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Annals of Surgical Oncology

, Volume 23, Issue 12, pp 3811–3821 | Cite as

The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis

  • M. Luke Marinovich
  • Lamiae Azizi
  • Petra Macaskill
  • Les Irwig
  • Monica Morrow
  • Lawrence J. Solin
  • Nehmat Houssami
Breast Oncology

Abstract

Purpose

There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS.

Methods

A study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression (frequentist) and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time.

Results

Based on 20 studies (LR: 865 of 7883), odds of LR were associated with margin status [logistic: odds ratio (OR) 0.53 for negative vs. positive/close (p < 0.001); network: OR 0.45 for negative vs. positive]. In logistic meta-regression, relative to >0 or 1 mm, ORs for 2 mm (0.51), 3 or 5 mm (0.42) and 10 mm (0.60) showed comparable significant reductions in the odds of LR. In the network analysis, ORs relative to positive margins for 2 (0.32), 3 (0.30) and 10 mm (0.32) showed similar reductions in the odds of LR that were greater than for >0 or 1 mm (0.45). There was weak evidence of lower odds at 2 mm compared with >0 or 1 mm [relative OR (ROR) 0.72, 95 % credible interval (CrI) 0.47–1.08], and no evidence of a difference between 2 and 10 mm (ROR 0.99, 95 % CrI 0.61–1.64). Adjustment for covariates, and analyses based only on studies using whole-breast radiotherapy, did not change the findings.

Conclusion

Negative margins in BCS for DCIS reduce the odds of LR; however, minimum margin distances above 2 mm are not significantly associated with further reduced odds of LR in women receiving radiation.

Keywords

Local Recurrence Positive Margin Margin Status Online Appendix Negative Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

M.L. Marinovich is supported by a Cancer Institute NSW (CINSW) Early Career Fellowship. N. Houssami receives research support via a National Breast Cancer Foundation (NBCF) Australia Breast Cancer Research Leadership Fellowship. This work was partly supported by a National Health and Medical Research Council (NHMRC) program Grant to the STEP.

Supplementary material

10434_2016_5446_MOESM1_ESM.docx (257 kb)
Supplementary material 1 (DOCX 258 kb)

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • M. Luke Marinovich
    • 1
  • Lamiae Azizi
    • 1
  • Petra Macaskill
    • 1
  • Les Irwig
    • 1
  • Monica Morrow
    • 2
  • Lawrence J. Solin
    • 3
  • Nehmat Houssami
    • 1
  1. 1.Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Radiation OncologyAlbert Einstein Healthcare NetworkPhiladelphiaUSA

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