620 Re-Operation Following Initial Breast Conservation Surgery for DCIS and Invasive Breast Cancer at ELHT Breast Unit, in 2021

Abstract

Abstract Aim Breast conserving surgery (BCS), as an alternative to mastectomy, in appropriately selected patients with early-stage breast cancer is recommended. Cancer specimens from BCS can be reported as involved or close margins; this finding might increase patients’ future risk of local and distant recurrence. Association of Breast Surgery advises re-excision of breast if disease is present at radial margins (<1mm). The reported (2014-2018) national re-excision rates for invasive disease and DCIS were 13% and 22% respectively. This audit reviewed our Breast Unit BCS re-excision rates in 2021. Method All breast procedures performed at ELHT in 2021 were retrospectively reviewed. Patients who underwent BCS for invasive and DCIS were included in our audit. We examined the total number of patients who required further surgery following BCS, secondary to incomplete excision margin and reviewed their subsequent pathological finding and management following their re-excision surgery. Patients who had incidentally found invasive/ DCIS disease at diagnostic excision were excluded. Results 633 breast procedures were performed in the study period: 232 were BCS for invasive disease and DCIS. Re-excision rate for invasive disease was 15.1% (31/205) and 33.3% (9/27) for DCIS. Some patients (7.5%) required more than one re-excision surgery. Among these patients, a few opted for completion mastectomy. Conclusions We reported a comparable BCS re-excision rate for invasive cancer but higher than national standard re-excision rate for DCIS. This might be explained by the overall small number of BCS for DCIS. We aimed to make changes to our practice and re-audit.