TP8.1.10 Factors predicting residual disease on re-excision after breast conserving surgery. (28th October 2021)

• Record Type: Journal Article
• Authors: Simpson, Duncan; Allan, Jennifer; McFall, Brendan
• Is Part Of: British journal of surgery. Volume 108:Supplement 7(2021)
• Publication Date: 2021-10-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab362.072
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Breast conserving surgery is the standard of care for early breast cancer, however in a quarter of patients, satisfactory margins are not achieved, usually leading to re-excision. Residual disease is found in less than half of these re-excisions, leading to increased morbidity, poorer cosmesis and increased cost with no oncological benefit. Our study aimed to identify a group of patients with unsatisfactory margins but a low risk of residual disease, who may be able to avoid re-excision. Methods: All patients from our unit undergoing re-excision for unsatisfactory margins after breast conserving surgery between January 2013 and October 2019 were identified. Pathological factors predicting residual disease were investigated using univariable and multivariable analysis. Results: 220 patients were included. 90 (41%) had residual disease in the re-excision specimen. Residual disease was more likely in those having mastectomy than cavity shaves (61% vs 32%, p < 0.0001). Residual disease increased in a linear fashion with number of involved margins and with increasing tumour size. Tumour size <20mm (p = 0.045), a pathological to radiological tumour size ratio less than 1.5 (p < 0.0001) and disease-free cavity shaves taken at initial surgery (p = 0.041) were all significant predictors of a low chance of residual disease on multivariable analysis. Patients with all three factors had a 14% chance of residual disease. Conclusions: More than half of patients undergo unnecessary re-excision, and patients with small, radiologically obvious tumours are less likely to have residual disease. The decision on re-excision should include these factors in addition to the margin status.