What are the Appropriate Surgical Margins for Breast Cancer Surgery?

The Society of Surgical Oncology – American Society for Radiation Oncology (SSO-ASTRO) 2014 Consensus Guidelines:
- Regarding margins of resection for invasive carcinoma of the breast:
  - Recommend the use of “no ink on tumor” as the standard
    - Patients with invasive cancer, even with associated ductal carcinoma in situ (DCIS):
      - Are treated according to these guidelines
In a meta-analysis of 33 studies including 32,363 patients:
- Odds of local recurrence were associated with margin status of positive vs. negative:
  - But not decreased with increasing margin distance for patients with invasive carcinoma
- The study reported that rates of in-breast tumor recurrence are twice as high with positive margins regardless of tumor biology, radiation boost, or endocrine therapy
- There was no evidence that wide margins reduce recurrence, even in patients with extensive intraductal component
However, the American Society of Clinical Oncology (ASCO) guidelines recommend consideration of post-excision mammography to document adequate resection in patients with microcalcifications
References
- Moran MS, Schnitt SJ, Giuliano AE, et al. SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):553-564.
- Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717-730.
- Buchholz TA, Somerfield MR, Griggs JJ, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32(14):1502-1506.