64 A Prospective Study to Accurately Define the Nipple-Ward Margins in Patients Undergoing Lumpectomy for Breast Cancer

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 51-52

64 A Prospective Study to Accurately Define the Nipple-Ward Margins in Patients Undergoing Lumpectomy for Breast Cancer

64 A Prospective Study to Accurately Define the Nipple-Ward Margins in Patients Undergoing Lumpectomy for Breast Cancer

Background

Breast conserving therapy (BCS) followed by adjuvant radiotherapy has been shown to be as effective as mastectomy in terms of oncological outcomes. Ensuring negative resection margins is critical to minimizing recurrence, with studies supporting the benefit of shaving additional margins during BCS. However, there is limited data on which specific margin contributes most to re-excision rates. A retrospective study at our institution investigated the role of the nipple-ward margin (margin of tissue oriented in the direction of the nipple in situ) and how it contributed to re-excision rates by correlating imaging findings with surgical pathology. The study found that 38.8% of re-excisions were due to positive nipple-ward margins, with nearly 50% of single-positive margins in this direction. This study aims to identify true nipple-ward margins immediately after surgical excision to determine their role in ductal carcinoma in situ (DCIS) and invasive breast cancer spread.

Materials and Methods

This prospective study will recruit women aged ≥ 18 years with DCIS or invasive breast cancer undergoing lumpectomy. Exclusion criteria include re-excision surgery, central lumpectomy with nipple removal, and mastectomy. Once informed consent is obtained, patients will undergo standard lumpectomy. Once the specimen is removed, an additional suture marking the nipple-ward margin will be placed (in addition to institution-specific standard suture orientation markings). Surgeons will also note distance from nipple-ward margin to nipple as well as distance from incision to lesion. Pathology will be reviewed with emphasis on the nipple-ward margin, looking for residual tumor cells on ink for invasive cancer and less than a 2-mm margin for DCIS. Patient factors, tumor characteristics, and treatment modalities (eg, age, race, body mass index, receptor status, stage, neoadjuvant chemotherapy, etc.) will be retrospectively reviewed. Statistical analysis will assess the correlation between positive nipple-ward margins, re-excision rates, and other variables.

Status

Patient enrollment began in November 2024 and will continue with the goal of recruiting at least 100 patients within a single institution. The anticipated completion date will be November 2025.

Download Issue PDFDownload PDF
Articles in this issue
TPS 25 Phase 1/2 Study of the Novel Radioligand Therapy [177Lu]Lu-NeoB Plus Capecitabine in Patients With ER+/HER2− Advanced Breast Cancer (ABC) With GRPR Expression After Progression on Prior Endocrine Therapy Plus a CDK4/6 Inhibitor for ABC
TPS 25 Phase 1/2 Study of the Novel Radioligand Therapy [177Lu]Lu-NeoB Plus Capecitabine in Patients With ER+/HER2− Advanced Breast Cancer (ABC) With GRPR Expression After Progression on Prior Endocrine Therapy Plus a CDK4/6 Inhibitor for ABC
26 Risk of Recurrence in Real-World NATALEE- and monarchE-Eligible Populations of Patients With HR+/HER2− Early Breast Cancer in an Electronic Health Record-Derived Database
26 Risk of Recurrence in Real-World NATALEE- and monarchE-Eligible Populations of Patients With HR+/HER2− Early Breast Cancer in an Electronic Health Record-Derived Database
27 Elacestrant vs Standard of Care in ER+, HER2- Advanced or Metastatic Breast Cancer With ESR1-Mutated Tumors: ESR1 Allelic Frequencies and Clinical Activity From the Phase 3 EMERALD Trial
27 Elacestrant vs Standard of Care in ER+, HER2- Advanced or Metastatic Breast Cancer With ESR1-Mutated Tumors: ESR1 Allelic Frequencies and Clinical Activity From the Phase 3 EMERALD Trial
TPS 28 ELEGANT: Elacestrant VS Standard Endocrine Therapy in Women and Men With Node-Positive, Estrogen Receptor-Positive, HER2-Negative, Early Breast Cancer With High Risk of Recurrence in a Global, Multicenter, Randomized, Open-Label Phase 3 Study
TPS 28 ELEGANT: Elacestrant VS Standard Endocrine Therapy in Women and Men With Node-Positive, Estrogen Receptor-Positive, HER2-Negative, Early Breast Cancer With High Risk of Recurrence in a Global, Multicenter, Randomized, Open-Label Phase 3 Study
29 A Real-World Exploratory Analysis to Identify Disparities in Breast Cancer Tumor Biopsy Practice at Community Oncology Clinics in the United States
29 A Real-World Exploratory Analysis to Identify Disparities in Breast Cancer Tumor Biopsy Practice at Community Oncology Clinics in the United States
30 Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and Combined With Abemaciclib, for Patients with ER+, HER2– Advanced Breast Cancer, Pretreated With Endocrine Therapy: Results of the Phase 3 EMBER-3 Trial
30 Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and Combined With Abemaciclib, for Patients with ER+, HER2– Advanced Breast Cancer, Pretreated With Endocrine Therapy: Results of the Phase 3 EMBER-3 Trial
TPS 31 Real-World Sacituzumab Govitecan Treatment Patterns and Outcomes in Second-Line or Later Metastatic Triple-Negative Breast Cancer: Leveraging Electronic Health Records and Manual Curation of a US Database
TPS 31 Real-World Sacituzumab Govitecan Treatment Patterns and Outcomes in Second-Line or Later Metastatic Triple-Negative Breast Cancer: Leveraging Electronic Health Records and Manual Curation of a US Database
36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists
36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists
TPS 38 ELCIN: Elacestrant in Women and Men With CDK4/6 Inhibitor-Naive Estrogen Receptor-Positive, HER2-Negative Metastatic Breast Cancer: An Open-Label, Multicenter, Phase 2 Study
TPS 38 ELCIN: Elacestrant in Women and Men With CDK4/6 Inhibitor-Naive Estrogen Receptor-Positive, HER2-Negative Metastatic Breast Cancer: An Open-Label, Multicenter, Phase 2 Study
39 Development and Validation of a Questionnaire to Assess Motivation and Satisfaction in Mastectomy Patients With or Without Reconstruction
39 Development and Validation of a Questionnaire to Assess Motivation and Satisfaction in Mastectomy Patients With or Without Reconstruction
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
Recent Videos
Breast oncologist Jade E. Jones, MD, says she tries to send patients with BRCA-mutant HR-positive TNBC to clinical trials that use PARP inhibitors.
Following progression on a CDK4/6 inhibitor, ascertaining the endocrine sensitivity of HR-positive/HER2-negative disease may inform sequential treatment.
T-DXd improved progression-free survival over standard chemotherapy among patients with HR-positive/triple-negative breast cancer in DESTINY-Breast04.
The use of chemotherapy trended towards improved recurrence-free intervals in older patients with high-risk tumors as determined via the MammaPrint assay.
Use of a pharmacist-directed resource appears to improve provider confidence and adverse effect monitoring for patients undergoing infusion therapy.
Reshma L. Mahtani, DO, describes how updates from the DESTINY-Breast09, ASCENT-04, and VERITAC-2 trials may shift practices in the breast cancer field.
Stage IV lung cancer may be curable based on the success of the DREAM Program, according to thoracic surgeon, Ankit Bharat, MBBS,
Ankit Bharat, MBBS, a thoracic surgeon, discussed potential treatment emergent adverse effects or complications, as well as strategies for managing them.
Thoracic surgeon, Ankit Bharat, MBBS, discussed surgical strategies among patients with advanced lung cancer diagnoses based on staging.
In a CancerNetwork® YouTube video, Cornelia Tischmacher, a mother of twins from Germany, outlined her receipt of double lung transplantation.
Related Content
TPS 25 Phase 1/2 Study of the Novel Radioligand Therapy [177Lu]Lu-NeoB Plus Capecitabine in Patients With ER+/HER2− Advanced Breast Cancer (ABC) With GRPR Expression After Progression on Prior Endocrine Therapy Plus a CDK4/6 Inhibitor for ABC

TPS 25 Phase 1/2 Study of the Novel Radioligand Therapy [177Lu]Lu-NeoB Plus Capecitabine in Patients With ER+/HER2− Advanced Breast Cancer (ABC) With GRPR Expression After Progression on Prior Endocrine Therapy Plus a CDK4/6 Inhibitor for ABC

Radhika Appaya;Mario Campone;Louise Emmett;Dejan Juric;Debasish Tripathy;Sonia Pernas;Monica Zuradelli;Kevin Perraud;Aleix Prat
June 21st 2025
Article

Findings highlight a need to incorporate diverse populations when developing guideline-concordant breast cancer care to achieve efficacy for all patients.

Eliminating Racial Disparities in Guideline-Concordant Breast Cancer Care

Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, FACS
April 21st 2025
Podcast

Findings highlight a need to incorporate diverse populations when developing guideline-concordant breast cancer care to achieve efficacy for all patients.

26 Risk of Recurrence in Real-World NATALEE- and monarchE-Eligible Populations of Patients With HR+/HER2− Early Breast Cancer in an Electronic Health Record-Derived Database

26 Risk of Recurrence in Real-World NATALEE- and monarchE-Eligible Populations of Patients With HR+/HER2− Early Breast Cancer in an Electronic Health Record-Derived Database

Radhika Appaya;Paolo Tarantino, MD;Hope S. Rugo, MD;Guiseppe Curigliano;Joyce O’Shaughnessy, MD;Wolfgang Janni;Komal Jhaveri;Jason Mouabbi;Adam M. Brufsky, MD, PhD;Erika P. Hamilton, MD;Ruth M. O’Regan; Julia Kim;Liz Santarsiero;Murat Akdere;Fen Ye;Henry Owusu;Stephanie L. Graff, MD
June 20th 2025
Article

Experts from Sibley Memorial Hospital discuss how multidisciplinary work has enhanced outcomes such as survival and resource use at their institution.

Elevating the Quality of Cancer Care via Cross-Department Collaboration

Rachit Kumar, MD;Michael J. Pishvaian, MD, PhD;Nina D. Wagner-Johnston, MD;Valerie Lee, MD;Armine K. Smith, MD;Pouneh Razavi, MD;Curtiland Deville Jr., MD
April 7th 2025
Podcast

Experts from Sibley Memorial Hospital discuss how multidisciplinary work has enhanced outcomes such as survival and resource use at their institution.

TPS 28 ELEGANT: Elacestrant VS Standard Endocrine Therapy in Women and Men With Node-Positive, Estrogen Receptor-Positive, HER2-Negative, Early Breast Cancer With High Risk of Recurrence in a Global, Multicenter, Randomized, Open-Label Phase 3 Study

TPS 28 ELEGANT: Elacestrant VS Standard Endocrine Therapy in Women and Men With Node-Positive, Estrogen Receptor-Positive, HER2-Negative, Early Breast Cancer With High Risk of Recurrence in a Global, Multicenter, Randomized, Open-Label Phase 3 Study

Aditya Bardia, MD, MPH;Virginia Kaklamani, MD, DSc;Joyce A. O’Shaughnessy;Peter Schmid, MD;J. Thaddeus Beck,;Michelino De Laurentiis;Guiseppe Curigliano;Hope S. Rugo, MD;Carlos Barcenas;William J. Gradishar, MD;Michail Ignatiadis;David Cameron;Giulia Tonini;Simona Scartoni;Jennifer Crozier;Leo Viana Nicacio;Tomer Wasserman;Sara M. Tolaney, MD, MPH
June 18th 2025
Article
30 Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and Combined With Abemaciclib, for Patients with ER+, HER2– Advanced Breast Cancer, Pretreated With Endocrine Therapy: Results of the Phase 3 EMBER-3 Trial

30 Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and Combined With Abemaciclib, for Patients with ER+, HER2– Advanced Breast Cancer, Pretreated With Endocrine Therapy: Results of the Phase 3 EMBER-3 Trial

Aarti Chawla;Komal Jhaveri;Patrick Neven, MD, PhD;Monica Lis Casalnuovo;Sung-Bae Kim;Eriko Tokunaga;Philippe Aftimos;Cristina Saura;Joyce A. O’Shaughnessy;Nadia Harbeck, MD, PhD;Lisa A. Carey, MD;Guiseppe Curigliano;Antonio Llombart-Cussac;Elgene Lim, MBBS, FRACP, PhD;María de la Luz García Tinoco;Joohyuk Sohn;Andre Mattar;Qingyuan Zhang;Chiun-Sheng Huang;Chih-Chiang Hung;Jorge Luis Martinez Rodriguez;Manuel Ruiz Borrego
June 16th 2025
Article