Rath et al. conducted a study in patients who had palpable, invasive carcinomas of the breast, and had undergone a primary breast-conserving therapy and found that patients who had multifocal disease, accompanying DCIS, involvement of regional lymph nodes, high-grade breast cancer, lympho-vascular invasion or negative hormone-receptor status, were significantly more likely to have undergone incomplete removal of tumor tissue and these patients thus required a secondary surgery (29). This evidence concerns the gene NR4A1 and invasive breast carcinoma.