Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Nasute Fauerbach, Paola V.; Tyryshkin, Kathrin; Rodrigo, Silvia Perez; Rudan, John; Fichtinger, Gabor; Reedijk, Michael; Varma, Sonal; Berman, David M.
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 10(2021)
• Page Start: 2483
• Page End: 2491
• Publication Date: 2021-10
• Subjects: Breast-conserving surgery (BCS) -- Breast cancer -- Surgical margins -- Definitive presurgical diagnosis -- Core needle biopsy and vacuum-assisted biopsy -- High-risk lesions; IM inadequate margins -- BCS breast-conserving surgery -- CNB core needle biopsy -- WL hookwire localization -- DCIS ductal carcinoma in situ -- IDC NOS invasive ductal carcinoma not otherwise specified -- LVI lymphovascular invasion -- ILC invasive lobular carcinoma; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.05.047
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Purpose: To determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed. Methods: This retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed. Results: 360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23–4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM. Conclusion: Lack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.