Association Between Surgery Preference and Receipt in Ductal Carcinoma In Situ After Breast Magnetic Resonance Imaging

Abstract

IMPORTANCEGuiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. OBJECTIVE To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy.EXPOSURES Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. MAIN OUTCOMES AND MEASURESPatient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. RESULTS Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%]were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P = .007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P < .001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P = .03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR,

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

“…Third, we used multivariable logistic regression with Firth biasreducing penalized likelihood method. Different from conventional maximum likelihood estimation, the Firth log likelihood is penalized by the determinant of the information matrix, provides bias reduction for a small number of events, and yields finite and consistent estimates even in the case of separation (48)(49)(50)(51)(52)(53)(54)(55)(56)(57).…”

Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes

“…A study by Fosh et al reported high levels of satisfaction in DCIS patients treated with partial mastectomy and OPS2 [ 32 ], and a recent study by Fazeli and colleagues interviewed 316 women with DCIS prior to surgery and found that 80% would have preferred wide local excision over mastectomy as a treatment of choice [ 33 ]. Our data suggests that breast-conserving surgery with OPS2 yields lower morbidity than conservative mastectomy, a finding that is in line with that reported by Livingston-Rosanoff and colleagues, who found that DCIS patients treated with mastectomy were more likely to report lower levels of satisfaction than patients treated with BCS [ 34 ].…”

Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study

“…The role of preoperative breast magnetic resonance imaging (MRI) in guiding the treatment of ductal carcinoma in situ (DCIS) diagnosed at core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) is an open issue in clinical practice [ 1 – 4 ] that has been extensively investigated considering different outcomes, e.g., short-term surgical results [ 5 – 16 ], upgrade to invasive cancer at final pathology [ 17 , 18 ], detection of additional ipsilateral or contralateral disease [ 19 ], long-term recurrence [ 20 ], and patient preferences [ 21 , 22 ]. Surgical outcomes are crucial, as the rate of mastectomy and the rate of reoperation after breast-conserving surgery are major indicators of breast care quality and the focus of multidisciplinary efforts towards surgical de-escalation [ 23 – 25 ].…”