Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

Abstract

Selection of patients for breast-conserving surgery relies on inexact parameters such as the preoperative estimation of lesion size. This study investigates the value of needle core biopsy findings, in particular, the relative quantity of DCIS, in improving patient selection for breast conservation. Patients undergoing breastconserving surgery for invasive ductal carcinoma from 1999 to 2004 were identified. Only patients who had a preoperative diagnosis of carcinoma (DCIS and invasive) on core biopsy were included. All core biopsies were reviewed by a breast histopathologist to document the quantity and characteristics of the DCIS component. Of a total of 281 patients, 46% (n ¼ 129) had invasive disease on core biopsy (group 1) and 54% (n ¼ 152) had either invasive disease with an accompanying DCIS component or DCIS only on core biopsy (group 2). The compromised margin rate for group 1 was 23% compared to 39% for group 2 (P ¼ 0.004). The rate of compromised margins increased progressively as the core biopsy DCIS component increased until a rate of 75% (n ¼ 18/24) was reached in patients with DCIS only on core biopsy. In patients with a DCIS component on core biopsy, the presence of necrosis (P ¼ 0.002), solid type architecture (P ¼ 0.008), high grade DCIS (P ¼ 0.007), calcification (P ¼ 0.003), and the relative proportion of DCIS present (Po0.001) were associated with compromised margins on univariate analysis. On multivariate analysis of this subgroup, the proportion of DCIS in this subgroup (P ¼ 0.048) was an independent predictor of compromised margins. The presence and relative proportion of DCIS on core biopsy provides important information as to whether patients are at risk of compromised margins. Documentation of these parameters may assist patient selection for breast-conserving surgery or identify patients who may benefit from wider margins at the time of initial operation.

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

“…Our findings demonstrate that morphology and other tumor characteristics (e.g., margin width, mammographic size, extent of involvement of the cores by DCIS, in addition to solid type, high grade, presence of necrosis, and presence of calcifications), which have been correlated with compromised surgical margins [14,56], are histological surrogates for mechanistic parameters. Using the novel, biophysics-based approach applied here, we can more accurately predict surgical volumes in the form of explicit mathematical functions.…”

“…Patients with DCIS (possibly the most prevalent precursor to invasive breast cancer [6][7][8][9][10][11]) currently undergo some combination of breast conserving surgery, radiation therapy, and hormonal therapy. Breast conserving surgery fails to remove the entire tumor 38-72% of the time, requiring up to three surgeries for adequate tumor excision [12][13][14]. In the absence of adjuvant radiation and hormonal therapy, the estimated rate of recurrence after surgery is up to 25%.…”

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016

“…In general, positive margins indicate a reexcision procedure. Because of insufficient intraoperative assessment of the lesion extension, the reexcision rates for DCIS reported in the ma jority of studies are high, ranging from 31 to 46% for DCIS only [51][52][53][54]. In contrast to invasive breast cancer there are just a very few possibilities to intraoperatively assess the spec imen margin (touch prep cytology, spectroscopy) and to lower the reoperation rate.…”

Preoperative and intraoperative predictors of positive margins after breast-conserving surgery: a retrospective review

“…Our rate of compromised margins was 52%, which is at the high end of the reported range (7-63%) [12]. This can be partially explained by the inclusion of close margins (\1 mm) in this group as well as the high rate of DCIS overall (26%).…”