TY - JOUR
T1 - Tumor margins that lead to reoperation in breast cancer
T2 - A retrospective register study of 4,489 patients
AU - Lepomäki, Maiju
AU - Karhunen-Enckell, Ulla
AU - Tuominen, Jalmari
AU - Kronqvist, Pauliina
AU - Oksala, Niku
AU - Murtola, Teemu
AU - Roine, Antti
N1 - Funding Information:
Maiju Lepomäki declares funding from the Doctoral School of Tampere University, The Finnish Medical Foundation (grant numbers 2167, 4038), and Cancer Foundation of Finland (Kauppaneuvos Satu Tiivolan rahasto). This study was also financially supported by Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and Pirkanmaa Hospital District (Grants 9AA057, 9×040, and 9v044), and Non‐Competitive Research Funding of the Expert Responsibility Area of Pirkanmaa Hospital District (Grant 9AA049). Antti Roine and Niku Oksala are shareholders and employees of Olfactomics Ltd., a medical device company that develops novel technology for intraoperative surgical margin assessment. Teemu Murtola is a consultant for Astellas, Janssen‐Cilag, and Ferring and reports receiving speakers’ bureau honoraria from Astellas and Janssen‐Cilag, in addition to participating in congresses at the expense of Janssen‐Cilag and Pfizer. He also owns stock in Arocell Ab. For the remaining authors, no conflicts of interest relevant to this study are declared.
Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - breast-conserving surgery
KW - DCIS
KW - mastectomy
KW - positive margins
KW - reoperation
U2 - 10.1002/jso.26749
DO - 10.1002/jso.26749
M3 - Article
AN - SCOPUS:85119336283
SN - 0022-4790
VL - 125
SP - 577
EP - 588
JO - JOURNAL OF SURGICAL ONCOLOGY
JF - JOURNAL OF SURGICAL ONCOLOGY
IS - 4
ER -
