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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2009 June;22(3):129-32
Breast conservation therapy with separate cavity margins excision in breast cancer: a different approach to the classic quadrantectomy
Paludetti A., Mangiarotti S., Mauri E., Ferro M., Borgo M. F., Fenaroli P.
Senology, Surgery II, Bergamo Hospitals, Bergamo, Italy
Aim. Breast conservation therapy (BTC) requires the tumor resection, clear margins, while maintaining an acceptable aesthetic result. Classic quadrantectomy includes en-bloc resection of the tumor with at least 2-3 cm of surrounding macroscopically healthy tissue. Smaller resections have an increased risk of relapse. This article proposes quadrantectomy in two different steps: lumpectomy plus separate cavity margins (CM) excision.
Methods. This study enrolled 144 consecutive patients undergoing BCT. Data collected included patients age, tumor size, minimal lumpectomy size, thickness of the margins, tumor type, margin involvement, and local recurrence.
Results. Mean follow-up period for the enrolled patients was 64 months. The mean tumor size measured pathologically was 1.6 cm. The dimension of the lumpectomy containing the tumor measured on the minor axis has been mean 2.9 cm and all the tissue removed (lumpectomy plus margins) measured a mean thickness of 5.2 cm. The thickness of the tissue removed from CMs measured a mean of 2.2 cm. In 17 cases (11%) a tumor located at <2 mm from the margins was found and this cases underwent further surgery. In the follow-up there were two cases (1.4%) of local relapse.
Conclusion. This technique allows to extend BCT also to small breasts and in patients with unfavorable breast/tumor ratio. The selective approach to margins reduces the amount of tissue excised with good esthetic results and without compromising the oncological excision.