M. R. Decker1, H. B. Neuman1, A. Trentham-Dietz3, N. K. LoConte4, M. A. Smith3, R. S. Punglia2, C. C. Greeberg1, L. G. Wilke1 1University Of Wisconsin Hospital & Clinics,Department Of Surgery,Madison, WI, USA 2Dana Farber Cancer Institute,Radiation Oncology,Boston, MA, USA 3University Of Wisconsin School Of Medicine & Public Health,Population Health Sciences,Madison, WI, USA 4University Of Wisconsin Hospital & Clinics,Carbone Cancer Center,Madison, WI, USA
Introduction: The elevated number of repeat operations for the treatment of ductal carcinoma in situ (DCIS) is costly for patients and the medical community, financially and psychologically. Intraoperative pathologic assessment of DCIS may lead to reduction in these additional surgeries. This study examines the relationship between intraoperative pathologic assessment and subsequent operations after a diagnosis of DCIS.
Methods: SEER-Medicare patients diagnosed with DCIS from 1999 to 2007 who underwent lumpectomy without axillary surgery, as their initial surgical procedure, were eligible. All subsequent breast surgical procedures were identified. Use of intraoperative pathology (frozen section or touch preparation) during the initial surgery was assessed. Multivariable logistic regression was used to describe the relationship between the use of intraoperative pathologic assessment and any subsequent mastectomy or lumpectomy within 90 days of the initial operation.
Results: Of 8,259 DCIS patients who underwent lumpectomy without axillary surgery, 3,510(43%) underwent a subsequent mastectomy or lumpectomy. Claims for intraoperative pathologic assessment were present for 2,172 (26%) patients. On univariate analysis, patients with intraoperative pathology during their initial surgery were more likely to have additional breast surgery than patients without intraoperative pathology (28% vs 25%, p=0.009). However, multivariable analysis demonstrated that intraoperative pathologic assessment had no statistically significant relationship with ocurrance of subsequent breast surgery (Adjusted OR 1.06 (95%CI: 0.93-1.19), p = 0.387). Only tumor size >2cm (AOR 2.28 (95%CI: 1.99 -2.60), p<0.001), poorly differentiated tumor grade (AOR 1.36 (95%CI: 1.13 -1.63), p<0.001 ), and patient residence in a rural area (AOR 1.20 (95%CI: 1.01 to 1.43), p=0.034) were associated with greater likelihood of subsequent surgery.
Conclusion: The use of intraoperative pathologic assessment during lumpectomy from 1999-2007 was not associated with a reduction in subsequent breast operations in women with DCIS. Surgery in 2014 for DCIS has not changed from 2000, as there are no novel intraoperative tools that have been developed or standardization of margin assessment implemented. These results highlight a need to identify cost-effective tools and strategies to facilitate surgical decision making and reduce the number of subsequent operations for women with intraductal disease.