Initial Localization Is Associated With Margin Status but Not Re‐Excision Outcomes in Breast Conservation Surgery: A Single‐Center Cohort Analysis
Ahmed Alosdody, Syed Zahid Afzal Zadie, Habib Gulam Mohemad Charfare, Joyanto Biswas, Yogeshkumar Malam, Kanapathipillai Rajaratnam, Fanourios GeorgiadesABSTRACT
Introduction
Positive margins following breast‐conserving surgery (BCS) remain a common cause of re‐operation. Image‐guided localization techniques may reduce margin positivity at index wide local excision (WLE), but their influence on re‐operation outcomes is less well defined. Our objective was to evaluate the association between index localization method and margin positivity and to assess re‐operation pathology and operative outcomes following positive margins in BCS.
Methods
A retrospective cohort study was conducted at a single breast unit including women undergoing re‐operation for positive margins following index WLE between January 2020 and January 2025. Patients were stratified by index localization: none, wire, or radio‐frequency identification tag (RFID). Localization groups were pooled for comparison with non‐localized cases. Primary outcomes were margin involvement pattern at index surgery and residual tumor at re‐excision. Secondary outcomes included re‐operation type, operative duration, interval to re‐operation, and adjuvant radiotherapy.
Results
Among 524 index WLEs, 72 patients (13.7%) underwent re‐operation for positive margins. Margin positivity was higher in non‐localized cases compared with localized cases (18.6% vs. 10.6%; p = 0.013; OR 0.52, 95% CI 0.31–0.85). Among re‐operated patients, margin involvement patterns, re‐operation strategy, residual tumor rates (39.5% vs. 55.9%; p = 0.238), operative duration, and time to re‐operation were similar between groups. All re‐operations were performed as day‐case procedures without complications.
Conclusions
Localization at index WLE is associated with lower rates of positive margins, reflecting case selection. However, localization does not significantly influence re‐operation pathology or operative outcomes once margin positivity occurs.