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Breast Conservation and Negative Margins in Invasive Lobular Carcinoma: The Impact of Oncoplastic Surgery and Shave Margins in 358 Patients

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

Abstract

Background

Invasive lobular carcinoma (ILC) of the breast grows in a diffuse pattern, making complete surgical excision difficult. This results in high rates of positive margins and low rates of successful breast-conserving surgery. We hypothesized that utilizing oncoplastic surgical techniques and selective shave margins would be associated with lower positive margin rates and increased breast conservation in women with ILC.

Methods

We performed a retrospective cross-sectional analysis in a large cohort of prospectively collected ILC cases who received surgical treatment at the University of California, San Francisco, between 1992 and 2017. We identified all patients with histologically proven, unilateral or bilateral, stage 1–3 ILC. The primary outcome was positive margin rates, defined as no ink on tumor.

Results

We identified 365 tumors in 358 women, with an average age of 61 years, who underwent breast-conserving surgery, and found that the use of oncoplastic techniques (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.21–0.79, p = 0.008) and the selective use of shave margins (OR 0.393, 95% CI 0.22–0.7, p = 0.002) were significantly associated with lower positive margin rates, when adjusted for tumor size and multifocality. The success rate for breast-conservation surgery was 75%, with a 25% conversion rate to mastectomy.

Conclusions

Surgeons should consider routine use of oncoplastic techniques and shave margins when performing breast-conservation surgery for women with ILC as these methods are associated with significantly lower odds of having positive margins and higher breast-conservation rates.

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Acknowledgment

The authors would like to thank Pamela Derish, MA, from the UCSF Department of Surgery, for editorial assistance and manuscript preparation.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA

    Rita A. Mukhtar MD, Jasmine Wong MD, Zelos Zhu BS, Kelly Fahrner-Scott BA, Matina Mamounas BS, Michael Alvarado MD, Cheryl Ewing MD & Laura Esserman MD, MBA

  2. Division of Plastic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Merisa Piper MD, Hani Sbitany MD & Robert Foster MD

Authors
  1. Rita A. Mukhtar MD
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  2. Jasmine Wong MD
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  3. Merisa Piper MD
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  4. Zelos Zhu BS
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  5. Kelly Fahrner-Scott BA
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  6. Matina Mamounas BS
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  7. Hani Sbitany MD
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  8. Michael Alvarado MD
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  9. Robert Foster MD
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  10. Cheryl Ewing MD
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  11. Laura Esserman MD, MBA
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Corresponding author

Correspondence to Rita A. Mukhtar MD.

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Mukhtar, R.A., Wong, J., Piper, M. et al. Breast Conservation and Negative Margins in Invasive Lobular Carcinoma: The Impact of Oncoplastic Surgery and Shave Margins in 358 Patients. Ann Surg Oncol 25, 3165–3170 (2018). https://doi.org/10.1245/s10434-018-6682-4

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  • DOI: https://doi.org/10.1245/s10434-018-6682-4

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