Tang R, Coopey SB, Specht MC, Lei L, Gadd MA, Hughes KS, Brachtel EF, Smith BL. Lumpectomy specimen margins are not reliable in predicting residual disease in breast conserving surgery.
Am J Surg 2014;
210:93-8. [PMID:
25613784 DOI:
10.1016/j.amjsurg.2014.09.029]
[Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/06/2014] [Accepted: 09/15/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND
In breast conserving surgery, the concordance between lumpectomy margin (LM) status and the status of the corresponding lumpectomy cavity remains uncertain.
METHODS
We analyzed pathology reports of lumpectomies from 2004 to 2006. We included those which contained both ink-directed LM and complete (≥4) separate corresponding shaved cavity margins (SCMs). SCM pathology was used as a surrogate for lumpectomy cavity status, to determine the predictive value of LM for residual disease.
RESULTS
Pathology from 1,201 pairs of LM and SCM from 242 patients was compared. LM status predicted corresponding lumpectomy cavity status with 50.9% sensitivity, 69.5% specificity, 35% positive predictive value, and 81.4% negative predictive value, giving an overall accuracy of 64.9%.
CONCLUSIONS
Oriented LMs are not reliable for predicting lumpectomy cavity status, and therefore not reliable for directing re-excision. Taking complete, oriented SCMs at the time of lumpectomy may improve accuracy compared with traditional LM assessment.
Collapse