Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
Division of Breast Surgery, Department of Surgery, Norton Hospital, Louisville, KY, USA.
Ann Surg Oncol. 2021 Nov;28(12):7432-7438. doi: 10.1245/s10434-021-10120-z. Epub 2021 May 27.
The 2016 consensus guideline on margins for breast-conserving surgery (BCS) with whole-breast irradiation (WBI) for ductal carcinoma in situ (DCIS) recommended 2 mm margins to decrease local recurrence rates. We examined re-excision rates, cost, and patient satisfaction before and after guideline implementation.
From an Institutional Review Board-approved database, patients with DCIS who underwent BCS with over 1 year of follow-up at one academic institution and one community cancer center were evaluated. Two groups were compared based on when they received treatment, i.e. before (pre-consensus [PRE]) and after November 2016 (post consensus [POST]), with respect to outcome and cost parameters.
After consensus guideline implementation, re-excision rate (32.1% vs. 20.0%) and mastectomy conversion (8.3% vs. 2.3%) significantly increased, although total resection volume, operative cost per patient, and satisfaction with breast scores did not differ. Not all patients with <2 mm margins were re-excised, although the re-excision rate among this subset significantly increased (62.4% vs. 31.3%). On multivariable analysis controlling for age, estrogen receptor status, WBI use, and margin status, surgery after consensus guideline publication was independently associated with a higher re-excision rate (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.08-3.59, p = 0.03) and a higher rate of conversion to mastectomy (OR 6.84, 95% CI 1.67-28.00, p = 0.007).
Implementation of the 2016 margin consensus guideline for DCIS resulted in an increase in re-excisions and mastectomy conversions at two institutions. Research is needed for operative tools and strategies to decrease DCIS re-excision rates.
2016 年关于保乳手术（BCS）与全乳放疗（WBI）治疗导管原位癌（DCIS）的共识指南建议切缘为 2mm，以降低局部复发率。我们在指南实施前后检查了再切除率、成本和患者满意度。
从机构审查委员会批准的数据库中，评估了在一家学术机构和一家社区癌症中心接受 BCS 治疗且随访时间超过 1 年的 DCIS 患者。根据治疗时间（即共识前[PRE]和 2016 年 11 月后[POST]）将两组进行比较，比较结果和成本参数。
在共识指南实施后，再切除术率（32.1% vs. 20.0%）和乳房切除术转化率（8.3% vs. 2.3%）显著增加，尽管总切除体积、每位患者的手术费用和对乳房评分的满意度没有差异。并非所有<2mm 切缘的患者都进行了再切除，尽管这部分患者的再切除率显著增加（62.4% vs. 31.3%）。在多变量分析中，控制年龄、雌激素受体状态、WBI 使用和切缘状态后，共识指南发布后的手术与再切除率更高（比值比[OR]1.97，95%置信区间[CI]1.08-3.59，p=0.03）和乳房切除术转化率更高（OR 6.84，95% CI 1.67-28.00，p=0.007）相关。
在两家机构实施 2016 年 DCIS 切缘共识指南后，再切除术和乳房切除术转化率增加。需要研究减少 DCIS 再切除术率的手术工具和策略。
