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

Publication Title

Annals of surgical oncology : the official journal of the Society of Surgical Oncology

Authors

Kyle Lee, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Angela Pallesi, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Betsy Valdez, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Douglas A Hanes, Center for Cardiovascular Analytics, Research and Data Science, Providence Research Network, Portland, OR, USA.Follow
Estela Samuels, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Stacey Stern, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Nicketti Handy, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Crystal E Fancher, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Javier I Orozco, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Janie Grumley, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow

Document Type

Article

Publication Date

12-6-2025

Keywords

Breast neoplasm; Breast-conserving surgery; Margin re-excision; Residual disease; Surgical margins.; california; sjci; santa monica; cards; cards publication; oregon; prn; california; sjci; santa monica

Abstract

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.

Area of Special Interest

Cancer

Area of Special Interest

Women & Children

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

DOI

10.1245/s10434-025-18813-5