ASO Author Reflections: Re-Excision for Ductal Carcinoma In Situ: Who Is at Risk?
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Re-Excision for Ductal Carcinoma In Situ: Who Is at Risk? Leslie R. Lamb, MD, MSc, and Manisha Bahl, MD, MPH Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
PAST
FUTURE
For women with ductal carcinoma in situ (DCIS), successful breast-conserving surgery (BCS) requires tumornegative surgical margins to decrease the risk of local recurrence.1 If necessary, one or more re-excisions can be performed to achieve negative margins, but these additional surgeries after BCS result in adjuvant treatment delays and undesirable cosmesis, in addition to financial and psychological consequences.2 In the past, research on re-excision and associated risk factors has tended to focus less on DCIS, as compared to invasive cancer, and often has combined patients with DCIS and those with invasive cancer despite higher re-excision rates for DCIS and evolving guidelines for appropriate margin width.3
The results of this study may be used to identify women with pure DCIS at increased risk of re-excision and thus to inform preoperative planning. For example, women with increased re-excision risk may benefit from an oncoplastic approach with possible tissue rearrangement, in which a larger volume of breast tissue could be excised, and/or additional imaging such as magnetic resonance imaging (MRI) to evaluate extent of disease.5 Emerging techniques, such as higher spatial resolution MRI and deep learning algorithms, may be able to better delineate extent of DCIS at imaging. In the future, findings from the ongoing active surveillance trials, artificial intelligence tools, genomic prognostic testing, and molecular biomarkers will be used to support more targeted, personalized treatment options for women with DCIS.
PRESENT In this retrospective study of nearly 550 women with pure DCIS who underwent BCS during a 10-year period at a large academic center, the re-excision rate was 31.6%, which is within the range of reported rates from other institutions.4 In the multivariable analysis, the features associated with re-excision were younger patient age, African American race, biopsy method of ultrasound, and earlier year of surgery (all p \ 0.05). No pathologic features of DCIS, such as nuclear grade or hormone receptor status, were associated with risk of re-excision.
Ó Society of Surgical Oncology 2020 First Received: 1 September 2020 Accepted: 2 September 2020 M. Bahl, MD, MPH e-mail: [email protected]
ACKNOWLEDGMENT This work was supported by the Agfa HealthCare/Radiological Society of North America (RSNA) Research Scholar Grant (PI: Dr. Manisha Bahl) and the Electronic Space Systems Corporation (ESSCO)-MGH Breast Cancer Research Fund (PI: Dr. Manisha Bahl and Dr. Tawakalitu O. Oseni).
DISCLOSURE interest.
The authors declare that there are no conflicts of
REFERENCES 1. Solin LJ, Fourquet A, Vicini FA, et al. Mammographically detected ductal carcinoma in situ of the breast treated with breastconserving surgery and definitive breast irr
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