Pre-operative factors indicating risk of multiple operations versus a single operation in women undergoing surgery for screen detected breast cancer

• Published in: Breast (Edinburgh) 2013-02, Vol.22 (1), p.78-82
• Main Authors: O'Flynn, E.A.M, Currie, R.J, Mohammed, K, Allen, S.D, Michell, M.J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy, Large-Core Needle; Breast - pathology; Breast Neoplasms - diagnosis; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Carcinoma, Lobular - diagnostic imaging; Carcinoma, Lobular - pathology; Carcinoma, Lobular - surgery; Decision Support Techniques; Ductal carcinoma in situ; Early Detection of Cancer; Female; Hematology, Oncology and Palliative Medicine; Humans; Lobular carcinoma; Logistic Models; Lymph Node Excision - statistics & numerical data; Mammography; Mastectomy - methods; Mastectomy - statistics & numerical data; Microcalcification; Middle Aged; Multivariate Analysis; Neoplasm Grading; Reoperation; Reoperation - statistics & numerical data; Risk Factors; Tumor Burden
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2012.06.011

Abstract We aim to identify preoperative factors at diagnosis which could predict whether women undergoing wide local excision (WLE) would require further operations. 1593 screen-detected invasive and non-invasive breast cancers were reviewed. Age, presence of ductal carcinoma in situ (DCIS), invasive cancer size on mammography, mammographic sign, tumour type, grade and confidence of the radiologist in malignancy were compared. 83%(1315/1593) of women had a WLE. Of these, 70%(919/1315) had a single operation, and 30%(396/1315) multiple operations. These included repeat WLE to clear margins (60%(238/396)), mastectomy (34%(133/396)) and axillary dissection (6%(25/396)). The presence of mammographic microcalcification, lobular carcinoma and grade 2 malignancy on core biopsy were independent risk factors for multiple operations on multivariate analysis. Women with mammographic DCIS >30 mm were 3.4 times more likely to undergo repeat surgery than those with smaller foci. The multidisciplinary team should pay particular attention to these factors when planning surgery.