保乳术、改良根治术和改良根治术联合放疗治疗三阴性乳腺癌术后局部复发情况比较

目的探讨保乳术、改良根治术和保乳术联合放疗治疗三阴性乳腺癌的术后局部复发情况。 方法回顾性分析2009年1月至2014年12月间接受治疗的320例三阴乳腺癌患者资料,根据手术方案分为保乳术(BCT组)132例、改良根治术(MRM组)120例、保乳术联合放疗(联合组)68例。采用SPSS19.0软件进行统计分析。术中术后等计量资料采用( ±s)描述,组间比较采用单因素方差分析。采用COX生存回归分析术后3年的局部复发风险。P<0.05为差异有统计学意义。 结果三组的手术时间差异无统计学意义(P>0.05),BCT组和联合组的切口长度、术中出血量和住院时间显著优于MRM(P<0.05);术后3年,BCT组、MRM组的局部复发风险分别是联合组的2.37倍、2.24倍(P<0.05);胸壁转移风险是联合组的3.14倍、3.85倍(P<0.05);BCT组的淋巴结转移风险是联合组的2.65倍(P<0.05),MRM组的淋巴结转移风险和联合组差异无统计学意义(P>0.05)。 结论相较于改良根治术,保乳术联合放疗治疗乳腺癌不仅能术后恢复快、降低局部复发风险,还能保证相对正常的乳房外形,有利于患者术后生存质量提高,具有临床价值。     

Contributions of pathologic margins and Dukes' stage to local recurrence in colorectal carcinoma

Two hundred fourteen patients with colorectal carcinoma who underwent curative resection for biopsy-proved or autopsy-proved local recurrences with a minimum of 2 years follow-up were evaluated. The only predictive variables for anastomotic recurrence were Dukes' stage and tumor margins. There were 49 Dukes' A lesions with no observed recurrences. There were also 83 Dukes' B lesions and 84 Dukes' C lesions with a total of 18 local recurrences in 214 cases or 8.4 percent (of Duke's B lesions or 6 percent and 14 of Dukes' C lesions or 17 percent). When proximal or distal margins were less than 5 cm there were seven total recurrences (three Dukes' B lesions and four Dukes' C lesions). However, when margins were greater than 5 cm, 11 local recurrences were observed (1 Dukes' B and 10 Dukes' C lesions). It appears that margins are not as important in preventing local recurrences of Dukes' A lesions as they are of both Dukes' B and C lesions. Although the numbers are small in this study, it appears that Dukes' B lesions can be satisfactorily resected with a very low incidence of local recurrence if their margins are 5 cm or greater, whereas if the resected margins are less than 5 cm, the incidence of local recurrences increases from 9 percent (1 of 11 lesions) to 43 percent (3 of 7 lesions), or almost a fivefold increase. Therefore, it appears that good surgical technique and adequate margins of greater than 5 cm are very important in reducing local recurrences of Dukes' B lesions. However, when margins are greater than 5 cm, this does not guarantee freedom from local recurrence of Dukes' C lesions. This may merely reflect the difference in the biologic characteristics among Dukes' A, B, and C lesions and the fact that limited resection, particularly in the rectosigmoid region, cannot possibly remove all intralymphatic disease, which is the presumed culprit in locally recurrent Dukes' C lesions.     

Intraoperative assessment of margins in breast conserving therapy: A systematic review

Approximately one quarter of patients undergoing breast conserving therapy for breast cancer will require a second operation to achieve adequate clearance of the margins. A number of techniques to assess margins intraoperatively have been reported. This systematic review examines current intraoperative methods for assessing margin status. The final pathology status, statistical measures including accuracy of tumour margin assessment, average time impact on the procedure and second operation rate, were used as criteria for comparison between studies. Although pathological methods, such as frozen section and imprint cytology performed well, they added on average 20–30 min to operation times. An ultrasound probe allows accurate examination of the margins and delivers results in a timely manner, yet it has a limited role with DCIS where calcification is present and in multifocal cancer. Further research is required in other intraoperative margin assessment techniques, such as mammography, radiofrequency spectroscopy and optical coherence tomography.     

术中定向放疗推量照射在乳腺癌保乳术中临床应用研究

目的 研究乳腺癌保乳手术联合IntraBeam术中放疗系统进行术中靶向瘤床推量放射治疗的可行性、安全性、有效性及美容效果。方法 共69例早期乳腺癌保乳手术患者接受了治疗,其中18.8%（13/69）患者年龄少于45岁,52.2%（36/69）肿物大于2 cm,40.6%（28/69）组织细胞学分级3级,29.0%（20/69）病人有淋巴结转移。病人保乳术后采用IntraBeam术中放疗系统瘤床表面20 Gy剂量进行术中靶向瘤床推量放射治疗,待化疗完成（或伤口愈合后）2周后给予传统全乳外照射放射疗治疗（50 Gy,共25次,省略瘤床推量照射）,评估患者近期疗效及不良反应。结果 总共27.5%（19/69）患者出现急性并发症,2.9%（2/69）患者出现血肿,8.7%（6/69）出现血清肿,7.2%（5/69）出现切口感染,8.7%（6/69）切口愈合延迟,切口中位愈合时间3.8（1.0~11）个月,中位随访24.8个月（12~51）,2.9%（2/69）患者出现同侧乳房内复发,未出现远处转移及死亡病例,乳房美容效果评估优、良者术后1年占89.9%,术后2年占89.7%。结论 乳腺癌保乳手术联合IntraBeam术中放疗系统进行术中靶向瘤床推量放射治疗近期疗效满意、不良反应较少,由于病人数量较少,随访时间较短,长远疗效仍需要进一步的验证。     

Lumpectomy margins, reexcision, and local recurrence of breast cancer

BACKGROUND: The diagnosis of breast cancer is often made by excisional biopsy without margin assessment for mammographic findings or palpable masses. Many patients treated with breast conservation undergo reexcision to obtain clear margins although the relationship between clear margins and local recurrence remains controversial. METHODS: Patients undergoing breast conservation and adjuvant radiation therapy with complete follow-up over 5 years were studied. Factors associated with obtaining clear histopathologic margins and undergoing reexcision to obtain clear margins were studied in relation to the risk of local recurrence. RESULTS: Clear biopsy margins were associated with diagnosis by fine-needle aspiration cytology (fine-needle aspiration 42%, spot localization 11%, excisional biopsy 10%; P <0.001). Reexcision was significantly related to diagnostic method (spot localization 63%, excisional biopsy 36%, fine-needle aspiration 10%; P <0.001), first margin status (clear 0%, close 11%, positive 46%, unknown 48%; P <0.001), patient age (54 years for reexcised patients and 58 for non-reexcised patients; P <0.001), and tumor size (mean tumor size 1. 4 cm for reexcised patients and 1.7 cm for non-reexcised patients; P = 0.003). Patients undergoing reexcision were significantly more likely to be diagnosed by spot localization, have nonnegative excisional biopsy margins, be younger, and have smaller tumors than patients not undergoing reexcision. Local recurrence was not significantly related to margin status (8% with clear margins, 7% with positive margins, 19% with close margins, and 11% with unknown margins) or reexcision (10% local recurrence rate for patients with negative final margins after reexcision and 12% with positive, close or unknown first margin without reexcision). Estrogen receptor status was the only variable related to local recurrence in Cox proportional hazards model (P = 0.009). Estrogen receptor negative patients with nonnegative margins experienced a 20% rate of local recurrence compared with 10% for estrogen receptor negative patients with negative margins and 7% for estrogen receptor positive patients regardless of margin status (P = 0.021). CONCLUSIONS: Clear excision margins are facilitated by preoperative diagnosis by fine-needle cytology. For patients with nonnegative margins, reexcision was more commonly performed in young patients with small tumors diagnosed by spot localization biopsy. The relationship of local recurrence to margins and reexcision was not statistically significant. Estrogen receptor negative tumors with nonnegative margins had a significantly higher rate of local recurrence than estrogen receptor negative tumors with clear margins and estrogen receptor positive tumors regardless of margin status.     

Reconstructive measures in local recurrence after breast saving therapy of breast cancer]

Local recurrence after breast preserving treatment of breast cancer will usually be treated by simple mastectomy. Safe immediate reconstruction is only possible by use of a musculocutaneous flap, the latissimus dorsi flap or better by the rectus abdominis musculocutaneous flap in it's vertical (VRAM) or transverse (TRAM) variation. As a sequel of the irradiation, one stage reconstruction with a simple submuscular implant or an expander prosthesis has a higher complication rate. Personal experience with 42 rectus flaps is reported. The rate of total necrosis was 5%, in one patient a late desmoid tumor was found in the donor area.     

乳腺癌保乳治疗后局部复发的临床研究

目的 比较分析乳腺癌保乳治疗后局部复发病例与同期非复发病例资料,分析影响局部复发的风险因素.方法 密切随访2000年1月至2008年6月收治的1034例保乳治疗患者.患者年龄23～94岁,中位年龄48岁.分析年龄、雌激素受体(ER)/孕激素受体(PR)状态、人类表皮生长因子受体2(HER-2)状态、淋巴结转移状态、肿瘤大小、新辅助化疗、病理类型对局部复发的影响.结果 随访截至2010年6月,中位随访42个月(3～126个月),同侧乳房局部复发35例(3.3%),远位转移47例(4.5%),5年无病生存率87.7%,5年无远处转移生存率94.0%,5年总体生存率99.3%.单因素分析显示,淋巴结状态、年龄及HER-2表达状态是影响局部复发的风险因素;复发高峰时间为术后第2年至第3年,以及第5年至第6年;多因素分析显示HER-2状态是局部复发的独立影响因素.结论 保乳治疗后出现两个局部复发高峰时间段,HER-2表达状态是局部复发的独立影响因素,对于具有高危因素的患者需更积极治疗.     

Ipsilateral breast tumor relapse after breast conserving surgery in women with breast cancer

Ipsilateral breast tumor relapse (IBTR) is a potentially a significant problem after breast conserving surgery (BCS). With a median follow-up period of 64.7 months, IBTR occurred as a first relapse in 67 (3.0%) of a total of 2243 patients and distant recurrence occurred in 167 (7.4%). A positive surgical margin and the omission of radiotherapy (RT) were independently associated with IBTR. The five-year cumulative IBTR rates were 5.1% in patients with positive margins and 2.0% in the patients with negative margins. The five-year cumulative IBTR rates were 1.8% in patients with RT and 8.1% in patients without RT. IBTR was independently associated with distant-recurrence-free survival rates as well as age, nodal metastasis, lymphovascular invasion and progesterone receptor status. The five-year distant-recurrence-free survival rates were 81.9% in patients with IBTR and 93.2% in patients without IBTR. In order to prevent IBTR, a negative margin and the administration of RT are therefore considered to be important in patients who undergo BCS.     

Intraductal carcinoma of the breast: pathologic features associated with local recurrence in patients treated with breast-conserving therapy

Local excision and radiation therapy is a standard treatment option for duct carcinoma in situ (DCIS) of the breast. There is no consensus regarding the significant histologic features associated with recurrence. The authors studied a large group of patients with mammographically detected DCIS treated with breast-conserving therapy to explore DCIS volume relationships, DCIS features, specimen characteristics, and the effect of patient age at diagnosis. Thirteen patients (10%) developed a recurrent carcinoma in the ipsilateral breast, resulting in 5- and 10-year actuarial recurrence rates of 8.9% and 10.3%, respectively. Local recurrences were identified as a true recurrence/marginal miss (TR/MM) in nine patients, and elsewhere in the breast in four patients. The notable features associated with TR/MM recurrences on univariate analysis included patient age less than 45 years old, six or more slides with DCIS, no microscopic calcifications within DCIS ducts, and five or more DCIS ducts or terminal duct lobular units (TDLUs) with cancerization of lobules (COL) within 0.42 cm of the final surgical margin. DCIS tumor size, nuclear grade, amount of central necrosis, and margin status were not associated with outcome. Multivariate analysis found that the absence of microcalcifications within DCIS ducts, patient age, number of slides with DCIS or TDLUs with COL, and the number of DCIS ducts or TDLUs with COL within 0.42 cm of the final margin were related significantly to TR/MM recurrence. Patients with a total of six or more slides with DCIS, or who have 11 or more DCIS ducts or TDLUs with COL near the final margin are at increased risk of having a substantial volume of residual DCIS in the adjacent unexcised breast. These results suggest that the volume of DCIS in the specimen, and the volume of DCIS near the margin are associated with local recurrence. These features can be used to identify those patients with a higher chance of local recurrence.     

发病年龄对乳腺癌保留乳房治疗后长期生存的影响

目的探讨年龄对乳腺癌患者保留乳房治疗后长期复发及生存结局的影响。方法从北京大学肿瘤医院乳腺癌预防治疗中心数据库中回顾性收集1999年12月至2014年12月2778例原发性乳腺癌保留乳房治疗病例的资料,中位年龄47岁(范围:21~91岁)。根据发病年龄将患者分为≤40岁组(677例)与>40岁组(2101例),比较两组患者的临床特征。采用Kaplan-Meier法绘制生存曲线,并用Log-rank法比较两组局部复发率、无远处转移动生存(DDFS)、无病生存(DFS)及乳腺癌特异性生存(BCSS),采用Cox比例风险模型分析复发及生存的预后因素。结果≤40岁组和>40岁组的激素受体阳性比例(490/677比1581/2101,χ²=6.981,P=0.030)、腋窝淋巴结阳性比例(314/677比713/2101,χ²=34.966,P<0.01)、T1期比例(301/677比1160/2101,χ²=37.660,P<0.01)、接受新辅助化疗比例(413/677比1010/2101,χ²=34.272,P<0.01)的差异均有统计学意义。中位随访102个月。≤40岁组和>40岁组10年局部复发率差异无统计学意义(2.5%比1.6%,P=0.147)。≤40岁组和>40岁组10年DDFS率分别为90.6%和95.3%(P<0.01),10年DFS率分别为86.5%和91.1%(P=0.001),10年BCSS率分别为91.0%和93.7%(P=0.105)。年龄不是局部复发的独立预后因素(P>0.05);淋巴结状态(阳性比阴性,HR=2.73,95%CI:1.94~3.84,P<0.01)、年龄(≤40岁比>40岁,HR=1.73,95%CI:1.24~2.42,P=0.001)、肿瘤最大径(>2 cm比≤2 cm,HR=1.61,95%CI:1.14~2.28,P=0.001)是DDFS和DFS的独立预后因素;激素受体状态(阳性比阴性,HR=0.54,95%CI:0.39~0.74,P<0.01)、淋巴结状态(阳性比阴性,HR=2.94,95%CI:2.12~4.07,P<0.01)、肿瘤最大径(>2 cm比≤2 cm,HR=1.45,95%CI:1.05~2.01,P=0.025)是BCSS的独立预后因素。结论≤40岁与>40岁乳腺癌患者保留乳房治疗后局部复发风险相似,前者长期生存劣于后者。     

Prognostic factors for local recurrence in breast conservation therapy: Residual cancers after lumpectomy

In order to evaluate the local residual cancer following breast conservation therapy (BCT) with lumpectomy, we investigated the relationships between residual cancer and age, tumor location, tumor diameter (T), mammography findings, nipple discharge findings, histopathological type, lymphatic and/or vascular invasion by tumor cells, histological grading, histological lymph node metastases (n), and estrogen receptor (ER) status, in 1494 patients with breast cancer that involved diagnostic excisional biopsy. Residual cancers were found in 581 of 1448 (40%) mastectomy specimens, after 46 (3.1%) with multicentricity had been excluded. No correlation was observed between residual cancer and age, histological grading, and ER. However, residual cancer rates were significantly higher in patients with: (1) tumor diameters of 3.1 cm or larger; (2) tumors beneath or in the vicinity of the nippleareola; (3) malignant calcifications noted in mammography findings; (4) serous or bloody nipple discharge, particularly with positive cytologic findings; (5) papillotubular carcinoma diagnosed by biopsy, (6) lymphatic invasion by tumor cells; or (7) a high degree (n4) of lymph node metastases. The above seven clinicopathologic factors are thus considered useful prognostic indicators for local recurrence in BCT with lumpectomy.     

Successful use of intraoperative radiotherapy for local control of an Askin's tumor recurrence

Askin s tumor is an infrequent disease, with a high tendency to local recurrence. We present the case of a 16-year-old female diagnosed with a new recurrence of this tumor affecting the thoracic wall. There had been a previous 5-year history of 3 local recurrences treated each time by apparently complete surgery. A multidisciplinary approach consisting of chemotherapy, complete chest tumor resection and intraoperative radiotherapy was undertaken. After 2-year follow-up, the patient is alive and free of disease. The role of surgery is still the key to obtaining good survival, but in this case intraoperative radiotherapy proved to be a good adjuvant treatment.     

Soft tissue tumor recurrence after intramedullary stabilization of impending pathologic fractures

This article describes the cases of 3 patients who were treated for impending pathologic fractures with intramedullary stabilization who developed soft tissue tumor recurrence along the surgical tract site postoperatively, with confirmed histologic diagnoses consistent with each of their prior-known metastatic primaries. This sequela of treatment can lead to additional surgical procedures, longer recovery, and a delay in further systemic treatment, which negatively affects patient outcomes and survival. This can occur despite the use of adjuvant radiation therapy to the surgical site. Between June 2008 and July 2010, our institution surgically treated 71 pathologic (or impending) fractures, of which 52 were femoral nails and 19 were humeral nails. Three of these patients sustained soft tumor tissue recurrence along the surgical tract. Due to the unfavorable long-term prognoses for patients with metastatic disease, these surgeries are palliative and not curative in nature. The purpose of this article is to draw attention to this sequala and heighten awareness for physicians who treat inpending or pathologic fractures. It is difficult to make strong recommendations based on a series of 3 patients, but some general principles can be used. We recommend copious intraoperative irrigation of the wound sites and consideration for routine surveillance with physical examination and prompt imaging and biopsy if any suspicion for local soft tissue recurrence arises. Our approach includes fine-needle aspiration of suspicious lesions followed by resection. The plastic surgery team is consulted pre- or intraoperatively if the resection defect cannot be closed primarily. The patient is also referred back to a medical oncologist for consideration of systemic chemotherapy because soft tissue tumor recurrence is a sign of progressive disease.     

Combination of two local flaps for large defects after breast conserving surgery

PurposeOncoplastic surgery is a technique for wide excision of breast cancer without compromising the natural shape of the breast. We have combined two local flaps, referred to as a ‘combined local flap’, for large defects of the breast after a partial mastectomy.Patients and methodsTwenty-one patients with breast cancer underwent a partial mastectomy with immediate reconstruction when the surgical margin was positive and further excision was required or the tumor size was larger than the pre-operative evaluation. Reconstruction was consisted of a rotational local flap and a thoraco-epigastric flap (TEF), so-called a combined local flap. The cosmetic results were self-estimated after chemotherapy and radiotherapy according to a four-point scoring system.ResultsThe mean age of patients was 53.3 years and the mean tumor size was 2.2 cm. The mean excised breast volume was 133.8 mm³ and the percentage of excised volume was 20.4%. The cosmetic outcomes were judged as excellent, good, and fair in 11, 8, and 2 cases, respectively.ConclusionThe combined local flap, consisting of a rotational local flap and a TEF is a useful oncoplastic technique for large defects after breast-conserving surgery.     

An autopsy study to clarify characteristics of local recurrence after extended pancreatectomy with intraoperative radiation therapy in patients with pancreatic cancer

Purpose

Local relapses frequently occur even after curative resection of pancreatic cancer. To control local recurrence, we adopted extended radical resection combined with intraoperative radiation therapy.

Methods

A retrospective review was conducted on 41 patients who underwent extended radical pancreatectomy combined with intraoperative radiation therapy for pancreatic cancer. Fourteen patients underwent autopsies. We took en bloc specimens of the abdominal aorta with surrounding connective tissue to evaluate histological characteristics of local status at autopsies.

Results

Autopsies disclosed microscopic local recurrence in five (36%) of the 14 patients, although no evidence of local relapse was observed in either follow-up images or macroscopic findings at autopsy. Of the three patients with R1 resection, two had no local recurrence microscopically at autopsy. Histological features of local recurrence in autopsy samples showed small numbers of cancer cells surrounded by thick connective tissue without mass formation.

Conclusions

The autopsy study revealed that a characteristic of local recurrence after this treatment was tiny cancer cells scattered in dense connective tissue; these cells were undetected by follow-up imaging.     

Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer

BACKGROUND: This study investigates the effect of full-thickness versus superficial closure of the breast parenchyma on the likelihood of subsequent infection and local recurrence after lumpectomy for early-stage breast cancer. In patients undergoing breast-conserving therapy (BCT), operative closure technique has been largely influenced by expected cosmetic outcome. However, the common practice of promoting postoperative fluid collection raises concerns about potential bacterial colonization, tumor cell migration, and impaired post-BCT surveillance. METHODS: From 1985 through 2004, operative closure technique was determined in 516 breasts in 580 women with stage T0-2N0-1 breast cancers undergoing BCT. Medical records were reviewed to determine closure technique, incidence of postoperative infection, and local recurrence characteristics. RESULTS: Median follow-up was 6.4 years from the completion of radiotherapy. The rate of acute infection was higher with the superficial closure technique: 11.7% (27/230) versus 5.2% (15/286) (P = .009). In T1-2 patients, there was no difference in the rate of local recurrence based on closure type: 5.6% (11/195) versus 3.5% (8/231) (P = .348). On multivariate analysis, acute infections and margin status were associated with increased local recurrence. Superficial closure was associated with larger recurrences less likely to be detected on mammogram. In stage T0-T2 patients, 80% of recurrent tumors after superficial closures were greater than 1 cm compared with no recurrent tumors greater than 1 cm after full-thickness closures (P = .005). In patients with superficial closure, 29% of recurrences in the tumor bed were initially detected on mammogram versus 100% in patients with deep closure (P = .003). CONCLUSIONS: Closure method was not predictive of local recurrence. Our findings regarding infection and post-treatment surveillance suggest, however, that full-thickness closure may be the preferred technique in BCT patients.     

Predictors of local recurrence following conservative breast surgery and radiation therapy. The influence of tumor size

Size of tumor has not been established as a predictor of tumor recurrence in the breast following conservative surgery and radiation therapy. We analyzed 783 patients with infiltrating carcinoma treated with simple excision and radiation therapy. Median follow-up was 91 months. Median age at diagnosis was 50 years. There was a 13% recurrence among patients with T1 lesions compared with a 12% recurrence among patients with T2 tumors. Size did not predict for local recurrence when the tumor was analyzed by 1-cm increments and whether the tumor was estrogen receptor protein positive or estrogen receptor protein negative. Patients with an extensive intraductal component had a significantly higher local recurrence rate for every tumor size compared with patients with extensive intraductal component-negative tumors. We concluded that size did not predict local recurrence.     

Diagnostic problems in local recurrence after breast saving treatment]

353 patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer have been treated consecutively by breast conserving therapy in a prospective, nonrandomized study at the University Hospital Basel and the Women's Clinic Rheinfelden/Baden/Germany. The median age was 47 years, the median follow-up time 67 months, and 4% only of this collective were lost to follow-up after a median time of 42 months. In 79% of the cases the tumor was excised totally, while in 19% the resection margins were positive and in 2% only the margins were not available for histological judgement. The rate of local failure reached 8% with a median time interval of 53 months. 116 patients showed postactinic induration in the primary tumor region. 73 of these were given additional diagnostic examination: The postactinic induration was judget clinically suspicious in 51 cases and clinically nonsuspicious of local failure in 22 cases. All 73 patients received additional examination by mammography and biopsy. By comparison with the histological results the clinical results were correct in 59% and false in 41%, while the mammographic results were correct in 82% and false in 18% of the cases.     

Factors associated with local breast cancer recurrence after lumpectomy alone

Background: The purpose was to determine the rate of local breast relapse in patients with breast cancer uniformly treated with partial mastectomy but without postoperative radiotherapy and without systemic adjuvant therapy. We also systematically examined the factors associated with local recurrence to determine whether a low-risk subgroup existed. Methods: A retrospective review of a prospectively followed (median, 8 years) cohort of 293 patients was performed. The end-point was ipsilateral local breast cancer recurrence. The patient's age, tumor size, nodal status, estrogen and progesterone receptor status, histology, and tumor and nuclear grade were studied, as were the presence and amount of carcinoma in situ and the presence of tumor emboli using univariate Kaplan-Meier and Cox step-wise multivariate analyses. Results: The overall local relapse rate was 26% (77 recurrences). Univariate factors significantly associated with decreased local relapse included older age, negative nodes, small tumor size, positive estrogen receptor status, and absence of tumor emboli. Significant multivariate variables were age, nodal status, estrogen receptor status, absence of comedo carcinoma in situ, and tumor emboli. A low-risk subgroup of 66 patients was defined with a 6% 10-year local recurrence rate. Conclusion: Important patient and tumor variables associated with local breast cancer relapse after breast-conserving surgery can define a low-risk subgroup.