{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T17:31:23Z","timestamp":1782581483195,"version":"3.54.5"},"reference-count":44,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Radiological underestimation of the actual tumor size is a relevant problem in reaching negative margins in ductal carcinoma in situ (DCIS) associated with microcalcifications in breast-conserving therapy (BCT). The aim of this study is to evaluate whether the radiological underestimation of tumor size has an influence on the histopathological margin status. Methods: Patients who underwent BCT with preoperatively diagnosed pure DCIS were included (pooled analysis of two trials). Multiple factors were analysed regarding radiological underestimation \u226510 mm. Radiological underestimation was defined as mammographic minus histological tumor size in mm. Results: Positive margins occurred in 75 of 189 patients. Radiological underestimation \u226510 mm was an independent influencing factor (OR 5.80; 95%CI 2.55\u201313.17; p &lt; 0.001). A radiological underestimation was seen in 70 patients. The following parameters were statistically significant associated with underestimation: pleomorphic microcalcifications (OR 3.77; 95%CI 1.27\u201311.18), clustered distribution patterns (OR 4.26; 95%CI 2.25\u20138.07), and mammographic tumor sizes \u226420 mm (OR 7.47; 95%CI 3.49\u201315.99). Only a mammographic tumor size \u226420 mm was an independent risk factor (OR 6.49; 95%CI 2.30\u201318.26; p &lt; 0.001). Grading, estrogen receptor status, and comedo necrosis did not influence the size estimation. Conclusion: Radiological underestimation is an independent risk factor for positive margins in BCT of DCIS associated with microcalcifications predominantly occurring in mammographic small tumors.<\/jats:p>","DOI":"10.3390\/cancers14102367","type":"journal-article","created":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T10:19:46Z","timestamp":1652264386000},"page":"2367","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Radiological Underestimation of Tumor Size as a Relevant Risk Factor for Positive Margin Rate in Breast-Conserving Therapy of Pure Ductal Carcinoma In Situ (DCIS)"],"prefix":"10.3390","volume":"14","author":[{"given":"Gesche","family":"Schultek","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Gerber","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3014-370X","authenticated-orcid":false,"given":"Toralf","family":"Reimer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1284-6164","authenticated-orcid":false,"given":"Johannes","family":"Stubert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0145-1589","authenticated-orcid":false,"given":"Steffi","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annett","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angrit","family":"Stachs","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1245\/s10434-015-4876-6","article-title":"Microcalcifications in 1657 Patients with Pure Ductal Carcinoma In Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence","volume":"23","author":"Rauch","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5880","DOI":"10.1007\/s00330-021-07873-2","article-title":"Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: A systematic review for the European Commission Initiative on Breast Cancer (ECIBC)","volume":"31","author":"Rigau","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e348","DOI":"10.1016\/S1470-2045(13)70135-9","article-title":"Predictors of recurrence for ductal carcinoma in situ after breast-conserving surgery","volume":"14","author":"Benson","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13058-021-01404-z","article-title":"Multi-modal imaging of high-risk ductal carcinoma in situ of the breast using C2Am: A targeted cell death imaging agent","volume":"23","author":"Szucs","year":"2021","journal-title":"Breast Cancer Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1001\/jamasurg.2016.4752","article-title":"Difficulty of Achieving Clear Margins in Nonpalpable Ductal Carcinoma of the Breast","volume":"152","author":"Yip","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1007\/s10549-020-05816-x","article-title":"Prognostic value of histopathological DCIS features in a large-scale international interrater reliability study","volume":"183","author":"Groen","year":"2020","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.ajpath.2019.03.002","article-title":"Breast Ductal Carcinoma In Situ: Precursor to Invasive Breast Cancer","volume":"189","author":"Coleman","year":"2019","journal-title":"Am. J. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s10549-020-06042-1","article-title":"Treating (low-risk) DCIS patients: What can we learn from real-world cancer registry evidence?","volume":"187","author":"Byng","year":"2021","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3811","DOI":"10.1245\/s10434-016-5446-2","article-title":"The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis","volume":"23","author":"Mph","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3273","DOI":"10.1245\/s10434-015-4740-8","article-title":"Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery over 30 Years","volume":"22","author":"Subhedar","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/jnci\/djq499","article-title":"Comparative Effectiveness of Ductal Carcinoma In Situ Management and the Roles of Margins and Surgeons","volume":"103","author":"Dick","year":"2011","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1200\/JCO.2015.65.1869","article-title":"Patient Prognostic Score and Associations with Survival Improvement Offered by Radiotherapy after Breast-Conserving Surgery for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study","volume":"34","author":"Sagara","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/SLA.0000000000002439","article-title":"Ductal Carcinoma In Situ and Margins < 2 mm: Contemporary Outcomes with Breast Conservation","volume":"269","author":"Tadros","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1245\/s10434-015-4789-4","article-title":"Excising Additional Margins at Initial Breast-Conserving Surgery (BCS) Reduces the Need for Re-excision in a Predominantly African American Population: A Report of a Randomized Prospective Study in a Public Hospital","volume":"23","author":"Jones","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1007\/s10549-017-4475-2","article-title":"Performance characteristics of specimen radiography for margin assessment for ductal carcinoma in situ: A systematic review","volume":"166","author":"Versteegden","year":"2017","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1178223421993459","DOI":"10.1177\/1178223421993459","article-title":"Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma","volume":"15","author":"Koopmansch","year":"2021","journal-title":"Breast Cancer Basic Clin. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1115","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":"ref_18","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.mayocp.2017.11.023","article-title":"Factors Associated with Positive Margins in Women Undergoing Breast Conservation Surgery","volume":"93","author":"Murphy","year":"2018","journal-title":"Mayo Clin. Proc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/ans.14467","article-title":"Factors influencing reoperation following breast-conserving surgery","volume":"88","author":"Philpott","year":"2018","journal-title":"ANZ J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.2147\/CMAR.S190852","article-title":"Positive or close margins: Reoperation rate and second conservative resection or total mastectomy?","volume":"11","author":"Houvenaeghel","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1001\/jamasurg.2016.4751","article-title":"Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer after Wire-Guided Breast-Conserving Surgery","volume":"152","author":"Langhans","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"106","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":"ref_23","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1245\/s10434-020-09101-5","article-title":"Predictors of Reexcision Following Breast-Conserving Surgery for Ductal Carcinoma In Situ","volume":"28","author":"Lamb","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s10549-018-4951-3","article-title":"Micro-computed tomography enables rapid surgical margin assessment during breast conserving surgery (BCS): Correlation of whole BCS micro-CT readings to final histopathology","volume":"172","author":"McClatchy","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1245\/s10434-019-07226-w","article-title":"Digital Breast Tomosynthesis for Intraoperative Margin Assessment during Breast-Conserving Surgery","volume":"26","author":"Park","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s10549-019-05428-0","article-title":"Long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ","volume":"178","author":"Warren","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/jnci\/djs142","article-title":"Network Meta-Analysis of Margin Threshold for Women with Ductal Carcinoma In Situ","volume":"104","author":"Wang","year":"2012","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1111\/tbj.13738","article-title":"Impact of hormonal status on ductal carcinoma in situ of the breast: Outcome and prognostic factors","volume":"26","author":"Tay","year":"2019","journal-title":"Breast J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1245\/s10434-016-5711-4","article-title":"Breast-Conserving Surgery Alone for Ductal Carcinoma In Situ: Factors Associated with Increased Risk of Local Recurrence","volume":"24","author":"Mele","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1002\/jso.25388","article-title":"Evaluating the relationship between ductal carcinoma in situ, calcifications, and margin status in patients undergoing breast conserving surgery","volume":"119","author":"Bruenderman","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.breast.2015.12.014","article-title":"The role of specimen radiography in breast-conserving therapy of ductal carcinoma in situ","volume":"26","author":"Lange","year":"2016","journal-title":"Breast Edinb. Scotl."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/jso.25248","article-title":"Does intra-operative margin assessment improve margin status and re-excision rates? A population-based analysis of outcomes in breast-conserving surgery for ductal carcinoma in situ","volume":"118","author":"Laws","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1308\/rcsann.2016.0299","article-title":"Radiopathological features predictive of involved margins in ductal carcinoma in situ","volume":"99","author":"Layfield","year":"2017","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.amjsurg.2021.03.043","article-title":"Measurements using mammography and ultrasonography underestimate the size of high-volume ductal carcinoma in situ","volume":"221","author":"Liu","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/j.clinimag.2016.09.003","article-title":"Assessment of the extent of microcalcifications to predict the size of a ductal carcinoma in situ: Comparison between tomosynthesis and conventional mammography","volume":"40","author":"Berger","year":"2016","journal-title":"Clin. Imaging"},{"key":"ref_36","first-page":"466","article-title":"Mammographic extent of microcalcifications and oestrogen receptor expression affect preoperative breast carcinoma in situ size estimation","volume":"24","author":"Mojal","year":"2016","journal-title":"Breast Cancer"},{"key":"ref_37","first-page":"5065","article-title":"Detection of Ductal Carcinoma In Situ by Ultrasound and Mammography: Size-Dependent Inaccuracy","volume":"37","author":"Eichler","year":"2017","journal-title":"Anticancer Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1002\/bjs.9797","article-title":"Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ","volume":"102","author":"Fancellu","year":"2015","journal-title":"Br. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.acra.2018.07.013","article-title":"Accuracy of Breast Magnetic Resonance Imaging Compared to Mammography in the Preoperative Detection and Measurement of Pure Ductal Carcinoma In Situ: A Retrospective Analysis","volume":"26","author":"Preibsch","year":"2018","journal-title":"Acad. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1148\/radiol.2020200076","article-title":"Preoperative MRI Improves Surgical Planning and Outcomes for Ductal Carcinoma In Situ","volume":"295","author":"Pinker","year":"2020","journal-title":"Radiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1148\/radiol.2020191535","article-title":"Surgical Outcomes for Ductal Carcinoma In Situ: Impact of Preoperative MRI","volume":"295","author":"Yoon","year":"2020","journal-title":"Radiology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.acra.2019.05.013","article-title":"The Impact of Preoperative Breast MRI on Surgical Management of Women with Newly Diagnosed Ductal Carcinoma In Situ","volume":"27","author":"Lam","year":"2019","journal-title":"Acad. Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1504473","article-title":"A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer","volume":"373","author":"Chagpar","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_44","first-page":"373","article-title":"Impact of Cavity Shave Margins on Margin Status in Patients with Pure Ductal Carcinoma In Situ","volume":"232","author":"Dupont","year":"2020","journal-title":"J. Am. Coll. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/10\/2367\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:09:05Z","timestamp":1760137745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/10\/2367"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,11]]},"references-count":44,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["cancers14102367"],"URL":"https:\/\/doi.org\/10.3390\/cancers14102367","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,11]]}}}