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Objective: Breast cancer represents the most prevalent malignant disease among women globally, accounting for approximately 30% of all female cancers. Wire-guided localization is now a commonly utilized method for diagnosing breast lesions that are not palpable on clinical examination but can be identified through the use of mammography (MG) and/or ultrasound (US). The objective of the study was to determine the cancer prediction rate of the method in patients with non-palpable breast lesions who underwent excisional biopsy with wire guided localization and to evaluate the diagnostic significance of the method by comparing age, size, family history, radiomorphologic type, Breast Imaging and Data System (BI-RADS) category, location, and histopathologic features. Furthermore, the objective was to elucidate the advantages of the method in breast cancer treatment by determining the re-excision rates and types according to the surgical margin status of malignant lesions. Methods: The study was planned retrospectively. A total of 228 histopathologically examined lesions that underwent US or MG-guided wire-guided excisional biopsy for non-palpable breast lesions between June 2006 and December 2011 were included in the study. Results: Of all lesions, 58 (25.4%) were diagnosed as malignant, while 170 (74.6%) were diagnosed as benign pathologies. The cancer prediction rate of the method was determined to be 25.4%. The malignancy rate demonstrated a statistically significant correlation with age, with an increasing trend observed with advancing age (p=0.006). No statistically significant differences were observed between malignant and benign lesions with respect to size, localization, or family history. With regard to lesion type, the malignancy rate was higher in lesions comprising micro-calcification clusters (p=0.005). Malignancy rates were significantly higher in the BI-RADS 4b (OR:6.06) and BI-RADS 4c (OR:6.77) groups compared to the other BI-RADS categories. In cases where the surgical margins were positive for malignancy (28/58), the rate of mastectomy was significantly higher than in cases where the margins were negative (p=0.006). The majority of malignant lesions (79.3%) were classified as stage 0 or 1 cancers. Conclusion: Wire-guided localization is still an effective method for early diagnosis of breast cancer and identification of suspicious non-palpable lesions. Developing new techniques in pathology, radiology, and surgery to better localize suspicious non-palpable lesions and reduce surgical margin positivity rates will facilitate the fight against breast cancer. [ABSTRACT FROM AUTHOR]

The rate of mastectomy in lumpectomy-eligible patients with unilateral breast cancer is increasing. We sought to investigate the association between magnetic resonance imaging (MRI) and surgical management of patients with early-stage breast cancer by comparing the rate of mastectomy as first surgery in patients with and without preoperative MRI. A bi-institutional retrospective study included patients diagnosed between 2016 and 2020. Lumpectomy-eligible patients with in situ and invasive cancer were included. Those receiving preoperative therapy, MRI before diagnosis, or with known bilateral cancer were excluded. The risk factors for bilateral and multicentric disease were accounted for. Fisher's exact and chi-square tests compared categorical variables, Wilcoxon two-sample test analyzed continuous variables, and multivariate analyses were performed with Poisson regression. Four hundred twenty-eight participants met inclusion criteria. Patients who received MRI were younger (58 versus 67 y; P < 0.001) and had denser breasts (group 3 or 4; 61% versus 25%; P < 0.001). Mastectomy rate was twice as high in patients undergoing MRI (32% versus 15%, rate ratio 2.16; P < 0.001), which remained significant in multivariate analysis (rate ratio 2.0; P < 0.001). Contralateral mastectomy (12% versus 4%; P = 0.466) and reexcision (13% versus 12%; P = 0.519) rates were similar. Time to surgery was greater in those receiving MRI alone and MRI biopsy (34 [no MRI] versus 45 [MRI] versus 62 [MRI biopsy]; P < 0.001 for both). MRI receipt is associated with a doubled rate of mastectomy in lumpectomy-eligible patients. Future work is needed to standardize patient selection for MRI to those with the highest likelihood of having additional undiagnosed disease. [ABSTRACT FROM AUTHOR]

Abstract: Background: NHS Breast Screening Programme (NHSBSP) guidelines recommend using a protocol to orientate excised specimens, thus allowing accurate reexcision of positive margins. Variation between units, and surgeons, in protocols may cause confusion, labelling errors and specimen misorientation. We investigated variation of, and satisfaction with, specimen labelling protocols in breast surgery units. Methods: Questionnaires were sent to the lead pathologist of all English breast units, addressing method (clips/staples/ink) and system (eg long suture = lateral) of orientation, and pathologist''s satisfaction with the consistency and method used. Results: Of 141 units, 117 responded: 82 screening and 35 non-screening units. 92 use a standardised orientation protocol. Eleven screening and 15 non-screening units report no protocol. Of responding units, 33 use sutures, 9 use clips, 67 use clips + sutures, 3 use coloured ink and 5 suture the specimen to paper/foam/marginmap®. The commonest protocol is suture: short-superior, medium–medial, long-lateral, by 50 units. However eleven labelling systems for sutures and 14 for clips were reported. Twenty-six pathologists reported no standardised method, with labelling technique either written on the specimen card (n = 15) or presumed, based on the surgeon-in-charge''s usual practice. Thirty-four pathologists are satisfied with a locally established protocol, however 56 want a nationally standardised marking system. Conclusion: Despite NHSBSP guidelines, nearly one quarter of breast units have no specimen orientation protocol. Specimen marking protocols vary widely – a concern in view of the transient nature of locum and trainee doctors. There is a clear wish by pathologists for specimen marking standardisation, whether this is nationally or locally defined. [Copyright &y& Elsevier]

Abstract: Background: A significant proportion of patients undergoing breast conservation therapy require additional operations to obtain clear margins. The aim of this study was to assess the impact of initial margins and residual carcinoma found on second surgery on the outcomes of breast cancer patients. Methods: In this retrospective study, Cox proportional-hazard regression analysis was performed to evaluate data from 437 patients with stage I to IIIA breast cancer who underwent initial breast-conserving surgery between 1994 and 2004. Results: The distant recurrence rate was higher among patients with initial positive margins than among those with initial negative margins (15.5% vs 4.9%; hazard ratio, 3.6; 95% confidence interval 1.5–8.7; P = .003). For patients who had underwent second surgery, the finding of a residual invasive carcinoma was associated with increased risk for distant recurrence (22.8% vs 6.6%; hazard ratio, 3.5; 95% confidence interval, 1.8–7.4; P = .0001). Conclusion: Invasive residual carcinoma found during subsequent surgery after initial compromised margins is an important prognostic marker for distant recurrence. [Copyright &y& Elsevier]

The article discusses a study which aims to investigate how margin status and other clinicopathologic factors correlate with the presence of reexcision and residual tumor. The study was participated by breast-cancer patients who underwent breast conservation surgery (BCS) followed by reexcision because they had positive or close margins. It concludes that relevant residual disease cannot be ruled out in the presence of positive margins.

One of the most important factors associated with local recurrence after lumpectomy in breast cancer patients is the status of the surgical margin. Standard surgical practice is to obtain clear margins even if this requires a second surgical procedure. It is assumed that reexcision to achieve clear margins when positive margins are present at initial excision is as effective as complete tumor removal at a single procedure; however, the efficacy of reexcision in this context has not been well studied. A retrospective search of the Henrietta Banting Breast Centre database from 1987 to 1997 identified 1430 patients who underwent lumpectomy for invasive breast cancer: 1225 patients (group A) had negative margins at the initial surgery and 152 patients (group B) underwent one or more reexcisions to achieve negative margins. Fifty-three patients had positive margins at final surgery, but no reexcision was done (group C). Logistic regression was used to identify factors that were predictive of a positive margin; predictors of local recurrence in women whose tumors were completely resected were determined using Cox's proportional hazards model. Patients in groups A, B, and C differed with respect to mean age at diagnosis (58 years, 51 versus, and 56 years, respectively, p < 0.0001), mean tumor size (19 mm, 16 mm, and 26 mm, respectively, p < 0.0001), node positivity (30%, 22%, and 41%, respectively, p = 0.004), and the presence of a ductal carcinoma in situ (DCIS) component (60%, 64%, and 79%, respectively, p = 0.007). The mean follow-up period was similar for the three groups (8 years, 8 years, and 9 years, respectively, p = 0.17). Young age was the only variable predictive of positive margins. Among patients undergoing complete tumor excision, there was a suggestion of a higher 10 year local recurrence rate in reexcision group B, but the difference did not reach statistical significance (11.6% versus 16.6%, p = 0.11). Cox's multivariate regression analyses identified older age, smaller tumor size, receiving radiation therapy, and tamoxifen use as significantly decreasing the rate of local recurrence in patients with negative margins at initial surgery or after reexcision. Our data confirm the results of previous studies indicating that young age is an independent predictor of positive margins after lumpectomy for invasive breast cancer. The only independent predictor of local recurrence in our study cohort was large tumor size. There was a trend toward a higher local recurrence rate if more than one procedure was required to secure clear margins, although this effect was not independent of other factors. Reexcision to clear involved margins is an important surgical intervention for both younger and older women. [ABSTRACT FROM AUTHOR]