title: Incidence and consequence of close margins in patients with ductal carcinoma-in situ treated with mastectomy: is further therapy warranted?
abstract: BACKGROUND
  The impact of close margins in patients with ductal carcinoma-in situ (DCIS) treated with mastectomy is unclear; however, this finding may lead to a recommendation for postmastectomy radiotherapy (PMRT). We sought to determine the incidence and consequences of close margins in patients with DCIS treated with mastectomy.
  
  
  METHODS
  The records of 810 patients with DCIS treated with mastectomy from 1996 through 2009 were reviewed. Clinical and pathologic factors were analyzed with respect to final margin status. Median follow-up was 6.3 years.
  
  
  RESULTS
  Overall, 94 patients (11.7 %) had close margins (positive, n = 5; negative but ≤1 mm, n = 54; 1.1-2.9 mm, n = 35). Independent risk factors for close margins included multicentricity, pathologic lesion size ≥1.5 cm, and necrosis, but not age, use of skin-sparing mastectomy, or immediate reconstruction (p > 0.05). Seven patients received PMRT, and none had a locoregional recurrence (LRR). Among the remaining 803 patients, the 10-year LRR rate was 1 % (5.0 % for margins ≤1 mm, 3.6 % for margins 1.1-2.9 mm, and 0.7 % for margins ≥3 mm [p < 0.001]). The 10-year rate of contralateral breast cancer was 6.4 %. On multivariate analysis, close margins was the only independent predictor of LRR (p = 0.005).
  
  
  CONCLUSIONS
  Close margins occur in a minority of patients undergoing mastectomy for DCIS and is the only independent risk factor for LRR. As the LRR rate in patients with close margins is low and less than the rate of contralateral breast cancer, PMRT is not warranted except for patients with multiple close/positive margins that cannot be surgically excised.
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Elizabeth
authors: E
authors: Fitzsullivan
authors: Sara A
authors: SA
authors: Lari
authors: Benjamin
authors: B
authors: Smith
authors: Abigail S
authors: AS
authors: Caudle
authors: Savitri
authors: S
authors: Krishnamurthy
authors: Anthony
authors: A
authors: Lucci
authors: Elizabeth A
authors: EA
authors: Mittendorf
authors: Gildy V
authors: GV
authors: Babiera
authors: Dalliah M
authors: DM
authors: Black
authors: Jamie L
authors: JL
authors: Wagner
authors: Isabelle
authors: I
authors: Bedrosian
authors: Wendy
authors: W
authors: Woodward
authors: Sarah M
authors: SM
authors: Gainer
authors: Rosa
authors: R
authors: Hwang
authors: Funda
authors: F
authors: Meric-Bernstam
authors: Kelly K
authors: KK
authors: Hunt
authors: Henry M
authors: HM
authors: Kuerer
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology* / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy; D015996:Survival Rate
references: Int J Radiat Oncol Biol Phys. 2011 May 1;80(1):25-30
references: 20646871
references: Am Surg. 2009 Jul;75(7):592-5; discussion 595-7
references: 19655603
references: Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):703-10
references: 17544591
references: Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):e129-34
references: 23195778
references: N Engl J Med. 2004 Apr 1;350(14):1430-41
references: 15070793
references: Ann Surg Oncol. 2011 Feb;18(2):459-62
references: 20859695
references: Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1397-403
references: 16750316
references: J Am Coll Surg. 2007 May;204(5):1074-8; discussion 1078-80
references: 17481544
references: J Cancer. 2011 May 01;2:232-61
references: 21552384
references: J BUON. 2012 Apr-Jun;17(2):245-8
references: 22740200
references: J Clin Oncol. 2009 Jan 10;27(2):279-88
references: 19064970
references: J Clin Oncol. 1998 Apr;16(4):1367-73
references: 9552039
references: Eur J Cancer. 1995;31A(9):1425-7
references: 7577065
references: Cancer J. 2006 Mar-Apr;12(2):92-101
references: 16630397
references: Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1016-20
references: 18954711
references: J Natl Cancer Inst. 2004 Mar 17;96(6):443-8
references: 15026469
references: Int J Surg Oncol. 2012;2012:423520
references: 22778939
references: CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
references: 18287387
references: Am J Surg. 2006 Oct;192(4):416-9
references: 16978940
references: Int J Radiat Oncol Biol Phys. 2013 Mar 15;85(4):948-52
references: 22975615
references: Ann Surg Oncol. 2008 Jan;15(1):235-43
references: 17987342