Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery.

Autor: Nasute Fauerbach PV; Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, Ontario, K7L 3N6, Canada. Electronic address: 16pvnf@queensu.ca., Tyryshkin K; Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, Ontario, K7L 3N6, Canada. Electronic address: kt40@queensu.ca., Rodrigo SP; Department of Radiology, MD Anderson Cancer Center, C. de Arturo Soria, 270, 28033, Madrid, Spain. Electronic address: drasilviap@gmail.com., Rudan J; Department of Surgery, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Electronic address: John.Rudan@kingstonhsc.ca., Fichtinger G; School of Computing, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Electronic address: fichting@queensu.ca., Reedijk M; Department of Surgery, University Health Network and Princess Margaret Hospital, University of Toronto, 610 University Ave, Toronto, Ontario M5G 2M9, Canada. Electronic address: Michael.reedijk@uhn.ca., Varma S; Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, Ontario, K7L 3N6, Canada. Electronic address: sonalvarma@queensu.ca., Berman DM; Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, Ontario, K7L 3N6, Canada. Electronic address: bermand@queensu.ca.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2021 Oct; Vol. 47 (10), pp. 2483-2491. Date of Electronic Publication: 2021 Jun 04.
DOI: 10.1016/j.ejso.2021.05.047
Abstrakt: Purpose: To determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed.
Methods: This retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed.
Results: 360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23-4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM.
Conclusion: Lack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.
Competing Interests: Declaration of competing interest None.
(Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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