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J Clin Oncol. 2016 Nov 20;34(33):4040-4046. doi: 10.1200/JCO.2016.68.3573. Epub 2016 Oct 31.

Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ.

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Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia.


Background Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT). Methods A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. Results Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2 mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2 mm margins. Negative margins less than 2 mm alone are not an indication for mastectomy, and factors known to impact rates of IBTR should be considered in determining the need for re-excision. Conclusion The use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.

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