Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast

Neuschatz, Andrew C.; DiPetrillo, Thomas A.; Safaii, Homa; Lowther, D; Landa, Marcia; Wazer, David E.

doi:10.1002/ijc.10357

Cited by 36 publications

(27 citation statements)

References 26 publications

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“…These have included young age, tumor size, nuclear grade, intraductal necrosis, mammographic appearance, histological presence of calcifications and margin status. 5,10,[12][13][14][15][16][17][18][22][23][24][25][26] Results have been inconsistent and various reasons have been cited, including the lack of data with the necessary prolonged follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…One of the potential predictors for local recurrence in DCIS is the margin status of the excised specimen. 5,10,[12][13][14][15][16][17][18] It is therefore a major determinant for further treatment decisions in breast-conserving surgery for DCIS as it is the only factor that can be influenced by physician intervention. The real issue, however, is the presence of residual disease in the remaining breast.…”

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confidence: 99%

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Histological margin assessment for breast ductal carcinoma in situ: precision and implications

Sigal‐Zafrani

Klimberg²

2003

Mod Pathol

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Local recurrence after lumpectomy for ductal carcinoma in situ (DCIS) is a major concern and is related to residual disease in the breast. We studied the predictive value of lumpectomy margins for residual DCIS and compared our results and pathological processing techniques with those published in the literature. Margin status was determined for 89 patients with screen-detected DCIS who had lumpectomy and re-excision, for the presence and extent of residual disease. Margin width was defined as the narrowest distance between tumor and any inked margin or, where margins were positive, classified into focal involvement (o1 mm of the inked surface involved), minimal (Z1o15 mm) and extensive (Z15 mm). The amount of residual tumor was quantified according to the number of ducts involved with tumor: small (fewer than 10 ducts) or large (10 or more ducts) residuum. The initial margin status was a significant predictor for the presence of residual tumor in re-excision specimens (P ¼ 0.006). There was residual tumor in 44 and 45% of close non-involved (41 and r1 mm width) margins, 67% of focally, 71% of moderately and 94% of extensively positive margins. The pathologic tumor size was also a predictor for the presence of residual tumor with 27, 68 and 74% of lesions measuring r10, 11-25, 425 mm,respectively, showing residual disease. The presence of residual tumor was not significantly related to age, mammographic appearance, nuclear grade or intraductal necrosis. The initial margin status was found to predict for the amount of residual tumor. With careful margin assessment, margin status after lumpectomy for DCIS can be used to predict for the presence and amount of residual tumor in the breast and is a guide to further management decisions. A standard for margin status reporting and pathological processing of screen-detected DCIS in situ lesions will help in the interpretation of data from different institutions. Keywords: ductal carcinoma in situ; lumpectomy; margin; residual disease; histopathology; classification With the widespread use of mammographic screening for breast cancer, more cases of ductal carcinoma in situ (DCIS) are being detected. Between 1983 and 1992, there was a 500% increase in the prevalence of diagnosis of DCIS.1 DCIS now accounts for over 14% of breast cancers diagnosed annually in the United States. 2Treatment options for patients with DCIS and DCIS associated with microinvasion have moved from mastectomy to breast-conserving surgery, as conservation of the breast for DCIS allows comparable survival rates with mastectomy.3-5 Local recurrences for DCIS are of major concern as half of these are invasive cancers that could impair survival 4,[6][7][8][9][10][11] Achieving a low recurrence rate is therefore a major goal. One of the potential predictors for local recurrence in DCIS is the margin status of the excised specimen. 5,10,[12][13][14][15][16][17][18] It is therefore a major determinant for further treatment decisions in breast-conserving surgery for DCIS as it is the only factor that can be ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

Sigal‐Zafrani

Klimberg²

2003

Mod Pathol

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“…Previous studies have established that surgical margin status is predictive for the probability of residual tumor for both invasive breast carcinoma 6 -11 and in situ breast carcinoma. [12][13][14][15] It can be concluded from this that microscopic residual disease found adjacent to the resection cavity is a good surrogate for additional disease within the breast. We have performed an analysis of a data base consisting of women with early-stage breast carcinoma who underwent breast-conserving surgery and received whole breast irradiation over a 12-year period at our institution.…”

Section: Conclusion For Excisions Amenable To Use Of Thementioning

confidence: 95%

MammoSite excision volume as a predictor for residual disease

Kaufman

DiPetrillo

Ruthazer

et al. 2005

Cancer

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BACKGROUNDThe MammoSite catheter is a brachytherapy device used for accelerated partial breast irradiation. Currently, it is available as 2 spherically shaped balloons meant to fill 70‐cc and 120‐cc cavity volumes. This study was designed to define the relation of these excision volumes to the likelihood of microscopically detectable, residual disease based on tumor size, margin status, patient age, and histology.METHODSThe study data base was comprised of 531 patients with Stage 0, I, and II breast carcinoma (using American Joint Committee on Cancer staging criteria) who received breast‐conserving therapy and underwent surgical reexcision. Patients in the data base were stratified based on the volume of their initial excision: ≤ 70 cc versus > 70 cc and ≤ 120 cc versus > 120 cc.RESULTSSurgical margin size was found to be a strong predictor of residual disease both for patients with smaller excision volumes (P = 0.0014) and patients with larger excision volumes (P = 0.0003); histology (extensive intraductal component [EIC] or pure ductal carcinoma in situ [DCIS]) also was a strong predictor. Tumor size was significant only for the larger volume group (P = 0.029). On multivariate analysis, only histology and initial margin status were significant correlates with residual disease. The adjusted odds ratio for residual disease with pure DCIS was 0.79, and the adjusted odds ratio for invasive ductal or lobular carcinoma (IDC/ILC) without EIC was 0.44 relative to IDC/ILC with EIC (P = 0.008). The adjusted odds ratio for residual disease with a positive initial margin versus a negative initial margin was 2.65 (P ≤ 0.0001).CONCLUSIONSFor excisions amenable to use of the MammoSite catheter, a margin ≥ 1.0 mm appeared to afford at most a 35% risk of microscopically detectable residual tumor. Evidence of EIC on excision of IDC/ILC connoted a significantly higher risk. Age did not appear to be predictive for residual disease. Cancer 2005. © 2005 American Cancer Society.

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“…Neuschatz and colleagues 27 have recenly shown that a tumor margin width of more than 1 mm is associated with a low recurrence rate at 5 years for either BCS alone or BCS plus RT (10.9% vs 4.6%; P, not significant [NS]). For all cases, the authors also observed that lesion size of more than 15 mm and margin width of 1 mm or less were associated with increased local recurrence.…”

Section: Prospective Randomized Controlled Trials (Rcts)mentioning

confidence: 98%

Current management of ductal carcinoma in situ of the breast

Mokbel

2003

International Journal of Clinical Oncology

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Ductal carcinoma in situ (DCIS) accounts for approximately 20% of all screen-detected breast cancers. Total mastectomy can achieve a 98% cure rate in patients with DCIS, but its impact on quality of life should be weighed against the risk of local recurrence. Skin-sparing mastectomy with immediate reconstruction using autologous tissue can achieve excellent cosmesis and therefore should be considered when mastectomy is indicated. Nevertheless, mastectomy is considered an over-treatment for localized DCIS, and breast conservation is the goal of modern treatment. Three recent randomized controlled trials have demonstrated that adjuvant radiotherapy (RT) after adequate local excision of localized DCIS significantly reduces the incidence of local recurrence. Non-randomized studies suggest that patients with adequately excised small (<15 mm), non-high-grade DCIS not associated with necrosis can be safely spared adjuvant RT. However, this issue requires further evaluation in randomized controlled trials. The role of adjuvant tamoxifen is not well established, especially in relation to the hormone receptor status. Formal axillary dissection is not appropriate for DCIS; however, the potential role of the sentinel node biopsy (SNB) in selected high-risk cases requires further evaluation. The potential role of new selective estrogen receptor (ER) modulators and third-generation aromatase inhibitors in postmenopausal women with ER-positive DCIS, gene and protein expression profiling, and mammary ductoscopy will be the focus of future research.

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Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast

Cited by 36 publications

References 26 publications

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

MammoSite excision volume as a predictor for residual disease

Current management of ductal carcinoma in situ of the breast

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