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Should breast density influence patient selection for breast-conserving surgery?
Nimmi S Kapoor1, Anne Eaton, Tari A King
1Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 300 E. 66th St., New York, NY, USA.
Annals of Surgical Oncology
|September 4, 2012
Summary
Extremely dense breasts may lead to a higher initial mastectomy rate, but breast density does not impact surgical outcomes or margin status during breast-conserving surgery. Further research is needed to understand this disparity.
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- Previous studies indicated a higher mastectomy rate in patients with extremely dense breasts.
- This study investigates the underlying reasons for this observed association.
Purpose of the Study:
- To determine if breast density influences the initial surgical decision for mastectomy versus breast-conserving surgery (BCS).
- To assess the impact of breast density on margin status and conversion to mastectomy after BCS.
- To evaluate the role of magnetic resonance imaging (MRI) in managing dense breasts.
Main Methods:
- Analysis of a prospectively maintained database of 1,056 invasive breast cancer patients.
- Mammographic density assessed using Breast Imaging-Reporting and Data System (BI-RADS) classification.
- Comparison of initial surgical procedures, preoperative MRI use, margin status, and conversion to mastectomy rates based on breast density.
Main Results:
- Patients with the highest breast density (BI-RADS 4) were less likely to undergo initial BCS (52%) compared to those with less dense breasts (74%), with higher odds of initial mastectomy (OR 1.94).
- Preoperative MRI use was higher in patients with dense breasts (65%) but did not correlate with reduced positive margins or conversion to mastectomy.
- After BCS, breast density did not predict margin status or conversion to mastectomy; age, grade, extensive intraductal component, and multicentricity/multifocality were independent predictors of conversion.
Conclusions:
- Breast density alone appears to influence the initial decision for mastectomy.
- Breast density is not associated with positive margins or conversion to mastectomy when BCS is attempted.
- These findings do not support using breast density as a criterion for selecting patients for BCS.
