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Original Investigation
December 21, 2016

Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

Author Affiliations
  • 1Department of Plastic Surgery, Breast Surgery and Burns, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  • 2Danish Breast Cancer Cooperative Group, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  • 3Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  • 4Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
JAMA Surg. Published online December 21, 2016. doi:10.1001/jamasurg.2016.4751
Key Points

Question  What is the reoperation rate in patients with verified nonpalpable invasive breast cancer or ductal carcinoma in situ treated with wire-guided breast-conserving surgery?

Findings  In this population-based registry study, of 4118 patients who underwent wire-guided breast-conserving surgery, the overall reoperation rate was 17.6% (14.4% reexcisions and 3.2% mastectomies). The risk of a reoperation owing to positive margins was 3 times higher in patients with ductal carcinoma in situ (37.3%) vs those with invasive breast cancer (13.4%).

Meaning  The reoperation rate for invasive breast cancer was lower than anticipated; however, the risk of reoperation in patients with ductal carcinoma in situ is still high and a more accurate localization method is needed.

Abstract

Importance  New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions.

Objectives  To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) and to examine whether the risk of reoperation is associated with DCIS or histologic type of the IBC.

Design, Setting, and Participants  This nationwide study including women with histologically verified IBC or DCIS having wire-guided BCS performed between January 1, 2010, and December 31, 2013, used data from the Danish National Patient Registry that were cross-checked with the Danish Breast Cancer Group database and the Danish Pathology Register.

Main Outcomes and Measures  Reoperation rate after wire-guided BCS in patients with IBC or DCIS.

Results  Wire-guided BCS was performed in 4118 women (mean [SD] age, 60.9 [8.7] years). A total of 725 patients (17.6%) underwent a reoperation: 593 were reexcisions (14.4%) and 132 were mastectomies (3.2%). Significantly more patients with DCIS (271 of 727 [37.3%]) than with IBC (454 of 3391 [13.4%]) underwent a reoperation (adjusted odds ratio, 3.82; 95% CI, 3.19-4.58; P < .001). After the first reexcision, positive margins were still present in 97 patients (16.4%). The risk of repeated positive margins was significantly higher in patients with DCIS vs those with IBC (unadjusted odds ratio, 2.21; 95% CI, 1.42-3.43; P < .001). The risk of reoperation was significantly increased in patients with lobular carcinoma vs those with ductal carcinoma (adjusted odds ratio, 1.44; 95% CI 1.06-1.95; P = .02). A total of 202 patients (4.9%) had a subsequent completion mastectomy, but no difference was found in the type of reoperation between patients with DCIS and those with IBC.

Conclusions and Relevance  A lower reoperation rate after wire-guided BCS was found in this study than those shown in previous studies. However, the risk of reoperation in patients with DCIS was 3 times higher than in those with IBC. The widespread use of mammographic screening will increase the number of patients diagnosed with DCIS, making a precise localization of nonpalpable DCIS lesions even more important.

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