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

Maiju Lepomäki, Ulla Karhunen-Enckell, Jalmari Tuominen, Pauliina Kronqvist, Niku Oksala, Teemu Murtola, Antti Roine

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    Abstract

    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.

    Original languageEnglish
    Pages (from-to)577-588
    Number of pages12
    JournalJOURNAL OF SURGICAL ONCOLOGY
    Volume125
    Issue number4
    Early online date15 Nov 2021
    DOIs
    Publication statusPublished - Mar 2022
    Publication typeA1 Journal article-refereed

    Keywords

    • breast-conserving surgery
    • DCIS
    • mastectomy
    • positive margins
    • reoperation

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • Surgery
    • Oncology

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