Outcome and risk factors for local recurrence after breast conserving surgery in patients affected by ductal carcinoma in situ

Tomasicchio, G.; Picciariello, Arcangelo; Stucci, Luigia Stefania; Panebianco, Annarita; Montanaro, Alda Elena; Cirilli, Alfredo; Punzo, Clelia

doi:10.23736/s2724-5691.22.09284-x

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…In the literature, "no ink on tumor" in invasive breast cancer was found to be an acceptable margin status [11][12][13]. Meanwhile, a distance of 2 mm from the tumor margin was considered adequate for ductal carcinoma in situ (DCIS) [13][14][15][16][17][18]. Table 2 shows the overview of the methods used in non-palpable tumors to mark and remove the area of interest in conservative breast surgery [19][20][21][22][23][24][25][26][27][28].…”

Section: Resultsmentioning

confidence: 99%

“…Considering the high number of negative findings in the specimens of reoperations, some authors retrospectively observed that, especially in the case of close margins after BCS for DCIS, individual assessment should be used in decisions on reoperation, as opposed to rigid adherence to guidelines [16]. Similarly, while deciding which patients truly may benefit from margin re-excision, other authors suggested the use of clinical judgment, based on patient and tumor characteristics [17,18].…”

Section: Margin Acceptability In the Case Of Ductal Carcinoma In Situmentioning

confidence: 99%

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Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Breast-conserving surgery (BCS) experienced a significant surge during the last decades due to the increase of early breast cancer detection. Central to the discussion is margin adequacy which represents one of the most significant predictive factors for local relapse. This paper aims to shed light on the problem of margins in breast surgery. Mechanism: We performed a systematic narrative review of the literature by conducting a search using Medline/PubMed, Scopus, and Embase. The following keywords were considered: "breast-conserving surgery" AND "margins"/"margin". Findings in Brief: In the case of invasive breast cancer, "no ink on tumor" can be considered an adequate margin, while for ductal carcinoma in situ (DCIS), a distance of 2 mm from tumor should be obtained. Many novel tools have been developed based both on the latest radiological imaging techniques and on the tissue expression of certain markers, with the aim of precise navigation of tumor excision and intraoperative evaluation of cavity excision margins. Oncoplastic surgery can be considered oncologically safe while improving the cosmetic outcome and patients' quality of life. The appropriate use of adjuvant treatments in the context of a multidisciplinary and personalized management of breast cancer is the only means to omit a second intervention in some carefully selected cases. Conclusions: Debate still exists concerning the definition of adequate clear margin following BCS for DCIS. Further studies are required to better assess multimodal treatment approaches in this condition.

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Section: Resultsmentioning

confidence: 99%

Section: Margin Acceptability In the Case Of Ductal Carcinoma In Situmentioning

confidence: 99%

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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“…Long-term results from these trials reaffirmed the sustained effect of RT in reducing intramammary recurrence by half and maintaining an absolute risk reduction of 10–12%, although none of the studies showed a significant effect on breast cancer mortality ( 12 - 14 ). A recent study found that BCS + adjuvant RT had a low 6% overall recurrence rate at 85 months follow-up, with margin status, multifocality, hormone receptor status, and Her-2/Basal-like subtype identified as risk factors for local recurrence ( 15 ). Mastectomy, which is predominantly recommended when complete surgical removal through BCS is not feasible, has shown excellent outcomes.…”

Section: Discussionmentioning

confidence: 99%

Changing trends in the management of ductal carcinoma in situ in Republic of Korea: a comprehensive analysis using Health Insurance Review and Assessment data [2009–2020]

Joo,

Kim,

Nam

et al. 2024

Gland Surg

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Background Increasing rates of diagnosis of ductal carcinoma in situ (DCIS), given the widespread use of mammography, is a global trend. Various attempts have been made in the selection of surgical methods and application of radiation therapy (RT), and the prevalence of infectious diseases has also affected these attempts. This study aimed to investigate evolving treatment patterns and trends in the management of DCIS in South Korea. Methods We conducted a comprehensive search of the Korean Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database and selected patients who underwent breast surgery following a DCIS diagnosis between 2009 and 2020. Based on this sample, the analyses were weighted according to the Korean population. We examined annual variations in mastectomy types, reconstructive procedures, and RT utilization from a multidisciplinary perspective. Results In our weighted sample, 43,780 patients with DCIS underwent surgery, with a consistent annual increase of 10%. The proportion of lumpectomy procedures increased from 56.7% to 65.4%, showing a greater growth rate than that of total mastectomies (TMs). Following the availability of reconstruction data in 2015, shifts have emerged toward a preference for implant-based autologous tissue reconstruction. As we transitioned to the latter part of our study, the trend was marked by the increasing adoption of hypofractionated RT and omission of RT. Of the patients who underwent lumpectomy in 2020, 25.6% adopted hypofractionated RT and 53.8% omitted RT. This transformation was particularly evident among older patients, individuals treated in metropolitan areas, and those treated in small-sized healthcare facilities. Conclusions Our study sheds light on the changing landscape of DCIS treatment in South Korea incorporating perspectives from surgeons, plastic surgeons, and radiation oncologists. We observed an increase in the rates of lumpectomy and implant-based reconstruction. Adoption of hypofractionated RT and omission of RT showed increasing trends.

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“…In contrast, patients who have undergone BCS are generally more satisfied with breast appearance and overall aesthetics, have higher quality of life scores, and are not significantly affected in long-term survival rates ( 25 ). A recent study found that BCS + adjuvant radiotherapy had an overall recurrence rate as low as 6% at 85 months of follow-up, with margin status, multifocality, hormone receptor status, and Her-2/basal-like subtype identified as risk factors for local recurrence ( 26 ). In primary BC treatment, SM has been considered the preferred method, especially during follow-up, as SM with immediate breast reconstruction significantly reduces the risk of recurrence ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of surgical types on overall survival in patients with ductal carcinoma in situ: an analysis based on the SEER database

Jiang,

Ren,

Shang

2024

Gland Surg

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Background Breast cancer, as one of the most common malignancies among women globally, presents a concerning incidence rate, underscoring the importance of addressing the treatment of its precursor lesion, ductal carcinoma in situ (DCIS). Treatment decisions for DCIS, involving the balance between breast-conserving surgery (BCS) and mastectomy, remain an area requiring further investigation. This study aimed to compare influence of different surgical types on overall survival (OS) of patients with DCIS and identify specific subgroups with improved OS to develop an effective survival nomogram for patients. Methods Patient data from the Surveillance, Epidemiology, and End Results (SEER) database for DCIS cohort from 2010 to 2020 were retrieved. Kaplan-Meier (K-M) survival curves were utilized to compare prognostic OS of patients with different surgical methods. Cox regression analysis was employed to determine prognostic factors and establish a nomogram to predict 3-, 5-, and 10-year survival rates. The model was confirmed by Concordance Index (C-index), calibration curves, and receiver operating characteristic (ROC) curves. Results A total of 71,675 patients with DCIS were included. Patients who underwent subcutaneous mastectomy (SM) demonstrated the best OS compared to other surgical types. Additionally, adjuvant radiotherapy or chemotherapy in combination with surgery significantly improved OS compared to surgery alone. Among DCIS patients aged ≤74 years, those who underwent SM benefited the most in terms of OS, while in the age group of 63–74 years, patients who underwent BCS had significantly higher OS than those who underwent total (simple) mastectomy (TM)/modified radical mastectomy (MRM). Multiple factors were associated with improved OS in DCIS patients, and these factors were integrated into the nomogram to establish OS predictions. The C-index, calibration curves, and ROC curves indicated that the nomogram was suitable for assessing patient prognosis. Conclusions This study demonstrated that SM treatment yielded the best survival rates for DCIS patients, providing important guidance for future surgical decision-making. Moreover, identifying multiple independent factors related to survival and establishing reliable survival nomograms can assist physicians in developing personalized treatment plans and prolonging patient survival.

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Outcome and risk factors for local recurrence after breast conserving surgery in patients affected by ductal carcinoma in situ

Cited by 4 publications

References 24 publications

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Changing trends in the management of ductal carcinoma in situ in Republic of Korea: a comprehensive analysis using Health Insurance Review and Assessment data [2009–2020]

Impact of surgical types on overall survival in patients with ductal carcinoma in situ: an analysis based on the SEER database

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