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Nomogram for predicting positive resection margins after breast-conserving surgery

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Abstract

A positive resection margin after breast-conserving surgery (BCS) is the most important risk factor for tumor recurrence. Re-excision after BCS often results in unnecessary wider excisions, or even mastectomies and poor cosmetic results, as well as increased medical costs and patients’ anxiety. A nomogram for predicting positive resection margins may allow the surgeon to develop an individualized surgical plan. Data from 1,034 consecutive breast cancer patients with invasive or in situ breast cancer who initially underwent BCS between January 2008 and December 2009 were used to develop a nomogram for predicting positive resection margins. The nomogram was then validated independently using a cohort of 563 patients who underwent breast surgery in 2010. Multivariate logistic regression analysis showed that microcalcifications (OR 1.574, P = 0.034), grade 4 mammographic density (OR 4.515, P = 0.005), >0.5 cm difference in tumor size between magnetic resonance imaging and ultrasonography (OR 10.001, P < 0.0001), ductal carcinoma in situ (DCIS) on needle biopsy (OR 1.575, P = 0.044), and lobular component on needle biopsy (OR 3.985, P = 0.015) were independent predictors of positive resection margins. These significant variables were used to develop a nomogram for predicting positive resection margins after BCS; the AUCs of the study and the validation cohorts were 0.823 [95 % confidence interval (CI), 0.785–0.862] and 0.846 (95 % CI, 0.800–0.892), respectively. Our new nomogram using 5 variables that were determined before surgery to predict positive resection margins should aid the surgeon in developing individualized surgical plans for breast cancer patients who are scheduled for BCS.

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Acknowledgments

We thank the Medical Research Collaborating Center (MRCC) of Seoul National University Hospital for the excellent assistance in statistical analysis. This work was supported by National Research Foundation of Korea (NRF) Grant funded by the Korean Government (A110961) and by a grant of the Korea Health technology R&D Project, Ministry of Health & Welfare, Republic of Korea (2012-0000994).

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Authors and Affiliations

  1. Department of Surgery, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea

    Hee-Chul Shin & Sung Jun Park

  2. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Wonshik Han, Hyeong-Gon Moon & Dong-Young Noh

  3. Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Wonshik Han & Dong-Young Noh

  4. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Nariya Cho & Woo Kyung Moon

  5. Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    In-Ae Park

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  1. Hee-Chul Shin
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Correspondence to Dong-Young Noh.

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Shin, HC., Han, W., Moon, HG. et al. Nomogram for predicting positive resection margins after breast-conserving surgery. Breast Cancer Res Treat 134, 1115–1123 (2012). https://doi.org/10.1007/s10549-012-2124-3

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