Addressing the Challenge of Successful One-Stage Lumpectomy for DCIS

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Breast conserving surgery (BCS) is the preferred treatment for early-stage breast cancer.
• Higher reexcision rates occur in ductal carcinoma in situ (DCIS) lumpectomies due to assessment difficulties.
• Investigating factors influencing reexcision in pure DCIS treated with BCS is crucial.

Purpose of the Study:

• To identify clinicopathological factors associated with reexcision in patients undergoing BCS for pure DCIS.
• To evaluate the impact of the MarginProbe™ device on reexcision rates.
• To analyze trends in reexcision rates over time.

Main Methods:

• Retrospective analysis of a prospectively maintained Institutional Breast Cancer Database (2010-2021).
• Inclusion criteria: patients with pure DCIS treated with primary BCS.
• Data collected: age, race, imaging, breast density, biopsy method, nuclear grade, DCIS size, multifocality, subtype, and MarginProbe™ use.

Main Results:

• Papillary DCIS and larger DCIS size were significantly associated with increased reexcision rates (P < 0.004 and P < 0.001, respectively).
• Stereotactic core biopsy was more common in patients who did not require reexcision (71.3% vs 49.5%).
• Intraoperative margin assessment using MarginProbe™ was associated with an 81% reduction in reexcision odds (OR = 0.19, P < 0.0001).

Conclusions:

• Younger age, papillary DCIS subtype, larger DCIS size, and non-stereotactic biopsy methods are risk factors for reexcision.
• The MarginProbe™ device demonstrated a significant reduction in reexcision rates for DCIS.
• Intraoperative margin assessment can improve surgical outcomes in breast conserving surgery for DCIS.