Tumor margins that lead to reoperation in breast cancer: A retrospective register study of 4,489 patients.

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Tytuł:: Tumor margins that lead to reoperation in breast cancer: A retrospective register study of 4,489 patients.
Autorzy:: Lepomäki M; Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Karhunen-Enckell U; Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.; Department of Surgery, Tampere University Hospital, Tampere, Finland.
Tuominen J; Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Kronqvist P; Department of Pathology, Turku University Hospital, Turku, Finland.
Oksala N; Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.; Vascular surgery, Vascular Centre, Tampere University Hospital, Tampere, Finland.
Murtola T; Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.; Department of Urology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland.; Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland.
Roine A; Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Źródło:: Journal of surgical oncology [J Surg Oncol] 2022 Mar; Vol. 125 (4), pp. 577-588. Date of Electronic Publication: 2021 Nov 15.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: <2005-> : Hoboken, NJ : Wiley-Liss
Original Publication: New York, Plenum.
MeSH Terms:: Margins of Excision*
Breast Neoplasms/*surgery
Carcinoma, Ductal, Breast/*surgery
Carcinoma, Intraductal, Noninfiltrating/*surgery
Carcinoma, Lobular/*surgery
Mastectomy/*methods
Reoperation/*statistics & numerical data
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/pathology ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Carcinoma, Lobular/pathology ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Prognosis ; Retrospective Studies
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Grant Information:: 9AA057 Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and Pirkanmaa Hospital District; 9v044 Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and Pirkanmaa Hospital District; 9x040 Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and Pirkanmaa Hospital District; Kauppaneuvos Satu Tiivolan rahasto Cancer Foundation of Finland; 2167 The Finnish Medical Foundation; 4038 The Finnish Medical Foundation; 9AA049 Noncompetitive Research Funding of the Expert Responsibility Area of Pirkanmaa Hospital District
Contributed Indexing:: Keywords: DCIS; breast-conserving surgery; mastectomy; positive margins; reoperation
Entry Date(s):: Date Created: 20211115 Date Completed: 20220221 Latest Revision: 20220731
Update Code:: 20240104
PubMed Central ID:: PMC9298886
DOI:: 10.1002/jso.26749
PMID:: 34779520
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Background and Objectives: Optimal margins for ductal carcinoma in situ (DCIS) remain controversial in breast-conserving surgery (BCS) and mastectomy. We examine the association of positive margins, reoperations, DCIS and age.
Methods: A retrospective study of histopathological reports (4489 patients). Margin positivity was defined as ink on tumor for invasive carcinoma. For DCIS, we applied 2 mm anterior and side margin thresholds, and ink on tumor in the posterior margin.
Results: The incidence of positive side margins was 20% in BCS and 5% in mastectomies (p < 0.001). Of these patients, 68% and 14% underwent a reoperation (p < 0.001). After a positive side margin in BCS, the reoperation rates according to age groups were 74% (<49), 69% (50-64), 68% (65-79), and 42% (80+) (p = 0.013). Of BCS patients with invasive carcinoma in the side margin, 73% were reoperated on. A reoperation was performed in 70% of patients with a close (≤1 mm) DCIS side margin, compared to 43% with a wider (1.1-2 mm) margin (p = 0.002). The reoperation rates were 55% in invasive carcinoma with close DCIS, 66% in close extensive intraductal component (EIC), and 83% in close pure DCIS (p < 0.001).
Conclusions: Individual assessment as opposed to rigid adherence to guidelines was used in the decision on reoperation.
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