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Predictors of Re-excision among Women Undergoing Breast-Conserving Surgery for Cancer

¹ Section of General Surgery, Department of Surgery, University of Michigan, Ann Arbo, Michigan, USA
² Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, University of Michigan, 6312 Medical Sciences Building I 1150 West Medical Center Drive, Ann Arbor, Michigan 48109, USA
³ Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbo, Michigan, USA
⁴ Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Care System, Ann Arbor, Michigan, USA

Correspondence: Address correspondence and reprint requests to: Jennifer F. Waljee, MD, MPH; E-mail: . filip{at}med.umich.edu

Background: Up to 60% of breast cancer patients who undergo breast-conserving surgery (BCS) require re-excision to obtain clear margins, causing delays in adjuvant treatment and poor aesthetic results. However, patient and treatment-related factors associated with re-excision are not well defined.

Methods: We surveyed all women undergoing breast conserving surgery between January 2002 and May 2006 regarding their breast disease (n = 714, response rate = 79.5%). The medical record was reviewed to determine the receipt of re-excision lumpectomy following BCS, and obtain tumor stage, histology, and biopsy method (surgical versus needle biopsy). Patient age, breast size, tumor location in the breast, and receipt of chemotherapy were self-reported. Logistic regression was used to determine significant predictors of re-excision lumpectomy.

Results: In this sample, 51.4% of women required only one breast excision, 41.9% required two breast excisions, and 6.6% required three breast excisions. Overall, 10.8% of women required a mastectomy following initial attempt at BCS. Factors significantly correlated with re-excision lumpectomy included smaller breast size (A cup: OR = 2.7; 95%CI: 1.32–5.52; B cup: 1.63; 95%CI: 1.02–2.62), lobular histology (OR = 1.93; 95%CI: 1.15–3.25), and receipt of surgical biopsy (OR = 3.35; 95%CI: 2.24–5.02). Women who received adjuvant chemotherapy (OR = 2.49; 95%CI: 1.19–5.22) were more likely to require re-excision compared with women who received neoadjuvant chemotherapy.

Conclusions: Re-excision lumpectomy is common, and is significantly correlated with smaller breast size, lobular histology, surgical biopsy, and chemotherapy timing. Attention to these risk factors can improve the quality of care delivered to BCS patients by decreasing the cost and morbidity associated with multiple re-excision procedures.

Key Words: Breast-conserving surgery • Reoperation • Neoadjuvant chemotherapy • Diagnostic technique

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