Radiopathological features predictive of involved margins in ductal carcinoma in situ
Radiopathological features predictive of involved margins in ductal carcinoma in situ
INTRODUCTION
Ductal carcinoma in situ (DCIS) usually manifests as microcalcification on mammography but may be uncalcified. Consequently, a quarter of patients undergoing excision of a presumed pure DCIS require further surgery to re-excise margins. Patients at highest risk of margin involvement may benefit from additional preoperative assessment.
METHODS
A retrospective review was carried out of patients treated for screen detected, biopsy proven DCIS in a single centre over a ten-year period (1999–2009). Logistic regression analysis identified factors predictive of need for further surgery to clear margins.
RESULTS
Overall, 248 patients underwent surgery for DCIS (low/intermediate grade: 82, high grade: 155) and 49 (19.8%) required further surgery. High grade disease was associated with greater mammographic extent (mean: 32mm [range: 5–120mm] vs 25mm [range: 2–100mm]), p=0.009) and higher incidence of mastectomy (38% vs 24%, p=0.034). Factors predictive of involvement of surgical margins necessitating further surgery included negative oestrogen receptor status (OR: 5.2, 95% CI: 2.1–12.8, p<0.001) and mammographic extent (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2–2.1, p=0.004). Once size exceeded 30mm, more than 50% of patients required secondary breast surgery for margins.
CONCLUSIONS
Reoperation rates for DCIS increase with preoperative size on mammography and negative oestrogen receptor status on core biopsy. Patients with these risk features should be counselled accordingly and consideration should be given to the role of additional preoperative imaging.
137-144
Layfield, D.M.
3f5ffdd6-6ec0-43dd-95a8-5752bcefe7f5
See, H.
ce9344a1-f33c-452d-9784-67b10dca66b4
Stahnke, M.
a5b36c65-2862-4b7d-be55-5072674a2ac2
Hayward, L
2a58cfc4-7303-4a86-84ca-c70fb00b56fb
Cutress, R.
68ae4f86-e8cf-411f-a335-cdba51797406
Oeppen, Rs
e9e53b3f-23f4-46ab-9e95-171f519c6cc9
1 February 2017
Layfield, D.M.
3f5ffdd6-6ec0-43dd-95a8-5752bcefe7f5
See, H.
ce9344a1-f33c-452d-9784-67b10dca66b4
Stahnke, M.
a5b36c65-2862-4b7d-be55-5072674a2ac2
Hayward, L
2a58cfc4-7303-4a86-84ca-c70fb00b56fb
Cutress, R.
68ae4f86-e8cf-411f-a335-cdba51797406
Oeppen, Rs
e9e53b3f-23f4-46ab-9e95-171f519c6cc9
Layfield, D.M., See, H., Stahnke, M., Hayward, L, Cutress, R. and Oeppen, Rs
(2017)
Radiopathological features predictive of involved margins in ductal carcinoma in situ.
Annals of The Royal College of Surgeons of England, 99 (2), .
(doi:10.1308/rcsann.2016.0299).
Abstract
INTRODUCTION
Ductal carcinoma in situ (DCIS) usually manifests as microcalcification on mammography but may be uncalcified. Consequently, a quarter of patients undergoing excision of a presumed pure DCIS require further surgery to re-excise margins. Patients at highest risk of margin involvement may benefit from additional preoperative assessment.
METHODS
A retrospective review was carried out of patients treated for screen detected, biopsy proven DCIS in a single centre over a ten-year period (1999–2009). Logistic regression analysis identified factors predictive of need for further surgery to clear margins.
RESULTS
Overall, 248 patients underwent surgery for DCIS (low/intermediate grade: 82, high grade: 155) and 49 (19.8%) required further surgery. High grade disease was associated with greater mammographic extent (mean: 32mm [range: 5–120mm] vs 25mm [range: 2–100mm]), p=0.009) and higher incidence of mastectomy (38% vs 24%, p=0.034). Factors predictive of involvement of surgical margins necessitating further surgery included negative oestrogen receptor status (OR: 5.2, 95% CI: 2.1–12.8, p<0.001) and mammographic extent (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2–2.1, p=0.004). Once size exceeded 30mm, more than 50% of patients required secondary breast surgery for margins.
CONCLUSIONS
Reoperation rates for DCIS increase with preoperative size on mammography and negative oestrogen receptor status on core biopsy. Patients with these risk features should be counselled accordingly and consideration should be given to the role of additional preoperative imaging.
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e-pub ahead of print date: 23 September 2016
Published date: 1 February 2017
Identifiers
Local EPrints ID: 413361
URI: http://eprints.soton.ac.uk/id/eprint/413361
ISSN: 0035-8843
PURE UUID: fde9453a-bc50-4435-82d2-43f12450efc7
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Date deposited: 22 Aug 2017 16:32
Last modified: 15 Mar 2024 14:05
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Author:
D.M. Layfield
Author:
H. See
Author:
M. Stahnke
Author:
L Hayward
Author:
Rs Oeppen
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