Surgical Options and Locoregional Recurrence in Patients Diagnosed with Invasive Lobular Carcinoma of the Breast
Recent consensus guidelines on margins for breast-conserving surgery (BCS) recommend the use of “no ink on tumor” as the standard for an adequate margin. The recommendations extend to invasive lobular carcinoma (ILC), but the data on this subset are limited. We reviewed our modern dataset on margin status with outcomes of ILC.
We performed a retrospective cohort study on 736 patients with a diagnosis of stage I–III ILC treated at our cancer center between May 1997 and December 2007. Clinicopathologic data were extracted from the Clinical Research Information Systems Database. Margin status was defined using the latest ASCO/ASTRO/SSO consensus guideline criteria.
The initial surgery performed was mastectomy in 352 patients (48 %) and BCS in 384 patients (52 %). In multivariate analysis, tumor size and multifocality were significantly associated with high rates of mastectomy and positive surgical margins at initial BCS. After initial BCS, additional surgery was performed in 92 patients (24 %). During a 72-month median follow-up period, 12 (3.1 %) ipsilateral breast tumor recurrences (IBTR) and 5 (1.3 %) other locoregional recurrences (LRR) were observed. Patients with margins with ink on tumor who did not receive further surgery were found to have significantly increased LRR [odds ratio (OR) 5.5; p = 0.02] and IBTR (OR 8.5; p = 0.006), whereas patients with close margins (1–3 mm) and margins within 1 mm were not.
Our study supports the validity of using “no ink on tumor” as the standard for a negative margin for pure and mixed ILC treated with multimodality therapy.
KeywordsInvasive Lobular Carcinoma Negative Margin Ipsilateral Breast Tumor Recurrence Close Margin Margin Assessment
This work was supported by the Susan G. Komen Foundation for the Cure Grant (PDF14302599) and by the NIH Grant R25CA089017. Dr. Sonal Jhaveri at Dana-Farber’s Postdoc and Graduate Student Affairs Office (PGSAO) edited an earlier version of the manuscript. The authors gratefully acknowledge the support and generosity of Linda Cutone and Hakuaikai Medical Cooperation.
The authors have no conflicts of interest concerning this study.
- 18.Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr. 1992;(11):19–25.Google Scholar
- 26.Buchholz TA, Somerfield MR, Griggs JJ, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32:1502–6.CrossRefPubMedGoogle Scholar