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Invited Commentary
April 2017

Difficulty of Achieving Clear Margins in Nonpalpable Ductal Carcinoma of the Breast

Author Affiliations
  • 1Department of Surgery, Subang Jaya Medical Centre, Subang Jaya, Malaysia
  • 2Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
JAMA Surg. 2017;152(4):385. doi:10.1001/jamasurg.2016.4752

Population-based mammographic screening programs have led to the identification of small nonpalpable breast tumors. More than 20% of tumors detected via such screening are ductal carcinoma in situ (DCIS).1 Breast-conserving surgery is suitable for most tumors detected via such screening. However, if margins are involved, reoperations are required, which could lead to patient distress and increased costs, as well as poor cosmetic outcomes and increased risk of surgical complications. In this issue of JAMA Surgery, Langhans et al2 reviewed information on 4118 patients with nonpalpable tumors (3391 IBC and 727 DCIS) from the Danish National Patient Registry during a 4-year period between January 2010 and December 2013 and demonstrated that the reoperation rate of wire-guided breast-conserving surgery in patients with confirmed invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) was 3 times higher in patients with DCIS (37.3%) vs those with IBC (13.4%).

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