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Indication for relumpectomy—a useful scoring system in cases of invasive breast cancer

Authors

  • Ariel Halevy MD, FACS,

    Corresponding author
    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
    2. Comprehensive Breast Care Institute, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
    • Division of Surgery, Assaf Harofeh Medical Center, Zerifin 70300 Israel. Fax: 972-8-9779225
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  • Ron Lavy MD,

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Itzhak Pappo MD,

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
    2. Comprehensive Breast Care Institute, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Tima Davidson MD,

    1. Department of Radiology, The Chaim Sheba Medical Center (affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel), Tel Hashomer, Israel
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  • Ruth Gold-Deutch MD,

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Igor Jeroukhimov MD,

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Zahar Shapira MD,

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Ilan Wassermann MD,

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Judith Sandbank MD,

    1. Department of Pathology, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • Bar Chikman MD, PhD

    1. Division of Surgery, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel), Zerifin, Israel
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  • The authors do not have conflicts of interest. There are no sources of funding and no commercial interest.

Abstract

Background and Objectives

In two-thirds of breast cancer patients undergoing reoperation no residual tumor will be found. A scoring system for selection of patients who might benefit from relumpectomy is proposed.

Methods

This study is based on 293 patients with invasive breast cancer undergoing reoperation due to margins of <2 mm. Eighteen parameters were evaluated by univariate and multivariate stepwise logistic regression.

Results

Univariate analysis identified nine parameters associated with a residual invasive tumor: surgical margins; lobular histological type; grade 3; multifocality; positive lymph modes; non-fine needle localization (FNL) versus FNL lumpectomy; vascular/lymphatic invasion; age <50 years; and tumor size ≥3 cm. Multivariate stepwise logistic regression study identified six out of nine parameters associated with a higher probability of finding a residual invasive tumor: margins <1 mm, multifocality, tumor size ≥3 cm, positive lymph nodes, age <50 years, and lumpectomy without previous FNL. Odds of these factors were used for scoring.

Conclusions

For patients with surgical margins <2 mm and a score of <4, the probability of finding a residual invasive tumor is 0%, while the probability of finding a microfocus of <2 mm of invasive carcinoma is 3.2% and of finding residual DCIS is up to 10%. J. Surg. Oncol. 2012;105:376–380. © 2011 Wiley Periodicals, Inc.

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