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

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

Abstract

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.

Keywords: DCIS; breast-conserving surgery; mastectomy; positive margins; reoperation.

Conflict of interest statement

Maiju Lepomäki declares funding from the Doctoral School of Tampere University, The Finnish Medical Foundation (grant numbers 2167, 4038), and Cancer Foundation of Finland (Kauppaneuvos Satu Tiivolan rahasto). This study was also financially supported by Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and Pirkanmaa Hospital District (Grants 9AA057, 9×040, and 9v044), and Non‐Competitive Research Funding of the Expert Responsibility Area of Pirkanmaa Hospital District (Grant 9AA049). Antti Roine and Niku Oksala are shareholders and employees of Olfactomics Ltd., a medical device company that develops novel technology for intraoperative surgical margin assessment. Teemu Murtola is a consultant for Astellas, Janssen‐Cilag, and Ferring and reports receiving speakers’ bureau honoraria from Astellas and Janssen‐Cilag, in addition to participating in congresses at the expense of Janssen‐Cilag and Pfizer. He also owns stock in Arocell Ab. For the remaining authors, no conflicts of interest relevant to this study are declared.

© 2021 Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Flow chart of data management. (A) Structured histopathological tables were named based on laboratory workflow: 46 different consultation types (n = 133,307). All breast‐related consultation types were included. (B) Histopathological reports were classified in 91 categories according to anatomical site (n = 21,200). A random sample from each category (5% of reports) was collected and reviewed from the viewpoint of study relevance. Relevant reports were included. (C) Relevant histopathological reports were manually reviewed, and the data in the structured tables were supplemented accordingly. (D) Irrelevant data were excluded (n = 4080)
Figure 2
Figure 2
Annual distribution of mastectomies and resections (primary BCS and reresections) included in the study sample. The number of procedures varied significantly each year. BCS, breast‐conserving surgery
Figure 3
Figure 3
The relative number of positive surgical margins increased as the extent of DCIS increased. The positive margin rate was 13% in invasive carcinoma, 18% in invasive carcinoma with DCIS, 43% in invasive carcinoma with EIC, and 38% with pure DCIS (n = 3914; p < 0.001). Margin status encompasses all margin orientations (anterior, posterior, and side). DCIS, ductal carcinoma in situ; EIC, extensive intraductal component

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Source: PubMed

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