- In 2013:
- Recognizing that while breast-conserving therapy had become standard practice in the management of early-stage breast cancer:
- There were no accepted consensus on optimal negative margin width:
- The SSO and ASTRO convened a multidisciplinary expert panel to:
- Review the available evidence regarding margin width and ipsilateral breast tumor recurrence (IBTR)
- The SSO and ASTRO convened a multidisciplinary expert panel to:
- There were no accepted consensus on optimal negative margin width:
- Meta-analysis and secondary data from prospective and retrospective trials led them to conclude that:
- Positive margins:
- Defined as:
- Ink on invasive cancer is associated with:
- At least a 2-fold increase in IBTR
- Ink on invasive cancer is associated with:
- Defined as:
- However:
- Meta-analysis and retrospective data provide evidence that:
- Negative margins (no ink on tumor):
- Optimize IBTR and
- That the routine practice of obtaining wider negative margins than ink on tumor:
- Is not indicated
- Negative margins (no ink on tumor):
- Meta-analysis and retrospective data provide evidence that:
- While younger age is associated with both increased IBTR after breast-conserving therapy as well as increased local relapse on the chest wall after mastectomy, there is no evidence that increased margin width nullifies this increased risk of IBTR in younger patients. Classic LCIS at surgical margin is not an indication for re-excision. The significance of pleomorphic LCIS at the margin is uncertain.
- Positive margins:
- Recognizing that while breast-conserving therapy had become standard practice in the management of early-stage breast cancer:
REFERENCES
- Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88:553-564.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 