External validation of a multivariable prediction model for positive resection margins in breast-conserving surgery

Positive resection margins after breast-conserving surgery (BCS) most often demands a repeat surgery. To preoperatively identify patients at risk of positive margins, a multivariable model has been developed that predicts positive margins after BCS with a high accuracy. This study aimed to externally validate this prediction model to explore its generalizability and assess if additional preoperatively available variables can further improve its predictive accuracy. The validation cohort included 225 patients with invasive breast cancer who underwent BCS at Aarhus University Hospital, Aarhus, Denmark during 2020-2022. Receiver operating characteristic (ROC) and calibration analysis were used to validate the prediction model. Univariable logistic regression was used to evaluate if additional variables available in the validation cohort were associated with positive margins and backward elimination to explore if these variables could further improve the model´s predictive accuracy.

The AUC of the model was 0.60 (95% CI: 0.50-0.70) indicating a lower discriminative capacity in the external cohort. We found weak evidence for an association between increased preoperative breast density on mammography and positive resection margins after BCS (p = 0.027), but the AUC of the model did not improve, when mammographic breast density was included as an additional variable in the model.