CYTOLOGIC EVALUATION OF LUMPECTOMY MARGINS IN PATIENTS WITH DUCTAL CARCINOMA IN-SITU - CLINICAL OUTCOME

Backround: Breast conservation therapy is controversial for ductal car cinoma in situ (DCIS) due to recently reported high recurrence rates. We believe that cytologic evaluation of lumpectomy margins improves ef ficiency and leads to a lower recurrence rate following lumpectomy for DCIS. Methods: A prospectively accrued database of 1255 breast cancer patients at the H. Lee Moffitt Cancer Center and Research Institute w as found to have 218 patients with DCIS (17.4%). Of those 218 cases, 1 14 were treated with lumpectomy, axillary dissection, and radiation th erapy; the remaining 104 patients were treated with mastectomy with or without reconstruction. Imprint cytology was used to evaluate all lum pectomy margins. Permanent sections and imprint cytology were reviewed by the same pathologist. Results: All lumpectomy specimens (116 tumor s in 114 patients) were evaluated. The median follow up was 57.5 month s (range 2-110 months). One hundred and three patients with 104 tumors were selected on the basis of pure DCIS (with or without microinvasio n), and treated with lumpectomy, axillary dissection and radiation the rapy, Of the 104 tumors utilizing attempted breast conservation therap y, 7 (6.6%) required mastectomy. There were 6 recurrences (6.1%) with a median time for recurrence of 47.5 months (range 27-85 months): four recurrences were comedo and two were noncomedo at original diagnosis. Conclusions: The determination of lumpectomy margins in DCIS patients using imprint cytology leads to an overall recurrence rate of 6.1% wi th reduction in operative time, and re-excision rate. Significant recu rrence rates were associated with microinvasion and multifocal tumors (28%) versus simple DCIS at 5 years. Breast conservation therapy and s urgical margin determination with imprint cytology for DCIS is a cost- effective and reliable method of treatment for simple DCIS.