Does Gross Margin Examination Reduce Re-excision Rate in Breast Conservation for Invasive Carcinoma? CALLER Review

Abstract

Objective: Determine if Gross Margin Examination reduces margin re-excision rate. Our institutional practice is to perform Gross Margin Examination (GME) with Real-time re-excision (RRE) for all breast conservation specimens with Invasive Carcinoma. Materials and Methods: Chart review was done to determine if this practice is helpful. 51 CALLER charts were reviewed from December 2016 to December 2017. Results: Thirty-three underwent margin RRE based on the GME. 11 had cancer in the re-resected margin, 6 of which were cleared with the RRE. The other 5 were reoperated on to clear the margin because on final pathology a margin other than the re-resected margin was positive for malignancy. GME was helpful in preventing reoperation in 55%. None of the remaining 22 patients receiving were found to have a positive margin on final pathology, with 1.6 margins on average re-resected. 13/18 patients did not have RRE and had a final clear margin, but of the other 5, final margin was positive for DCIS in 2 and Invasive Cancer in 3. GME missed invasive disease at the margin in 3 of these 18 patients. Conclusion: GME was helpful in preventing reoperation in 6 of 11 patients who would have had a positive margin. However, this resulted in the unnecessary removal of additional normal breast tissue in 22 patients. 3 patients’ positive margins were missed with GME and required reoperation. 13 patients were able to avoid re-excision and 11 were able to clear their margin in real-time, improving outcomes 24/51 patients. GME therefore does appear useful.