Preoperative and intraoperative predictors of positive margins after breast-conserving surgery: a retrospective review

Breast-conserving therapy is an established treatment for early breast cancer. Current practice mandates reoperation for positive margins. Presently most patients are brought to the operating room with a diagnosis of breast cancer made on core biopsy. Preoperative and intraoperative predictors of margin status are needed. A retrospective review of patients with adenocarcinoma proven on core biopsy undergoing breast-conserving surgery between 2000 and 2007. Clinical, radiographic, pathological, and operative data were collected. These were correlated with margin status on excision. One hundred twenty-seven patients met the inclusion criteria. Predictors of positive margins at lumpectomy were younger age, larger size on imaging, calcifications on mammography, multifocality, ductal carcinoma in situ (DCIS) or necrosis on core biopsy, and close margins on specimen films. In the era of preoperative diagnosis of breast cancer with core biopsy, several pre- and intraoperative predictors of positive margins are identified that can aid the surgeon in surgical planning.