Tumour Size, Microcalcifications, and Multifocal Disease May Predict Surgical Margin Status in Breast-Conserving Surgery: Presented at ESSO

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Title: Tumour Size, Microcalcifications, and Multifocal Disease May Predict Surgical Margin Status in Breast-Conserving Surgery: Presented at ESSO
URL: http://www.pslgroup.com/dg/22BE76.htm
Doctor's Guide
September 11, 2008

By Shazia Qureshi

THE HAGUE, Netherlands -- September 11, 2008 -- Researchers have identified 3 predictors of surgical margin status in women who undergo breast-conserving surgery -- these are large tumour size, mammographic microcalcifications, and multifocal disease, researchers reported here at the 14th Congress of the European Society of Surgical Oncology (ESSO).

"Mammographic appearance is an undervalued tool in breast cancer surgery," noted lead author Emil Kurniawan, BMedSc, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia.

He presented the findings of this prospectively maintained database study on September 11. The study was published simultaneously in the Annals of Surgical Oncology.(1)

The investigators reviewed data from more than 350,000 women who had taken part in a population-based breast-screening programme in Melbourne between 1994 and 2005.

A total of 1,648 patients were found to have undergone breast-conserving surgery after receiving a diagnosis of ductal carcinoma in situ or invasive cancer. Of these women, 304 (18.4%) had a palpable lesion indicating malignancy.

The study evaluated the records of the 1,648 patients in greater detail, looking especially at surgical margin status. Clear surgical margins rather than so-called "involved" or positive margins are known to help reduce local tumour recurrence.

Involved margins were seen in 223 patients (13.5%), close margins (<=1 mm) in 274 patients (16.6%), and clear margins (>1 mm) in 1151 patients (69.8%).

Of the group of 1,648 women studied, 281 (17.1%) went on to have a second tumour excision surgery, and 69.5% of these women were found to have positive margins.

On univariate analyses, the researchers found that several patient-related and tumour-related factors were significantly associated with involved margins. These included mammographic microcalcifications, absence of a mammographic mass, presence of ductal carcinoma in situ, high histological tumour grade, large size of tumour (>=30 mm), multifocal disease, and lobular histology indicating invasive cancer.

With multivariate analysis, only 3 of these factors were found to be independently associated with involved margins -- mammographic microcalcifications (odds ratio [OR] = 1.97), large tumour size (OR = 4.22), and multifocal disease (OR = 2.85).

"Knowing what the prognostic factors are, surgeons can take a larger volume of excision to reduce the risk of positive margins," Kurniawan said in an interview following the presentation. "These features act like warning signs and may help to avoid a second surgery in these patients."

He added that the research group is currently evaluating recurrence rates in the study patients.

1. Kurniawan ED et al. Ann Surg Oncol. 2008;15:2542-2549.

[Presentation title: Predictors of Surgical Margin Status in Breast Conserving Surgery Within a Breast Screening Program. Abstract 69]

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