Evaluating Residual Disease and Upstaging Rates Following Vacuum-Assisted Breast Excision for DCISHigh rates of residual disease found after vacuum-assisted breast excision

This meta-analysis evaluates the clinical outcomes of patients with ductal carcinoma in situ (DCIS) undergoing radiologically complete vacuum-assisted breast excision (VABE). The study focuses on the prevalence of residual disease and the frequency of progression to invasive carcinoma following the procedure. With a substantial sample size of 5,302 patients, the analysis provides a robust overview of the limitations and clinical implications of VABE in managing localized breast cancer.

The primary finding indicates a high rate of residual disease, reported at 67.4% (95% CI 63.9-70.8%). This suggests that even when a procedure is deemed radiologically complete, a significant majority of patients still harbor residual tissue. This high prevalence underscores the necessity of surgical excision as the standard of care for DCIS, as VABE alone may not consistently achieve clear margins in a majority of cases.

Regarding the progression of the disease, the study identified a 16.4% rate of progression to invasive carcinoma (95% CI 12.8-20.4%). While this metric is critical for staging and treatment planning, the authors noted that the certainty of evidence for this specific outcome was very low. Clinicians should interpret these figures with caution when making definitive prognostic statements, despite the clear trend toward significant residual disease in the cohort.

Several key predictors for residual disease were identified through odds ratios. Notably, the presence of suspicious axillary lymph nodes was strongly associated with residual disease (OR 12.16). Additionally, a high nuclear grade served as a significant predictor (OR 1.90). These factors suggest that patients with more aggressive histological features or suspicious lymphadenopathy are at a higher risk for incomplete excision.

Conversely, certain factors appeared to have a protective effect regarding the presence of residual disease. Lesions with a size of 10 mm or less showed a significantly lower odds of residual disease (OR 0.02). Similarly, lesions with low or intermediate nuclear grades were associated with lower odds of residual disease (OR 0.08). These findings suggest that smaller, less aggressive lesions may be managed differently than larger, high-grade cases.

From a clinical practice perspective, the high incidence of residual disease following VABE reinforces the role of surgical excision in the management of DCIS. However, the data regarding smaller, lower-grade lesions provides a pathway for future research. Specifically, patients with lesions $\leq$10 mm and low/intermediate grades may be suitable candidates for active surveillance trials, potentially sparing these patients from more invasive surgical interventions while maintaining safety standards.