Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS

被引:5
作者
Vanni, Gianluca [1 ]
Pellicciaro, Marco [1 ,2 ]
Di Lorenzo, Nicola [3 ]
Barbarino, Rosaria [4 ]
Materazzo, Marco [1 ,2 ]
Tacconi, Federico [5 ]
Squeri, Andrea [6 ]
D'Angelillo, Rolando Maria [4 ]
Berretta, Massimiliano [7 ]
Buonomo, Oreste Claudio [1 ]
机构
[1] Tor Vergata Univ, Dept Surg Sci, Breast Unit Policlin Tor Vergata, Viale Oxford 81, I-00133 Rome, Italy
[2] Tor Vergata Univ, Dept Surg Sci, PhD Program Appl Med Surg Sci, I-00133 Rome, Italy
[3] Tor Vergata Univ, Dept Surg Sci, I-00133 Rome, Italy
[4] Policlin Tor Vergata, Dept Oncoematol, Radiotherapy, I-00133 Rome, Italy
[5] Tor Vergata Univ, Dept Surg Sci, Unit Thorac Surg, I-00133 Rome, Italy
[6] Univ Messina, Sch Specializat Med Oncol Unit, Dept Human Pathol G Barresi, I-98100 Messina, Italy
[7] Univ Messina, Dept Clin & Expt Med, I-98100 Messina, Italy
关键词
DCIS; ductal carcinoma in situ; omitting margin re-excision; surgical de-escalation; locoregional recurrence; CARCINOMA-IN-SITU; BREAST-CONSERVING SURGERY; CANCER; RECURRENCE; SIMULATION;
D O I
10.3390/cancers16040743
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose of this study is to understand the importance of surgical margin width, re-excision, and treatments to avoid additional surgery on locoregional recurrence (LRR). The study is retrospective and analyzed surgical margins, adjuvant treatments, re-excision, and LRR in patients with DCIS who underwent breast-conserving surgery (BCS). A total of 197 patients were enrolled. Re-operation for a close margin rate was 13.5%, and the 3-year recurrence was 7.6%. No difference in the LRR was reported among the patients subjected to BCS regardless of the margin width (p = 0.295). The recurrence rate according to margin status was not significant (p = 0.484). Approximately 36.9% (n: 79) patients had resection margins < 2 mm. A sub-analysis of patients with margins < 2 mm showed no difference in the recurrence between the patients treated with a second surgery and those treated with radiation (p = 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant (p = 0.161). The margin was not a predictive factor of LRR p = 0.999. Surgical re-excision should be avoided in patients with a focally positive margin and no evidence of the disease at post-surgical imaging.
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页数:13
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