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Abstract
Introduction. Surgery is fundamental in complex treatment of breast cancer (BC). The main indicator of safety of the breast-conserving surgery (BCS) is a negative resection margin. The standard surgical practice is re-excision in case the resection margin contains cancer cells. However, the BCS goal is to preserve volume and shape of the breast and, if possible, to remove less surrounding tumor tissue, which is associated with a minimal risk of recurrence. Aim. To assess and analyze surgery performed during BCS and oncoplastic procedures for BC using a planned pathomorphological examination of the resection margins status.
Materials and Methods. 2,168 conservative surgeries were analyzed; patients were divided in two groups depending on the neoadjuvant systemic therapy (NST). The first group included 1,357 patients who didn’t receive NST before surgery; the second group included 811 patients who underwent NST. Subset analysis of the positive resection margin (R1) detection rate was carried out or without intraoperative resection margin on the X-ray device. After each BCS, resection margin status was assessed on planned histologic examination for the presence of the tumor cells, with subsequent analysis of the frequency of reoperations when R1 was found.
Results. In 2 168 tested surgical specimens after BCS, R1 was found in 111 (5.11 %) cases. From 1357 first group patients after BCS, R1 was found in 83 (6.11 %) cases; from 811 surgeries conducted in the second group R1 was found in 28 (3.45 %) cases. Reoperations were performed in 80 cases and tumor cells were found in 28 cases on follow-up pathomorphological examination. Intraoperative X-ray assessment was performed in 705 (32.5 %) patients; R1 was detected in 17 (2.4 %) cases, which reduced the number of reoperations.
Conclusion. Today the gold standard for accurate assessment of resection margins status remains postoperative morphological examination of resection margins. Unfortunately, this method cannot influence the intraoperative decision of a surgeon. Intraoperative X-ray examination of the resection margins can reduce the frequency of repeated surgical interventions due to timely detection.
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