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Original Article |
1 Department of Surgery, St Vincent’s University Hospital, Dublin, Ireland
2 Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland
3 Department of Pathology, St Vincent’s University Hospital, Dublin, Ireland
4 Breastcheck, Merrion unit, National Breast Screening Programme, Dublin, Ireland
Correspondence: Address correspondence and reprint requests to: Mary F. Dillon, MB, MRCSI; Department of Surgery, Education and Research Centre, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; E-mail: maryfdillon{at}hotmail.com
Background: Successful breast-conserving therapy in DCIS is restricted by high rates of residual disease resulting in the need for radiotherapy and/or re-excision. This study identifies patients with DCIS who are most at risk of compromised margins and of residual disease.
Methods: All patients undergoing breast-conserving surgery for DCIS over a 6-year period were included. Method of diagnosis, mammographic size, pathological size, DCIS-margin distance and residual disease on re-excision were analysed.
Results: One hundred and thirty-five patients underwent initial breast-conserving surgery for DCIS. The compromised margin rate was 72%, and the rate of residual disease on re-operation was 54%. On univariate analysis, underestimation of pathological size by mammography by >1 cm occurred in 40% of those with compromised margins undergoing a therapeutic operation compared to only 14% of those with clear margins (P = 0.02). However, on multivariate analysis only pathological size (P < 0.0001, OR = 1.0,95% CI 1.037–1.128) and lack of a preoperative diagnosis by core biopsy (P < 0.0001, OR = 5.3,95% CI 1.859–15.08) were predictive of compromised margins. The presence of residual disease on re-excision was associated with increasing pathological size (P < 0.0001, OR = 1.085,95% CI 1.038–1.134) and decreasing DCIS-margin distance (P = 0.03, OR = 6.694,95% CI 1.84–37.855). Twenty-nine percent (n = 13/45) of lesions 
3 cm compared to 84% (n = 27/32) of lesions >3 cm had residual disease on re-operation (P < 0.0001). Residual disease was present in 62% (n = 34/55), 64% (n = 7/11) and 17% (n = 2/12) of patients with DCIS-margin distances 1, 1–2 and 2–5 mm, respectively.
Conclusion: Considerable underestimation of DCIS extent by mammography occurs in a high proportion of patients with compromised margins in breast conservation. Patients at particularly high risk of residual disease on re-excision are those with lesions >3 cm and those with DCIS-margin distances of 2mm.
Key Words: Breast conserving surgery • Residual tumour • Histopathology • Breast neoplasm
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