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Ann Surg Oncol. 2016 Nov;23(12):3801-3810. Epub 2016 Aug 15.

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.

Author information

1
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. morrowm@mskcc.org.
2
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
3
Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA.
4
Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
5
Departments of Medical Oncology and Health Service Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6
Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA.
7
Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
8
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
9
Advocate in Science, Susan G. Komen, Kansas City, USA.
10
Department of Pathology, Harvard Medical School, Boston, MA, USA.
11
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
12
Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA.

Abstract

PURPOSE:

Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation.

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 7,883 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 narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision.

CONCLUSION:

Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.

PMID:
27527714
PMCID:
PMC5047939
DOI:
10.1245/s10434-016-5449-z
[Indexed for MEDLINE]
Free PMC Article

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