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Authors Pan Z, Zhu L, Li Q, Lai J, Peng J, Su F, Li S, Chen K
Received 20 December 2017
Accepted for publication 21 March 2018
Published 8 May 2018 Volume 2018:11 Pages 2627—2635
DOI https://doi.org/10.2147/OTT.S160433
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Dr William Cho
Background: We sought to develop and validate a model for prediction of initial
margin status during breast-conserving surgery (BCS).
Methods: We included eligible breast cancer patients receiving BCS in Sun Yat-sen
Memorial Hospital from January 2003 to December 2014. All patients received
intraoperative frozen-section analysis for initial margin assessment. We used
univariate and multivariate logistic regression analyses to screen for
predictors. A nomogram was developed in the training cohort (n=1,193) from the
south branch of the hospital and externally validated in the validation cohort
(n=499) from the north branch. We used the area under the receiver-operating
characteristic curve and Hosmer–Lemeshow tests to assess the discrimination and
accuracy of the nomogram.
Results: The initial margin-positivity rates were 19.5% and 25.2% in the training
and validation cohorts, respectively. Preoperative tumor size, preoperative
lymph-node status, suspicion of multifocality, hormone-receptor status, and
HER2 status were significantly associated with margin status. The model included
these five variables. The discrimination and calibration of the model were
considered acceptable in both cohorts.
Conclusion: The nomogram can predict the likelihood of having positive initial
margins during BCS and may be useful for clinical decision-making in the
surgical treatment of breast cancer patients.
Keywords: breast cancer, breast-conserving surgery, margins, nomogram