Predictors of Reexcision following Breast-Conserving Surgery for Ductal Carcinoma In Situ

Background Reexcision following breast-conserving surgery (BCS) in women with ductal carcinoma in situ (DCIS) results in adjuvant treatment delays, higher health care costs, and undesirable cosmetic outcomes. The purpose of this study is to determine patient, imaging, pathological, and surgical predictors of reexcision following BCS for DCIS. Patients and Methods A retrospective review of women with DCIS who had BCS from 2007 to 2016 was conducted. Patient, imaging, pathological, and surgical features, in addition to surgical outcomes, were collected from medical records. Standard statistical tests were used to compare features between patients who did and did not undergo at least one reexcision. A multivariable logistic regression model was fit to assess features associated with reexcision. Results A total of 547 women (mean age 59 years; range 30–88 years) diagnosed with DCIS at core needle biopsy underwent BCS. Of all women, 31.6% (173/547) had at least one reexcision. With multivariable analysis, features associated with reexcision included younger patient age (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.97–1.0, p = 0.049), African-American race (aOR 2.66, 95% CI 1.13–6.26, p = 0.03), biopsy modality of ultrasound (aOR 2.35, 95% CI 1.22–4.53, p = 0.01), and earlier year of surgery (aOR 0.92, 95% CI 0.86–0.98, p = 0.01). No pathological features of DCIS were associated with reexcision risk. Conclusions In our cohort of nearly 550 women with DCIS who underwent BCS, 31.6% had at least one reexcision. Features associated with reexcision include younger patient age, African-American race, biopsy modality of ultrasound, and earlier year of surgery.