Abstract：
BACKGROUND: Consensus guidelines recommend ≥ 2 mm margins in patients undergoing partial mastectomy (PM) for ductal carcinoma in situ (DCIS). It is unknown whether the number or proximity of margins less than 2 mm is associated with an increased mastectomy rate in patients attempting breast conservation therapy (BCT) for DCIS. The aim of this study is to examine this relationship.
METHODS: An institutional database review identified 208 patients with DCIS who underwent PM at a tertiary referral center and community hospitals from July 2020 to June 2023. Patients with a history of breast cancer, previous surgery for breast cancer, ipsilateral invasive carcinoma, papillary carcinoma, Paget\'s disease, more lobular carcinoma in situ (LCIS) than DCIS present, initial mastectomy, no DCIS present, routine shave margins (of all vectors), and ≥ 2 mm margins of all six vectors were excluded. Selective intraoperative margin re-excisions were included.
RESULTS: A total of 208 patients who met inclusion criteria were retrospectively reviewed. 122 (25%) had one close/positive (< 2 mm) margin and 86 (18%) had two or more close/positive margins. Of the patients with one close/positive margin, 7% (9/122) eventually underwent mastectomy. Of the patients with two or more close/positive margins, 20% (17/86) eventually underwent mastectomy. Overall, no patients with opposing margins underwent mastectomy.
CONCLUSIONS: Patients undergoing PM for DCIS have a mastectomy rate that is increased threefold, with two or more close/positive margins at initial PM, when compared with those with only one close/positive margin. The presence of opposing close/positive margins at initial PM did not increase the mastectomy rate and most were cleared with re-excision.
METHODS: An institutional database review identified 208 patients with DCIS who underwent PM at a tertiary referral center and community hospitals from July 2020 to June 2023. Patients with a history of breast cancer, previous surgery for breast cancer, ipsilateral invasive carcinoma, papillary carcinoma, Paget\'s disease, more lobular carcinoma in situ (LCIS) than DCIS present, initial mastectomy, no DCIS present, routine shave margins (of all vectors), and ≥ 2 mm margins of all six vectors were excluded. Selective intraoperative margin re-excisions were included.
RESULTS: A total of 208 patients who met inclusion criteria were retrospectively reviewed. 122 (25%) had one close/positive (< 2 mm) margin and 86 (18%) had two or more close/positive margins. Of the patients with one close/positive margin, 7% (9/122) eventually underwent mastectomy. Of the patients with two or more close/positive margins, 20% (17/86) eventually underwent mastectomy. Overall, no patients with opposing margins underwent mastectomy.
CONCLUSIONS: Patients undergoing PM for DCIS have a mastectomy rate that is increased threefold, with two or more close/positive margins at initial PM, when compared with those with only one close/positive margin. The presence of opposing close/positive margins at initial PM did not increase the mastectomy rate and most were cleared with re-excision.
摘要：
背景：共识指南建议接受乳腺导管原位癌（DCIS）部分切除术（PM）的患者边缘≥2mm。目前尚不清楚边缘的数量或接近度小于2mm是否与尝试乳房保护治疗（BCT）的DCIS患者的乳房切除术率增加有关。这项研究的目的是研究这种关系。
方法：一项机构数据库审查确定了从2020年7月至2023年6月在三级转诊中心和社区医院接受PM的208例DCIS患者。有乳腺癌病史的患者,以前做过乳腺癌手术,同侧浸润性癌，乳头状癌,佩吉特病,小叶原位癌（LCIS）比DCIS多，初次乳房切除术,没有DCIS，（所有向量的）常规刮边距，排除所有六个向量的≥2mm边缘。包括选择性术中边缘再切除。
结果：对符合纳入标准的208例患者进行回顾性分析。122（25％）具有一个接近/阳性（<2mm）边缘，86（18％）具有两个或更多个接近/阳性边缘。在有一个接近/阳性切缘的患者中，7%(9/122)终究行乳房切除术。在有两个或两个以上接近/阳性切缘的患者中，20%(17/86)最终接受了乳房切除术。总的来说,没有相对边缘的患者接受乳房切除术。
结论：接受PM治疗的DCIS患者的乳房切除术率增加了三倍，在初始PM有两个或更多接近/正的利润率，与那些只有一个接近/正利润率的人相比。在初始PM时存在相反的闭合/阳性切缘并没有增加乳房切除术率，并且大多数通过重新切除被清除。
方法：一项机构数据库审查确定了从2020年7月至2023年6月在三级转诊中心和社区医院接受PM的208例DCIS患者。有乳腺癌病史的患者,以前做过乳腺癌手术,同侧浸润性癌，乳头状癌,佩吉特病,小叶原位癌（LCIS）比DCIS多，初次乳房切除术,没有DCIS，（所有向量的）常规刮边距，排除所有六个向量的≥2mm边缘。包括选择性术中边缘再切除。
结果：对符合纳入标准的208例患者进行回顾性分析。122（25％）具有一个接近/阳性（<2mm）边缘，86（18％）具有两个或更多个接近/阳性边缘。在有一个接近/阳性切缘的患者中，7%(9/122)终究行乳房切除术。在有两个或两个以上接近/阳性切缘的患者中，20%(17/86)最终接受了乳房切除术。总的来说,没有相对边缘的患者接受乳房切除术。
结论：接受PM治疗的DCIS患者的乳房切除术率增加了三倍，在初始PM有两个或更多接近/正的利润率，与那些只有一个接近/正利润率的人相比。在初始PM时存在相反的闭合/阳性切缘并没有增加乳房切除术率，并且大多数通过重新切除被清除。
