title: The Role of Intraoperative Pathologic Assessment in the Surgical Management of Ductal Carcinoma In Situ.
abstract: Re-excision surgeries for the treatment of ductal carcinoma in situ (DCIS) put a strain on patients and healthcare resources; however, intraoperative pathologic assessment of DCIS may lead to a reduction in these additional surgeries. This study examined the relationship between intraoperative pathologic assessment and subsequent operations in patients with a diagnosis of DCIS.
  
  
  
  Surveillance, Epidemiology, and End Results-Medicare patients diagnosed with DCIS from 1999 to 2007 who initially underwent partial mastectomy, without axillary surgery, were included in this study. Use of intraoperative frozen section or touch preparation during the initial surgery was assessed. Multivariable logistic regression was used to describe the relationship between the use of intraoperative pathologic assessment and any subsequent mastectomy or partial mastectomy within 90 days of the initial partial mastectomy.
  
  
  
  Of 8259 DCIS patients, 3509 (43 %) required a second surgery, and intraoperative pathologic assessment was performed for 2186 (26 %). Intraoperative pathologic assessment had no statistically significant effect on whether or not a subsequent breast surgery occurred (adjusted odds ratio 1.07, 95 % confidence interval 0.95-1.21; p = 0.293). Patient residence in a rural area, tumor size ≥2 cm, and poorly differentiated tumor grade were associated with a greater likelihood of subsequent surgery, while age 80 years and older was associated with a lower likelihood of subsequent surgery.
  
  
  
  The use of intraoperative frozen section or touch preparation during partial mastectomy from 1999 to 2007 was not associated with a reduction in subsequent breast operations in women with DCIS. These results highlight the need to identify cost-effective tools and strategies to reduce the need for additional surgery in patients with DCIS.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. mrdecker@wisc.edu.
authors.forename: Marquita R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
authors.affiliation: University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
authors.forename: Noelle K
authors.initials: NK
authors.lastname: Loconte
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Rinaa S
authors.initials: RS
authors.lastname: Punglia
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Lee G
authors.initials: LG
authors.lastname: Wilke
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005629:Frozen Sections / Q000706:statistics & numerical data*; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental; D060787:Neoplasm Grading; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D018426:SEER Program; D047368:Tumor Burden; D014505:Urban Population / Q000706:statistics & numerical data