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Nomogram for predicting positive resection margins after breast-conserving surgery.

Hee-Chul Shin¹, Wonshik Han, Hyeong-Gon Moon

¹Department of Surgery, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea.

Breast Cancer Research and Treatment

|June 14, 2012

Summary

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A new nomogram accurately predicts positive resection margins in breast-conserving surgery (BCS). This tool helps surgeons personalize surgical plans, reducing unnecessary re-excisions and improving patient outcomes.

Area of Science:

Oncology
Surgical Oncology
Radiology

Background:

Positive resection margins after breast-conserving surgery (BCS) are a primary risk factor for tumor recurrence.
Re-excision often leads to suboptimal outcomes, including wider excisions, mastectomies, poor cosmetic results, increased costs, and patient anxiety.

Purpose of the Study:

To develop and validate a predictive nomogram for positive resection margins following BCS.
To assist surgeons in creating individualized surgical plans for breast cancer patients undergoing BCS.

Main Methods:

A nomogram was developed using data from 1,034 breast cancer patients who underwent BCS.
Multivariate logistic regression identified predictors of positive margins.
The nomogram was validated on an independent cohort of 563 patients.

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Main Results:

Key predictors identified: microcalcifications, grade 4 mammographic density, tumor size discrepancy (>0.5 cm) between MRI and US, ductal carcinoma in situ (DCIS) on biopsy, and lobular component on biopsy.
The nomogram demonstrated strong predictive performance with AUCs of 0.823 (development cohort) and 0.846 (validation cohort).

Conclusions:

The developed nomogram effectively predicts positive resection margins before surgery.
This tool can guide surgeons in planning BCS, potentially minimizing re-operations and improving cosmetic outcomes.