Abstract

Objective: To determine the relationship between negative margin width and locoregional recurrence (LRR) in a contemporary cohort of ductal carcinoma in situ (DCIS) patients. Background: Recent national consensus guidelines recommend an optimal margin width of 2 mm or greater for the management of DCIS; however, controversy regarding re-excision remains when managing negative margins <2 mm. Methods: One thousand four hundred ninety-one patients with DCIS who underwent breast-conserving surgery from 1996 to 2010 were identified from a prospectively managed cancer center database and analyzed using univariate and multivariate Cox proportional hazard models to determine the relationship between negative margin width and LRR with or without adjuvant radiation therapy (RT). Results: A univariate analysis revealed that age <40 years (n = 89; P = 0.02), no RT (n = 298; P = 0.01), and negative margin width <2 mm (n = 120; P = 0.005) were associated with LRR. The association between margin width and LRR differed by adjuvant RT status (interaction P = 0.02). There was no statistical significant difference in LRR between patients with <2 mm and ≥2 mm negative margins who underwent RT (10-yr LRR rate, 4.8% vs 3.3%, respectively; hazard ratio, 0.8; 95% CI, 0.2-3.2; P = 0.72). For patients who did not undergo RT, those with margins <2 mm were significantly more likely to develop a LRR than were those with margins ≥2 mm (10-yr LRR rate, 30.9% vs 5.4%, respectively; hazard ratio, 5.5; 95% CI, 1.8-16.8, P = 0.003). Conclusions: Routine additional surgery may not be justified for patients with negative margins <2 mm who undergo RT but should be performed in patients who forego RT.

Original languageEnglish (US)
Pages (from-to)150-157
Number of pages8
JournalAnnals of surgery
Volume269
Issue number1
DOIs
StatePublished - Jan 1 2019

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Carcinoma, Intraductal, Noninfiltrating
Breast
Radiotherapy
Recurrence
Segmental Mastectomy
Proportional Hazards Models
Databases
Guidelines

Keywords

  • breast conservation
  • ductal carcinoma in situ
  • local regional recurrence
  • margins

ASJC Scopus subject areas

  • Surgery

Cite this

@article{54b59afa97d84b7bb2d9107ad97d2572,
title = "Ductal Carcinoma in Situ and Margins <2 mm: Contemporary Outcomes with Breast Conservation",
abstract = "Objective: To determine the relationship between negative margin width and locoregional recurrence (LRR) in a contemporary cohort of ductal carcinoma in situ (DCIS) patients. Background: Recent national consensus guidelines recommend an optimal margin width of 2 mm or greater for the management of DCIS; however, controversy regarding re-excision remains when managing negative margins <2 mm. Methods: One thousand four hundred ninety-one patients with DCIS who underwent breast-conserving surgery from 1996 to 2010 were identified from a prospectively managed cancer center database and analyzed using univariate and multivariate Cox proportional hazard models to determine the relationship between negative margin width and LRR with or without adjuvant radiation therapy (RT). Results: A univariate analysis revealed that age <40 years (n = 89; P = 0.02), no RT (n = 298; P = 0.01), and negative margin width <2 mm (n = 120; P = 0.005) were associated with LRR. The association between margin width and LRR differed by adjuvant RT status (interaction P = 0.02). There was no statistical significant difference in LRR between patients with <2 mm and ≥2 mm negative margins who underwent RT (10-yr LRR rate, 4.8{\%} vs 3.3{\%}, respectively; hazard ratio, 0.8; 95{\%} CI, 0.2-3.2; P = 0.72). For patients who did not undergo RT, those with margins <2 mm were significantly more likely to develop a LRR than were those with margins ≥2 mm (10-yr LRR rate, 30.9{\%} vs 5.4{\%}, respectively; hazard ratio, 5.5; 95{\%} CI, 1.8-16.8, P = 0.003). Conclusions: Routine additional surgery may not be justified for patients with negative margins <2 mm who undergo RT but should be performed in patients who forego RT.",
keywords = "breast conservation, ductal carcinoma in situ, local regional recurrence, margins",
author = "Tadros, {Audree B.} and Benjamin Smith and Yu Shen and Heather Lin and Savitri Krishnamurthy and Anthony Lucci and Barcenas, {Carlos Hernando} and Hwang, {Rosa Frances} and Rauch, {Gaiane Margishvili} and Lumarie Santiago and Strom, {Eric A} and DeSnyder, {Sarah Marie} and Yang, {Wei Tse} and Black, {Dalliah Mashon} and Constance Albarracin and {Chavez Mac Gregor}, Mariana and Hunt, {Kelly K} and Kuerer, {Henry Mark}",
year = "2019",
month = "1",
day = "1",
doi = "10.1097/SLA.0000000000002439",
language = "English (US)",
volume = "269",
pages = "150--157",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Ductal Carcinoma in Situ and Margins <2 mm

T2 - Contemporary Outcomes with Breast Conservation

AU - Tadros, Audree B.

AU - Smith, Benjamin

AU - Shen, Yu

AU - Lin, Heather

AU - Krishnamurthy, Savitri

AU - Lucci, Anthony

AU - Barcenas, Carlos Hernando

AU - Hwang, Rosa Frances

AU - Rauch, Gaiane Margishvili

AU - Santiago, Lumarie

AU - Strom, Eric A

AU - DeSnyder, Sarah Marie

AU - Yang, Wei Tse

AU - Black, Dalliah Mashon

AU - Albarracin, Constance

AU - Chavez Mac Gregor, Mariana

AU - Hunt, Kelly K

AU - Kuerer, Henry Mark

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To determine the relationship between negative margin width and locoregional recurrence (LRR) in a contemporary cohort of ductal carcinoma in situ (DCIS) patients. Background: Recent national consensus guidelines recommend an optimal margin width of 2 mm or greater for the management of DCIS; however, controversy regarding re-excision remains when managing negative margins <2 mm. Methods: One thousand four hundred ninety-one patients with DCIS who underwent breast-conserving surgery from 1996 to 2010 were identified from a prospectively managed cancer center database and analyzed using univariate and multivariate Cox proportional hazard models to determine the relationship between negative margin width and LRR with or without adjuvant radiation therapy (RT). Results: A univariate analysis revealed that age <40 years (n = 89; P = 0.02), no RT (n = 298; P = 0.01), and negative margin width <2 mm (n = 120; P = 0.005) were associated with LRR. The association between margin width and LRR differed by adjuvant RT status (interaction P = 0.02). There was no statistical significant difference in LRR between patients with <2 mm and ≥2 mm negative margins who underwent RT (10-yr LRR rate, 4.8% vs 3.3%, respectively; hazard ratio, 0.8; 95% CI, 0.2-3.2; P = 0.72). For patients who did not undergo RT, those with margins <2 mm were significantly more likely to develop a LRR than were those with margins ≥2 mm (10-yr LRR rate, 30.9% vs 5.4%, respectively; hazard ratio, 5.5; 95% CI, 1.8-16.8, P = 0.003). Conclusions: Routine additional surgery may not be justified for patients with negative margins <2 mm who undergo RT but should be performed in patients who forego RT.

AB - Objective: To determine the relationship between negative margin width and locoregional recurrence (LRR) in a contemporary cohort of ductal carcinoma in situ (DCIS) patients. Background: Recent national consensus guidelines recommend an optimal margin width of 2 mm or greater for the management of DCIS; however, controversy regarding re-excision remains when managing negative margins <2 mm. Methods: One thousand four hundred ninety-one patients with DCIS who underwent breast-conserving surgery from 1996 to 2010 were identified from a prospectively managed cancer center database and analyzed using univariate and multivariate Cox proportional hazard models to determine the relationship between negative margin width and LRR with or without adjuvant radiation therapy (RT). Results: A univariate analysis revealed that age <40 years (n = 89; P = 0.02), no RT (n = 298; P = 0.01), and negative margin width <2 mm (n = 120; P = 0.005) were associated with LRR. The association between margin width and LRR differed by adjuvant RT status (interaction P = 0.02). There was no statistical significant difference in LRR between patients with <2 mm and ≥2 mm negative margins who underwent RT (10-yr LRR rate, 4.8% vs 3.3%, respectively; hazard ratio, 0.8; 95% CI, 0.2-3.2; P = 0.72). For patients who did not undergo RT, those with margins <2 mm were significantly more likely to develop a LRR than were those with margins ≥2 mm (10-yr LRR rate, 30.9% vs 5.4%, respectively; hazard ratio, 5.5; 95% CI, 1.8-16.8, P = 0.003). Conclusions: Routine additional surgery may not be justified for patients with negative margins <2 mm who undergo RT but should be performed in patients who forego RT.

KW - breast conservation

KW - ductal carcinoma in situ

KW - local regional recurrence

KW - margins

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U2 - 10.1097/SLA.0000000000002439

DO - 10.1097/SLA.0000000000002439

M3 - Article

C2 - 28742682

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VL - 269

SP - 150

EP - 157

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

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