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The Superficial Margin of the Skin-Sparing Mastectomy for Breast Carcinoma: Factors Predicting Involvement and Efficacy of Additional Margin Sampling

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

No study has systematically evaluated the significance of involvement of the superficial specimen margin in skin-sparing mastectomies (SSMs).

Methods

168 SSMs with a small, additional superficial margin (ASM) specimen taken directly over the tumor to the dermis intraoperatively were studied.

Results

64 SSMs (38%) had a positive superficial specimen margin but only 13 (20%) of these had residual breast carcinoma in ASMs. Only 1 of 104 SSMs with a negative superficial specimen margin had residual breast carcinoma in its ASM (P < 0.05). ASM sampling rendered the final true margin directly over the tumor negative in 54 of 58 (93%) SSMs with a focally positive superficial specimen margin, but did not negate the nonfocally positive superficial specimen margin in six other cases. In SSMs with a positive superficial specimen margin, multivariate analysis revealed that the presence of extensive ductal carcinoma in situ (DCIS) in the SSM and a thicker ASM specimen were the only independent factors predictive of residual breast carcinoma in ASM. Eighty-nine (53%) ASMs contained benign breast tissue.

Conclusions

Superficial specimen margins in SSMs are often microscopically positive and approximately half of ASMs contain benign breast tissue, likely reflecting the difficulty in completely removing breast tissue near the skin flaps in SSMs. ASM sampling effectively decreases positive superficial specimen margins directly over the tumor in SSMs, but fails to account for positive superficial specimen margins in other quadrants in patients with multicentric disease, especially extensive DCIS. Patients whose superficial margins remain positive could potentially represent a subset of patients for whom postmastectomy radiation is beneficial.

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Authors and Affiliations

  1. Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, 63110, USA

    Dengfeng Cao MD, PhD

  2. Department of Pathology, The Johns Hopkins Hospital, 401 North Broadway, 2242 Weinberg Building, Baltimore, MD, 21231, USA

    Nina Kouprina BA, Russell Vang MD & Pedram Argani MD

  3. Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA

    Theodore N. Tsangaris MD & Charles M. Balch MD

  4. Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA

    Charles M. Balch MD & Pedram Argani MD

  5. Department of International Health, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA

    Lee Shun-Fune Wu MHS

Authors
  1. Dengfeng Cao MD, PhD
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  2. Theodore N. Tsangaris MD
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  3. Nina Kouprina BA
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  4. Lee Shun-Fune Wu MHS
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  5. Charles M. Balch MD
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  6. Russell Vang MD
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  7. Pedram Argani MD
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Correspondence to Pedram Argani MD.

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Cao, D., Tsangaris, T.N., Kouprina, N. et al. The Superficial Margin of the Skin-Sparing Mastectomy for Breast Carcinoma: Factors Predicting Involvement and Efficacy of Additional Margin Sampling. Ann Surg Oncol 15, 1330–1340 (2008). https://doi.org/10.1245/s10434-007-9795-8

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  • DOI: https://doi.org/10.1245/s10434-007-9795-8

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