Radiological Underestimation of Tumor Size as a Relevant Risk Factor for Positive Margin Rate in Breast-Conserving Therapy of Pure Ductal Carcinoma In Situ (DCIS)
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Risk Factors Associated with Positive Margins
3.2. Mammographic Size Estimation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | All Patients | Negative Margins | Positive Margins | p Value |
---|---|---|---|---|
n = 189 | n = 114 | n = 75 | ||
Age (years) | ||||
Mean (range) | 59.7 (34–84) | 59.6 (35–84) | 60 (34–81) | 0.73 |
Specimen size (mm) | ||||
Median (range) | 50.0 (23–110) | 52.5 (30–110) | 48.0 (23–95) | 0.009 |
Mammographic tumor size (mm) | ||||
Median (range) | 15 (2–86) | 13 (2–70) | 22 (2–86) | 0.011 |
Histological tumor size (mm) | ||||
Median (range) | 25 (2–84) | 17 (3–60) | 31 (2–84) | <0.001 |
Grade of differentiation | 0.36 | |||
Low grade | 18 (9.5%) | 13 (11.4%) | 5 (6.7%) | |
Intermediate grade | 78 (41.3%) | 49 (43%) | 29 (38.7%) | |
High grade | 93 (49.2%) | 52 (45.6%) | 41 (54.7%) | |
Estrogen receptor | 0.039 | |||
positive | 154 (84.2% *) | 97 (89% *) | 57 (77% *) | |
negative | 29 (15.8% *) | 12 (11% *) | 17 (23% *) | |
Progesteron receptor | 0.003 | |||
positive | 120 (71% *) | 77 (80.2% *) | 43 (58.9% *) | |
negative | 49 (29% *) | 19 (19.8% *) | 30 (41.1% *) | |
Radiological margins | 0.004 | |||
<5 mm | 111 (58.7%) | 57 (50%) | 54 (72%) | |
≥5 mm | 78 (41.3%) | 57 (50%) | 21 (28%) | |
Radiological underestimation | 0.006 | |||
≥10 mm | 70 (37.0%) | 33 (28.9%) | 37 (49.3%) | |
<10 mm | 119 (63.0%) | 81 (71.1%) | 38 (50.7%) | |
Intraoperative re-excision | 0.524 | |||
yes | 58 (30.7%) | 33 (28.9%) | 25 (33.3%) | |
no | 131 (69.3%) | 81 (71.1%) | 50 (66.7%) |
Variable | Univariate Logistic Regression | Multivariable Logistic Regression | ||
---|---|---|---|---|
Odds Ratio (95% CI) | p Value | Odds Ratio (95% CI) | p Value | |
Specimen size | ||||
≤50 mm vs. (vs.) >50 mm * | 1.69 (0.94–3.05) | 0.080 | 2.51 (1.15–5.49) | 0.021 |
Mammographic tumor size | ||||
>20 mm vs. ≤20 mm * | 2.05 (1.13–3.73) | 0.018 | 5.46 (2.04–14.6) | 0.001 |
Histological tumor size ** | ||||
>25 mm vs. ≤25 mm * | 7.36 (3.82–14.2) | <0.001 | ||
Estrogen receptor | ||||
Negative vs. positive * | 2.41 (1.07–5.41) | 0.033 | 0.75 (0.21–2.64) | 0.659 |
Progesteron receptor | ||||
Negative vs. positive * | 2.83 (1.42–5.61) | 0.003 | 2.13 (0.77–5.90) | 0.145 |
Radiological margins | ||||
<5 mm vs. ≥5 mm * | 2.57 (1.38–4.80) | 0.003 | 2.71 (1.27–5.83) | 0.010 |
Mammographic underestimation | ||||
≥10 mm vs. <10 mm * | 2.39 (1.30–4.39) | 0.005 | 5.81 (2.39–14.12) | <0.001 |
Variable | All Patients | No Relevant | Underestimation | p Value |
---|---|---|---|---|
n = 189 (%) | Underestimation | ≥10 mm | ||
n = 119 (%) | n = 70 (%) | |||
Microcalcification | 0.013 | |||
Fine linear (branched) | 27 (14.3%) | 22 (18.5%) | 5 (7.14%) | |
Fine pleomorphic | 57 (30.2%) | 28 (23.5%) | 29 (41.4%) | |
Coarse heterogenous | 97 (51.3%) | 62 (52.1%) | 35 (50%) | |
amorphous | 8 (4.2%) | 7 (5.9%) | 1 (1.43%) | |
Distribution pattern of microcalcification | <0.001 | |||
Ductal/segmental | 95 (50.3%) | 75 (63.0%) | 20 (28.6%) | |
clustered | 94 (49.7%) | 44 (37.0%) | 50 (71.4%) | |
Comedo necrosis | 0.251 | |||
yes | 153 (81%) | 93 (78.2%) | 60 (85.7%) | |
no | 36 (19%) | 26 (21.8%) | 10 (14.3%) | |
Grading | 0.689 | |||
Low grade | 18 (9.5%) | 13 (10.9%) | 5 (7.1%) | |
Intermediate grade | 78 (41.3%) | 48 (42.9%) | 30 (42.9%) | |
Hgh grade | 93 (49.2%) | 58 (48.7%) | 35 (50%) | |
Estrogen receptor | 0.402 | |||
positive | 154 (84.2% *) | 97 (85.1% *) | 57 (82.6% *) | |
negative | 29 (15.8% *) | 17 (14.9% *) | 12 (17.4% *) | |
Progesteron receptor | 0.861 | |||
Positive | 120 (71% *) | 76 (71.7% *) | 44 (69.8% *) | |
negative | 49 (29% *) | 30 (28.3% *) | 19 (30.2% *) | |
Mammographic tumor size | <0.001 | |||
≤20 mm | 113 (59.8%) | 53 (44.5%) | 60 (85.7%) | |
>20 mm | 76 (40.2%) | 66 (55.5%) | 10 (14.3%) |
Variable | Univariate Logistic Regression | Multivariable Logistic Regression | ||
---|---|---|---|---|
Odds Ratio (95% CI) | p Value | Odds Ratio (95% CI) | p Value | |
Microcalcification Fine linear (branched) * Fine pleomorphic heterogeneous | 3.77 (1.27–11.18) 2.48 (0.86–7.14) | 0.017 0.091 | 2.87 (0.85–9.69) 1.75 (0.54–5.72) | 0.163 0.089 0.354 |
Distribution pattern of Microcalcification Ductal * vs. clustered clustered | 4.26 (2.25–8.07) | <0.001 | 0.87 (0.34–2.22) | 0.764 |
Comedo necrosis no * vs. yes | 1.68 (0.76–3.73) | 0.204 | ||
Grading G1 * vs. G2 G3 | 1.63 (0.53–5.02) 1.57 (0.52–4.78) | 0.399 0.428 | ||
Estrogenreceptor positive * vs. negative negative | 1.20 (0.54–2.69) | 0.657 | ||
Mammographic DCIS Size > 20 mm * vs. ≤ 20 mm | 7.47 (3.49–15.99) | <0.001 | 6.49 (2.30–18.26) | <0.001 |
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Schultek, G.; Gerber, B.; Reimer, T.; Stubert, J.; Hartmann, S.; Martin, A.; Stachs, A. Radiological Underestimation of Tumor Size as a Relevant Risk Factor for Positive Margin Rate in Breast-Conserving Therapy of Pure Ductal Carcinoma In Situ (DCIS). Cancers 2022, 14, 2367. https://doi.org/10.3390/cancers14102367
Schultek G, Gerber B, Reimer T, Stubert J, Hartmann S, Martin A, Stachs A. Radiological Underestimation of Tumor Size as a Relevant Risk Factor for Positive Margin Rate in Breast-Conserving Therapy of Pure Ductal Carcinoma In Situ (DCIS). Cancers. 2022; 14(10):2367. https://doi.org/10.3390/cancers14102367
Chicago/Turabian StyleSchultek, Gesche, Bernd Gerber, Toralf Reimer, Johannes Stubert, Steffi Hartmann, Annett Martin, and Angrit Stachs. 2022. "Radiological Underestimation of Tumor Size as a Relevant Risk Factor for Positive Margin Rate in Breast-Conserving Therapy of Pure Ductal Carcinoma In Situ (DCIS)" Cancers 14, no. 10: 2367. https://doi.org/10.3390/cancers14102367