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The impact of preoperative magnetic resonance imaging and lumpectomy cavity shavings on re‐excision rate in pure ductal carcinoma in situ—A single institution's experience
Author(s) -
So Alycia,
De La Cruz Lucy M.,
Williams Austin D.,
Bahng Joseph,
Liao Geraldine,
McDonald Elizabeth S.,
Fisher Carla S.,
Czerniecki Brian J.,
Sataloff Dahlia,
Tchou Julia
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24890
Subject(s) - lumpectomy , medicine , magnetic resonance imaging , ductal carcinoma , in situ , radiology , stage (stratigraphy) , mastectomy , breast cancer , cancer , paleontology , physics , biology , meteorology
Background and Objectives The impact of preoperative magnetic resonance imaging (pMRI) and cavity shave margins (CSM) on re‐excision rate (RR) in DCIS is unclear. We investigated whether either modality was associated with RR in DCIS. Methods This is a single‐institution retrospective study of 295 women undergoing breast conservation surgery for pure DCIS (2010‐2013). CSM were the systematic resection of 4‐6 margins during lumpectomy whereas selective shave margins (SSM) were the selective resection of 1‐3 margins. Patient demographics and clinical characteristics were abstracted. RR was analyzed according to the use of pMRI, SSM, or CSM with respect to three high‐volume breast surgeons at our institution. Results RR was not associated with the use of pMRI ( P = 0.87). Any shave margins ( P = 0.05), DCIS size ( P < 0.001), and DCIS grade ( P = 0.14) associated with a lower RR. Of our high‐volume surgeons, RR was lower for Surgeon A ( P = 0.02). Multivariate analyses showed larger DCIS (OR 1.35, P = 0.005) and practices specific to surgeons B (OR 3.23, P = 0.04) and C (OR 3.57, P = 0.04) increased re‐excision odds. Conclusions SSM/CSM and pMRI use varied among surgeons. Our results suggested the routine use of CSM, not pMRI, could lower re‐excision rate, which highlighted a quality improvement opportunity at our institution.