy. Results: In this study, 53.8% had positive or close margins. Ninety-two percent of this group underwent re-excision (86.5%) and total mastectomy (13.5%). We also observed that 53.1% of patients who underwent second operation had no residual disease. Factors significantly associated with positive or close margins include a family history of breast cancer (OR=2.3, p=0.01), a non-palpable mass (OR=2.4, p=0.01), or an excisional biopsy (OR=6.02, p=0.022). Age, race, use of hormone replacement therapy, menopausal status, use of preoperative MRI or US, BIRAD, use of neoadjuvant chemotherapy, tumor size, staging, waiting time, histology, receptor status, and axillary status were not significantly correlated with positive or close margins. Conclusions: For patients who were recommended to have a lumpectomy, an increased risk of a positive or close margin was significantly associated with a family history of breast cancer, a nonpalpable mass, or an excisional biopsy. These predictors should be weighed in the decision for attempting lumpectomy with the goal of a negative margin versus the ability to obtain a satisfactory cosmetic outcome.
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Nawrocki, Shiri, Nagy Mikhail, Sara Ghotb, and Amin Maghari. "Assessment of Shave Removal Without Further Excision in the Treatment of Spitz Nevi: A Retrospective Study of 58 Cases." Journal of Cutaneous Medicine and Surgery 24, no. 2 (December 6, 2019): 144–48. http://dx.doi.org/10.1177/1203475419892956.
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Background Spitz nevi (or tumors) are noncancerous growths that are found particularly in the pediatric population. Their histologic features overlap with melanoma, but they have a favorable prognosis, even when showing atypical features. Objectives The aim of this research is to examine whether Spitz nevi can be sufficiently removed by adequate shave excisions without a subsequent excision. Methods Melan-A stained shave removal specimens (SRS) were obtained for 58 consecutively diagnosed Spitz nevi, along with slides of their postshave excision specimens. The SRS were reviewed for negative (clear) margins, defined as no neoplastic melanocytes detected within <0.2 mm of the deep and lateral margins of the specimen. Postshave excision specimens were reviewed for residual or recurrent lesions. Results The 15 shave excision specimens with negative margins had no corresponding residual lesions on postshave specimens. There were no recurrences in any of the cases in an average of 17 months of follow-up. Conclusions Observation may be a logical approach for the management of Spitz nevi when shave removal achieves clear margins and the lesion lacks atypical features.
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McGrath, Lindsay A., Adam Meeney, Zanna I. Currie, Hardeep Singh Mudhar, and Jennifer H. Tan. "Staged excision of primary periocular basal cell carcinoma: absence of residual tumour in re-excised specimens: a 10-year series." British Journal of Ophthalmology 103, no. 7 (September 4, 2018): 976–79. http://dx.doi.org/10.1136/bjophthalmol-2018-312441.
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AimsThe aim is to study staged periocular basal cell carcinoma (BCC) excision in a tertiary oculoplastic referral centre in Sheffield, UK. In particular, we examined patients with close or positive margins and no tumour seen on re-excision to identify demographics and tumour characteristics in this population.MethodsA retrospective review of medical records of 437 cases of staged periocular BCC excisions over a 10-year period (2007–2017) was carried out. Patients had surgical excision with 3 mm clinically clear margins. Staged excision was performed for all cases included in this study. Standard reconstruction techniques were employed. Histopathology was analysed for tumour type, subtype and stage.ResultsOver the 10-year period, of the 437 periocular BCCs, 156 had close or involved margins. Residual tumour was found in 29 (18.6%), whereas in 122 eyelids of 120 patients (78.2%) no residual tumour was identified on histological examination. Micronodular (54.1%) and nodular (23.7%) growth patterns of BCC, as well as lower eyelid location (72.1%), were the most prevalent in this population. Two patients (1.6%) had recurrence of BCC over a mean follow-up of 57 months (range 1–125 months).ConclusionsA significant proportion of BCCs transected on initial excision show no residual tumour in the re-excision specimens. In the interval between initial excision and re-excision, there may be eradication of the residual tumour. The exact mechanisms for this are unclear, however, and re-excision remains the appropriate recommended course in the presence of involved surgical margins of periocular BCC, particularly when high-risk tumour subtypes are encountered.
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Morrow, Monica, Kimberly J. Van Zee, Lawrence J. Solin, Nehmat Houssami, Mariana Chavez-MacGregor, Jay R. Harris, Janet Horton, et al. "Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ." Journal of Clinical Oncology 34, no. 33 (November 20, 2016): 4040–46. http://dx.doi.org/10.1200/jco.2016.68.3573.
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Background Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT). Methods A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. Results Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2 mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2 mm margins. Negative margins less than 2 mm alone are not an indication for mastectomy, and factors known to impact rates of IBTR should be considered in determining the need for re-excision. Conclusion The use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.
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McSweeney, William, Matthew Leaning, and Darius Dastouri. "Keratinocyte Skin Cancers in General Surgery: The Impact of Anaesthesia, Trainee Supervision, and Choice of Reconstruction." Journal of Skin Cancer 2021 (April 13, 2021): 1–3. http://dx.doi.org/10.1155/2021/5537273.
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Background. Keratinocyte skin cancers are common in Australia, incurring disproportionately high health expenditure in comparison with mortality. General surgeons often excise these lesions as day-surgery. Balancing individual complexities of these cancers with trainee supervision and health expenditure is key to deliver efficacious care and maintain day-surgery volume for patients during a pandemic. Methods. A retrospective, cross-sectional study was performed, examining 414 procedures from January 2019 to December 2020. Pathology was reviewed, and benign lesions excluded. Complete excision was based on 5 mm margins for squamous cell carcinoma (SCC), 0.5 mm microscopic margins for low-risk basal cell carcinoma (BCC) subtypes, and 3 mm for high-risk. Results of trainee-performed local anesthetic (LA) excision and general anesthetic (GA) excision (consultant scrubbed) were compared. Results. 288 excisions were reviewed for completeness, location, and reconstruction modality. 69% were BCC (199), and 31% were SCC (89). These were excised under GA (72.5%) and LA (27.5%). 25.6% of BCC excisions were “close,” and 22.6% were “positive” under GA, whilst 31% were “close” and 15.5% were “positive” under LA. 52.8% of SCC excisions were “close,” and 7.8% were “positive” under GA, compared with 42.8% “close” and 9.5% “positive” under LA. Complex reconstruction (skin graft, flap) was more common under GA (38% SCC and 36.1% BCC), but occurred at a modest rate under LA (22% BCC and 28.5% SCC). Conclusions. The results confirm that comparable margins and reconstruction options are achievable when excising keratinocyte cancers under LA by surgical trainees. This is fundamental in cost and timesaving, as well as reducing risk of aerosolisation of virus during GA, in a pandemic.
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Chiu, Jeffrey C., Saira Ajmal, Xiang Zhu, Elizabeth Griffith, Tiffany Encarnacion, and Louis Barr. "Radioactive Seed Localization of Nonpalpable Breast Lesions in an Academic Comprehensive Cancer Program Community Hospital Setting." American Surgeon 80, no. 7 (July 2014): 675–79. http://dx.doi.org/10.1177/000313481408000722.
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Wire localized excision (WLE) has been a long-standing method for localization of nonpalpable breast lesions. Disadvantages of this method include difficulty locating the wire tip in relation to borders of the lesion, imprecise placement of the wire, and the need to place the wire shortly before scheduled surgery. These shortcomings may lead to a high positive margin rate requiring re-excision to obtain clear margins for breast cancer. Radioactive seed localized excision (RSLE) of nonpalpable breast lesions has been advocated as a safe and effective alternative to WLE. The primary endpoints of the study were to compare re-excision rates between WLE and RSLE of nonpalpable breast lesions and to determine if there were any differences in volume of tissue removed. One hundred three patients were included in a retrospective review of localized breast excisions done by a single surgeon. Forty-four patients underwent WLE between April 2007 and February 2009. Fifty-nine patients underwent RSLE between September 2009 and January 2012. Margins were considered to be clear if at least 1 mm of normal tissue was obtained from the circumferential periphery of the lesion in question. RSLE resulted in a re-excision rate of 17 versus 55 per cent re-excision rate for wire localization ( P < 0.001). Excision volume was greater for patients having wire localization ( P = 0.074). RSLE is an effective technique for excision of non-palpable breast lesions in the community setting. This technique allows for accurate localization and appears to allow for smaller volume of tissue to be excised.
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Wolf, J. H., Y. Wen, D. Axelrod, D. Roses, A. Guth, R. Shapiro, J. Cohen, and B. Singh. "Higher Volume at Time of Breast Conserving Surgery Reduces Re-Excision in DCIS." International Journal of Surgical Oncology 2011 (2011): 1–10. http://dx.doi.org/10.1155/2011/785803.
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Purpose. The purpose of this study was to compare the surgical and pathological variables which impact rate of re-excision following breast conserving therapy (BCS) with or without concurrent additional margin excision (AM).Methods. The pathology database was queried for all patients with DCIS from January 2004 to September 2008. Pathologic assessment included volume of excision, subtype, size, distance from margin, grade, necrosis, multifocality, calcifications, and ER/PR status.Results. 405 cases were identified and 201 underwent BCS, 151-BCS-AM, and 53-mastectomy. Among the 201 BCS patients, 190 underwent re-excision for close or involved margins. 129 of these were treated with BCS and 61 with BCS-AM (P<.0001). The incidence of residual DCIS in the re-excision specimens was 32% (n=65) for BCS and 22% (n=33) for BCS-AM (P<.05). For both the BCS and the BCS-AM cohorts, volume of tissue excised is inversely correlated to the rate of re-excision (P=.0284). Multifocality (P=.0002) and ER status (P=.0382) were also significant predictors for rate of re-excision and variation in surgical technique was insignificant.Conclusions.The rate of positive margins, re-excision, and residual disease was significantly higher in patients with lower volume of excision. The performance of concurrent additional margin excision increases the efficacy of BCS for DCIS.
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Gray, Kelsey, Reed Ayabe, Andrew Shover, Ashkan Moazzez, Junko Ozao-Choy, and Christine Dauphine. "Can Selective Image-Guided Intraoperative Margin Resection Improve Re-Excision Rates after Lumpectomy in Ductal Carcinoma In Situ of the Breast?" American Surgeon 84, no. 10 (October 2018): 1580–83. http://dx.doi.org/10.1177/000313481808401008.
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The rate of positive margins after breast conserving surgery (BCS) can be as high as 50 per cent, and optimal techniques for reducing rates of positive margins are presently debated. Our institution has previously demonstrated low rates of margin re-excision using a standardized approach to intraoperative selective margin excision for patients undergoing BCS. We hypothesized that this approach can be used for patients with ductal carcinoma in situ (DCIS) and can yield similar rates when compared with invasive cancer. We performed a retrospective analysis of women with breast cancer who underwent BCS from January 2012 through July 2016 using our institution's standardized approach to selective margin resection. Of the 152 patients who underwent BCS, there were 30 (20%) with DCIS and 122 (80%) with invasive cancer. There was no statistically significant difference in re-excision rates for DCIS (13.3%) and invasive cancer (13.1%). Notably, the DCIS group had a larger mean lesion size ( P = 0.00009); however, the lesion was visible on ultrasound more often in the invasive cancer group ( P = 0.007). This standardized approach to intraoperative selective margin excision can produce similar rates of margin re-excision for DCIS and invasive cancer and may be a viable option for lowering re-excision rates for patients with DCIS.
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Barnes, Martyn Lawrence, Steven Ross, Alison Jayne Barnes, and Leo George McClymont. "S108 – Close Margin Excision Outcomes in Head and Neck Skin Cancer." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P113. http://dx.doi.org/10.1016/j.otohns.2008.05.281.
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Objectives 1) Determine clinical and histological outcomes for patients following close margin excisions of head and neck skin cancer. 2) Guide decisions regarding further intervention and follow-up. Methods Retrospective review of Otolaryngology department skin excisions from 1991 to 2008. Pathology reports and casenotes were reviewed to identify lesions excised with less than 1mm margins and determine their further management and outcome. Kaplan-Meier survival analysis was used to obtain the number needed to follow up for 2 years (NNFU) to detect a recurrence. Results Of 1223 skin cancers, 1207 histology reports were obtained-24% were squamous cell carcinomas, 76% were basal cell carcinomas. 1060 had histological (lateral and deep) margin assessments. Of these, 72.4% were complete, 16.1% close (<1mm) and 11.5% incomplete. 112 closely excised lesions were identified and 107 casenotes were obtained. 2 underwent ‘immediate’ further excision, both demonstrating no residual tumour. Of the remaining 105 subjects, 8 developed clinically suspected recurrence, but 5 were disproved histologically. During follow-up, 10 subjects had a new lesion diagnosed (9 malignant). 12 patients had new lesions diagnosed beyond follow-up; 6 were malignant. 104 (97%) of the original closely excised lesions did not require further excision within the study's 4.1 years of observation (mean) following the initial procedure (range 1.5–12.1). The NNFU following close margin excisions was 34 (95% CI 16 to infinity). Conclusions In similar cases, close surgical margins will rarely indicate a need for further surgery or follow-up. Good quality patient advice leaflets and self-monitoring is advised.
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Morinaga, Sei, Norio Yamamoto, Katsuhiro Hayashi, Akihiko Takeuchi, Shinji Miwa, Kentaro Igarashi, Hirotaka Yonezawa, Yohei Asano, Shiro Saito, and Hiroyuki Tsuchiya. "Clinical outcomes and life expectancy of patients with unplanned excisions of soft tissue sarcoma." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e23554-e23554. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e23554.
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e23554 Background: As soft tissue sarcomas are rare, it is not uncommon that soft tissue sarcoma excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. This study investigated the characteristics of unplanned excision and analyzed the recurrence, life expectancy, and proper treatment for unplanned excision. Methods: Patients who underwent unplanned excision at another institution followed by additional wide excision at our hospital from January 2002 to December 2018 were identified. Forty-two patients met our criteria. The relationships between variables and oncological outcomes were statistically analyzed. Results: The mean age was 57.3 years (15–85 years). Sixty-nine percent (29 in 42) of tumors was in the subcutaneous tissue. Six tumors were located in the upper extremity, 24 in the lower extremity, and 12 in the trunk. Surgical margin after additional wide excision was positive in 10 cases and negative in 32 cases. Pathological examination of specimen showed 34 of 42 cases (80.9%) had residual tumor after primary tumor excision. Fourteen patients (33.3%) required reconstructions. Of the 42 patients, one had both preoperative MRI and biopsy, while nine patients underwent MRI only. Among them, only one patient had enhanced MRI. Ten patients had chemotherapy while no patient had radiotherapy over the follow-up period. The mean tumor size was 5.3 cm (0.8-20 cm). The unplanned excisions were performed by orthopaedic surgeons in 18 cases, by general surgeons in eight, by plastic surgeons in seven, by other surgeons in four. Four primary surgeries (9.5%) were performed in a sarcoma center. On multivariate analysis, positive surgical margin (HR 4.04, 95% CI 1.57-10.4, p < 0.01) was significantly associated with lower 5-year recurrence-free survival. Conclusions: First, to reduce the number of cases of unplanned excision, it should be recognized that small, subcutaneous tumors may be malignant. Second, it is considered that the high recurrence rate with positive margins after additional wide excision might be due to failure to recognize the nature and extent of the tumor without enhanced MRI and biopsy before primary surgery. Finally, surgeons should be aware that positive margin at additional wide excision is an independent risk factor for local recurrence.[Table: see text]
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Sanchez, Daisy, Erica Bloomquist, Heather Wright, and Yoav Barnavon. "Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision." Annals of Plastic Surgery 91, no. 2 (August 2023): 211–14. http://dx.doi.org/10.1097/sap.0000000000003570.
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Abstract Nipple-sparing mastectomies (NSMs) have become a common surgical approach in the management of invasive breast cancers and ductal carcinoma in situ, and as a risk-reducing approach in genetically predisposed patients. The current standard of care in the management of positive nipple margin after NSM is total excision of the nipple-areola complex. In this article, we aimed to present a case series describing a novel approach to positive nipple margins with nipple-only excision and immediate nipple reconstruction using areolar flaps in patients who underwent NSM for noninvasive tumors. We conducted a retrospective review of patients who underwent NSM and were found to have positive nipple margins and underwent subsequent nipple excision with immediate areolar flap reconstruction. We identified 6 patients who underwent NSM and were found to have nipple margins—5 for ductal carcinoma in situ and 1 for invasive ductal carcinoma. These patients underwent nipple excision with immediate reconstruction using “sickle” flaps. We concluded that if nipple excision and immediate reconstruction with areolar sickle flaps can be performed, it results in good aesthetic outcomes without compromising oncologic results.
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Fisher, Jack C. "Safe Margins for Melanoma Excision." Annals of Plastic Surgery 14, no. 2 (February 1985): 158–61. http://dx.doi.org/10.1097/00000637-198502000-00012.
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Green, Nikki, Darren Scroggie, Pippa Leighton, Asmaa Al-Allak, James Bristol, Clare Fowler, Richard Hunt, Eleanore Massey, Sarah Vestey, and Fiona Court. "Factors affecting positive excision margins." European Journal of Surgical Oncology (EJSO) 43, no. 5 (May 2017): S48. http://dx.doi.org/10.1016/j.ejso.2017.01.186.
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Walker, Edward, Dean Palmer, Nausheen Siddiqui, and Diane Patterson. "Excision margins for lentigo maligna." British Journal of Oral and Maxillofacial Surgery 54, no. 10 (December 2016): e102. http://dx.doi.org/10.1016/j.bjoms.2016.11.104.
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Thompson, John F., and David W. Ollila. "Optimum excision margins for melanoma." Lancet 378, no. 9803 (November 2011): 1608–10. http://dx.doi.org/10.1016/s0140-6736(11)61615-2.
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Qu, Feilin, Cheng-Jia Shen, Wen-Tao Yang, Jun-Jie Li, Guangyu Liu, and Zhi-Ming Shao. "Abstract PO1-22-09: Current margin assessment practice for breast-conserving surgery in China: a single institution audit." Cancer Research 84, no. 9_Supplement (May 2, 2024): PO1–22–09—PO1–22–09. http://dx.doi.org/10.1158/1538-7445.sabcs23-po1-22-09.
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Abstract Background The appropriate negative margin width following breast-conserving surgery (BCS) for both ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) has witnessed a shift towards de-escalation in international guidelines. However, there are limited nationwide data regarding margin assessment practice for BCS in China. This study aims to clarify the current real-world status of margin assessment from a single institution audit and secondarily to update the evidence on the association between margin width and local recurrence. Methods Eligible cases were derived from an extensive series of consecutive unselected patients with early invasive breast cancer who were treated with BCS at the Department of Breast Surgery in Shanghai Cancer Center Fudan University (FUSCC) between January 2015 and December 2017. Patient demographic and clinicopathological information as well as follow-up data were extracted from the hospital's electronic medical records. Pathological evaluation of negative margins was defined as no ink on tumor for IC in accordance with the SSO/ASTRO consensus guidelines released in 2014. Where applicable, margins were categorized as tumor on ink (involved), close margins (no tumor on ink but ≤1 mm), clear margins (1-2 mm), wide margins (2-5 mm), and wider margins (>5 mm). The positive margin rate (PMR), reoperation rate, and ipsilateral breast recurrence (IBR) rate were calculated according to different margin widths. Multivariable analyses of factors associated with re-excision were performed using binary logistic regression. Kaplan‒Meier survival curve analysis was performed for local recurrence-free survival (LRFS). Results A total of 2707 patients were enrolled in the current study, with a total PMR of 2.7%. The distribution of margin width revealed that wider margins (>5 mm) were optimized by most surgical oncologists (2092/2707, 77.3%) for BCS in our center. Additionally, the reoperation rates were 1.9% in the whole population, accounting for 48.3%, 7.5%, 4.2%, 0.8%, and 0.4% in each margin group. Specifically, among 247 patients with margins ≤2 mm, 41 (16.6%) received reoperation either by margin re-excision or mastectomy. Multivariable analyses identified that lobular histology, no selective additional resection and in situ pathology of involved/close margins are independent factors of re-excision recommendation. With a median follow-up of 54.3 months, the incidence of IBR was 1.7% in the whole cohort, representing for 5.2%, 4.2%, 2.8%, 1.9%, and 1.3% in each margin group, respectively. Kaplan‒Meier survival curve analysis showed a marginally significant difference in 5-year LRFS between groups with margins >2 mm and margins ≤2 mm (95.9% vs 97.8%, Table 1). Conclusions A wider margin width was preferably adopted in the routine practice of BCS. Our audit was aligned with previous evidence that a minimum clear margin of 2 mm is associated with a lower reoperation rate but favorable local control. Patients with margins no more than 2 mm were more likely to have re-excision in cases of lobular histology, no selective additional resection, and in situ pathology of involved/close margins. Ipsilateral breast recurrence models by margin status Citation Format: Feilin Qu, Cheng-Jia Shen, Wen-Tao Yang, Jun-Jie Li, Guangyu Liu, Zhi-Ming Shao. Current margin assessment practice for breast-conserving surgery in China: a single institution audit [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-22-09.
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Schaefgen, Benedikt, Annika Funk, H. P. Sinn, Thomas Bruckner, Christina Gomez, Aba Harcos, Anne Stieber, et al. "Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries?" Breast Cancer Research and Treatment 191, no. 3 (December 8, 2021): 589–98. http://dx.doi.org/10.1007/s10549-021-06466-3.
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Abstract Purpose This is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. Methods This retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a positive predictive value (PPV) of 7.7%, and a negative predictive value (NPV) of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9%, and the NNT was 85. Conclusion Positive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR. In summary, CSR after NACT is inadequate for intraoperative margin assessment but remains useful to document removal of the biopsy site clip.
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Rose, Kyle M., Rosalie Zurlo, Roger Li, Gerard Mosiello, and Philippe E. Spiess. "Oncologic Outcomes of a Novel Mapping Biopsy Technique Before Surgical Excision in the Management of Extramammary Paget Disease." Société Internationale d’Urologie Journal 4, no. 1 (January 13, 2023): 34–38. http://dx.doi.org/10.48083/lcme5237.
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Objective To analyze oncologic outcomes of patients with extramammary Paget disease (EMPD) undergoing a novel mapping biopsy before tumor excision (WLE). Methods We analyzed 19 consecutive patients with EMPD treated with biopsy and/or surgical excision at Moffitt Cancer Center from 2013 to 2021. Biopsy technique, patient demographics, pathology, and oncologic outcomes were analyzed. Results In total, 19 patients were included in the analysis. Median age at diagnosis was 72. No patients were diagnosed with secondary malignancy during mandatory workup. Of the 17 patients receiving novel mapping biopsy, 8/17 had at least one positive core biopsy site, with a mean of 7% positivity of the total core sites (4/60). Mapping biopsy positive sites helped shape perimeters for wide local excision (WLE) for patients opting for surgical treatment. Although an extensive mapping biopsy was performed, WLE margins were positive in 11/17 patients. Although positive pathologic margins following surgical excision were prominent, only one patient experienced recurrence of EMPD during a median follow-up period of 38 months. Conclusions We have demonstrated a standardized mapping biopsy before surgical excision in the management of EMPD in men. Despite extensive mapping biopsies, positive surgical margin rates are high, and this may reflect the occult nature of the disease process. Close follow-up is warranted in patients regardless of margin status, but those with positive surgical margins may benefit from more aggressive regimens.
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Sanderink, W. B. G., L. J. A. Strobbe, P. Bult, M. S. Schlooz-Vries, S. Lardenoije, D. J. Venderink, I. Sechopoulos, N. Karssemeijer, W. Vreuls, and R. M. Mann. "Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance." Breast Cancer Research and Treatment 184, no. 1 (August 1, 2020): 37–43. http://dx.doi.org/10.1007/s10549-020-05814-z.
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Abstract Purpose To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. Methods From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. Results Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0–13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). Conclusions BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.
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Sevray, Marine, Emilie Brenaut, Yann Grangier, Laurent Misery, Florence Poizeau, and Frédéric Staroz. "Retraction of cutaneous specimens: tumours and margins after surgical excision." Journal of Clinical Pathology 73, no. 1 (August 30, 2019): 42–46. http://dx.doi.org/10.1136/jclinpath-2019-205988.
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AimsIn previous studies, skin retraction of dermato-pathological specimens after the surgical excision of tumours was calculated at 30% for the surface, with approximately 20% for the length and 15% for the width. The aim of this study was to analyse the retraction of the specimens and the retraction of the lesion and the margins.MethodsPatients who underwent excision of a skin tumour between January 2013 and July 2014 were randomly included.ResultsA total of 104 patients was included. There were 52% male with a mean age of 68.3 years. Seventy-eight per cent of the lesions were malignant (51% were basal cell carcinoma, 10% squamous cell carcinoma). The retraction of the area of the specimen (29%) was significantly greater than the retraction of the tumour (21%). On multivariate analysis, the localisation and the duration of fixation were independent predictors of the specimen area retraction. The retraction of the specimen was 17% in length and 15% in width. The retraction of the margins was calculated at 19% in length and 12% in width. The surgeon correctly evaluated the localisation of the smallest margin in 55% of cases.ConclusionsOur study provided additional data regarding the retraction of the tumours and margins. The guidelines for surgical excision of skin cancers recommend a clinical margin before excision, but the evaluation of the sufficiency of the margins is based on histological measurement. Our data are useful for the interpretation of the sufficiency of the margins.
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Koopmansch, Caroline, Jean-Christophe Noël, Calliope Maris, Philippe Simon, Marième Sy, and Xavier Catteau. "Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma." Breast Cancer: Basic and Clinical Research 15 (January 2021): 117822342199345. http://dx.doi.org/10.1177/1178223421993459.
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Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment ( P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment ( P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.