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Incidence and Consequence of Close Margins in Patients with Ductal Carcinoma-In Situ Treated with Mastectomy: Is Further Therapy Warranted?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The impact of close margins in patients with ductal carcinoma-in situ (DCIS) treated with mastectomy is unclear; however, this finding may lead to a recommendation for postmastectomy radiotherapy (PMRT). We sought to determine the incidence and consequences of close margins in patients with DCIS treated with mastectomy.

Methods

The records of 810 patients with DCIS treated with mastectomy from 1996 through 2009 were reviewed. Clinical and pathologic factors were analyzed with respect to final margin status. Median follow-up was 6.3 years.

Results

Overall, 94 patients (11.7 %) had close margins (positive, n = 5; negative but ≤1 mm, n = 54; 1.1–2.9 mm, n = 35). Independent risk factors for close margins included multicentricity, pathologic lesion size ≥1.5 cm, and necrosis, but not age, use of skin-sparing mastectomy, or immediate reconstruction (p > 0.05). Seven patients received PMRT, and none had a locoregional recurrence (LRR). Among the remaining 803 patients, the 10-year LRR rate was 1 % (5.0 % for margins ≤1 mm, 3.6 % for margins 1.1–2.9 mm, and 0.7 % for margins ≥3 mm [p < 0.001]). The 10-year rate of contralateral breast cancer was 6.4 %. On multivariate analysis, close margins was the only independent predictor of LRR (p = 0.005).

Conclusions

Close margins occur in a minority of patients undergoing mastectomy for DCIS and is the only independent risk factor for LRR. As the LRR rate in patients with close margins is low and less than the rate of contralateral breast cancer, PMRT is not warranted except for patients with multiple close/positive margins that cannot be surgically excised.

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Acknowledgment

The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health through Cancer Center Support Grant CA016672. The authors thank Stephanie Deming for editorial assistance.

Disclosures

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Elizabeth FitzSullivan MD, Sara A. Lari BS, Abigail S. Caudle MD, Anthony Lucci MD, Elizabeth A. Mittendorf MD, PhD, Gildy V. Babiera MD, Dalliah M. Black MD, Jamie L. Wagner DO, Isabelle Bedrosian MD, Sarah M. Gainer MD, Rosa Hwang MD, Funda Meric-Bernstam MD, Kelly K. Hunt MD & Henry M. Kuerer MD, PhD

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Benjamin Smith MD & Wendy Woodward MD

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Savitri Krishnamurthy MD

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  1. Elizabeth FitzSullivan MD
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  2. Sara A. Lari BS
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  3. Benjamin Smith MD
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  4. Abigail S. Caudle MD
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  5. Savitri Krishnamurthy MD
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  6. Anthony Lucci MD
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  7. Elizabeth A. Mittendorf MD, PhD
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  8. Gildy V. Babiera MD
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  9. Dalliah M. Black MD
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  10. Jamie L. Wagner DO
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  11. Isabelle Bedrosian MD
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  12. Wendy Woodward MD
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  13. Sarah M. Gainer MD
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  14. Rosa Hwang MD
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  15. Funda Meric-Bernstam MD
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  16. Kelly K. Hunt MD
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  17. Henry M. Kuerer MD, PhD
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Corresponding author

Correspondence to Henry M. Kuerer MD, PhD.

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FitzSullivan, E., Lari, S.A., Smith, B. et al. Incidence and Consequence of Close Margins in Patients with Ductal Carcinoma-In Situ Treated with Mastectomy: Is Further Therapy Warranted?. Ann Surg Oncol 20, 4103–4112 (2013). https://doi.org/10.1245/s10434-013-3194-0

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  • DOI: https://doi.org/10.1245/s10434-013-3194-0

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