Abstract
Purpose. The purpose of this study was to compare the surgical and pathological variables which impact rate of re-excision following breast conserving therapy (BCS) with or without concurrent additional margin excision (AM). Methods. The pathology database was queried for all patients with DCIS from January 2004 to September 2008. Pathologic assessment included volume of excision, subtype, size, distance from margin, grade, necrosis, multifocality, calcifications, and ER/PR status. Results. 405 cases were identified and 201 underwent BCS, 151-BCS-AM, and 53-mastectomy. Among the 201 BCS patients, 190 underwent re-excision for close or involved margins. 129 of these were treated with BCS and 61 with BCS-AM (P < .0001). The incidence of residual DCIS in the re-excision specimens was 32% (n = 65) for BCS and 22% (n = 33) for BCS-AM (P < .05). For both the BCS and the BCS-AM cohorts, volume of tissue excised is inversely correlated to the rate of re-excision (P = .0284). Multifocality (P = .0002) and ER status (P = .0382) were also significant predictors for rate of re-excision and variation in surgical technique was insignificant. Conclusions. The rate of positive margins, re-excision, and residual disease was significantly higher in patients with lower volume of excision. The performance of concurrent additional margin excision increases the efficacy of BCS for DCIS.
Highlights
Ductal carcinoma in situ (DCIS) is a noninvasive cancer that can be an obligate precursor of invasive ductal carcinoma (IDC)
Patients who underwent breast conserving surgery (BCS) (n = 201), BCSAM (n = 151), or total mastectomy (TM) (n = 53) for DCIS between 2004 and 2008 at NYUMC were compared by clinicopathological variables and were found to be similar in age, grade and size of DCIS, necrosis, multifocality, calcifications, and estrogen receptor (ER)/progesterone receptor status (PR)
We evaluated the efficacy of simultaneous additional margin excision at the time of initial BCS in reducing the rate of surgical re-excision
Summary
Ductal carcinoma in situ (DCIS) is a noninvasive cancer that can be an obligate precursor of invasive ductal carcinoma (IDC). Since the early 1990s, reported survival outcome for DCIS is equivalent for breast conserving surgery (BCS). BCS is an oncoplastic procedure, in that its goal is to remove all DCIS, including a circumferential margin of noncarcinomatous tissue, commensurate with preserving as much of the normal breast tissue and appearance as possible. While there is no consensus on a safe margin width in breast conservation therapy, margins may be categorized as positive if directly involved with cancer cells, as inadequate if less than 1-2 mm, and as negative if greater than 10 mm [3]. Multiple studies have shown that ipsilateral breast tumor recurrence (IBTR) is associated with positive margins in patients undergoing BCS [4,5,6].
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