680例乳腺癌保留乳房治疗的远期疗效分析

目的探讨对临床Ⅰ、Ⅱ期乳腺癌患者选择性行乳腺癌保留乳房治疗（BCT）的远期生存、同侧乳房复发（IBR）、美容效果及其相关因素。方法1985年10月至2007年12月共对680例临床Ⅰ、Ⅱ期乳腺癌开展BCT临床研究。乳腺癌保乳手术先后采用乳腺象限／区段切除术及肿瘤扩大切除术，联合全腋淋巴结清扫术或前哨淋巴结活检术。术后放疗先后采用Co^60及加速器全乳放疗及瘤床缩野照射。结果中位随访10年，680例BCT患者10年总生存率IBR83．7％、同侧乳房复发为8．5％、远处转移率为23．7％。患者年龄、肿瘤大小、病理组织学类型、腋淋巴结转移状况等临床病理因素对BCT后IBR差异无统计学意义（均P〉0．05）；切缘阳性、术后未行全乳照射的患者IBR显著升高（均P=0．000）。在确保切缘阴性的前提下，不同切除范围的手术方式对IBR差异无统计学意义（P=0．799），但切除范围较大的区段／象限切除术对BCT后乳房美容效果差异有统计学意义（优秀组P=0．043，优秀＋良好组P=0．005）。结论临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较好的远期疗效、较好的美容效果和较低的IBR，可以安全地替代乳房切除性手术；确保切缘阴性及接受术后全乳放疗仍是现阶段乳腺癌BCT的金标准；在确保切缘阴性的前提下，切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。     

Plastic surgery and conservative treatment of breast cancer. Indications and results]

After conservative treatment for breast cancer, 75% of patients have good cosmetic results, but 20 to 25% of patients have a fair or a bad result. The tumor itself is responsible for some of these bad results (tumor volume, location in the inferior quadrants of the breast) but more often, failures are related to surgery and/or radiotherapy. Some patients will then ask for reconstructive surgery. It should always be preceded by a careful examination of the breast, both with an oncologic and a reconstructive approach. The techniques used are numerous, ranging from simple reexcision of the lumpectomy scar to mastectomy with immediate TRAM flap reconstruction. We believe that plastic surgery techniques should be used as soon as the initial lumpectomy, as they help to fill in the defect. In the case of a tumor located in the inferior quadrants, bad cosmetic results are twice as frequent as in the upper quadrants: we treated 16 of these patients with immediate bilateral breast reduction, reshaping the breast at the same time as the lumpectomy, and achieving symmetry of the contralateral breast. This technique did not interfere with radiotherapy or chemotherapy. When radiotherapy followed surgery, cosmetic results were good. Local and distant recurrences were not modified by the adjunction of a breast reduction to the lumpectomy. In 49 cases, we also proposed a bilateral breast reduction for larger tumors (T > 3 cm, bifocal cancer). 4-year local recurrence rate was less than 10%: this technique could help to extend the indications for conservative treatment for breast cancer. More cases and longer follow-up are necessary.     

Axilloscopy and endoscopic sentinel node detection in breast cancer patients

Background: Sentinel node biopsy is a promising technique that allows the axillary status of breast cancer patients to be predicted with high accuracy. Reducing false negative results remains a major challenge for the improvement of this procedure. Furthermore, new techniques are required to achieve axillary clearing with less morbidity in cases of unsuccessful mapping or multicentric carcinoma. We analyzed whether axilloscopy and endoscopic sentinel node biopsy is a feasible procedure for visualization of the axillary space and resection of the sentinel node using endoscopic techniques. Methods: Following blue dye–guided lymphography and liposuction of the axillary fat, endoscopic axillary sentinel node biopsy was performed in 35 breast cancer patients. We then assessed the exposure of anatomical landmarks, the detection rate of the sentinel node, the false negative rate, and the accuracy of consecutive axillary clearing. Results: In almost every case, an excellent anatomical orientation was achieved. The detection rate for the sentinel node was 83.3%. In one case, the sentinel node did not reflect the status of the residual axilla. A mean number of 17.1 lymph nodes was harvested at consecutive axillary clearing. Conclusions: Axilloscopy and endoscopic sentinel node biopsy, following liposuction of the axillary fat, is a feasible procedure that allows identification and minimally invasive resection of the sentinel node with high accuracy. The endoscopic approach might help to minimize the pitfalls of sentinel node biopsy by visualizing the axillary space. In future, it may become a technique that enables minimally invasive axillary clearing when complete lymphadenectomy is required. Received: 7 April 1999/Accepted: 16 December 1999/Online publication: 17 April 2000     

A large epidermoid cyst of breast mimicking carcinoma: A case report and review of literature

INTRODUCTIONTriple assessment of a suspicious breast lesion may not always provide a definite diagnosis. We report a case of epidermoid cyst of breast, which caused diagnostic dilemma in spite of a thorough triple assessment and entailed mastectomy.PRESENTATION OF CASEA 69-year-old woman presented with a large painful retroareolar left breast mass. Clinical examination, ultrasound and mammography were highly suspicious of malignancy. However, core biopsy suggested a benign lesion. Due to size of the lesion and diagnostic uncertainty, various options were discussed with the patient. She opted for a simple mastectomy. The histology confirmed a large epidermoid cyst.DISCUSSIONIt is rare for an epidermoid cyst to present as such an advanced lesion, mimicking carcinoma. Excision of such a large retroareolar ‘benign’ lesion, however, may sometime entail mastectomy. This is the first reported case of an epidermoid cyst of breast necessitating mastectomy.CONCLUSIONDiagnostic dilemma while dealing with a suspected breast cancer is not rare. Involvement of multidisciplinary team as well as patient is important in the decision-making. The report illustrates a rare presentation of a deep seated large epidermoid cyst of breast, which mimicked carcinoma, caused diagnostic confusion and entailed mastectomy. We strongly advocate the option of breast reconstruction in such cases.     

乳晕边缘小切口切除乳房多发或巨纤维腺瘤

目的探索采用乳晕边缘小切口切除乳房多发或巨大良性纤维腺瘤,达到既切除病灶又能起到美容目的的可行性。方法2006年1月～2008年2月选择46例乳房多发良性纤维腺瘤和2例巨纤维腺瘤（〉7cm）,根据多数肿瘤或巨大肿瘤存在的部位,选择不同象限的乳晕边缘切口,切口长度不超过乳晕周长的1/2。对于多发乳房良性肿瘤,在皮下脂肪和腺体之间潜行游离到肿瘤表面,放射状切开肿瘤表面的腺体,将肿瘤完整切除;对于巨大良性肿瘤,同法切开腺体至肿瘤表面,将肿瘤分块全部切除。结果46例多发乳房纤维腺瘤共计切除肿瘤165个,其中1例双侧乳房肿瘤数量达19个,均完整切除;乳房巨纤维腺瘤2例,肿瘤最大直径8cm,也将肿瘤完整切除。乳晕边缘切口长度〈3.5cm,术后均未发生乳头坏死。48例随访1～24个月,平均14.4月,11例切口瘢痕不明显,26例注意观察才能发现切口瘢痕,9例比较容易看到切口瘢痕,2例因瘢痕体质切口瘢痕明显。结论乳晕边缘小切口切除乳房多发或巨纤维腺瘤,手术方法简便易行,可达到较好的美容效果,值得推广。     

超声定位下可疑淋巴结取样在早期乳腺癌手术中的临床研究

目的 探讨早期乳腺癌更为合理的腋窝淋巴结处理方法,明确腋窝可疑淋巴结取样结合前哨淋巴结活检(SLNB)替代单纯SLNB时的假阴性率是否明显降低,为临床应用提供依据.方法 采用传统的腋窝淋巴结外科学分群方法,对符合入组条件的42例早期乳腺癌患者术前行B超引导下钩丝定位,术中行腋窝SLNB和定位的可疑淋巴结活检,再行全腋窝...     

经胸乳入路腔镜甲状腺切除术影响美容效果的因素分析

目的:探讨影响腔镜甲状腺切除术美容效果的因素.方法:为43例患者采用经胸部乳晕入路行腔镜甲状腺肿瘤切除术,其中甲状腺腺瘤26例,结节性甲状腺肿16例,甲状腺癌1例.结果:41例手术获得成功,26例行单侧甲状腺包块切除术,15例行甲状腺腺叶大部切除术.2例中转开放手术.手术时间80 ～ 140 min,平均100.5 m...     

PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价

目的：评价PET／CT诊断乳腺癌和腋窝淋巴结转移的临床价值。方法：对33例疑似乳腺癌病人进行PET／CT检查，定性分析肿瘤病灶、淋巴结摄取氟脱氧葡萄糖（FDG）的程度，半定量测量标准摄取值（SUV），根据乳腺和淋巴结的FDG摄取强度诊断乳腺癌和淋巴结转移，检验SUV与乳腺癌分化程度、有丝分裂计数的关联性。结果：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度和精确度分别为92．6％、100％、93．9％和82．3％、90％、85．2％；SUV与乳腺癌分化程度、有丝分裂计数显著相关（P〈0．05）；诊断乳腺癌的Kappa指数=0．835，μ=8．48，（P〈0．01）。结论：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度较高，作为一种非侵袭性检查方法，可提供乳腺癌在活体内的多方面生物学信息，为选择合理的手术方式及新辅助化疗提供参考，弥补传统检查方法的不足。     

Treatment of the axilla by tangential breast radiotherapy in women with invasive breast cancer

BACKGROUND: The objective of this study was to determine if standard tangential breast radiation covered the sentinel lymph node in women with invasive breast cancer. METHODS: Women with invasive breast cancer treated by lumpectomy, radiotherapy and sentinel node biopsy at our institution were included in this study if the sentinel lymph node site had been marked with a clip. Plain films were used to determine if the clip fell within the tangential fields. RESULTS: Between April 1999 and May 2001, 36 women with invasive breast cancer treated by lumpectomy, sentinel lymph node biopsy and breast radiation were identified. Median age was 56 years (range 34 to 80) with a median tumor size of 1.1 cm (range 0.3 to 2.9 cm). The clip marking the sentinel lymph node fell within the tangential fields in 34 of 36 (94%) of the patients. The radiation dose to the clip area was greater than 4,400 cGy in 50% of those calculated by three-dimensional techniques. CONCLUSIONS: The sentinel lymph node is located within classic tangential fields in the overwhelming majority of women with invasive breast cancer. The extent of the radiation fields, and ultimately the final dose, may need to be modified if the intent is for prophylactic treatment.     

Intraoperative Gamma Detection Of125I-Lanreotide in Women With Primary Breast Cancer

Background: Somatostatin receptors are present in most human breast cancers. We performed a pilot trial of intraoperative tumor-gamma detection using the radiolabeled somatostatin analog 125I-lanreotide in 13 women with 14 primary breast carcinomas.Methods: All patients were given¹²⁵I-lanreotide intravenously before surgery. Patients underwent lumpectomy, and postresection margins were evaluated with the gamma probe. Axillary dissection specimens were evaluated ex vivo.Results: Seven of 13 women had gamma probe-positive or clinically suspicious margins reexcised at the time of lumpectomy. Four of six probe-positive margins were histologically positive, and two of six probe-positive margins were histologically negative; a single clinically suspicious margin was histologically positive. A total of 270 axillary lymph nodes were evaluated ex vivo by gamma probe and histology. McNemars contingency tests demonstrated a highly statistical correlation between histology and gamma probe counts (P < .0001).Conclusions: The overall accuracy of nodal evaluation with¹²⁵I-lanreotide/intraoperative gamma detection was 77%; the negative predictive value of this technique was 97%, however. This technique predicted the presence of tumor in 20% of axillary lymph nodes that were negative by routine histology. This technique appears safe and is able to detect positive tumor resection margins and accurately predict axillary lymph node negativity. Further trials of this technique are required to validate its utility.     

The thoracoscopic approach for internal mammary nodes in breast cancer

Background: This pilot study was conducted to estimate the use of the thoracoscopic surgery as a new approach for the internal mammary nodes (IMN) in breast cancer. Patients and methods: For this study, 21 women with breast cancer who underwent the approach for nodes IMN were enrolled. All the women had suspicious IMN metastasis and no distant metastasis. Results: Thoracoscopic IMN dissection was performed safely for 20 of the women, with an average operative time of 44 min. One woman was excluded from the procedure because of pleural adhesion. The patients were restricted from walking for 1.3 days because of chest drainage, but no patients had severe complication or chest wall deformity after the operation. Six patients had positive IMN outcomes. After surgery, 10 of the 20 patients had a lower tumor node metastases (TNM) staging. Two patients who tested positive for IMN and three who tested negative experienced a relapse, but none had pleural dissemination in a median follow-up period of 24 months. Conclusion: Thoracoscopic surgery may be useful in managing patients with IMN. Received: 2 June 1999/Accepted: 17 January 2000/Online publication: 29 August 2000     

The Role of Ultrasound-Guided Fine-Needle Aspiration of Axillary Nodes in the Staging of Breast Cancer

Background As a complement to sentinel node dissection (SLND), we evaluated ultrasound-guided fine-needle aspiration (USFNA) of normal and abnormal axillary nodes in breast cancer patients. We hypothesized that USFNA would be accurate for primary breast tumors larger than 2 cm. Methods We retrospectively reviewed 68 patients who underwent 69 preoperative USFNAs from 2003 to 2005. The results of 65 preoperative USFNA were compared with the results of SLND or axillary node dissection (ALND) for concordance. Four USFNAs were excluded from analysis because of a complete response to neoadjuvant therapy. We evaluated whether primary tumor features (histology, size, grade, vascular invasion, estrogen/progesterone receptor status and Her-2-neu status) predicted concordance of USFNA results and the final lymph node pathology. Results Of 65 axillae analyzed, 39 (60%) were positive, four (6%) were non-diagnostic, and 22 (34%) were negative by USFNA. USFNA had 89% sensitivity, 100% specificity, and 100% positive predictive value (PPV) in patients with palpable or ultrasonographically suspicious nodes. USFNA sensitivity dropped significantly for nonpalpable, ultrasonographically normal nodes (54%), while specificity and PPV remained 100%. None of the primary tumor features predicted concordance of USFNA and SLND/ALND. Conclusions USFNA of axillary nodes has a high specificity and PPV in clinically or radiologically suspicious nodes. Sensitivity of USFNA is low for nodes of normal appearance, but positive USFNA may allow definitive management of the axilla without a SLND. Thus, USFNA of normal appearing nodes might be beneficial in cases where decisions regarding neoadjuvant chemotherapy would be affected by the results.     

Mucinous breast carcinoma: a large contemporary series

BACKGROUND: Mucinous breast cancer is typically associated with a favorable prognosis. This study aimed to assess recent trends and prognostic features in the treatment of mucinous breast carcinoma. METHODS: A retrospective review of our database of patients who presented with mucinous breast cancer was performed. We evaluated patient and tumor characteristics and examined the relationships between these factors and risk for locoregional recurrence. RESULTS: One hundred eleven patients with mucinous breast cancer were identified. Seventy-one (64%) underwent lumpectomy with radiotherapy. Fourteen (13%) had lymph node metastasis, and node positivity was associated with larger tumor size; node-positive patients had a mean tumor size of 2.7 cm compared with 1.5 cm for node-negative patients (P = .0003). No patients with tumor size <1 cm had lymph node metastasis. Five patients (5%) had local and/or distant recurrence. CONCLUSIONS: Mucinous breast cancer is associated with a low recurrence rate as well as a low incidence of lymph node metastasis. In patients with small (<1 cm) tumors, consideration for deferring nodal evaluation may be made.     

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy Is Accurate in Breast Cancer Patients with a Clinically Negative Axillary Nodal Status at Presentation

Background In breast cancer, neoadjuvant chemotherapy (NAC) is widely used in order to enable a conservative surgery. In patients treated with NAC, the use of sentinel lymph node (SLN) biopsy, which is a good predictor of the axillary nodal status in previously untreated patients, is still discussed. The aim of our study was to determine clinicopathological factors that may influence the accuracy of SLN biopsy after NAC. Methods Between March 2001 and December 2006, 129 patients with infiltrating breast carcinoma were studied prospectively. Preoperatively, all of them underwent NAC. At surgery, SLN biopsy followed by axillary lymph node (ALN) dissection was performed. Lymphatic mapping was done using the isotope method. Results The SLN identification rate was 93.8% (121/129). Fifty-six out of the 121 successfully mapped patients had positive ALN. Eight out of these 56 patients had tumor-free SLN (false-negative rate of 14.3%). The false-negative rate was correlated with larger tumor size (T1-T2 versus T3; P = 0.045) and positive clinical nodal status (N0 versus N1-N2; P = 0.003) before NAC. In particular, the false-negative rate was 0% (0/29) in N0 patients and 29.6% (8/27) in N1-N2 patients. Clinical and pathological responses to NAC did not influence the accuracy of SLN biopsy. Conclusion Our results show that clinical nodal status is the main clinicopathological factor influencing the false-negative rate of SLN biopsy after NAC for breast cancer. SLN biopsy after NAC can predict the ALN status with a high accuracy in patients who are clinically lymph node negative at presentation.     

The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery

BACKGROUND: It is unclear whether the additional removal of breast tissue during breast-conserving therapy (BCT) for breast cancer beyond the standard lumpectomy reduces the incidence of inadequate microscopic margins found at pathological examination and subsequent reoperation. This study compares the reoperative rates after initial BCT in 3 groups of patients who underwent lumpectomy with complete resection of 4 to 6 additional margins, lumpectomy with selective resection of 1 to 3 additional margins, or standard lumpectomy. METHODS: Retrospective data were reviewed from 171 selected cases of BCT, from May 2000 to February 2006. Forty-five cases involved lumpectomy with complete resection of 4 to 6 additional margins; 77 involved lumpectomy with selective resection of 1 to 3 additional margins, whereas 49 involved standard lumpectomy. All samples underwent pathologic analysis of inked resection margins by permanent section. The 3 groups were compared for patient demographics, tumor size and histologic subtype, tumor stage, margin status, excised specimen volume, and eventual subsequent reoperation. Adequate surgical margin was defined as any negative margin greater than 2 mm. RESULTS: The group with complete resection of 4 to 6 additional margins had a subsequent reoperation rate of 17.7%, whereas the group with selective resection of 1 to 3 additional margins and the standard lumpectomy group had a subsequent reoperation rate of 32.5% and 38.7%, respectively, because of inadequate margins. The mean total excised specimen volume in the 3 groups was 129.19, 46.04, and 37.44 cm3, respectively. CONCLUSIONS: The complete resection of 4 to 6 additional margins during the initial BCT resulted in the lowest subsequent reoperation rate, and the largest total volume specimen excised among the 3 techniques studied.     

广泛切除和局部肿块切除术治疗乳腺分叶状肿瘤的临床效果比较

目的比较广泛肿块切除术与乳腺局部肿块切除术治疗乳腺分叶状肿瘤的临床效果。方法选取2005-08—2010-10间接受治疗的80例乳腺分叶状肿瘤患者,按治疗方法不同,分为广泛肿块切除术组(A组)45例,局部肿块切除术组(B组)35例,分别以患者患侧肢体运动能力、无疾病生存期和中位生存时间等评价指标对2组进行比较分析。结果术后病理均诊断为乳腺分叶状肿瘤,其中良性A组30例(67%),B组23例(66%);交界性A组10例(22%),B组7例(20%);恶性A组5例(11%),B组5例(14%)。术后第12个月B组患者的外展、外旋、摸高高度功能显著优于A组患者(P0.05);而2组患者的肌力、前屈、后伸、内旋功能比较并无显著性差异(P0.05)。术后60个月,A组和B组患者的5 a中位生存时间分别为56个月和55个月(P=0.693);5 a复发率分别为24.14%和44.44%(P=0.061),差异均无统计学意义(P0.05)。A组患者的无疾病生存期为52个月,较B组的47个月显著延长(P=0.025),A组和B组交界性和恶性患者的5 a生存率分别为10.28%和11.17%(P=0.724)。结论广泛肿块切除术较乳腺局部肿块切除术对交界性和恶性乳腺分叶状肿瘤患者的预后更为有利,在患者情况允许的条件下应尽量考虑选择此术式。     

Optimal surgical treatment of invasive lobular carcinoma of the breast

Background: The roles of breast conservation and surgical evaluation of the contralateral breast in the treatment of lobular carcinoma of the breast remain unclear. The aim of this study was to compare local recurrence, 5-year survival, and incidence of contralateral breast cancer in women with lobular carcinoma to that in women with infiltrating ductal carcinoma. Methods: Women with infiltrating ductal carcinoma (IDC) and invasive lobular breast carcinoma (ILC) diagnosed during the years 1984 to 1994 were identified through a statewide tumor registry. The women were divided into groups based on their histology and treatment (breast conservation or modified radical mastectomy). The incidences of contralateral breast cancer, local recurrence, and 5-year survival were compared within each histologic group and treatment category. Results: During the period 1984 to 1994, 4886 women were diagnosed with invasive lobular or ductal breast carcinoma. Of these, 316 (6.5%) had infiltrating lobular cancer. The 5-year survival rates were 68% and 71% for ILC and IDC, respectively (p=0.5). The local recurrence rates were 2.8% and 4.3% for ILC treated with lumpectomy and axillary nodal dissection (LAND) and modified radical mastectomy (MRM), respectively, which were not significantly different from that obtained with IDC (LAND=2.5%, MRM=2.1%). The incidence of contralateral breast cancer during the period was 6.6% and 6.5% for ILC and IDC, respectively. Conclusions: Invasive lobular carcinoma can be safely treated with breast conservation with no difference in local recurrence or survival. In the absence of a suspicious finding on clinical or radiologic examination, routine contralateral breast intervention is not recommended.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Specimen Radiography: An Assessment Method for Reduction Mammaplasty Materials

Although, one out of every eight women has a risk of developing breast cancer, the reported incidence of breast carcinoma detection in reduction mammaplasty materials is rather low. To our knowledge, specimen radiography, which is used for breast biopsies has not been used for the assessment of breast reduction materials. We investigated the applicability of specimen radiography and its potential benefits in detection of the breast pathologies, especially malignancies in reduction mammaplasty materials. Forty patients scheduled for reduction mammaplasty operation were included. In all cases an inferior pedicle reduction technique was preferred and the radiographs of the resected breast tissues were taken immediately. The radiographs were evaluated for any possible pathologic appearance and all abnormal findings were marked. For the histopathologic evaluation, in addition to the random sampling of the pathologist, any marked areas were also microscopically examined. In two cases fibrocystic changes were found in radiographs and the same results were obtained in the histological examination. No false negative mammogram was seen. Specimen radiography, which is applicable for breast reduction materials is an easy and cheap method and does not cause any patient discomfort. It seems that the radiographs of reduction mammaplasty materials are useful to provide guidance to the pathologist during tissue sampling for microscopic examination especially when large amounts of breast tissue is excised.     

Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy

BACKGROUND: Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. METHODS: Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. RESULTS: Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). CONCLUSIONS: The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.     

Understanding the mechanisms creating false positive lumpectomy margins

OBJECTIVE: All breast surgeons deal with the frustration of initial pathologic close or positive margins that have no residual cancer upon re-excision. To understand the mechanisms that create false positive margins, specimen handling was standardized in a single surgeon's practice and margin issues were tracked. METHODS: Prospectively over a 3.5-year period, needle-localized lumpectomies for the management of early-stage breast cancer were standardized in all aspects of specimen handling, including surgeon inking and specimen compression for specimen radiography for quality assurance. The current study reviews 220 such cases where the original lumpectomy included a small piece of overlying skin from over the target lesion. All specimen radiography was performed with compression at the skin to deep level to bias the "pancaking" effect of pushing tumor to specimen surface to the deep margin. RESULTS: Of the 220 therapeutic lumpectomies performed for clinical stage 0-2 breast cancer in this fashion, 175 (79.5%) had negative margins by a distance of 10 mm or more. Margins less than 10 mm were classified as close and were present in 20 (9.1%) of cases. These were heavily biased toward margins closer than 2 mm. Positive initial margins accounted for 25 (11.4%) of cases. Of the 45 close or positive margin cases, 12 involved the deep margin only, and on re-excision none was found to have residual tumor. When other single margins were involved, re-excision found tumor in 5 of 14 cases (35.7%). When multiple margins were close or positive, 9 of 19 cases (47.3%) were found to have residual tumor at re-excision. CONCLUSIONS: Specimen compression increases the incidence of false margin positivity. The best predictors of true margin positivity are multiple close or positive margins or margin positivity in a direction not associated with specimen ex vivo compression.