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Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery

Institution:	1. Department of Pathology and Molecular Medicine, Queen''s University, 88 Stuart Street, Kingston, Ontario, K7L 3N6, Canada;2. Department of Radiology, MD Anderson Cancer Center, C. de Arturo Soria, 270, 28033, Madrid, Spain;3. Department of Surgery, Queen''s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada;4. School of Computing, Queen''s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada;5. Department of Surgery, University Health Network and Princess Margaret Hospital, University of Toronto, 610 University Ave, Toronto, Ontario M5G 2M9, Canada;1. Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China;2. Department of Liver Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China;1. Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India;2. Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India;3. Dept. of Radiology, Centre Hospitalier Lyon-sud, Lyon, France;4. Dept. of Surgical Oncology, Jehangir Hospital, Pune, India;5. Dept. of Pathology, Zydus Hospital, Ahmedabad, India;6. Dept. of Radiology, Zydus Hospital, Ahmedabad, India;7. Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France;8. India Dept. of Pathology, Centre Hospitalier Lyon-sud, Lyon, France;1. Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel;2. Sackler School of Medicine, Tel-Aviv University, Israel;3. Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel;4. Gastrointestinal Malignancy Service at Assuta Samson Hospital, Ashdod, Israel;1. Ospedale Sant’Andrea, Sapienza University of Rome, Roma, Italy;2. ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy;3. University of Southern California, Department of Urology, Los Angeles, USA;4. Mansoura University, Department of Urology, Mansoura, Egypt;5. Policlinico Umberto Io, Sapienza University of Rome, Roma, Italy;1. Division of Aging, Brigham and Women''s Hospital, Boston, MA, USA;2. Division of Thoracic Surgery, Brigham and Women''s Hospital, Boston, MA, USA;3. Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA;4. Marcus Institute of Aging Research, Boston, MA, USA;5. Department of Radiation Oncology, Brigham and Women''s Hospital, Boston, MA, USA;6. Center for Esophageal and Gastric Cancer, Dana-Farber/Brigham and Women''s Cancer Center, Boston, MA, USA;1. Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy;2. Student in Erasmus Exchange Programme, Faculty of Medicine, Sapienza University of Rome, Rome, Italy;3. Department of Public Health, Federico II University, Naples, Italy;4. Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium

Abstract:	PurposeTo determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed.MethodsThis retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed.Results360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23–4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM.ConclusionLack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.

Keywords:	Breast-conserving surgery (BCS) Breast cancer Surgical margins Definitive presurgical diagnosis Core needle biopsy and vacuum-assisted biopsy High-risk lesions IM"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"inadequate margins BCS"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"breast-conserving surgery CNB"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"core needle biopsy WL"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"hookwire localization DCIS"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"ductal carcinoma in situ IDC NOS"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"invasive ductal carcinoma not otherwise specified LVI"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"lymphovascular invasion ILC"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"invasive lobular carcinoma
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