Background:The amount of breast volume excised is an important determinant for cosmetic outcomes after breast-conserving surgery. Positive margins after breast conserving surgery negatively influence cosmetic outcomes by necessitating re-excisions. In this study, our aim was to evaluate the hypothesis that preoperative localized needle-core breast biopsy (LNCB) diagnosis can reduce the resected volume, margin positivity and cosmetic discontent after breast conserving surgery. Methods:Two hundred sixty five women (mean age:57; range 16-85 years) operated upon by a single dedicated breast surgeon in the year 2007 form the cohort for this study. All underwent excision of lesion with curative intent. LNCB was performed before breast conserving surgery in 237 (89%) patients. The final pathology result were classified by benign, high risk, DCIS, or invasive cancer and compared with the pre-op pathological diagnosis by LNCB. The cosmetic results were determined as excellent, good, fair, or poor during the post-operative period. Associations between various factors were analyzed using Student-t test, ANOVA test and chi-square test. Results:The resected volume (mean±SD) of the patients with preoperative needle core biopsy was higher than patients without core biopsy (101.11±78.1 cm3 vs 43.37±30.8 cm3; p=0.001). The core biopsy results were 36 (15%) benign, 45 (19%) high risk, 46 (19.5%) DCIS, and 110 (46.5%) invasive breast cancer. The LNCB and surgical path were concordant in 96% of cases. The resected volumes were higher in invasive cancer and DCIS cases.

Table: Preoperative needle-core breast biopsy characteristics (n=237).

  Benign disease (n=36) High risk (n=45) Ductal carcinoma in-situ (n=46) Invasive cancer (n=110) 
Pre-operative USG/Mammography/MRI A: 10 (27%) B: 26 (71%) A: 30 (66%) B: 15 (34) A: 37 (81%) B: 9 (19%) A: 10 (9%) B: 100 (91%) 
Initial resected volume (cm3) 33.79 64.17 106.44 123.8 
Total volume after re-excision (cm3) 33.79 65.66 112.79 132.77 
Cosmesis E=36 (100%) E= 44 (98%) G= 1 (2%) E= 39 (85%) G= 6 (13%) F= 1 (2%) E= 84 (76%) G= 21 (19%) F= 5 (5%) 
  Benign disease (n=36) High risk (n=45) Ductal carcinoma in-situ (n=46) Invasive cancer (n=110) 
Pre-operative USG/Mammography/MRI A: 10 (27%) B: 26 (71%) A: 30 (66%) B: 15 (34) A: 37 (81%) B: 9 (19%) A: 10 (9%) B: 100 (91%) 
Initial resected volume (cm3) 33.79 64.17 106.44 123.8 
Total volume after re-excision (cm3) 33.79 65.66 112.79 132.77 
Cosmesis E=36 (100%) E= 44 (98%) G= 1 (2%) E= 39 (85%) G= 6 (13%) F= 1 (2%) E= 84 (76%) G= 21 (19%) F= 5 (5%) 

A: Micro-calcification, B: Mass, E: Excellent, G: Good, F: Fair.

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Re-excision for positive margins were necessary in 9 (19.5%) of DCIS cases and 24 (21.8%) with a diagnosis of invasive cancer. Resection volumes were the same for a LNCB diagnosis of high risk lesion whether the final surgical path was benign or malignant (65.3±52.7 cm3 v. 69.8±8.7 cm3). The cosmetic outcomes of the surgery were excellent in 98% to 100% of patients who had lower volume resections; however, the outcome was less than excellent in 15% to 26% of patients if the final resection volume was more than 100 cm3. Conclusions: Pre-operative LNCB that establishes the benign nature of a lesion allows a more limited resection with improved cosmetic outcomes. Establishing the diagnosis of DCIS or invasive breast cancer by pre-operative biopsy allows for surgical planning of wider resection volumes, but the need for re-excision based on positive margins remains high, suggesting that newer imaging modalities that allow 3-demensional planning of segmental resection or even wider resections employing oncoplastic techniques are necessary.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1032.

2009