Does Nipple-Ward Positive Margin Contribute to a Higher Rate of Re-Excision Procedures After a Lumpectomy with Pathology-Confirmed Positive Margins? A Retrospective Study

Figures & data

Table 1 Patients’ Demographic and Pathological Information Along with the Type of Surgery Performed as the Re-Excision Procedure

Total Patients	98
Age, y, mean (SD)	61.4 (12.4)
Race/ethnicity
White	18 (18.3%)
Black	34 (34.7%)
Hispanic	39 (39.8%)
Asian/Pacific Islander	7 (7.1%)
BMI, mean (SD)	29.9 (6.6)
Laterality
Left	40 (40.8%)
Right	58 (59.2%)
Procedure following positive margins
Lumpectomy	73 (74.5%)
Mastectomy	25 (25.5%)
SLNB	28 (28.6%)
ALND	6 (6.1%)
Pathology
In situ Carcinoma	41 (41.8%)
Invasive Carcinoma	57 (58.2%)
Receptor Status
ER+	78
PR+	67
HER2+*	3
Triple Negative	10
N/A**	2
Stage
0	41 (41.8%)
1	40 (40.8%)
2	13 (13.3%)
3	4 (4%)
4	0
Neoadjuvant therapy	14 (14.3%)
Margin pathology
Ductal Carcinoma in Situ (DCIS)	41 (41.8%)
Invasive Ductal Carcinoma (IDC)	14 (14.3%)
Mixed (IDC+DCIS)	38 (38.8%)
Invasive Lobular Carcinoma (ILC)	5 (5.1%)

Notes: *HER2 receptor status was not performed on all patients **N/A includes data of the patients where the pathological sample was too small to assess the receptor status.

Figure 1 Example of positive inferior margin defined as positive nipple-ward margin for a lesion at 12:00.

Figure 2 (A) Frontal view of the breast highlighting the cancer (black mass) at 12’o clock in relation to the nipple with inferior margin positive (yellow) demonstrating cancer spread in the nipple-ward direction. (B) A lateral view of the breast highlighting the tumor (black mass) at 12 o’clock with a positive inferior margin (yellow) illustrating cancer spread in the nipple-ward direction.

Table 2 Nipple-Ward Margin Stratification

Margin Stratification	N = 98
0 = Single Margin Positive Non-Nipple-ward	19 (19.4%)
1 = Single Margin Positive Nipple-ward	26 (26.5%)
2 = Multiple Margin Positive Nipple-ward*	21 (21.4%)
3 = Multiple Margin Positive Non-Nipple-ward**	32 (32.7%)
Total Single Margin Positive	45 (45.9%)
Total Multiple Margin Positive	53 (54.1%)
Total Positive Nipple-ward Margin	47 (48%)
Single Margin Nipple-ward Positive	26 (55.3%)
Multiple Margin Nipple-ward Positive	21 (44.7%)

Notes: *Multiple margins positive less than 4 with at least 1 margin in the nipple-ward direction. **Multiple margins positive 4 or more.

Figure 3 Lateral view of the breast highlighting: (A) traditional spherical resection of tumor, (B) recommended elliptical resection in the nipple-ward direction.