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. Conference Paper uri icon

Overview

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.

authors

  • Morrow, Monica
  • Van Zee, Kimberly
  • Solin, Lawrence J
  • Houssami, Nehmat
  • Chavez-MacGregor, Mariana
  • Harris, Jay R
  • Horton, Janet
  • Hwang, Shelley
  • Johnson, Peggy L
  • Marinovich, M Luke
  • Schnitt, Stuart J
  • Wapnir, Irene
  • Moran, Meena S

publication date

  • August 15, 2016

Research

keywords

  • Breast Neoplasms
  • Carcinoma, Intraductal, Noninfiltrating
  • Margins of Excision
  • Mastectomy, Segmental
  • Neoplasm Recurrence, Local

Identity

PubMed Central ID

  • PMC5047939

Scopus Document Identifier

  • 84982156350

Digital Object Identifier (DOI)

  • 10.1016/j.ijrobp.2010.08.027

PubMed ID

  • 27527714

Additional Document Info

volume

  • 23

issue

  • 12