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A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens With Positive Margins

From the Departments of Surgery, Dartmouth-Hitchcock Medical Center (GRG, LAM, RJB), Lebanon, New Hampshire; Beth Israel-Deaconess Medical Center (B-AL, JY), Boston, Massachusetts; and Women and Infants’ Hospital (BC), Providence, Rhode Island.

Correspondence: Address correspondence and reprint requests to: Richard J. Barth Jr., MD, Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756; Fax: 603-650-8030; E-mail: richard.j.barth.jr{at}dartmouth.edu

Background: Excising a breast tumor with negative margins minimizes local recurrence. With a positive margin, the standard re-excision consists of excising the whole cavity and all surrounding breast tissue. By marking the sides of the lumpectomy specimen with six different colored inks, the surgeon can limit the re-excision to the involved margin. We compared the local recurrence rate after these two re-excision methods.

Methods: Records were reviewed of 527 women (546 breasts) treated with lumpectomy at two institutions. The log-rank test was used to compare the local recurrence–free survival.

Results: Of 546 tumors, 245 (45%) had negative margins on the initial lumpectomy and were not re-excised. Fifty-five percent had a positive or close margin; 181 underwent whole-cavity re-excision, and 120 had ink-directed re-excision. The mean follow-up time was 3.4 years. There was no significant difference in local recurrence for the patients whose initial margin was negative (3.7%) compared with the 243 patients with initially positive margins who underwent a re-excision (3.3%). Eleven of 181 (6%) patients undergoing a whole-cavity re-excision developed a local recurrence, compared with none of 120 (0%) patients with an ink-directed re-excision (P = not significant). Tissue mass excised was significantly smaller in the ink-directed group (23 vs. 83 g, P < .05).

Conclusions: Ink-directed re-excision of lumpectomy specimens with positive margins minimizes the amount of breast tissue removed without increasing the incidence of local recurrence and is therefore preferable to the standard whole-cavity method.

Key Words: Breast cancer • Ductal carcinoma in situ • Surgery • Margins

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