Positive margins (PM) may have an important role in predicting intramammary recurrences after conservative treatment of breast cancer (BC). We analyzed a variety of preoperative and pathologic factors to determine their association with the occurrence of PM. 1148 BC cases observed from 1980 to 1994 were reviewed. All patients had undergone wide excision of the tumour and 1108 had axillary dissection. Age ranged from 23 to 87 (mean 56). pT category was pT1 in 908, pT2 in 225, and pT4b in 15 cases, respectively. pN category was pN0 in 799, pN1 in 309, and pNx in 40 cases, respectively. PM were observed in 94 (8.2%) cases (intraductal = 56, invasive = 38). PM were significantly associated with a variety of factors, namely: a) age P = 0.03); b) microcalcifications vs. opacities at mammography (12.9% vs. 6.6%, P = 0.001); c) pT2 vs. pT1 (11.5% vs. 7.3%, P = 0.04); d) pN1 vs. pN0 (11.6% vs. 7%, P = 0.01); e) extensive intraductal component (EIC) or multifocality (24.2% or 17.5% vs. 3.3%, P Our experience suggests that in younger patients with microcalcifications at mammography, T2, EIC and multifocality, a wider excision of the tumour is necessary to obtain tumor free resection margins.

Between 1986 and 1995, 965 patients with T1 breast cancer were treated with wide excision (796 pts) or mastectomy (138 pts). Axillary dissection was performed in 934 patients. Nodal positivity was 8.7% for T1a, 15.6% for T1b and 37.7% for T1c. 68.5% of cases had one to three positive nodes, 18.3% four to ten and 13% more than ten nodes. No differences were observed in the frequency of lymph nodes involved according to the age of patients, menopausal status, pattern at mammography, histology and receptor status. Favourable histology (tubular, cribriform, papillary, colloid) shows a significant difference when compared with all the others histotypes. On the basis of data collected it is impossible to anticipate the axillary status and avoid axillary dissection.

Diagnostic features of 102 consecutive cases of cancer reoccurrence in the conserved breast are reported. The sensitivity of palpation, mammography, cytology or ultrasonography was 75.5%, 58.7%, 77.4% and 77.8%, respectively. Mammography failures were not due to natural breast density and could probably be explained by the masking effect of surgical scar and distortion. Most failures at cytology were due to inadequate sampling. Palpation should always be associated with mammography in the follow-up of the conserved breast. Aspiration cytology should.be performed incase of any abnormality seen at palpation or mammography.

The aim was to review a series of 183 intraductal breast cancer to define the diagnostic features and therapeutic outcome. Patients' average age was 54 years. Diagnostic procedures employed were clinical examination, mammography in 173 cases and fine-needle aspiration cytology in 98 cases. The sensitivity of clinical examination was 0.61, of mammography 0.74, of fine needle aspiration cytology 0.70. The sensitivity of clinical examination and mammography associated was 0.93. The surgical options adopted were: conservative surgery 80 cases, mastectomy 103 cases. Conservative surgery was followed by breast irradiation in 34 cases. Axillary dissection was performed in 122. 97 cases have been reviewed histologically. 60% of ductal carcinoma in situ (DCIS) were multifocal and 22% multicentric. Local recurrence, all infiltrating, occurred in the same breast after conservative surgery in 8 cases, 3 of which had received postoperative radiotherapy, and in 3 patients after mastectomy. Contralateral breast cancer was recorded in 13 cases, being synchronous in 4 (infiltrating in 3, DCIS in 1) and metachronous in 8 (all infiltrating). 3 patients died of breast cancer. The present series confirms the risk of ipsilateral cancer recurrence after conservative surgery but there are no significant differences relating to mammographic pattern, size, histological type, margin involvement and radiotherapy.