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

• Published in: Cancers 2024-02, Vol.16 (4), p.743
• Main Authors: Vanni, Gianluca, Pellicciaro, Marco, Di Lorenzo, Nicola, Barbarino, Rosaria, Materazzo, Marco, Tacconi, Federico, Squeri, Andrea, D'Angelillo, Rolando Maria, Berretta, Massimiliano, Buonomo, Oreste Claudio
• Format: Article
• Language: English
• Subjects: Basement membranes; Biopsy; Breast; Breast cancer; Breast surgery; Carcinoma; Carcinoma, Ductal; Care and treatment; Cell proliferation; Diagnosis; Diseases; Endocrine therapy; Health aspects; Lumpectomy; Lymphatic system; Mammography; Mastectomy; Medical research; Medicine, Experimental; Metastasis; Patients; Radiation; Radiation therapy; Regression analysis; Relapse; Surgery
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16040743

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 ( = 0.295). The recurrence rate according to margin status was not significant ( = 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 ( = 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant ( = 0.161). The margin was not a predictive factor of LRR = 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.