Investigation of resection margins during organ-sparing operations in patients with breast cancer

DOI: https://doi.org/10.29296/25877305-2020-12-09
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Issue: 
12
Year: 
2020

F. Khugaeva(2); E. Rasskazova(1), Candidate of Medical Sciences; V. Efanov(1), Candidate of
Medical Sciences; A. Tregubova(1); D. Ortabaeva(1); D. Omarova(2); N. Volchenko(1), MD; Professor I.
Reshetov(1, 2), Academician of the Russian Academy of Sciences, MD; A. Zikiryakhodzhaev(1)-3, MD (1)P.A.
Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center (2)I.M.
Sechenov First Moscow State Medical University (Sechenov University) (3)Peoples’ Friendship University of
Russia, Moscow

Objective: to improve relapse-free survival in patients with breast cancer (BC) after organ-sparing surgery (OSS). Subjects and methods. BC occupies a leading place in the pattern of malignant neoplasms among women worldwide and is one of the most important medical and socioeconomic problems. The treatment of BC is complex; however, the mainstay of therapy is surgery. As time elapses, surgical options have evolved from mutilating mastectomies to OSS. Today, oncoplastic resections (OPR) are widely used in oncological practice. Intraoperative assessment of resection margins is important for OSS and OPR. The presence of tumor cells in the resection margins is known to be one of the major factors in the development of local recurrence in patients with BC after OSS. The standard is the surgical practice of creating clean resection margins by re-excision. There are a huge number of publications describing the features of OSS and OPR, but without a detailed depiction of how to mark the resection margins. The development of a unified standard for the morphopathological assessment of operative material and its analysis will ultimately lead to a clearer definition of the relationship between resection margins and local recurrences, which will help decline the number of reoperations.
Keywords: 
oncology
breast cancer
organ-sparing operations
oncoplastic resections
radiation therapy
resection margins
positive R1 resection margins
recurrent breast cancer
intraoperative marginal assessment
positive margins
re-resection

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References: 
  1. Zikirjahodzhaev A.D., Rasskazova E.A. Pokazanija i tehnologija opredelenija kraev rezektsii pri organosohranjajuschih operatsijah pri rake molochnoj zhelezy. V kn.: Mat-ly Bol'shoj konferentsii RUSSCO «Rak molochnoj zhelezy». 22–24 janvarja 2014 g. M., 2014; s. 182–5 [Zikiryakhodzhaev A.D., Rasskazova E.A. Pokazaniya i tekhnologiya opredeleniya kraev rezektsii pri organosokhranyayushchikh operatsiyakh pri rake molochnoi zhelezy. V kn.: Mat-ly Bol’shoi konferentsii RUSSCO «Rak molochnoi zhelezy». 22–24 yanvarya 2014 g. M., 2014; s. 182–5 (in Russ.)].
  2. Davydov M.I., Letjagin V.P. Seminar po klinicheskoj mammologii. M.: ABV-press, 2006; s. 51–3 [Davydov M.I., Letyagin V.P. Seminar po klinicheskoi mammologii. M.: ABV-press, 2006; s. 51–3 (in Russ.)].
  3. Zikirjahodzhaev A.D., Ermoschenkova M.V. Proekt klinicheskih rekomendatsij «Onkoplasticheskie rezektsii pri rake molochnoj zhelezy». V kn.: II Ezhegodnyj kongress Rossijskogo obschestva onkomammologov (ROOM) s mezhdunarodnym uchastiem «Innovatsii v diagnostike i lechenii raka molochnoj zhelezy» 3–5 sentjabrja 2015 g. Sochi, 2015 [Zikiryakhodzhaev A.D., Ermoshchenkova M.V. Proekt klinicheskikh rekomendatsii «Onkoplasticheskie rezektsii pri rake molochnoi zhelezy». V kn.: II Ezhegodnyi kongress Rossiiskogo obshchestva onkomammologov (ROOM) s mezhdunarodnym uchastiem «Innovatsii v diagnostike i lechenii raka molochnoi zhelezy» 3–5 sentyabrya 2015 g. Sochi, 2015 (in Russ.)].
  4. Kachanov I.V., Oganesjan Ju.V. Kutukov V.V. i dr. Organosohranjajuschie podhody k hirurgicheskomu lecheniju raka molochnoj zhelezy. Astrahanskij meditsinskij zhurnal. 2009; 4 (1): 84–8 [Kachanov I.V., Oganesyan Yu.V. Kutukov V.V. et al. Organosokhranyayushchie podkhody k khirurgicheskomu lecheniyu raka molochnoi zhelezy. Astrakhanskii meditsinskii zhurnal. 2009; 4 (1): 84–8 (in Russ.)].
  5. Nevozhaj V.I., Apanasevich V.I. Hirurgicheskoe lechenie raka molochnoj zhelezy: istorija i sovremennye trendy. Tihookeanskij meditsinskij zhurnal. 2016; 61 (4): 11–3 [Nevozhay V.I., Apanasevich V.I. Surgical treatment of a breast cancer: history and trends. Pacific Medical Journal. 2016; 61 (4): 11–3 (in Russ.)]. DOI: 10.17238/PmJ1609-1175.2016.4.11–13
  6. Olijnichenko G.P., Zahartseva L.M., Anikus'ko N.F. i dr. Znachenie gistologicheskogo issledovanija kraja rezektsii tkani pri organosohranjajuschih operatsijah po povodu raka molochnoj zhelezy. Onkologija. 2008; 10 (4): 443–6 [Oliinichenko G.P., Zakhartseva L.M., Anikus’ko N.F. i dr. Znachenie gistologicheskogo issledovaniya kraya rezektsii tkani pri organosokhranyayushchikh operatsiyakh po povodu raka molochnoi zhelezy. Onkologiya. 2008; 10 (4): 443–6 (in Russ.)].
  7. Shtan'ko A.I., Karajani E.V., Timofeev N.F. i dr. Organosohranjajuschaja hirurgija raka molochnoj zhelezy. Zlokachestvennye opuholi. 2014; 3: 103–9 [Shtan’ko A.I., Karayani E.F., Timofeev N.F. et al. Organ-sparing breast cancer surgery. Malignant tumours. 2014; 3: 103–9 (in Russ.)]. https://doi.org/10.18027/2224-5057-2014-3-103-109
  8. Sostojanie onkologicheskoj pomoschi naseleniju rossii v 2018 godu. Pod red. Kaprina A.D., Starinskogo V.V., Petrova G.V. M., 2018; 236 c. [Sostoyanie onkologicheskoi pomoshchi naseleniyu rossii v 2018 godu. Pod red. Kaprina A.D., Starinskogo V.V., Petrova G.V. M., 2018; 236 c. (in Russ.)].
  9. Kulanbaev E.M., Makimbetov E.K. Znachenie kraja rezektsii v mul'tidistsiplinarnom podhode pri lechenii raka molochnoj zhelezy. Sovremennye problemy nauki i obrazovanija. 2018; 6 [Kulanbayev M.E., Makimbetov E.K. The importance of the resection margin at the multidisciplinary approach in the treatment of breast cancer. Modern problems of science and education. 2018; 6 (in Russ.)]. DOI: 10.17513/spno.28158
  10. Portnoj S.M., Blohin S.N., Laktionov K.P. i dr. Hirurgicheskoe lechenie pervichno operabel'nogo raka molochnoj zhelezy. V kn.: Mat-ly XIV Rossijskogo onkologicheskogo kongressa. Moskva 23–25 nojabrja 2010 g. M.: Izdatel'skaja gruppa RONTs im. N.N. Blohina RAMN, 2010; s. 177–85 [Portnoi S.M., Blokhin S.N., Laktionov K.P. et al. Khirurgicheskoe lechenie pervichno operabel’nogo raka molochnoi zhelezy. V kn.: Mat-ly XIV Rossiiskogo onkologicheskogo kongressa. Moskva 23–25 noyabrya 2010 g. M.: Izdatel’skaya gruppa RONTs im. N.N. Blokhina RAMN, 2010; s. 177–85 (in Russ.)].
  11. Allweis T.M., Kaufman Z., Lelcuk S. et al. A prospective, randomized, controlled, multicenter study of a real-time, intraoperative probe for positive margin detection in breast-conserving surgery. Am J Surg. 2008; 196 (4): 483–9. DOI: 10.1016/j.amjsurg.2008.06.024
  12. Aziz D., Rawlinson E., Narod S.A. et al. The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer. Breast J. 2006; 12 (4): 331–7. DOI: 10.1111/j.1075-122X.2006.00271.x
  13. Azu M., Abrahamse P., Katz S.J. et al. What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 2010; 17 (2): 558–63. DOI: 10.1245/s10434-009-0765-1
  14. Balch G.C., Mithani S.K., Simpson J.F. et al. Accuracy of intraoperative gross examination of surgical margin status in women undergoingpartial mastectomy for breast malignancy. Am Surg. 2005; 71 (1): 22–7.
  15. Biglia N., Maggiorotto F., Liberale V. et al. Clinical-pathologic features, long term-outcome and surgical treatment in a large series of patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Eur J Surg Oncol. 2013; 39 (5): 455–60. DOI: 10.1016/j.ejso.2013.02.007
  16. Chagpar A.B., Killelea B.K., Tsangaris T.N. et al. A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer. N Engl J Med. 2015; 373 (6): 503–10. DOI: 10.1056/NEJMoa1504473
  17. Ciocca R.M., Li T., Freedman G.M. et al. Presence of lobular carcinoma in situ does not increase local recurrence in patients treated with breast-conserving therapy. Ann Surg Oncol. 2008; 15 (8): 2263–71. DOI: 10.1245/s10434-008-9960-8
  18. Clarke M., Collins R., Darby S. et al Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366 (9503): 2087–106. DOI: 10.1016/S0140-6736(05)67887-7
  19. Clough K.B., Kaufman G.J., Nos C. et al. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010; 179 (5): 1375–91. DOI: 10.1245/s10434-009-0792-y
  20. Coopey S.B., Buckley J.M., Smith B.L. et al. Lumpectomy cavity shaved margins do not impact re-excision rates in breast cancer patients. Ann Surg Oncol. 2011; 18 (11): 3036–40. DOI: 10.1245/s10434-011-1909-7
  21. Galimberti V., Maisonneuve P., Rotmensz N. et al. Influence of margin status on outcomes in lobular carcinoma: experience of the European Institute of Oncology. Ann Surg. 2011; 253 (3): 580–4. DOI: 10.1097/SLA.0b013e31820d9a81
  22. Gatek J., Vrana D., Lukesova L. et al. Significance of resection margin as a risk factor for local control of early stage breast cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013; 157 (3): 209–13.
  23. Gibson G.R., Lesnikoski B.A., Yoo J. et al. A comparison of ink-directed and traditional whole-cavity reexcision for breast lumpectomy specimens with positive margins. Ann Surg Oncol. 2001; 8 (9): 693–704. DOI: 10.1007/s10434-001-0693-1
  24. Goldstein N.S., Kestin L., Vicini F. Factors associated with ipsilateral breast failure and distant metastases in patients with invasive breast carcinoma treated with breast conserving therapy: a clinicopathologic study of 607 neoplasms from 583 patients. Am J Clin Pathol. 2003; 120 (4): 500–27. DOI: 10.1309/8941-VDAJ-MKY2-GCLX
  25. Gomez C., Shah C., McCloskey S. et al. The role of radiation therapy after nipplesparing mastectomy. Ann Surg Oncol. 2014; 21 (7): 2237–44. DOI: 10.1245/s10434-013-3446-z
  26. Houssami N., Macaskill P., Marinovich M.L. et al. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014; 21 (3): 717–30. DOI: 10.1245/s10434-014-3480-5
  27. Inglebi H., Gershon C.J. Comparative anatomy, pathology, and roentgenology of the breast. Philadelphia: University of Pennsyl vania Press, 1960; 472 p.
  28. Keskek M., Kothari M., Ardehali B. et al. Factors predisposing to cavity margin positivity following conservation surgery for breast cancer. Eur J Surg Oncol. 2004; 30 (10): 1058–64. DOI: 10.1016/j.ejso.2004.07.019
  29. Ling C.S., Weisgerber-Kriegl U., Njue A.I. et al. The effect of positive margins on outcomes in breast cancer. In: Presented at ISPOR 16th Annual European Congress. November 2–6 2013, Dublin, Ireland.
  30. Luini A., Rososchansky J., Gatti G. et al. The surgical margin status after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat. 2009; 113 (2): 397–402. DOI: 10.1007/s10549-008-9929-0
  31. Mamounas E.P. Can we approach zero relapse in breast cancer? Oncologist. 2005; 10 (Suppl. 2): 9–17. DOI: 10.1634/theoncologist.10-90002-9
  32. Marinovich M.L., Azizi L., Macaskill P. et al. The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol. 2016; 23 (12): 3811–21. DOI: 10.1245/s10434-016-5446-2
  33. McCahill L.E., Single R.M., Aiello Bowles E.J. et al. Variaility in reexcision following reast conservation surgery. JAMA. 2012; 307: 467–75. DOI: 10.1001/jama.2012.43
  34. Melnik I., Lifshitz I., Weinshtein P. et al. Intraoperative margin evaluation in breast-conservation surgery using margin probe technique. Harefuah. 2014; 153 (1): 12–4.
  35. Morales Piato J.R., Aguiar F.N., Mota B.S. et al. Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer. Eur J Surg Oncol. 2015; 41 (8): 986–90. DOI: 10.1016/j.ejso.2015.04.019
  36. Moran M.S., Schnitt S.J., Giuliano A.E. et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014; 88 (3): 553–64. DOI: 10.1016/j.ijrobp.2013.11.012
  37. Obedian E., Haffty B.G. Negative margin status improves local control in conservatively managed breast cancer patients. Cancer J Sci Am. 2000; 6 (1): 28–33.
  38. Simmons R.M. et al. Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol. 2002; 9 (2): 165–8. DOI: 10.1007/BF02557369
  39. Smitt M.C., Nowels K., Carlson R.W. et al. Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys. 2003; 57 (4): 979–85. DOI: 10.1016/s0360-3016(03)00740-5
  40. Smitt M.C., Nowels K.W., Zdelick M.J. et al. The importance of the lumpectomy surgical margin status in long-term results of reast conservation. Cancer. 1995; 76: 259–67. DOI: 10.1002/1097-0142(19950715)76:23.0.co;2-2
  41. The American Society of Breast Surgeons. Consensus Guideline on Breast Cancer Lumpectomy Margins 2015; 5470: 15–8. Available at: http://www. breastsurgeons.org
  42. Tartter P.I., Kaplan J., Bleiweiss I. et al. Lumpectomy margins, reexcision, and local recurrence of breast cancer. Am J Surg. 2000; 179 (2): 81–5. DOI: 10.1016/s0002-9610(00)00272-5
  43. Wang J. et al. Predictors of nipple–areolar complex involvement by breast carcinoma: Histopathologic analysis of 787 consecutive therapeutic mastectomy specimens. Ann Surg Oncol. 2012; 19 (4): 1174–80. DOI: 10.1245/s10434-011-2107-3
  44. Zurrida S., Costa A., Luini A. et al. The Veronesi quadrantectomy an established procedure for the conservative treatment of early breast cancer. Int J Surg Investigat. 2001; 6 (12): 423–31. DeSnyder S.M., Hunt K.K., Smith B.D. et al. Assessment of Practice Patterns Following Publication of the SSO-ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer. Ann Surg Oncol. 2015; 22 (10): 3250–6. DOI: 10.1245/s10434-015-4666-1