title: Does Mammographic Density have an Impact on the Margin Re-excision Rate After Breast-Conserving Surgery?
abstract: BACKGROUND
  Limited and conflicting data exist on an association between mammographic density (MD) and re-excision rates after breast-conserving surgery (BCS). Additionally, the correlation of MD with resection of unnecessary margins during initial BCS is unknown.
  
  
  METHODS
  All women with a diagnosis of breast cancer from 2003 to 2012 and enrolled in a larger study on MD were evaluated. Operative and pathology reports were reviewed to determine margin resection and involvement. Mammographic density was determined both by breast imaging-reporting and data system (BI-RADS) classification and by an automated software program (Volpara Solutions). Additional margins were deemed unnecessary if the lumpectomy specimen margin was free of invasive tumor [≥2 mm for ductal carcinoma in situ (DCIS)] or if further re-excision was needed.
  
  
  RESULTS
  Of 655 patients, 398 (60.8%) had BCS, whereas 226 (34.5%) underwent initial mastectomy. The women with denser breasts (BI-RADS 3 or 4) underwent initial mastectomy more frequently than the women with less dense breasts (40.0 vs. 30.5%, respectively; p = 0.0118). Of the patients with BCS, 166 (41.7%) required separate re-excision. Additional margins were taken during BCS in 192 (48.2%) patients, with 151 (78.6%) proving to be unnecessary. In the bivariable analysis, the patients with denser breasts according to BI-RADS classification and volumetric density showed a trend toward requiring more frequent re-excision, but this association was not seen in the multivariable analysis. The rate of unnecessary margins did not differ by breast density. In the multivariate analysis, the re-excision rates increased with DCIS (p < 0.0003) and decreased with resection of additional margins (p = 0.0043).
  
  
  CONCLUSIONS
  Mammographic density is not associated with an increased need for re-excision or resection of unnecessary margins at initial BCS.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Brandy L
authors.initials: BL
authors.lastname: Edwards
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Guidry
authors.affiliation: School of Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Krista N
authors.initials: KN
authors.lastname: Larson
authors.affiliation: Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Novicoff
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Harvey
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA. ats2x@virginia.edu.|Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA. ats2x@virginia.edu.
authors.forename: Anneke T
authors.initials: AT
authors.lastname: Schroen
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D000071060:Breast Density; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D042361:Mammary Glands, Human / Q000002:abnormalities* / Q000473:pathology; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human