Highlights
- •Patients undergoing BCS for DCIS have high rates of suboptimal pathologic margins (51.7%) and subsequent re-excision (27.8%).
- •Larger tumor size, younger patient age, lower tumor grade, and ER negative disease are all predictive of suboptimal margins.
- •These findings may increase surgeon insight as to considerations for mitigating this problem.
Abstract
Introduction
Re-excisions following breast conserving surgery (BCS) are common, occurring more
frequently in ductal carcinoma in-situ (DCIS) than its’ malignant counterpart. Although
one quarter of patients with breast cancer will have DCIS, there is limited information
available regarding factors predisposing to inadequate pathologic margins, and the
need for re-excision.
Methods
Retrospective review of patients treated for DCIS between the years 2010–2016 was
conducted. Patients with DCIS undergoing BCS were identified and evaluated for demographic
and pathologic factors associated with suboptimal pathologic margins and re-excision.
Multivariate analysis with Wald Chi-Square testing was performed.
Results
241 patients underwent BCS with suboptimal margins (SOM) in 51.7% (123/238), with
27.8% undergoing re-excision (67/241). Tumor size was the most influential variable,
positively associated with SOM (OR = 10.25, CI: 5.50–19.13) and re-excision (OR = 6.36,
CI: 3.92–10.31). Patient age was inversely associated with SOM (OR = 0.58, CI: 0.39–0.85)
and subsequent re-excisions (OR = 0.56, CI: 0.36–0.86). Low tumour grade was associated
with re-excision (OR = 1.31, CI: 0.63–2.71), while ER negative disease was associated
with SOM (OR = 2.24, CI: 1.21–4.14).
Discussion
Inadequate pathologic margins following BCS, and subsequent re-excision rates are
common in patients with DCIS, and consistent with the literature. Tumour size is the
dominant factor driving this occurrence, with patient age and tumour grade also impacting
outcomes.
Keywords
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Article info
Publication history
Published online: February 25, 2023
Accepted:
February 24,
2023
Received in revised form:
January 28,
2023
Received:
November 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
