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

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

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

Murtola Teemu
Roine Antti
Oksala Niku
Tuominen Jalmari
Karhunen-Enckell Ulla
Lepomäki Maiju
Kronqvist Pauliina
Katso/Avaa
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WILEY
doi:10.1002/jso.26749
URI
https://onlinelibrary.wiley.com/doi/10.1002/jso.26749
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2022012710707
Tiivistelmä

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.

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