{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:29:37Z","timestamp":1781191777155,"version":"3.54.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The chances of second surgery due to positive margins in patients receiving breast-conversing surgery (BCS) were about 20-40%. This study aims to develop and validate a nomogram to predict the status of breast-conserving margins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The database identified patients with core needle biopsy-proven ductal carcinoma <jats:italic>in situ<\/jats:italic> (DCIS) or invasive breast carcinoma who underwent BCS in Shanxi Bethune Hospital between January 1, 2015 and December 31, 2021 (n = 573). The patients were divided into two models: (1) The first model consists of 398 patients who underwent BCS between 2015 and 2019; (2) The validation model consists of 175 patients who underwent BCS between 2020 and 2021. The development of the nomogram was based on the findings of multivariate logistic regression analysis. Discrimination was assessed by computing the C-index. The Hosmer-Lemeshow goodness-of-fit test was used to validate the calibration performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The final multivariate regression model was developed as a nomogram, including blood flow signals (OR = 2.88, p = 0.001), grade (OR = 2.46, p = 0.002), microcalcifications (OR = 2.39, p = 0.003), tumor size in ultrasound (OR = 2.12, p = 0.011) and cerbB-2 status (OR = 1.99, p = 0.042). C-indices were calculated of 0.71 (95% CI: 0.64-0.78) and 0.68 (95% CI: 0.59-0.78) for the modeling and the validation group, respectively. The calibration of the model was considered adequate in the validation group (p &amp;gt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We developed a nomogram that enables the estimation of the preoperative risk of positive BCS margins. Our nomogram provides a valuable tool for identifying high-risk patients who might have to undergo a wider excision.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.875665","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T05:46:06Z","timestamp":1652334366000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Development and Validation of a Prediction Model for Positive Margins in Breast-Conserving Surgery"],"prefix":"10.3389","volume":"12","author":[{"given":"Rong","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinnan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-012-2514-0","article-title":"Risk of Locoregional Recurrence in Patients With False-Negative Frozen Section or Close Margins of Retroareolar Specimen in Nipple-Sparing Mastectomy","volume":"19","author":"Kneubil","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.07.032","article-title":"Current Margin Practice and Effect on Re-Excision Rates Following the Publication of the SSO-ASTRO Consensus and ABS Consensus Guidelines: A National Prospective Study of 2858 Women Undergoing Breast-Conserving Therapy in the UK and Ireland","volume":"84","author":"Tang","year":"2017","journal-title":"Eur J Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2007.01.031","article-title":"Perpendicular Inked Versus Tangential Shaved Margins in Breast-Conserving Surgery: Does the Method Matter","volume":"204","author":"Wright","year":"2007","journal-title":"J Am Coll Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1245\/s10434-016-5756-4","article-title":"Intraoperative Margin Management in Breast-Conserving Surgery: A Systematic Review of the Literature","volume":"25","author":"Gray","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5401-2","article-title":"Intraoperative Margin Assessment in Wire-Localized Breast-Conserving Surgery for Invasive Cancer: A Population-Level Comparison of Techniques","volume":"23","author":"Laws","year":"2016","journal-title":"Ann Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200106000-00005","article-title":"Intraoperative Ultrasound is Associated With Clear Lumpectomy Margins for Palpable Infiltrating Ductal Breast Cancer","volume":"233","author":"Moore","year":"2001","journal-title":"Ann Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1901519","DOI":"10.1002\/advs.201901519","article-title":"Emerging Technologies for Real-Time Intraoperative Margin Assessment in Future Breast-Conserving Surgery","volume":"7","author":"Pradipta","year":"2020","journal-title":"Adv Sci (Weinh)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/jso.23634","article-title":"Intraoperative Assessment of Margins in Breast Conservative Surgery\u2013Still in Use","volume":"110","author":"Thill","year":"2014","journal-title":"J Surg Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0248768","DOI":"10.1371\/journal.pone.0248768","article-title":"Accuracy of Frozen Section in Intraoperative Margin Assessment for Breast-Conserving Surgery: A Systematic Review and Meta-Analysis","volume":"16","author":"Garcia","year":"2022","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001897","article-title":"Diagnostic Accuracy of Intraoperative Techniques for Margin Assessment in Breast Cancer Surgery: A Meta-Analysis","volume":"265","author":"St John","year":"2017","journal-title":"Ann Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1338\u201346","DOI":"10.1245\/s10434-020-08955-z","article-title":"Effect of Intraoperative Imprint Cytology Followed by Frozen Section on Margin Assessment in Breast-Conserving Surgery","volume":"28","author":"Tamanuki","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.43","article-title":"Variability in Reexcision Following Breast Conservation Surgery","volume":"307","author":"McCahill","year":"2012","journal-title":"JAMA"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2147\/OTT.S160433.","article-title":"Predicting Initial Margin Status in Breast Cancer Patients During Breast-Conserving Surgery","volume":"11","author":"Pan","year":"2018","journal-title":"Onco Targets Ther"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-012-2124-3","article-title":"Nomogram for Predicting Positive Resection Margins After Breast-Conserving Surgery","volume":"134","author":"Shin","year":"2012","journal-title":"Breast Cancer Res Treat"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2013.01.010","article-title":"A Validated Web-Based Nomogram for Predicting Positive Surgical Margins Following Breast-Conserving Surgery as a Preoperative Tool for Clinical Decision-Making","volume":"22","author":"Pleijhuis","year":"2013","journal-title":"Breast"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2014.08.474","article-title":"Prediction of Positive Resection Margins in Patients With non-Palpable Breast Cancer","volume":"41","author":"Barentsz","year":"2015","journal-title":"Eur J Surg Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4736-4","article-title":"Predictors of Residual Tumor in Breast-Conserving Therapy","author":"Rath","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"zrab092","DOI":"10.1093\/bjsopen\/zrab092","article-title":"Validated Prediction Model for Positive Resection Margins in Breast-Conserving Surgery Based Exclusively on Preoperative Data","volume":"5","author":"Ellbrant","year":"2021","journal-title":"BJS Open"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.3935","article-title":"Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer","volume":"32","author":"Moran","year":"2014","journal-title":"J Clin Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the Rule of Ten Events Per Variable in Logistic and Cox Regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am J Epidemiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1038\/s41598-019-57094-3","article-title":"The Prognostic and Predictive Potential of Ki-67 in Triple-Negative Breast Cancer","volume":"10","author":"Zhu","year":"2020","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3957-2","article-title":"Margins: A Status Report From the Annual Meeting of the American Society of Breast Surgeons","volume":"21","author":"Harness","year":"2014","journal-title":"Ann Surg Oncol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2020-0001","article-title":"Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals","volume":"25","author":"Yang","year":"2020","journal-title":"Oncologist"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3481-4","article-title":"Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer","volume":"21","author":"Moran","year":"2014","journal-title":"Ann Surg Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/ajco.13763","article-title":"Understanding Mammographic Breast Density Profile in China: A Sino-Australian Comparative Study of Breast Density Using Real-World Data From Cancer Screening Programs","author":"Li","year":"2022","journal-title":"Asia Pac J Clin Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4403-9","article-title":"Role of Imaging in Neoadjuvant Therapy for Breast Cancer","volume":"22","author":"Dialani","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3521","DOI":"10.3390\/cancers13143521","article-title":"Assessment and Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer: A Comparison of Imaging Modalities and Future Perspectives","volume":"13","author":"Romeo","year":"2021","journal-title":"Cancers (Basel)"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000019728","article-title":"Clinical and Sonographic Features of Nipple Lesions","volume":"99","author":"Cai","year":"2020","journal-title":"Med (Baltimore)"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1177\/1066896908327576","article-title":"Diagnostic Accuracy and Prognostic Value of Core Biopsy in the Management of Breast Cancer: A Series of 542 Patients","volume":"17","author":"Richter-Ehrenstein","year":"2009","journal-title":"Int J Surg Pathol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200001000-00015","article-title":"Clinicopathologic Significance of Ductal Carcinoma in Situ in Breast Core Needle Biopsies With Invasive Cancer","volume":"24","author":"Jimenez","year":"2000","journal-title":"Am J Surg Pathol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1376","article-title":"PROBAST: A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies","volume":"170","author":"Wolff","year":"2019","journal-title":"Ann Intern Med"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.875665\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T05:46:08Z","timestamp":1652334368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.875665\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,12]]},"references-count":32,"alternative-id":["10.3389\/fonc.2022.875665"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.875665","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,12]]},"article-number":"875665"}}