European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Prognostic impact of close margins on Loco-regional recurrence in ductal carcinoma in situ treated with breast-conserving surgery and radiotherapy.
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Kang Jongwon, Lee Seungmin, Jung Sungjin, Yoon Yena, Oh Jeong-Hun, Koh Hyoung Won, Yoon Kyung-Hwak, Shin Hee-Chul, Kim Eun-Kyu
Аннотация
INTRODUCTION: Current guidelines recommend achieving negative margins ≥2 mm for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and radiotherapy (RT). However, the need for re-excision in cases with close (<2 mm), but negative margins remain controversial. We evaluated the prognostic impact of close margins on locoregional recurrence (LRR) and identified factors associated with recurrence.
MATERIAL AND METHODS: We retrospectively analyzed 672 patients with pure DCIS who underwent BCS and adjuvant RT between 2004 and 2020. Patients were categorized into negative- and close-margin groups (n = 611 and 61, respectively). A subgroup analysis was performed on 175 patients with microinvasive carcinoma. Predictors of LRR were assessed using Cox proportional hazards models, and survival outcomes were compared using Kaplan-Meier analysis.
RESULTS: During a median follow-up of 88 months, 12 patients (1.8%) developed LRR. In pure DCIS, margin status was not significantly associated with recurrence. Younger age (≤50 years) and omission of hormonal therapy were risk factors for LRR. However, in microinvasive carcinoma, close margins were significantly associated with shorter LRR-free survival. On ultrasonography, lesion size ≥2 cm and non-mass-like appearance were associated with close margin status.
CONCLUSION: Close margins were not associated with an increased risk of LRR in pure DCIS patients treated with BCS and RT, suggesting that routine re-excision may be unnecessary. However, in microinvasive carcinoma, close margins were associated with a higher recurrence risk, indicating the need for wider excision. Ultrasonographic features may help to predict close margins and assist in preoperative surgical planning.
MATERIAL AND METHODS: We retrospectively analyzed 672 patients with pure DCIS who underwent BCS and adjuvant RT between 2004 and 2020. Patients were categorized into negative- and close-margin groups (n = 611 and 61, respectively). A subgroup analysis was performed on 175 patients with microinvasive carcinoma. Predictors of LRR were assessed using Cox proportional hazards models, and survival outcomes were compared using Kaplan-Meier analysis.
RESULTS: During a median follow-up of 88 months, 12 patients (1.8%) developed LRR. In pure DCIS, margin status was not significantly associated with recurrence. Younger age (≤50 years) and omission of hormonal therapy were risk factors for LRR. However, in microinvasive carcinoma, close margins were significantly associated with shorter LRR-free survival. On ultrasonography, lesion size ≥2 cm and non-mass-like appearance were associated with close margin status.
CONCLUSION: Close margins were not associated with an increased risk of LRR in pure DCIS patients treated with BCS and RT, suggesting that routine re-excision may be unnecessary. However, in microinvasive carcinoma, close margins were associated with a higher recurrence risk, indicating the need for wider excision. Ultrasonographic features may help to predict close margins and assist in preoperative surgical planning.