title: Non-menopausal Status, High Nuclear Grade, Tumor Size >30 mm and Positive Resection Margins Are Predictors of Residual Tumor After Lumpectomy for Ductal Carcinoma In Situ of the Breast.
abstract: OBJECTIVE
  Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in situ (DCIS). Re-excision is indicated when clear resection margins have not been achieved, although in some cases the procedure may be unnecessary as there is no residual tumor. The purpose of our three-Center retrospective study was to identify predictors of positive re-excision findings following breast-conserving surgery for DCIS.
  
  
  METHODS
  A total of 285 patients underwent re-excision following conservative treatment for DCIS between 01/01/08 and 12/31/13 at three breast-cancer referral Centers. We conducted a retrospective, comparative review of the factors that differentiated patients with a residual tumor from those without. The study was based on clinical, radiological, surgical and pathological criteria.
  
  
  RESULTS
  A total of 180 patients (63%) had residual tumor after conservative treatment. Six factors were predictive on univariate analysis: young age (p=0.025), non-menopausal status (p=0.016), absence of preoperative biopsy (p=0.0029), high nuclear grade (p=0.0181), lesion size >30 mm (p=0.032), and positive surgical margins (p=0.0016). Four factors remained independently predictive on multivariate analysis: non-menopausal status (p=0.0017), high nuclear grade (p=0.0031), lesion size >30 mm (p=0.012) and positive surgical margins (p=0.0013). We calculated a 93% probability of positive re-excision findings if all four factors were combined. On the other hand, if none of the factors were present, the rate fell to 18%.
  
  
  CONCLUSIONS
  In cases of DCIS, where risk factors for both involved lumpectomy margins and recurrence are carefully studied, knowledge of the risk factors for residual tumor can help guide therapeutic choices.
authors.affiliation: Gynecology Department, Anne de Bretagne University Hospital, Rennes, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Joste
authors.affiliation: Gynecology Department, Olympe de Gouges Center, Tours, France.
authors.forename: Vanda
authors.initials: V
authors.lastname: Mendes
authors.affiliation: Western Cancer Institute, Paul Papin Regional Cancer Center, Angers, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tixier
authors.affiliation: Clinical Pharmacology Department, Rennes University Hospital, Rennes, France.
authors.forename: Clement
authors.initials: C
authors.lastname: Palpacuer
authors.affiliation: Clinical Pharmacology Department, Rennes University Hospital, Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Laviolle
authors.affiliation: Gynecology Department, Anne de Bretagne University Hospital, Rennes, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Leveque
authors.affiliation: Gynecology Department, Olympe de Gouges Center, Tours, France.
authors.forename: Lobna
authors.initials: L
authors.lastname: Ouldamer
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Breast cancer; conservative treatment; ductal carcinoma in situ; residual tumor