Use of postexcision preirradiation mammography in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy |
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| Authors: | Jonathan T. Whaley Nataniel H. Lester-Coll Samantha M. Morrissey Abigail B. Milby Wei-Ting Hwang Robert G. Prosnitz |
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| Affiliation: | 1. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania;2. Department of Radiation Oncology, Lehigh Valley Health Network, The John and Dorothy Morgan Cancer Center, Allentown, Pennsylvania;1. Fellow, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA;2. Director, Fellowship for Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA;3. Research Associate, Coordinated Health, Bethlehem, PA;1. Foot and Ankle Surgery, VSAS Orthopaedics, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite # 110, Allentown, PA 18103, USA;2. Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA;1. Coordinated Health, Clinical Education and Research Department, 3435 Winchester Road, Allentown, PA 18104, USA;2. Coordinated Health, Foot and Ankle Department, 2775 Schoenersville Road, Bethlehem, PA 18017, USA;1. Fellowship Director, Department of Foot Ankle, Coordinated Health, Bethlehem, PA;2. Fellow, Department of Foot Ankle, Coordinated Health, Bethlehem, PA;3. Research Associate, Department of Clinical Education and Research, Coordinated Health, Bethlehem, PA;1. Fellow, Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, PA;2. Research Associate, Department of Clinical Education and Research, Coordinated Health, Bethlehem, PA;3. Director, Foot and Ankle Reconstruction Fellowship, Department of Foot and Ankle, Coordinated Health, Bethlehem, PA |
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| Abstract: | PurposePostexcision preirradiation mammography (PPM) is frequently performed in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving therapy (BCT) to evaluate for residual suspicious calcifications; but no clear evidence supports this practice. The current study was undertaken to investigate the value of PPM in the management of patients with DCIS.Methods and MaterialsWe conducted a retrospective review of patients treated for DCIS with BCT at the University of Pennsylvania. The impact of PPM on surgical management and on local recurrence was evaluated. Factors associated with the use of PPM, the results of PPM, and the likelihood of finding residual malignancy at the time of re-excision in patients with PPM were also examined.ResultsOne hundred forty-four of 281 patients (51%) underwent PPM. Of the 144 patients who received PPM, 34 (24%; 95% confidence interval, 17%-31%) had residual suspicious calcifications (a “positive PPM”). Of the 34 patients with a positive PPM, all underwent a re-excision and 19 (56%; 95% confidence interval, 35%-70%) were found to have residual malignancy. Ten of 34 patients with a positive PPM had negative margins, of which 6 had a residual malignancy. Assuming all patients with close, positive, or indeterminate surgical margins would have undergone re-excision regardless of the findings of PPM, PPM resulted in a change in surgical management in 7% (10/144) of patients and removal of residual DCIS in 4% (6/144). With a median follow-up of 9.5 years, the use of PPM was not associated with an improvement in 10-year local recurrence-free survival (94.8% vs 91.5%, P = .368).ConclusionsIn this study, PPM affected surgical management in only a small percentage of patients and had no impact on local recurrence. The routine use of PPM in women undergoing BCT for DCIS may not be warranted. |
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