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Does intra‐operative margin assessment improve margin status and re‐excision rates? A population‐based analysis of outcomes in breast‐conserving surgery for ductal carcinoma in situ
Author(s) -
Laws Alison,
Brar Mantaj S,
BouchardFortier Antoine,
Leong Brad,
Quan May Lynn
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.25248
Subject(s) - medicine , breast conserving surgery , mastectomy , ductal carcinoma , margin (machine learning) , confidence interval , odds ratio , surgical margin , breast cancer , population , mammography , surgery , logistic regression , radiology , cancer , resection , environmental health , machine learning , computer science
Background and Objectives Using a 2 mm margin criteria, we evaluated the effect of intra‐operative margin assessment on margin status and re‐excisions following breast‐conserving surgery (BCS) for ductal carcinoma in situ (DCIS). Methods We identified patients undergoing BCS for DCIS from a prospective, population‐based database. Multivariable logistic regression was used to determine the effect of specimen mammography, ultrasound and macroscopic assessment by a pathologist on margins and re‐excision rates. Results In 588 patients, 52% (95% confidence interval [CI], 48%‐56%) had positive margins (<2 mm), 39% (95% CI, 35%‐43%) had a re‐excision and 15% (95% CI, 12%‐18%) had completion mastectomy. There were few re‐excisions for margins ≥2 mm (2%). Adjusting for confounders, any margin assessment versus wire localization alone did not reduce positive margins (odds ratio [OR], 0.75; P = 0.202) or re‐excisions (OR, 1.14; P = 0.564), however both outcomes varied by type of technique ( P < 0.001). Individually, only macroscopic assessment by pathologist reduced positive margins (OR, 0.54; P = 0.002) and re‐excisions (OR, 0.61; P = 0.036). Conclusions Despite adherence to a 2 mm margin criteria, re‐excision rates remain high following BCS for DCIS, with 39% converted to mastectomy when re‐excision is required. Intra‐operative margin assessment does not appear to reduce re‐excisions; in particular, surgeons should be aware of the limitations of specimen mammography for margin assessment in DCIS.