Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

Dixon, JM; Newlands, Carrie; Dodds, C.; Thomas, Jeremy; Williams, Linda; Kunkler, I.; Bing, Alison; Macaskill, E. Jane

doi:10.1002/bjs.10126

Cited by 14 publications

(13 citation statements)

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“…29,32 Other studies, similar to the current findings, have shown that the diffuse DCIS growth patterns such as micropapillary and cribriform types, high nuclear grade DCIS with comedo type necrosis and high-risk VNPI are factors associated with an increased rate of re-excisions. [31][32][33][34] The current study shows that half of the patients with DCIS who underwent re-excision, due to positive or close surgical margins, were of low and intermediate grade. This practice might have an impact on the pending outcome of recent trials for more conservative management of low-risk DCIS.…”

Section: Discussionsupporting

confidence: 87%

“…The need to perform further surgery, re‐excision or completion mastectomy, is governed predominantly by what is regarded as a minimum free resection margin. Positive margins are partly due to radiologic under‐estimation of DCIS size which can occur in over 50% of cases . Other studies, similar to the current findings, have shown that the diffuse DCIS growth patterns such as micropapillary and cribriform types, high nuclear grade DCIS with comedo type necrosis and high‐risk VNPI are factors associated with an increased rate of re‐excisions …”

Section: Discussionsupporting

confidence: 84%

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Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

et al. 2019

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Background Management of breast ductal carcinoma in situ (DCIS) has various approaches with distinct institutional specific practice. Here, we review DCIS management in a single institution with emphasize on re‐operation rates and outcome. Methods Breast ductal carcinoma in situ cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n = 1249). Clinicopathological data were collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re‐excision, presence of residual tumor in the re‐excision specimens, use of radiotherapy and ipsilateral recurrences were analyzed. Results 34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumor grade, size >40 mm, and associated with comedo necrosis and Paget's disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumor tissue was detected in 53% of the re‐excision specimens. Re‐excision rates of patients treated with breast‐conserving surgery (BCS) were reduced from approximately 70% to 23%, and the final mastectomy rates decreased from 60% to 20%. Changes in surgical practice with acceptance of smaller excision margins and more frequent use of local radiotherapy have led to a significant decrease not only in the re‐excision rate but also in the final mastectomy rate together with non‐significant reduction in 5‐ and 10‐year local recurrence rates. Conclusion Although BCS is increasingly the preferred primary surgical option for DCIS management, a proportion of low‐risk DCIS patients continue to undergo re‐excision surgery or completion mastectomy. Despite acceptance of smaller margins, recurrence rate is decreasing.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 84%

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

et al. 2019

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“…The consensus panel, having considered data from this meta-analysis and other expert advice concluded that margins of >0mm are sufficient to determine a negative margin when performing BCS for invasive cancer [8]. The disease that is most often closest to the margin in patients undergoing BCS for invasive disease is DCIS [22]. Having different margins for BCS for invasive cancer and for DCIS thus makes little biological sense.…”

Section: Discussionmentioning

confidence: 99%

Margin width and local recurrence after breast conserving surgery for ductal carcinoma in situ

Ekatah

Turnbull

Arthur

et al. 2017

European Journal of Surgical Oncology

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“…The sensitivity of conventional mammography is limited, missing four in every ten cases of DCIS. Also, when DCIS is detected by conventional mammography and/or ultrasonography, the extent of the lesion is often underestimated . While DCE‐MRI has a good sensitivity of 98% for detecting high‐grade DCIS, its size is frequently overestimated .…”

Section: Future Perspectivesmentioning

confidence: 99%

Breast magnetic resonance elastography: a review of clinical work and future perspectives

et al. 2018

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This review on magnetic resonance elastography (MRE) of the breast provides an overview of available literature and describes current developments in the field of breast MRE, including new transducer technology for data acquisition and multi-frequency-derived power-law behaviour of tissue. Moreover, we discuss the future potential of breast MRE, which goes beyond its original application as an additional tool in differentiating benign from malignant breast lesions. These areas of ongoing and future research include MRE for pre-operative tumour delineation, staging, monitoring and predicting response to treatment, as well as prediction of the metastatic potential of primary tumours.

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Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

Abstract: Underestimation of tumour size by current imaging techniques is a major factor associated with incomplete excision in women undergoing BCS.

Cited by 14 publications

References 50 publications

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Margin width and local recurrence after breast conserving surgery for ductal carcinoma in situ

Breast magnetic resonance elastography: a review of clinical work and future perspectives

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