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Background <p>After breast-conserving surgery (BCS) for early-stage breast cancer, re-excision rates for positive or close margins remain high, although most re-excisions show no residual disease. This study aimed to identify clinicopathologic factors associated with residual disease to guide re-excision decisions.</p> Methods <p>The study evaluated women with ductal carcinoma <i>in situ</i> (DCIS) or invasive breast cancer who underwent BCS and re-excision for positive or close margins from 2018 to 2024 at the Saint John’s Cancer Institute. The association between clinical-pathologic variables and residual disease was evaluated by multivariable logistic regression.</p> Results <p>Of 932 patients treated with BCS, 184 (19.7 %) underwent re-excision for positive or close margins. Residual disease was found in 54 (29 %) patients, most commonly DCIS (<i>n</i> = 36, 66.7 %). In the multivariable analysis, residual disease was associated with three or more positive margins (odds ratio [OR], 9.87; 95 % confidence interval [CI], 3.23–30.17), DCIS at the margin (OR, 7.4; 95 % CI, 1.56–35.16), PR negativity (OR, 4.06; 95 % CI, 1.26–13.12), and mammographic microcalcifications (OR, 3.0; 95 % CI, 1.17–7.69). Conversely, reduced risk was associated with age ≥60 years (OR, 0.07; 95 % CI, 0.01–0.46), invasive carcinoma with extensive intraductal component (EIC: OR, 0.15; 95 % CI, 0.03–0.66), and pure DCIS (OR, 0.14; 95 % CI, 0.03–0.63).</p> Conclusions <p>Residual disease was found in fewer than one third of re-excision specimens. Factors reflecting margin burden and tumor biology, especially the number of positive margins, DCIS involvement of margin, and PR-negativity, were associated with residual malignancy, whereas EIC and older age were associated with a lower likelihood of residual disease. These findings support a risk-adapted, individualized approach to re-excision after BCS to minimize unnecessary surgery.</p>

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Factors Associated With Residual Disease on Re-Excision Specimens After Breast-Conserving Surgery for Breast Cancer

  • 期刊论文

  • 发表日期：

    2025年12月6日

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  • Kyle Lee,
  • Angela Pallesi,
  • Betsy J. Valdez,
  • Douglas A. Hanes,
  • Estela Samuels,
  • Stacey Stern,
  • Nicketti M. Handy,
  • Crystal E. Fancher,
  • Javier I. J. Orozco,
  • Janie G. Grumley

摘要

Background

After breast-conserving surgery (BCS) for early-stage breast cancer, re-excision rates for positive or close margins remain high, although most re-excisions show no residual disease. This study aimed to identify clinicopathologic factors associated with residual disease to guide re-excision decisions.

Methods

The study evaluated women with ductal carcinoma in situ (DCIS) or invasive breast cancer who underwent BCS and re-excision for positive or close margins from 2018 to 2024 at the Saint John’s Cancer Institute. The association between clinical-pathologic variables and residual disease was evaluated by multivariable logistic regression.

Results

Of 932 patients treated with BCS, 184 (19.7 %) underwent re-excision for positive or close margins. Residual disease was found in 54 (29 %) patients, most commonly DCIS (n = 36, 66.7 %). In the multivariable analysis, residual disease was associated with three or more positive margins (odds ratio [OR], 9.87; 95 % confidence interval [CI], 3.23–30.17), DCIS at the margin (OR, 7.4; 95 % CI, 1.56–35.16), PR negativity (OR, 4.06; 95 % CI, 1.26–13.12), and mammographic microcalcifications (OR, 3.0; 95 % CI, 1.17–7.69). Conversely, reduced risk was associated with age ≥60 years (OR, 0.07; 95 % CI, 0.01–0.46), invasive carcinoma with extensive intraductal component (EIC: OR, 0.15; 95 % CI, 0.03–0.66), and pure DCIS (OR, 0.14; 95 % CI, 0.03–0.63).

Conclusions

Residual disease was found in fewer than one third of re-excision specimens. Factors reflecting margin burden and tumor biology, especially the number of positive margins, DCIS involvement of margin, and PR-negativity, were associated with residual malignancy, whereas EIC and older age were associated with a lower likelihood of residual disease. These findings support a risk-adapted, individualized approach to re-excision after BCS to minimize unnecessary surgery.