In Ductal Carcinoma in Situ, Margin Status Need Not Dictate Reexcision


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A study of 252 patients with ductal carcinoma in situ raises questions regarding the need to reexcise close margins.1 The findings were presented at a poster session during the 2014 Breast Cancer Symposium by Rachel Gentile, BS, of the Medical College of Wisconsin.

The researchers evaluated data from 252 patients with ductal carcinoma in situ, who underwent breast-conserving surgery between 2003 and 2010. Two-thirds of patients also underwent radiation therapy and about one-half received hormonal therapy.

After a median follow-up of 5 years, margin status was not found to be predictive of locoregional recurrence, breast cancer-specific survival, or overall survival, the retrospective study showed. The researchers defined close margins as < 2 mm (observed in 29%) and negative margins as ≥ 2 mm (achieved in 63%); one patient had a positive margin, and margin status was not determined in 7% of patients.

Overall survival at 5 years was 96%. Locoregional recurrence was documented in 13 patients, 5 of whom had close margins, 7 of whom had negative margins and 1 of whom had margins of unknown status. Median time to recurrence was almost 5 years.

In the multivariate analysis, locoregional recurrence was significantly more likely among older patients (> 70), who had almost a sevenfold risk. Risk was increased sixfold for patients with progesterone receptor-negative tumors. In addition, mortality was four times higher in the absence of radiation therapy, but no variables were significantly associated with breast cancer-specific survival.

In their poster, the investigators suggested that for patients with ductal carcinoma in situ, “routine re-excision for close margins may not be warranted.” ■

Disclosure: Ms. Gentile reported no potential conflicts of interest.

Reference

1. Gentile R, Currey AD, Forrester JA, et al: The significance of margin status in patients with DCIUS undergoing breast-conserving surgery. 2014 Breast Cancer Symposium. Abstract 98. Presented September 4, 2014.

 


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