Breast Cancer Recurrence Rates In Patients Undergoing NSM For Multicentric DCIS: Is Additional Post-mastectomy Therapy Warranted?
Luke P. Poveromo, MD, Brienne C. Lubor, BS, Mia Talmor, MD.
Weill Cornell Medical Center, New York, NY, USA.
Recent literature has examined the oncologic safety of nipple sparing mastectomies (NSM) in patients with ductal carcinoma in-situ (DCIS). However, no study exists that stratifies outcomes by histologically focal, multifocal, or multicentric DCIS disease. This study seeks to evaluate recurrence rates in these subsets of DCIS to assess the need for additional therapy following NSM and to further guide reconstructive decision-making.
A retrospective review was conducted on 74 consecutive patients who underwent NSM between 2007-2015 with a final histological diagnosis of DCIS. Patient pathology was stratified as either focal, multifocal, or multicentric disease. Patients with concurrent invasive carcinoma were excluded. Patients were evaluated for prior therapeutic radiation, prior breast conserving therapy, and hormonal / adjuvant therapy.
A total of 74 patients with DCIS underwent NSM mastectomy between 2007-2015 for a total of 77 individual analyzed breasts. Of the 77 breasts identified: 34 had focal disease, 34 had multifocal disease, and 9 had multicentric disease. All nipple margins were negative upon histologic evaluation. The recurrence rate for focal disease was 1/34 (2.9%), 1/34 (2.9%) for multifocal disease, and 3/9 (33.3%) for multi-centric disease. The recurrence rate for non-multicentric vs multicentric disease was 2.9% (n=68) and 33.3% (n=9), respectively (p=0.01). Mean time to recurrence was 2.5 ±0.4 years across all groups.
Preliminary analysis suggests that patients with multicentric DCIS may have increased propensity for recurrence in the setting of NSM with immediate reconstruction. Additional adjuvant treatment may be warranted for this subset of patients.
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